RESTRAINT – What Does That Mean in a Nursing Home Setting?

If you look up restraint in the dictionary, you may see one of these definitions: (1) the act of restraining, holding back, controlling or checking; (2) the state or fact of being restrained; deprived of liberty; confinement. But what does the term “restraint” mean in a nursing home or hospital setting? You may be researching facilities and learn that one has a restraint free policy. The Virginia Administrative Code Section that speaks to Nursing Home facilities defines a “Physical restraint” as “any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the individual cannot remove easily which restricts freedom of movement or normal access to one’s own body.” 12 VAC 371-10. The same section defines a “Chemical restraint” as “a psychopharmacologic drug (a drug prescribed to control mood, mental status, or behavior) that is used for discipline or convenience and not required to treat medical symptoms or symptoms from mental illness or mental retardation that prohibit an individual from reaching his highest level of functioning.” 12 VAC 371-10.

Although these are more technical definitions, they mean the same thing – either something tangible or a medication that restricts the movement or level of function of an individual. So why would you want to restrict the level of function or movement of someone?

Imagine an Alzheimer’s patient that has poor awareness of her surroundings. Would a device that prevented her from leaving the nursing home be helpful? Or, consider someone who becomes aggressive toward others due to dementia – wouldn’t a psychopharmacologic drug that helps control that behavior be appropriate? The answer as to whether or not these physical or chemical restraints should be used is neither simple, nor clear. Families and friends of nursing home residents need to educate themselves on the use of restraints, their pros and cons, and make decisions regarding their use accordingly.

For starters, what are examples of physical restraints?

  • Bed rails
  • Wheel-chair straps / seat belts / lap buddies
  • Meri-walker
  • Walker with wheels
  • Door restraints

Why would a facility consider using any of these with your loved one? Maybe to prevent falls, which is always a goal, but other consequences can be equally devastating. Hundreds of people every year get caught in bedrails and suffer injury, strangulation, and frequently death. Keeping someone in bed or limiting their ability to get out of bed may also put the individual at risk of developing pressure ulcers or bed sores and incontinence. Additionally, there are mental and psychological effects that occur when you limit someone’s freedom and take away simple choices, such as when to get out of bed.

Meri-walkers may provide some stability for an ambulating resident but accidents frequently happen when residents in meri-walkers are faced with stairs, changes in the floor grade etc. Not only will the momentum of the walker help cause a fall, but the device itself may become entangled on the person and cause greater injury.

Wheel chair straps may prevent someone from getting out of the chair, but again, what if they come to a stairwell and have no means of stopping, getting up or preventing the fall. The injury could be fatal.

Chemical restraints can be equally dangerous. If a resident is given too much medication, they may have decreased appetite and suffer dehydration or malnutrition. They may also be less mobile, and at risk for pressure ulcers. If they are mobile, many medications may cause focus and balance problems, leading to increased fall risk. The risks are many and must be considered by the prescribing physician to evaluate dose, frequency etc.

Unfortunately, thousands of families have dealt with accidents, injuries and deaths caused, in whole or in part, by the use of physical and chemical restraints in medical care settings. Our office has handled cases involving each of the above restraints scenarios. Unfortunately, injury involving restraints are not uncommon. The lesson we take from these experiences is that restraints should only be used when absolutely necessary, and only if families have had the opportunity to speak to a physician about the known risks and benefits. So while they may sound like a great idea at first, please do your homework and ask the facility the following:

  • How many other residents use this restraint?
  • Will it make my father more mobile or less? Will you monitor him accordingly?
  • What will you do to make sure he does not get caught in the bed rails or wheelchair strap?
  • Will you review the use of the restraint monthly – if so, may I attend?

If the facility will not provide any additional monitoring because of the restraint, then its use should be very limited. At the very least, make sure the physician and facility are on the same page, and understand your concerns.

Role of a Certified Nursing Assistant

A certified nursing assistant is a medical employee who works with doctors and nurses in medical environments and care facilities. They do things like checking vital signs of patients and helping with things like bathing and feeding. They work with medical equipment, setting it up and checking it. They change bedpans and sheets. They are also at the front lines of checking and maintaining a patient’s mental and emotional state.

There are a lot of great reasons to become a CNA. One example is the strongly held belief that fully qualified nurses who started out as nursing assistants just tend to make better nurses. Being able to start out on the ground level gives you the patient-based perspective you need to be a great RN.

CNAs are an important part of any medical team these days, even within teams that don’t just include nurses. They provide a lot of base level routine care operations that free nurses up to help with more involved work. CNAs are great at not only helping with hands on procedures, but also with being the front line workers who keep track of each patient’s physical and mental condition. Nurses are often overburdened, and often can’t spend enough time with patients to get a good feel for how they are doing. This is where CNAs can really shine in monitoring patient’s well-being and helping to improve it.

While they have a wide variety of duties, they do have certain standard job descriptions. At the most basic level, the CNA provides basic nursing services while being supervised by a fully trained RN or LPN. They need to be supervised, as they do not have the legal abilities that a fully registered nurse has.

Their official duties involve taking care of patient grooming, bathing, feeding and hygiene, observing patient’s mental and physical well-being, checking and noting vital signs, moving and transporting patients around the facilities, and other ground level procedures. They are needed and helpful members of any medical facility that engages in long-term or resident care.

How To Become A Legal Nurse Consultant

There are many different specialties and fields that a nurse can work in. For example, there is neonatal nursing, paediatrics, and legal nursing. A certified legal nurse is going to work with members of the legal community so that they can help to better serve their clients regarding medical concerns and matters. To enter this particular field there are several steps that need to be taken.

First of these is to actually go to nursing school so that you can become a registered nurse. You can, therefore, apply for a four year program, a community college or a nursing school.

Complete all of the coursework that you are set. Before actually applying for specialized training all coursework needs to be completed to a sufficient standard. There are various different types of classes that nurses will take such as biochemistry, anatomy, and pharmacology. You can also take additional classes and should therefore look for those that will help you to improve your communication skills. This may be important when you are communicating with legal professionals.

Alongside your coursework you will need to pass your state exams. After finishing classroom studies you will then be required to gain some hands-on, on-the-job experience and therefore will go under the supervision of a nursing instructor. This will give you an opportunity to work specifically and directly with patients.

Once you have graduated get some direct experience working in nursing. It is important for you to have a good background in different fields and you should try to gain experience in different parts of the hospital if possible. The more experience you have in different areas, the more employment opportunity you are likely to get.

Once you have achieved a necessary level of experience and you have expose yourself to various different types of nursing then you can apply for programs that will enable you to gain experience in your intended field. The training will be relatively short and can be completed within six days by attending relevant seminars. After completing the coursework you will be required to sit an exam.

Once you have passed the relevant course or program you will then be in a position to start applying for relevant work. You can decide whether you want to work on a part-time basis while working as a staff nurse, or whether you would like to dive straight in and become a full-time consultant. Whichever path you choose, you will be well on your way to a successful career as a legal nurse.

The Hidden Treasure of Pediatric Nursing

As any parent knows, having children is a life-changing experience for which there is no adequate preparation. We all have ideas about how to raise children but most of the time we simply learn as we go. A young pediatric nurse can get a good head start on parenting through the day-to-day experience of pouring her heart and soul into caring for her young patients. It’s not exactly the same as real-life experience, but it might be the next best thing.

The Quandary of Pediatrics

When the new graduate takes a job as a pediatric nurse, she is immediately faced with the challenge of doing what’s best for a child and making sure that child is as comfortable as possible. Yet the two are not always compatible. Sometimes doing what’s best for a sick patient is going to cause that person to be extremely uncomfortable. For example, you may have to draw blood from a young patient. As a nurse you don’t want to make that child cry and scream, but it’s for his own good. Those are the same decisions parents make every day.

Individuals who choose pediatric travel nursing jobs get to take those challenges one step further. Not only do they have the same quandary in caring for their patients, they are also sacrificing the benefits of their own stability to go where the work is. Travel nurses always have to get used to new coworkers, learn their way around new cities and generally adapt to all the pressures that come with travel. But when they walk into work every day, all those things must be put behind them so they can concentrate on their young patients.

Look for the Hidden Treasures

With any job it’s easy to complain about all of the negatives; anyone can do that. But it takes a special kind of worker to look beyond those things and instead find the hidden treasures. If you’re pediatric nurse, look for those treasures in the smiles and tears of your young charges. You’ll find that the skills you learn as a pediatric nurse will make you a better parent.

If you’re currently employed in pediatric travel nursing, relish those opportunities while you have them. Most travel nurses don’t spend their entire careers on the road for obvious reasons. You probably won’t either if you intend to eventually have children. So use your opportunities wisely, learn as much as you can and look for your own hidden treasures as you go.