Nurses Attitudes towards the Use of Physical Restraints in the Elderly - Article Example

Nurses Attitudes and Feelings towards the Use of Physical Restraints in the Elderly Prevalence of physical restraint usage The application of physical restraints in the elderly is a usual practice in several nations - in home care, hospitals and nursing homes. The accounted prevalence numbers range from 41–64% in nursing homes and 33–68% in hospitals; numbers of restraint utilization in home care setting are not known. Instances of physical restraint comprise vests, straps/belts, limb ties, wheelchair bars and brakes, chairs that tip backwards, tucking in sheets too tightly, and bedside rails. Bed rails and belts are the most often used restraints in bed; chairs with a table and belts are the most commonly used restraints in a chair. It is obvious that physical restraints in most cases are made use as safety procedures; the important among these causes is the avoidance of falls. As in the case of the hospital setting, the secure use of medical procedure is as well a main reason for restraint use. In addition, there are indications that restraint use is linked to organizational features. Several undesirable effects of restraint use have been reported like falls, pressure sores, despair, violence, and even death. These possibilities are not always openly recognized to the physical restraint itself although more typically to the older persons physical and rational condition. An older person with reduced physical and/or mental capability will be more inclined than a healthy person to display damaging effects ensuing from physical restraint. It has as well been noticed that the restraint methods employed are not efficient in preventing falls or serious injury as a result of antagonistic performance. As the bad effects of restraints and the increasing proof that physical restraints are not the satisfactory measure for the avoidance of falls (Hamers, Huizing, 2005). Rational for applying physical restraints Even though providing restraints is one of the usual measures in nursing home setting, it is not clear how far the subject is understood. A restraint is a physical or mechanical tool for controlling the movement of a patient/resident. The rationale for using physical restraints normally can be put under three main issues; to avoid the patient from falling and injuring himself; to stop the patient from wandering around; and to check the patient from moving in either a chair or a bed. Elderly people report diverse feelings in relation to their experience with physical restraint. For few, these systems - for instance, bedside rails or wheelchair bars have an optimistic meaning. They express their feeling of security and stability and say they are safer with bed rails. Some elderly people don’t have a negative attitude towards dependence. They very much value the help being provided and they dont feel that it really hamper them. They dont in fact even think concerning it a great deal. But in a broader sense physical restraint is not considered as something positive. For a lot of elderly people the use of these methods is more disturbing than a remedial nature. This will create the feelings of shame, loss of dignity and self-esteem, loss of individuality, worry and anger, social separation, and disappointment. Several elderly people address their feelings as captivity and restriction to their liberty of movement. They are concerned regarding the possibility of injury in case of their effort to get away from physical restraint. Some communicate feelings of depression and indifference concerning the use of these methods (Gastmans, Milisen, 2005). Consequences of physical restraints From the previous few years, an agreement has been strengthening regarding the physical threat linked with the use of physical restraint to elderly people, the physical common consequences are: bruise, bedsore, respiratory complications, lacking normal voluntary control of excretory functions and constipation, under-nutrition, increased dependence, weak muscle strength and control, reduced cardiovascular stamina, heightened anxiety and bigger danger for death because of strangulation or as serious injuries - for instance, fracture, increased distress. These possibilities are not at all times directly ascribed to the bodily restraint itself however more regularly to the elder persons physical and psychological condition. An elder person with reduced bodily or mental ability will be more inclined than a healthy person to show damaging effects ensuing from bodily restraint. It is experimented that the techniques applied are not efficient in avoiding falls or severe injury because of violent behaviour. Lot of cases shows that uneasiness and anxiety of a restrained elderly person has gone up, causing in an increased chance of injury and even death as an outcome (Gastmans, Milisen, 2005). Harmful consequences from the use of bodily restraints are experienced not only by the elderly persons but in addition by the nurses. DiFabio (1981) talked to 15 nurses who worked in acute psychiatric inpatient settings and had been implicated in situations where persons were kept in restraints. She observed that majority of the nurses experienced strife responses for example anxiety, feelings of inadequacy, despair, frustration, guilt, displeasure, and disgust. The use or non-use of bodily restraints causes a range of mental reactions of nurses in addition to patient outcomes (ninr.nih.gov., 2006) Knowledge level of nurses on the guidelines and procedures regarding the use of physical restraint Lack of knowledge on getting old may not influence approaches toward elderly people but poor understanding of restraint use might cause nurses being not capable to adjust care accordingly and possibility of placing elderly residents at risk. Nurses must know that the restraint is any application, tool or act that hinder with an individual’s capability to make a decision or that controls their gratis movement. The present finest standard of patient care is without the use of restraint. The medical decision to use restraint ought to be taken only after other protective treatment alternatives have been recognized as unsuitable or useless. The wellbeing and individual self-respect of the person being restrained have to be preserved and secured always. Every hindrance with the person’s privileges ought to be kept to the least required in the state of affairs. Restraint comprises: Physical Restraint which is the deliberate control of a patient’s voluntary movement or behaviour by the use of a tool, or exclusion of mobility aids, or bodily force for behavioural intention. The environmental Restraint considered as a number of environmental or mechanical methods that might be used to check movement. These include bed rails, recliner or tub chairs, locked doors etc. The Chemical Restraint engages the use of medicine to manage or change a person’s feelings or behaviour that might not be linked to medical treatment. For example, the pharmacological agents used as chemical restraint comprise antipsychotic, antidepressant, antimanic, anxiolitic and hypnotic drugs. Nurses must know when planning to implement restraint that execution of restraint ought to be used as a means of protecting the safety of a patient who is at danger of individual injury, or anywhere the patient create a threat of harm to others. This is supposed to be thought as a temporary measure. In normal situations, restraint must be used only after cautious and complete evaluation. Appraisal credentials must make available proof that no safer substitute, setting or interference could be organized. The level of restraint must be no more than the required in the situations, and should in no way be used since the service circumstance engrosses a lack of suitable resources. Restraint can be used under a person’s or organization’s responsibility of care wherever there is apparent proof that the level of threat and possible injury be more significant than the person’s right to stay unrestrained. Restraint must be considered only after: appraisal of the patient, the surroundings, and the condition has been finished; hasty aspects have been recognized and removed where possible; consult on with other health care experts and person responsible; and a medical practitioner’s order for the use of restraint has been acquired. Unsuitable use of restraint can amount to attack, fake imprisonment or disregard and those accountable might face criminal accusation or civil action (nursingboardtas.org, 2008). Attitudes and feelings of Nurses’/staff towards physical restraints Few researches measured the connection between nurses’ outlook and restraint use. Every researcher permitted for an earlier account of concern regarding the application of physical restraints and the roles of confronting nurses while planning to apply the restraint. Hardin et al (1994) illustrated fairly optimistic but hesitant attitudes existed toward restraint utilization. In all decision making process regarding restrain Nurses were involved but were more satisfied when the decision was made in union with other health care experts. Sundel et al (1994) administered a 16-item closed-ended feedback form. They found restraint utilization in-service guidance aided nurses to differentiate between bedrails as restraints and as enablers, and their application as a expediency and a constructive restraint for residents. But, even though ensuing in-service education over 50% of the nurses believed that there were no substitute to bedrails as a restraint method. It is not apparent in these researches whether managerial strategies prejudiced nurses’ concern of restraint. Hantikainen (2001) inquired nurses concerned for elder people with physical ill-health or moderate cognitive impairments. The rationale for restraint-use were safety; avoid injury and damage to other residents; violence; confrontation to treatments; and uncertainty. Yet another reason for the use of restraint was as an approval to manage a situation assumed by nurses to be improper behavior, or a planned attempt to cause agony to the staff member. Nurses had contradictory opinions of restraint application and what it entails and demonstrated both optimistic and differing outlooks to its application. They equated the decision-making duty of restraint use to walking a proper and principled tightrope. However, frequently restraint decisions were mainly based on nurses’ privileges and situational deliberations rather than the happiness of residents. Pardoning themselves from the task of decision-making, staff thought that residents’ behavior have to adjust before staff might limit restraint use. Karlsson et al (2000) as well found it was uncertain whether nurses were facing the problem of morals or simply getting rid of the decision-making procedure. They asked nursing staff to read a clinical vignette to gauge nurses’ way of thinking in an imaginary state. The nurses agreed ‘caring’ to be a complex job and asked for more related detail before creating a decision to use restraint. Their decision to use restraint was made from a situational outlook: such as, the resident is an elderly dementia patient and did not understand what was good for the resident. Taking away of a restraint was directly connected with resident independence, or to lessen residents’ distress and to make them happy. The nurses realized the decision-making procedure was complex and the most of them told that they would alter their decision under diverse situations. Hantikainen and Kappeli (2000) as well realized resident protection was affirmed as a reasonable cause for restraint use. Majority of the nurses approved that there were both pessimistic and optimistic features of restraint, and several considered bodily restraint as a safeguard of staff members from responsibility. Further to that restraint utilization was as well seen as a lawful means of managing violent or troublesome behavior and preserving the peace and harmony of the surroundings for the happiness of every resident. Nurses agreed that the choice to use restraint was one for the nurse managing the situation rather than an organizational strategy. Since restraint was looked upon in a variety of ways, conclusions were frequently based on ‘routines, sentiments and approach more willingly than experimental truths (Hantikainen, Kappeli, 2000) (Wang, Moyle, 2004). Summary The use of bodily restraints in the elderly is a regular practice in several countries. Bed rails and belts are the most often used restraints in bed; chairs with a table and belts are the most commonly used restraints in a chair. The rationale for using physical restraints normally can be put under three main issues; to avoid the patient from falling and injuring himself; to stop the patient from wandering around; and to check the patient from moving in either a chair or a bed. The use of physical restraints may cause: bruise, bedsore, respiratory complications, lacking normal voluntary control of excretory functions and constipation, under-nutrition, increased dependence, weak muscle strength and control, reduced cardiovascular stamina, heightened anxiety and even death. Poor understanding of restraint use might cause nurses being not capable to adjust care accordingly and possibility of placing elderly residents at risk. Nurses must know that the restraint is any application, tool or act that hinder with an individual’s capability to make a decision or that controls their gratis movement. The present finest standard of patient care is without the use of restraint. Fairly optimistic but hesitant attitudes existed toward restraint utilization. In all decision making process regarding restrain Nurses were involved but were more satisfied when the decision was made in union with other health care experts (Hardin, et al 1994) References Difabio, S. (1981). Nurses reactions to restraining patients. American Journal of Nursing, 81, 973-975. [Quoted in] < http://ninr.nih.gov/ninr/research/vol3/Restraints.html> Gastmans, C., Milisen, K.(2005). Use of physical restraint in nursing homes: clinical-ethical considerations [On line] journal of Medical Ethics Available from: < http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2564468 > [17 September 2009] Hamers, J.P.H. Huizing, A.R. (2005). Why do we use physical restraints in the elderly? [On line] Journal Article Available from: < http://www.springerlink.com/content/h3303107547148k6/ > [17 September 2009] Hantikainen, V. (2001). Nursing staff perceptions of the behaviour of older nursing home residents and decision making on restraint use: A qualitative and interpretative study. Journal of Clinical Nursing. 10:246-256. Hantikainen, V and Kappeli, S. 2000. Using restraint with nursing home residents: A qualitative study of nursing staff perceptions and decision-making. Journal of Advanced Nursing. 32(5):1196-1205. Hardin, S.B., Magee, R., Stratmann, D., Vinson, M.H., Owen, M. and Hyatt, E.C. (1994). Extended care and nursing home staff attitudes toward restraints: Moderately positive attitude exist. Journal of Gerontological Nursing. 20(3):23-31. Karlsson, S et al. (2000). Restraint use in elder care: Decision making among registered nurses. Journal of Clinical Nursing. 9:842-850. ninr.nih.gov.(2006). Problems Associated with the Use of Physical Restraints [On line] Chapter 5: Restraints, NINR Available from: < http://www.ninr.nih.gov/NR/rdonlyres/87C83B44-6FC6-4183-96FE-67E00623ACE0/4769/Restraints.pd > [17 September 2009] nursingboardtas.org, (2008). Standards for the Use of Restraint for Nurses and Midwives [On line] Restraint for Nurses. Available from: < http://www.nursingboardtas.org.au/domino/nbt/nbtweb.nsf/v-lu-all/Publications~Nursing+Code~Standards+for+the+Use+of+Restraint+for+Nurses+and+Midwives+2008/$FILE/Use_of_Restraint_WEB.pdf?OpenElement > [17 September 2009] Sundel, M., Garrett, R.M. and Horn, R.D. (1994). Restraint reduction in a nursing home and its impact on employee attitudes. Journal of the American Geriatrics Society. 42(4):381-387 Wang, W.W., Moyle, W. (2004). Physical Restraint Use on People with Dementia: A Review of The Literature [On line] Available from: < http://www.ajan.com.au/Vol22/Vol22.4-7.pdf > [17 September 2009] Read More