Consumers
Topics in this Section:
PHYSICAL RESTRAINTS:
Important Information for Residents and Families
What exactly is a Physical Restraint?
The determination that a device is a restraint depends on the purpose for its use and its effect on the individual, not solely the device itself.
Regulations define a restraint as any manual method, or physical or mechanical device, material, or equipment attached or adjacent to the body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body.
A device (like a vest or waist restraint) can be specifically designed to restrain or restrict movement.
Many devices that restrain or restrict are not commonly thought of as restraints, such as recliners, lap buddies, bed rails.
Rules and Regulations
There are strict federal and State guidelines governing the use of restraints in nursing facilities. Your involvement in making the best decision regarding the need for individualized restraint use is important. The best time to begin discussing this issue is during the pre-admission and admission process. Please ask a facility representative to review these rules with you.
The Impact of Restraints on Quality of Life
Because we want to protect the ones we love, and because the results of falls are so obvious, it is easy to overlook the less obvious and negative effects of restraint use. These can include:
- Feelings of isolation and loneliness;
- Feelings of depersonalization and helplessness;
- Loss of appetite;
- Bowel and bladder incontinence and other related problems;
- Decreased bone and muscle strength;
- Skin breakdown;
- Feelings of entrapment;
- Risk of serious injury such as strangulation;
- Dependency and loss of self esteem; and
- Sense of hopelessness.
What About Safety?
The most common reason for restraint use has been to attempt to prevent falls. There is no reliable research that indicates restraints keep residents safer. In fact, research shows quite the opposite:
- Restrained residents are three times more likely to be injured in a fall than those not in restraints.
- Mortality rates are higher for residents who are routinely restrained.
- Restraint reduction does not increase the incidence of serious falls.
What About Bed Rails?
Bed rails are considered restraints when they are used to prevent residents from getting out of bed and can cause injury or death. On the other hand, they can be used to enable residents to move more independently. Use of bed rails must be evaluated in terms of risks and benefits for each individual resident.
How to Make a Good Decision
No one can foresee the future, but below are essential steps to making an informed decision. They are all a part of the care planning process.
Residents must be allowed to participate in the decision when capable. IT IS THEIR LEGAL RIGHT.
Residents and families should review State and federal guidelines with facility staff.
Potential negative outcomes of restraint use must be discussed with the resident (and families). Professional staff should assess the patient's risk for decline.
The medical symptoms requiring consideration of restraint use and how the use of a restraint would be of benefit must be identified.
Alternatives to restraints must be considered and an ongoing evaluation be made to utilize the least restrictive methods.
The resident's physician must order any restraining device.
Please consult your facility staff to discuss your concerns regarding restraint use. The first step in quality care for our loved ones is knowledgeable communication.
The members of the North Carolina Health Care Facilities Association, the non-profit trade association representing our state's nursing facilities, are committed to excellence in health care.
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