Increased use of physical restraint in nursing homes is an issue which has been attracting public attention in the United States. Physical restraint is used when dealing with elderly patients or people with violent behavior especially those with mental problems. Most professionals have been questioning whether nurses use excessive force when dealing with these patients. Additionally, it is not still clear whether this force is necessary for patient safety and quality care especially in the case of patients with the Alzheimer’s condition. In most cases, restraint is used when administering medication to these clients. Restraint is also used when a nurse realizes that dealing with a certain patient without any form of restraint may be dangerous. Clients suffering from mental illness may harm a caregiver when dealing with them ( Hamers, 2017) . At this point, a caregiver will opt to restrain the patient before serving them.
Nurse’s role in the Patient Care Situation
The primary role of a nurse in this situation is to administer medication and ensure that the patients follow the right prescription. However, owing to the fact that the patients in this situation are elderly (Alzheimer’s condition) or mentally hill, the nurse must pay attention to each of them. The nurse must keep a good record of the prescription of each patient as well as the time when this medication should be taken. The patient in case are not capable of making such decisions and hence close attention is necessary. Proper medication is necessary to ensure that quality care which is also safe is provided to the patients.
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Nurses are also charged with the role of determining when to use restraint. Physical restraints are devices used for medical services especially on patients with dementia. Legally, nurses can only use restraint when they have realized that there is a medical reason. Additionally, nurses have to follow instructions from the chief medical officer to avoid harming the patient. Nurses are also expected to explain to the patient why the restraint is being used and the expected benefits ( Hamers, 2017) . The potential risks of the exercise should be disclosed to the patient. If the patient is not in a position to make decision on their own, the next of kin is consulted.
Role of the Patient in their Own Quality or Safety Situation
Patients in these settings are expected to comply with the rules issued by the nurse when handling them. Nurses will use restraint to prevent the patient from falling, controlling aggression, as well as stabilizing their position. The patient should accept restraint to ensure that they are safe from falling which may lead to injuries. In most hospitals in the United States, inpatient falls are considered a risk to patients’ health ( Metzger, Racine & Inouye, 2017) . Additionally, for the purpose of quality care, the patients are expected to comply with the prescription given. If they cannot follow this prescription on their own, they are expected give the nurses an opportunity to do it. However, they should report to nurse leader if the restraint used is done in a way that it is aimed at permanently controlling them. A report should also be made if at any case restraint is used to punish or discipline them.
Relationship between the Patient’s Care and Outcome
Restraint is used to prevent patient falls while ensuring that nurses are secure from aggressive patients. When nurses have a sense of security, they are likely to attend to patients well leading to quality care. On the other hand, restraining patients to avoid falling ensures that they are safe from sustaining body injuries. With administration of quality care, patients will be satisfied with the services ( Metzger, Racine & Inouye, 2017) . In addition, cases of readmission which increase costs and consume time are minimized. All these positive outcomes are associated with quality care and this shows that proper administration of restraint will give good results.
How Care Environment Affected the Situation
Most nursing homes in the United States are frequented by patients with dementia as well as those with mental illnesses. Due to the fact that these facilities have large number of clients, physical restraint has been used extensively and this has been factor under concern. Nurses have been forced to use restraint indiscriminately to avoid cases of injuries from aggressive patients. In some cases, physical restraint has affected the health of some patients ( de Boer et al., 2018) . However, in this case, the patients have benefited because nurses have been able to give quality care in a safe environment. The patients are hence satisfied with the good services because they have often led to improvement in their health.
Whether Quality Model Was Employed
Quality model has not been employed in most of these nursing homes and this has been an issue of much concern in the United States. Although there are federal laws regarding the use of physical restraint, nurses do not always follow them. In most of the care facilities, nurses use restraint even before the chief nurse gives an order ( de Boer et al., 2018) . Additionally, it has been noted that in some instances, they don’t seek the consent of the patients. Hence, the facility did not follow a quality model because this is in violation of the patient’s rights.
Actions that can be taken to improve the Outcome
There are steps that ought to be taken to prevent future adverse effects associated with physical restraint. In most cases, physical restraint leads to bruises, respiratory complications, increased agitation and impaired muscle balance. One of the actions necessary in this scenario is that nurses should interpret their activities in the light of human dignity ( de Boer et al., 2018) . Their clinical actions should be guided by ethical values and norms. The benefits of using physical restraint especially in older people should outweigh the shortcomings. Clear consideration of ethical issues in physical restraint will prevent future adverse effects.
Conclusion
Physical restraint has been used in nursing homes in the United States. However, the adverse effects associated with the exercises have raised concern among professionals. Restraint in most cases lead to injuries on the patient. However, the practice is necessary when dealing with violent clients. Such clients must be restrained in order to give them quality services. The practice should be guided by ethics to avoid the adverse effects associated with it.
References
de Boer, M. E., Depla, M. F., Frederiks, B. J., Negenman, A. A., Habraken, J. M., van Randeraad-van der Zee, C. H., ... & Hertogh, C. M. (2018). Involuntary care–capturing the experience of people with dementia in nursing homes. A concept mapping study. Aging & mental health , 1-9.
Hamers, J. (2017). The Prevention and Reduction of Physical Restraint Use in Long-Term Care. In Dementia in Nursing Homes (pp. 219-228). Springer, Cham.
Metzger, E., Racine, A., & Inouye, S. K. (2017). Advanced dementia in long-term care: avoiding the pitfalls of fall prevention.
