Because dementia can trigger some challenging behaviors such as aggression and catastrophic reactions, restraints have been used at times in the past to help prevent injuries to that person or others around them. Fortunately, as a society and medical community, we've become more aware of the anxieties and agitation that restraints produce, as well as the increased risk of injuries with their use. In facilities, restraint use now is extremely limited. A restraint is anything that hinders movement or restricts freedom. Years ago, restraint use was much more common and included extremely restrictive restraints such as straight jackets and vests. While these restraints aren't used today in a nursing home, it's important to recognize that other equipment can act as a restraint even it the goal in its use is to keep someone safe. The types of restraints below are simple, safe, and successful.
Restraints are used for a multitude of reasons but below are the most common reason.
In order for a nursing home to use restraint, the staff must have tried and been unsuccessful in using less restrictive alternatives first, and these attempts must be clearly documented. (Less restrictive measures include attempts to more safely and comfortably position the person in a chair, providing increased supervision, offering meaningful activities or attempting to improve functioning through physical or occupational therapy.) Facilities must also have a time-limited order from a physician in order to use any type of restraint, and the person, his guardian or his power of attorney for health care must have been educated on the risks vs. the benefits of using restraint and have given permission to do so. Let's put us in the place of the person with dementia. Perhaps she needs to use the bathroom or stretch her legs, or she's feeling hungry or bored. When she tries to move around, she's unable to and consequently, can't tend to that need. Restraints affect a person's mental health. People who have been restrained report feelings of depression, fear, anger, humiliation, anxiety, and helplessness. Not surprisingly, a person might also experience a significant negative reaction to restraint such as screaming, fighting and extreme agitation which can be traumatic for that person and her caregiver. According to the March 2006 issue of the Journal of Medical Ethics, the negative consequences of restraints include:
In addition to those physical consequences, restraints are frequently ineffective and don't prevent falls. Rather, research has shown that injuries are escalated because of the force the person needed to use to escape from the restraint.
As caregivers and family members, the task of caring for others is ours because we care about them. This involves not only having good intentions but also maintaining current knowledge of the risks and benefits of how we provide care, including our philosophy and use of restraints for our patients and loved ones.
Information on bed rails, including using them as a form of restraint and risk assessment requirements when using bed rails Download |