Physical Restraints for the Elderly: Should They Be Used?

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Using physical restraints for elderly patients is fairly common, even in non-psychiatric care facilities. When used properly restraints provide protection for the patient and staff, but it has become a controversial issue as to whether or not they should be used.

Reasons Why Restraints Are Used

Some of the time restraints are used in nursing homes and other healthcare facilities to keep the patient and the staff safe under certain conditions. Since restraints are categorized as medical devices, there are procedures before a nursing staff can use physical restraint on a resident or patient.

By law, doctors may only assign restraints on a resident after defining the medical reason, how the medical staff should use the restraint, and the length of time to use the restraint. Then the medical staff needs consent from the resident or a family member if the patient is not able to make an informed decision on their own.

Restraints are often ordered by doctors to:

  • Keep patients from removing catheters and tubing
  • Prevent residents from scratching their skin with the use of mitts
  • Protection from falling out of bed and hurting themselves
  • Secure patients from harming medical staff or other patients
  • Restrain a patient from moving during surgery, while on a stretcher, or during other medical procedures

Some of the times restraints might be necessary, however, it has posed an issue for some nursing homes as it is being used too frequently. Whenever possible it is important that physical restraints are used as a last resort when other safety measures are not as effective.

What is a Restraint?

Restraint is defined as any object, material, device, or piece of equipment that is meant to restrict a patient from doing something that cannot be easily removed by the patient.

There are many things that could be used as restraints. Classifying an object as a restraint really depends on the purpose of the object.

Take a bed rail for example. It could be used as a tool to help a patient reposition themselves in bed or it could be used as a bed restraint to prevent a patient from getting out of bed.

Belts, hand mitts, bedrails, lap cushions, and many other items could be used as physical restraints.

Negative Effects of Restraints

There are some out there that would say that the improper use of restraints could negatively impact residents. Especially in prolonged and consistent use of restraints, some of these negative effects could occur.

Bed restraints could lead to muscle atrophy as the patient is unable to move.

They may cause pain or discomfort to the patient.

Muscles will become weak after an extended time of being restrained from walking, which could lead to a patient being unfit to walk on their own or have significantly decreased mobility.

This can lead to emotional and psychological distress for the resident.

A loss of dignity in the patient as they feel incapable to conduct daily routines independently.

How to Prevent Restraint Abuse

While there are laws for the use of restraints on patients, sometimes they aren’t followed correctly and legally.

In some situations, medical staff may believe they are restraining a patient for their own safety, but if they haven’t gotten consent from the patient and instructions from a doctor, then they are denying rights to the patient.

Abuse can be prevented by never allowing physical restraints to be used to discipline a patient, making the job easier for medical staff to care for a patient, be an alternative for other treatments, or control a resident for a prolonged period of time.

Medical staff should always follow instructions from a doctor and get consent from the patient or their caregiver or family member to follow the law and be in accordance with the patient’s rights.

Alternatives to Using Physical Restraints

Use of physical restraints as a medical device should be used after all other treatments and procedures have been tried. There are a lot of preventative alternatives that medical staff should practice before having a doctor prescribe medical restraints on a patient.

Some of those practices could be lowering beds for a patient, increasing their physical activity and therapy, frequent supervision and check-ins on the patient, individualized resting periods and toilet schedules, having personal items like glasses close by to the patient, giving secure and comfortable seating, among many other practices.

As long as physical restraints are used for the protection and safety of the patient, and after getting doctor instructions and consent from the patient, they can be used effectively, safely, and ethically as medical care for elderly residents.

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