Nursing Implications for Creating and Maintaining a Restraint-Free Unit - Research Paper Example

? Nursing Implications for Creating and Maintaining a Restraint-Free Unit of Central Florida Elyce Logalbo March 22, The useof restraints in the critical care setting to maintain patient safety is a widely-debated topic with conflicting research and varying practice. In response to JCAHO driven patient safety goals and emerging evidence, the benefits and risks of creating a restraint-free unit are examined in this paper. As restraints are used in critical care settings to prevent unplanned extubations in ventilated patients, the incidence and harm (or lack thereof) of such events is studied. Alternatives to physical and chemical restraints are explored in this research review, as well as the nursing implications for creating and maintaining a unit that is restraint-free. A restraint free environment in the ICU is a situation where there is nothing that restricts the movement of the patient in the ICU. In restraint ICU, the patient is not allowed to make any movements by either controlling them physically with physical devices that limit their movements. Most hospitals today work towards having restraint free environments that would not restrict the movement of patients. To achieve this, nurses have a very important role in the creation and maintenance of the restraint free environments. The philosophy of nurses suggests that nursing includes taking care of someone by showing them love and concern. “This love and concern must also include the use of professional care for the patient” (Benbenbishty, 2010). When taking care of someone, the nurse has to ensure that both his and her emotional, physical, and spiritual needs are met. It is also important for a nurse to ensure that while taking care of the patient, they must treat them with respect and dignity and to ensure that their needs and wishes are met. Nurses also have to realize that everyone ages, that aging is a very natural process, and that the old are human beings. This means that every nurse has the responsibility of taking care of the old with respect and not as people who are undergoing both mental and physical deterioration. Nurses also have to ensure that while taking care of a patient, their ultimate aim should be to rehabilitate, and maintain every patient in such a way that they enjoy their daily living in relation to their level of quality of life. It is, therefore, the responsibility of the nurses to ensure that a restraint free environment is created in the ICU. This is because as one patient is restrained, any or all of the above aims may be violated, hence leading to the violation of the nurse’s act. Therefore, nurses have a major role to play in the creation and maintaining of a restraint free ICU. They have to do this so as to fulfill their professional requirements and at the same time to act like human beings and to treat other people not as animals but as fellow humans. Since restraint causes a lot of pain and restrictions to the patient, it should be the main aim of every nurse to do away with it. In the event that the nurses create an environment that is free of any reins taint, then a lot will be achieved. First, the nurses would have fulfilled their career objective of providing an environment that is comfortable and that the wish of the patient can be put into consideration. To achieve this, however, there has to be a lot of increased responsibility on the nurses’ side. First, they have to increase the amount of time that they have to use in taking care of the patient. This also means that since no restriction is available, then nurses have to ensure that they are always there for their patients so that they do not get hurt, especially those who may have some mental problems. Nurses also have to ensure that they closely monitor every patient to know who needs more care. It is also very important that for a free restrain to be effective, nurses have to reduce their level of carelessness and to know the kind of materials that should be kept away from the patient. Even though there is controversy over the use of restraints, most hospitals use restraints for very many reasons. Adult critical care units remain one of the widest areas where restraints are used. These restraints are used for preventing any interference with medical administration. Some patients do not realize the importance of medication and so, may remove needles and other medical procedures that are imposed on them. The other reason for using restraints is to prevent the patients from hurting themselves. Some patients may hurt themselves by walking into structures and holes or using any device that is close to them to physically cause harm on themselves. Restraints are also important in preventing the patient from hurting other people or fellow patients and to prevent them from destroying property. There are two main types of restraints. These are the physical restraints and the chemical restraints. The use of manual method or any use of a mechanical or physical device that is attached to a patient’s body – and in all cases they cannot remove these restraints freely – is known as physical restraint. This may include the use of ropes, the use of chains or locks to prevent and to restrict the movement of the patient in any extent. Chemical restraints, on the other hand, are the use of chemicals or drugs that are psychoactive to administer discipline. These drugs and chemicals are administered to control mental status, behavior or the mood of the patient. By so doing, the patients end up controlled. It is very important to note that chemical restraints might lead to other serious diseases due to the nature of the chemicals used. These restraints are mainly used for safety purpose of the patients themselves and the property and the people around them. Delirium is a state where the patient is confused and does not know what they are doing. Many other cognitive effects are also involved. “Attention deficits, perceptual deficits and a series of alternating sleep and wake cycles are some of the cognitive effects involved” (Hofso, 2007). A patient suffering from this kind of mental confusion can have many serious injuries on themselves and to those around them. To prevent this, the use of physical restraints and chemical retains are sometimes very necessary. This is done to prevent the patient from unintentionally causing damage to themselves and to others. However, it is very important to note that the use of restraints is not the only way to achieve control of the patient. There are other ways that the patient can be controlled and this involves proper management of the patient. This management involves the identification of the patient, after which the patient is closely monitored to know how they behave with respect to themselves and to the people around them. After this, the nurse can now take care of the patient and note the various ways in which the patient is controlled. This type of patient control is very expensive since each patient has to have a specific person to look after him or her and to take care of him or her. It is for this reason that most hospitals prefer to use restraints to prevent the movement of the patients since this is cost effective. This is the unexpected and untimely removal of end tracheal tube from the trachea without the knowledge of a healthcare official. This is a very common occurrence in old patients and children. There are various incidents where unplanned estuation has led to very bad effects on the side of the patient (Yeh, 2004). This incident can lead to serious injuries and sometimes fatal. The effects of unplanned estuation can be very bad and this is the reason why most healthcare officials try as hard as they can to prevent this from happening since this incident leads to the premature cutting of medical supply or the physical damage that can be caused on the patient. It is an ethical issue to try to weigh the damages caused by restrictions and that caused by unplanned extubation. Unplanned extubation is fatal, and so it is necessary to ask which one would be worth risking: the prevention of freedom or the event that might lead to death or disruption of very important medical procedures. It is for this reason that most healthcare officials, especially nurses, opt to restrain the patients as opposed to risking. However, various ways can be used to prevent unplanned extubation such as good management of the patients (Butterworth, 2011). Various alternatives can be used instead of using restraints. However, in this work three of the most commonly used and effective methods are discussed. Instead of using bed rails in controlling the movement of aging people at night support pillows can be used. This is one of the ways that support pillows can be used. This support pillow is effective and does not cause any physical or mental damage on the seniors during their sleep. It effectively stops them from rolling out of bed and at the same time acts as a soft spot that they can use to rest at night. The other common way of using support pillows is to apply them in the wheelchairs of seniors rather than tying them with tight belts that cause a lot of harm and discomfort to them (Tanios, 2010). Restorative care is another very important alternative that most hospitals and relatives prefer to use as opposed to the use of restraints. This method involves the use of therapy in helping the seniors to maintain support of them and to help them take care of themselves. It is very expensive and time consuming but very effective to use. However, the senior get to have a lot of gained confidence and to help in building their bodies (Mion, 2007). In this type of safety measure, the patient is looked in relation to their records to know if there is any particular activity that they liked. Therefore, instead of restricting them to a place where they will not be fit, they can be placed in places where they are able to develop their physical and mental situations. Though restrictions are very important in the maintaining the safety of aging patients and patients who may harm themselves and other. It is very important to note that as a nurse, it is their responsibility to ensure that the use of restraints is eliminated by using other alternatives that are more comfortable to the patient and at the same time give them space to enjoy some of their basic freedom rights. References Benbenbishty, J., Adam, S., & Endacott, R. (2010). Physical restraint use in intensive care units across europe: The price study. British Association of Critical Care Nurses, 26(5), 241-45. Retrieved from http://www.sciencedirect.com.ezproxy.lib.ucf.edu/science/article/pii/ S0964339710000686 Butterworth, R., & Harbison, I. (2011). Restraint and never events: An opportunity for change. Mental Health Practice, 15(1), 30-32. Retrieved from: http://web.ebscohost.com.ezproxy. lib.ucf.edu/ehost/detail?vid=3&hid=104&sid=c90d5735-20c8-48f7-9db6d91abddcaa78@ sessionmgr104&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ Hofso, K., & Coyer, F. (2007). Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective. Intensive and Critical Care Nursing, 23(6), 316-22. Retrieved from http://web.ebscohost.com.ezproxy.lib.ucf.edu /ehost/detail?sid=c90d5735-20c8-48f7-9db6-d91abddcaa78@sessionmgr104&vid=5&hid =104 Mion, L., Minnick, A., Leipzig, R., Catrambone, C., & Johnson, M. (2007). Patient-initiated device removal in intensive care units: A national prevalence study. Critical Care Medicine, 35(12), 2714-20. Retrieved from http://ezproxy.lib.ucf.edu/login?url=http:// search.proquest.com.ezproxy.lib.ucf.edu/docview/69052106?accountid=10003 Tanios, M., Epstein, S., Livelo, J., & Daniel, D. (2010). Can we identify patients at high risk for unplanned extubation? A large-scale multi-disciplinary survey. Respiratory Care, 55(5), 561-568. Retrieved from http://ezproxy.lib.ucf.edu/login?url=http://search.proquest.com .ezproxy.lib.ucf.edu/docview/733279658?accountid=10003 Yeh, S., Lee, L., Ho, T., Chiang, M., & Lin, L. (2004). Implications of nursing care in the occurrence and consequences of unplanned extubation in adult intensive care units. Internation Journal of Nursing Studies, 41(3), 255-262. Retrieved from http://ezproxy. lib.ucf.edu/login?url=http://search.proquest.com.ezproxy.lib.ucf.edu/docview/80168082?accountid=10003 Read More