Releasing restraints: Providing safe care for the elderly

Abstract

To examine the behavioral effects of releasing restraints and the feasibility of caring for patients considered at risk if unrestrained, two patients were continuously videotaped using surveillance cameras for 1 week with and 1 week without restraints. The videotapes were coded and analyzed using nonparametric and parametric statistics. In Patient #1, motor behavioral changes with a decrease of restless behaviors, as well as changes in sleeping position, were observed. There were no changes in verbal behavior. For Patient #2, no changes in motor or verbal behavior were observed. Nursing care showed a non-significant decrease in nursing care time and an increase in the number of nursing contacts. The implications of the findings and the use of videotapes as a method for collecting observational data in the clinical area are discussed.

Factors Relating to the Use of Physical Restraints in Geriatric Care Settings

“…The literature indicates that the application of restraints causes muscle wasting, which in turn increases the impairment of the patient's gait and risk of injury. 34 Although cognitive impairment has been described as a strong predictor of the use of physical restraint use, 4,6,17,35 this factor alone was not found to be a variable that explained the frequency of restraint use in our study. One reason for this finding could be that a majority of the residents in the investigated institutions were cognitively impaired (83%).…”

“…In the same way, the residents' inability to walk independently could be a reason for physical restraint use, but it could also be a consequence of it (i.e., immobilization). The literature indicates that the application of restraints causes muscle wasting, which in turn increases the impairment of the patient's gait and risk of injury 34 …”

Initiation of physical restraint in nursing home residents following restraint reduction efforts

“…Concerns about costs and staff time contribute to resistance to restraint-free care (Evans & Strumpf, 1990). However, restrained individuals have been shown to require more, not less, time for care (Morse & McHutchion, 1991;Phillips et al, 1993; What is the law?, 1989), and restraint use negatively affects efficiency in nursing homes (Sexton, Leiken, Sleeper, & Coburn, 1989).…”

Cognitive Developmental Approach to Dementia

“…Scrutiny of such practices by researchers has demonstrated that the use of physical and chemical restraints has not only had less than desirable effects in patient therapeutics but has been associated with increased injuries accompanying falls, agitation, and disorientation (Blazer, 1993;Miles & Irvine, 1992;Morse & McHutchion, 1991;Strumpf & Evans, 1988;Werner, Cohen-Mansfield, Braun, & Marx, 1989). Overuse of pharmacologic restraint agents created sufficient concern that regulations regarding their use in nursing homes were established by the Health Care Financing Administration through the Omnibus Budget Regulatory Act in 1988 (Matteson, Linton, Lichtenstein, & Cleary, 1991).…”