Physical restraints aim to restrict or prevent movement of a resident. In a nursing home, physical restraint may be used to maintain resident and staff safety in certain circumstances. However, use of physical restraint has become an issue of ethical care in nursing homes, as restraint use may become too frequent. In some cases, the nature of physical restraint use may be dangerous or harmful to the resident. It is important to ensure that nursing home facilities use physical restraint as little as possible, and only in cases where no other safety techniques would be as efficient.
What Is Physical Restraint?
Physical restraint is defined as any mechanical or physical material, device, or equipment that is attached to or adjacent to a resident’s body. This item restricts the resident’s freedom of movement and normal access to his or her own body. It cannot be easily removed by the resident.
Types of Physical Restraint
Different items can be used as physical restraints. Defining a physical restraint depends on the intended use of an item. For example, bedrails can be considered physical restraint when they are installed solely for the purpose of restricting the resident from leaving his or her bed. However, the same bedrail may not be considered a physical restraint if it is installed to help the resident turn in bed.
Types of physical restraint may include:
- Soft ties
- Hand mitts
- Specialized chairs
- Lap cushions
- Lap trays or tables
Negative Impact of Restraints
Many allege that unnecessary use of physical restraint has a harmful impact on residents. Physical restraints may cause discomfort or pain. Unnecessary restraint may lead to a decrease in physical functioning and atrophy in muscles. If a resident is restricted from walking to prevent falls, the resident’s muscles will eventually weaken. This can lead to a decreased ability or complete inability to walk after time. Emotional and psychological effects include tarnishing a resident’s sense of dignity by decreasing autonomy and the ability to move freely and perform normal daily functioning.
Many believe that unless necessary, the use of physical restraint is an ethical issue. This is because some facilities have used physical restraint as a means of convenience, as opposed to necessity. In these unethical cases, physical restraint may be used to make resident management easier for nursing home staff members. There have also been reports of physical restraint use as a form of punishment, control, or substitution for other treatment or activities.
Physical Restraint Laws
There are certain laws discussing requirements and guidelines for physical restraint use. Federal law states that seclusion and physical restraint may only be used to ensure physical safety of the resident, other residents, or staff members. They may not be used as punishment or for the convenience of staff members.
State laws for physical restraint may vary from state to state. For example, Florida law requires that physical restraint use must be authorized in writing by a physician or another licensed practitioner who is permitted by state law and the nursing home facility. The authorization must specify an explicit amount of time during which the restraints may be used. In cases of emergency, only a licensed, qualified nurse can apply physical restraints without a physician’s authorization. The incident and use of physical restraint must be noted in writing in the resident’s records.
Reducing Physical Restraint Use
Federal and state laws, as well as nursing home advocates, urge the use of alternatives in place of physical restraint. When physical restraint is used as a preventative measure for falls and self-inflicted injuries, a number of alternatives may be effective. Increased supervision and more specialized attention to suit each resident’s needs can be among the most effective techniques for reducing the need for physical restraint.
Physical Restraint Alternatives
There are a number of alternatives to physical restraint use, including:
- Closer or more frequent supervision
- Frequent checks of resident areas and rooms
- Individualized rest periods
- Individualized toileting schedules
- Comprehensive environment assessment and modification
- Keeping call items and personal items within reach
- Appropriate seating
- Appropriately lowered beds
- Increased physical and social activities
- Occupational or physical therapy
Gastmans, Chris, and Koen Milisen. “Use of physical restraint in nursing homes: clinical‐ethical considerations.” Journal of Medical Ethics. 32.3 (2006): 148-152. Web. 24 Feb. 2014. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564468/>.
Goethals, Sabine, Bernatte, and Chris Gastmans. “Nurses’ Decision-Making in Cases of Physical Restraint: a Synthesis of Qualitative Evidence.” Journal of Advanced Nursing 68.6 (2012): 1198-1210. CINAHL Plus with Full Text. Web. 24 Feb. 2014.
Trueland, Jennifer. “A bid for freedom: nurses are working to reduce the use of physical restraint in care homes.”Nursing Standard. 27.3 (2012): 22. Print.