If nursing home residents are prone to falls or wandering, it may seem necessary for the nursing home staff to secure them to a bed or chair. In the past, this has been the accepted wisdom among professionals, as well.
Research has indicated that restraints are not as helpful as they appear to be. They may even be making the situation worse.
The research
As a long-term solution, restraints can cause more harm than good. According to the Texas Health and Human Services, restrained patients still fall. Not only that, but they are also more likely to sustain greater injuries in the fall.
For other health-compromising issues such as wandering, interfering with medical devices and displaying behavioral challenges, alternative methods have proven more effective.
Necessary restraints
Medical justifications for restraining patients are all short-term needs, but they are critical. These include:
- Violent behavior in the past week that put the patient or others at risk of injury
- Hip or leg fracture that requires immobility
- Risk of disruption of a life-sustaining medical device that would cause immediate harm if the patient disturbs it
Situations such as these that place the patient or someone else at immediate risk of serious harm must still have a doctor’s order before the nursing home staff can implement the restraints. The resident must also undergo a restraint assessment before restraint use, and continued restraint use requires recurring assessments.
Restraint alternatives
The first step in a therapeutic intervention for an at-risk patient is to determine the causes. Is the lack of balance or behavioral issue due to a medication side effect or a health condition? What are the resident’s individual physical strengths and needs? Residents may simply need a medication adjustment, or they may need strengthening and balance exercises or physical therapy.
Other restraint alternatives include assistive devices such as:
- Wedge cushions
- Motion detectors and alarms
- Headgear
- Hip protectors
- Scoop mattress
Patients with memory issues may be less likely to wander with door guards, doorknob covers, visual barriers, floor patterns and visual cues that help them identify safe areas.
Above all, the key to eliminating the need for restraints is to assess and address each resident’s individual circumstances.
