Hospital services serve as indispensable tools in providing care to patients. The staff employed may play a prominent role in executing diverse roles during an emergency, intensive care, long term pre and post operative conditions or illnesses. In recent years, patient safety has become a serious concern. Investigations have revealed that human errors are interfering with patient’s lives through the channel of specially designed equipment like bed rails or wheelchair belts. In most cases, the outcome of the patient’s condition relies on this equipment that is considered as physical restraints.
There are various opinions regarding these instruments as they are believed to contribute to the additional burden of inducing injuries or death instead of providing safety. So, there is a need to review the literature to gain a better understanding and the main objective of this article is to highlight and critique the key aspects focused on the utility of physical restraints in three relevant sources.
A previous article has indicated that the safety of side rails has been a major health concern for many years as it has claimed many lives. (Marcy-Edwards, 2007). This problem has seemingly intensified with the advancement of time. However, the usage rates of side rails have reportedly come down with certain discrepancies.
The article has unnecessarily pointed out factors like a change in law, the advent of consumer marketing, in addition, to post-war nurse shortage behind the fall incidents. But it is the sole role of the nurse that can ensure patient safety as they require assistance all the time during their stay in the hospital. Hence, the use of side rails in the absence of nurses or their short supply or as a substitute could not guarantee safety and is unacceptable.
This could increase the chances of injuries or even death of patients especially the elderly or those with cognitive impairments capable of injuring themselves, particularly in the case of the senile, irrational, confused, or otherwise impaired individual. Despite all concerns, the setting up of policies to review the bed rail usage and consider patients’ rights to safety during hospitalization is welcome news. Next, the initiative to design guidelines for beds, rails, and mattresses has come to light only after U.S. Food and Drug Administration (FDA) had reported nearly 68 death cases. This appears to be too late. The reason why FDA has taken such a long time is not understood as the article did not provide enough information in this regard.
This has partly coincided with the Canadian research that lacked enough documentation and policy help, and probably that might have put bed rail usage in question in their society. It would mean that many lives could have been saved with greater awareness if appropriate measures are taken at the earliest stages. This may indicate that the success of patient care equipment or more probably a physical restraint would require help from all the departments. Hence, the indication that Canada is lagging when compared to the US and UK, due to appropriate support seems narrow and suggests thinking from broad perspectives.
From the article, it has become apparent that the patients are meeting fall incidents when they are attempting to get out of bed or for other purposeful activities. This may further suggest the need for nurses to assist the patients without leaving the matter to bedrail usage. Hence hospital authorities must divert their attention on nurses in the light of fall incidents. This would enable the nurses to evaluate all kinds of equipment used as physical restraints meant for protection. The need for alternative actions if the bed rails impede the activity of the patient as a restraint, according to the article, is highly acceptable. This might allow the patients to express their rights and freedom. The moral and ethical beliefs of nurses regarding the use of bed rails might also play important role in ensuring patient safety.
However, to better understand the risk and proper implementation of using bed rails, a wide range of factors need to be considered like patient clinical history, usage documentation, alternatives, and thorough awareness on ethical grounds.
Since it appears that the article has provided some flaws and useful insights regarding the use of bed rails it is partly acceptable and supporting.
Secondly, it is essential to consider another article by Kevin Freking on the use of physical restraints, from the news magazine Charleston Gazette. This article has indicated a reduction in the use of physical restraints in many of the states (26) of the US. This may support the earlier article where attempts to minimize bed rail usage were described. This article has further highlighted an earlier federal law of 1987 that described that restraints could be used for medical reasons but not for punishing clients or for the sake of convenience. Here, it may appear reasonable to assume that this law might have previously failed to draw the attention of or control hospital authorities in providing safety to the patients that resulted in fall injuries and deaths.
The second article has vividly described the effects that restraints might bring which other articles have not provided. These are depression, pressure sores and dehydration, and another inactivity that could restrict the motility of the patient. A thorough understanding that these effects are restraint-related might enable health care professionals to come up with alternative strategies capable of providing relief to the clients, physically and mentally.
The article has emphasized that technology is a good substitute for restraints. But this does not necessarily prevent their rolling out of bed or any wandering out of the unit. Because this could increase the chances of leaving their clients alone by the staff and in case of technical fault the problem may reappear or worsen. Therefore, seeking the assistance of the latest technology cannot be acceptable. This may again indicate that the use of modern restraints needs to be regularly monitored which is only possible with the hospital staff especially, nurses.
Next, the drive to reduce physically restrained patients by nursing homes, consumer groups and other organizations could be very much appreciated. On the whole, this article appears to present a convincing description, with certain limitations in the context of technology, on minimizing the use of physical restraints.
Finally, the third article by Thom Dick & Steve Rollert presents the safe and humane use of prehospital restraints for emergency services (EMS) providers. Most often, some patients exhibit violent behavior by troubling themselves and others. The situation would be controlled only with the help of emergency medical technicians (EMTs) who possess the legal rights to restrain patients. For this purpose, there may be a need of predicting the violent condition of the patient and to this end, seven predictors have been identified by Michigan University such as sex, age, history of violence, history of chemical ingestion, history of mental disease, day of week and time of day.
The article describes that the main objective of the predictors is to identify patients who pose a risk and convince them to accept physical restraints without any hesitation. EMTs are trained in such a way that they would take pains to restrain the patient without losing patience and spoiling the dignity of the patient even in severe unpleasant cases. This might eliminate the risk of injury to patients and other participating members of the operation. They stress the need for intuitive sense as the indispensable tool in assessing the risk of violence in patients. It was reported that restraining patients by EMS operation involve team spirit which is possible through the interaction of local police officers, legal counsel, and medical director.
Restraining patients by EMS mostly relies on negotiation by verbal de-escalation because physical restraints if applied may pose a risk to patients who get drowned in fear and it might also lead to a fatal condition. Chemical stimulants like adrenaline, ecstasy, and cocaine are not reportedly effective as they also pose a risk of more violence and fatality by triggering the physical effects of fight-or-flight syndrome in patients.
Verbal Judo is another negotiating method in a soft manner much known to all the police officers. It seems that the article has provided good negotiating strategies that would restrain the patient with negligible risk.Hence, it is very much supporting and differs widely from the other articles that have not provided any relevant information on verbal strategies.
I suppose that these negotiating skills if applied in hospitals by nurses may also give some beneficial results. This is because it is well known that the violent behavior of patients even inwards could harm nurses or caretakers. As such, hospital authorities should realize the importance of soft negotiations and implement them. This strategy may be especially helpful for those patients who fear that bed rails or other physical restraining equipment might take away their liberty or injures them.
The other reported approach is Take–Downs when a violent restraint candidate was unable to get convinced by EMS staff. The patient would be tie-down in the ambulance cot and several injuries to EMS members by violent patients have also been reported during this process.
Hence, this process requires Police staff as they are believed to be universally trained and equipped for take-downs. It was found that while restraining violent patients Police use noxious irritants like Tasers that immediately disables people who cannot be controlled by any other nonlethal means. But the efficacy of Taser has also become an issue as it was found ineffective for some rare violent people. However, it may indicate that the prehospital restraints strongly require the involvement of Police when the situation becomes difficult to manage by EMS crew. In contrast, there may not be any requirement of police in controlling the hospital physical restraints. It is a comparatively
the smooth process that requires gentle handling by a well-trained nurse. Incidents arising from bed rails or other hospital equipment are uncertain and unpredictable compared to the violent behavior of patients outside. So, the use of physical restraints like bed rails must be properly streamlined with the assistance of all the members of the medical society.
References
- Marcy-Edwards, D. Bed rails. Is there an up side? Can Nurse, 101, 30-4. Web.
- Kevin Freking. (2008). Use of restraints declines greatly in nursing homes. Charleston Gazette. Web.
- Thom Dick & Steve Rollert. 2008. Coping-with-Violent-People. Web.