Physical restraints

Everyone Deserves Dignity and Freedom: Restraint- free individuals can eat, dress and move independently; maintain their muscle and strength; interact with others; and maintain their freedom and dignity.

Poor outcomes of restraints

• Accidents involving restraints which may cause serious injury: bruises, cuts, entrapment, siderail deaths by strangulation and suffocation.
• Changes in body systems which may include: poor circulation, constipation, incontinence, weak muscles and bone structure, pressure sores, agitation, depressed appetite, infections, or death.
• Changes in quality of life which may include: reduced social contact, withdrawal, loss of autonomy, depression, disrupted sleep, agitation, or loss of mobility.

Physical restraints are used in place of good care because:

• Facilities or family members mistakenly believe that they ensure safety;
• Facilities fear liability;
• Facilities may use them in place of adequate staff.

Restraints are most often used on:

• Frail elderly residents who have fallen or may fall.
• Residents with a dementing illness who wander unsafely or have severe behavioral symptoms.

Physical restraint use in Australia:

We don't have any readily available statistics for nursing home residents who are/have been restrained. Nationally, over 6% of nursing home residents are restrained. The Advancing Excellence in America’s Nursing Homes Campaign has set a goal of 5% or less for all nursing homes in the country. In many nursing homes across the country, residents are restraint-free without any increase in serious injuries.

Restraint reduction strategies

Restraint reduction involves the whole facility, including managers, nursing staff, physical and recreational therapists, personal care attendants, and housekeeping personnel. Family members and advocates can encourage the facility’s efforts, and expect and insist that the facility:

• Complete a comprehensive resident assessment that identifies strengths and weaknesses, self care abilities and help needed, plus lifelong habits and daily routines.
• Develop an individualized care plan for how staff will meet a resident’s assessed needs. It describes the care goals (e.g. safe walking), and when and what each staff person will do to reach the goal. The care team includes staff, residents and families (if the resident wants), and devises the plan at the quality care plan conference. The resident may also invite an ombudsman to attend. Care plans change as the resident’s needs change.
• Train staff to assess and meet an individual resident’s needs—hunger, toileting, sleep, thirst, exercise, etc.—according to the resident’s routine rather than the facility’s routine.
• Make permanent and consistent staff assignments and promote staff flexibility to meet residents’ individualized needs.
• Treat medical conditions, such as pain, that may cause residents to be restless or agitated.
• Support and encourage caregiving staff to think creatively of new ways to identify and meet residents’ needs. For example, a “night owl” resident could visit the day room and watch TV if unable to sleep at night.
• Provide a program of activities such as exercise, outdoor time, or small jobs agreed to and enjoyed by the resident.
• Provide companionship, including volunteers, family, and friends by making the facility welcoming.
• Create a safe environment with good lighting, pads on the floor to cushion falls out of bed; a variety of individualised comfortable seats, beds and mattresses; door alarms; and clear and safe walking paths inside and outside the building.

Nursing homes can implement specific programs for reducing physical restraints, including:

• Restorative care, including walking, and independent eating, dressing, bathing programs;
• Wheelchair management program—including correct size, and seat cushion good condition;
• Individualised seating program—chairs, wheelchairs, tailored to individual needs;
• Specialized programs for residents with dementia, designed to increase their quality of life;
• Videotaped family visits for distant families;
• Wandering program—to promote safe wandering while preserving the rights of others;
• Preventive program based on knowing the resident— to prevent triggering of behavioral symptoms of distress;
• Toileting of residents based on their schedules rather than on staff schedules.