After completing the chapter, you will be able to accomplish the following:
Safety and security are basic human needs. Safety is a paramount concern that underlies all nursing care, and patient safety is a responsibility of all health care providers. It is a focus in all health care facilities as well as in the home, workplace, and community. Nursing strategies that identify potential hazards and promote wellness from a person-centered perspective evolve from an awareness of individual factors that affect a patient's safety. Fundamentals Review 4-1 outlines patient safety risks related to developmental stage, as well as patient teaching to promote patient safety. Guidelines to promote patient safety are provided by health care accrediting, professional, and governmental organizations and agencies. For example, the Joint Commission identifies National Patient Safety Goals (NPSGs). The purpose of the NPSGs is to improve patient safety, focusing on problems in health care safety and how to solve them. These NPSGs are identified for a range of patient care settings, including ambulatory care, home care, hospitals, behavioral care, and office-based surgery. They are updated yearly and can be found on the Joint Commission website at https://www.jointcommission.org/en/standards/national-patient-safety-goals/.
The American Nurses Association (ANA) is a professional organization that also provides guidance to promote patient safety. A position statement from the ANA defines the nurses' role in reducing restraint use in health care. These recommendations are presented in Box 4-2 in Skill 4-3.
This chapter covers skills nurses will need when working with patients to monitor for safety, prevent injury, and to intervene when safety issues arise. The first skill addresses the use of a general patient and environmental survey to identify immediate patient concerns, as well as safety concerns. The next two skills address prevention of injury and discuss reduction of fall risk and utilizing alternatives to the use of restraints. The remaining skills address how to use several types of physical restraints safely and correctly. A physical restraint is any manual method, physical or mechanical device, material, or equipment that the person cannot remove easily, which immobilizes or reduces the person's freedom of movement or normal access to one's body (CMS, 2006). Physical restraints should be considered as a last resort after other care alternatives have been unsuccessful.
Whether or not a specific device is considered a restraint is determined by several factors:
For example, if a bed rail is used to facilitate a patient's mobility in and out of bed, it is not a restraint. If side rails could potentially restrict a patient's freedom to leave the bed, the rails would be a restraint. If a patient can release or remove a device, it is not a restraint. Side rails that are raised with the intent to prevent the patient from voluntarily attempting or actually getting out of bed, would be considered a restraint; if the intent of raising the side rails is to prevent a patient from inadvertently falling out of bed, or if the patient lacks the physical ability to even attempt to get out of bed, side rails would not be considered a restraint (The Joint Commission, 2017).
When it is necessary to apply a restraint, the nurse should use the least restrictive method and should remove it at the earliest possible time. Consider the laws regulating the use of restraints and facility regulations and policies. Ensure compliance with ordering, assessment, and maintenance procedures. Fundamentals Review 4-2 provides general guidelines for restraint use. Always treat patients with respect and protect their dignity.
Integrated Case Study Connection | |
The case studies in the back of the book focus on integrating concepts. Refer to the following case studies to enhance your understanding of the concepts and skills in this chapter.
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