...Ethics of Chemical and Physical Restraints Ethics of Chemical and Physical Restraints A restraint is the use of some kind of equipment or drug used for the purpose of restricting a patient from free will movements. There are times when using restraints would seem like the best thing to do for a patient, but in-fact it could be quite the opposite. Agens Jr., J. (2010). The use of restraints is mostly used to deal with an agitated patient, mainly can be found in residential-care facilities. Those 65 years and older have been reported to have higher restraint use rate in residential and acute care facilities. Many have been found with at least two different types of restraints at the same time. Mott, S., Poole, J., & Kenrick, M. (2005). How often restraints are used often will depend on what kind of restraint is used and the setting that it is being used in. According to Agens Jr., J. (2010) that in the health care facility setting has reported a 7.4% to 17% restraint use ten years ago, and a decade before that it was 28%-37%. Thanks to the Department of Health and Human Services and the new rules that the CMS put into effect in 2007, restraint use is down about 5%. The use of Chemical restraints is a bit higher than physical restraints that reached upwards to 34% in the long term care facilities. However, there is some hope that this number will decrease because of the US government regulation. Chemical and physical restraint use has been known to cause many hazards...
Words: 1347 - Pages: 6
...sensitive indicators, the nurses in this case could improve the structure, process, and outcomes of their nursing care. The structure of nursing care is indicated by the supply of nursing staff and the skill level of the nursing staff. By the nurses having increased knowledge of the issues hip fracture patients are prone to having, such as decrease mobility, increase need for surgical intervention, and increase risk of falls, could help improve the quality of patient care. A patient with decrease mobility is at higher risk for pressure sores. The nurses in this case may have prevented the one by proper padding and repositioning every 2 hours. The nurses in this case should aim to prevent surgical complications and infection (Sauls, 2013). With proper knowledge of dementia, fall prevention, restraint prevalence could lead to improved patient safety and satisfaction. Maybe with an understanding of dementia the patient could have been reoriented, medicated, moved to a room across from the nurses desk, or had a CNA sit with the patient to prevent the need for restraints. If the patient was drowsy there is a good chance the restraints in this case were not medically indicated. Dementia patients are more prone to weight loss and inadequate nutrition which could lead to other risk. In this case the staff should have offered a variety of foods the patient like to help maintain adequate nutrition (Sauls, 2013). B. Quality patient care Hospitals uses nursing-sensitive indicators...
Words: 740 - Pages: 3
...Organizational Systems and Quality Leadership Task 1 It is critical to have an understanding of nursing-sensitive indicators in order to provide safe, quality, compassionate and satisfactory patient care. In this scenario, applying restraints to Mr. J, a demented patient with hip fracture seems appropriate. However, it is standard practice that restraints are to be removed as soon as possible, and the patient in restraints may need assistance to change position every two hours. In Mr. J’s scenario, there should have been a bedside commode, and a urinal for him to use at the bedside so he does not have to walk very far to the restroom. As for the CNA, if she was well trained, she would have been able to recognize the marks on his spine are potential pressure sores. Her knowledge of pressure ulcer would have prevented her from putting Mr. J back to bed in a supine position. Regarding the wrong meal being provided to the patient, it could have been a transcription error of the person taking the meal order, or it could have been a few other reasons, but either way, an error has occurred and it cannot be undone. However, every staff members involved in the care of this patient owe him and his family an explanation and apology. Patients have the right to know about every aspect of their care, and as professionals we need to protect and respect those rights. In this scenario, the nursing supervisor had compromised the principle of integrity when she made the decision to dismiss...
Words: 713 - Pages: 3
...this case in identifying issues that may interfere with patient care. Nursing-sensitive indicators are determinations used to delineate the excellence of nursing interventions and positive patient outcomes. This is not a new concept. In the 1800’s, Florence Nightingale, a promoter of outcomes, revealed such indicators when she revealed her statistical findings of soldier’s mortality rate associated to environmental conditions during the Crimean War (Fee & Garofalo, 2010). Over the past decades, various studies world-wide have been conducted on the connection of nursing quality indicators and their outcomes. The American Nurses Association (ANA) recognized these studies were an important focus in evidenced-based practice among the nursing profession; and in 1998, they established a program for implementing, developing and storing these nursing-sensitive indicators, known as the National Database of Nursing Quality Indicators (NDNQI) (ANA, 2014). The NDNQI serves as a valuable resource for hospitals nationwide at the acute level for administrators and nurses alike to compare various indicators and outcomes with that of other facilities to determine best practices for patients and staff. In the case of Mr. J, it is clear the nurse caring for this patient had little or no knowledge of indicators of restraint prevalence. However, my initial concern after reading this case was why this patient was in restraints to begin with. There is no indication that this patient was...
Words: 1263 - Pages: 6
...to correspond to patient outcomes; “NSI reflect the structure, process and outcomes of nursing care.” (Nursing World, 2015). These data are collected in many types and locations of medical and nursing facilities and nursing units, which report their data to The National Database of Nursing Quality Indicators (Nursing World, 2015). Units and facilities which submit to and participate with the NDNQI have a means to compare their Nursing Sensitive Indicator data to national data standards. Nurses who have an understanding of NSI in this case may be more attuned to NSI that relate to the care of their patients; ie, the rate of use of restraints, patient fall rate, and pressure ulcer rate at their facility versus national standards and goals (Nursing World, 2015). Nurses and CNAs who understand that nursing indicators are reflective of good nursing care and good patient outcomes can more effectively focus their efforts in the care of patients. In the case of Mr J, issues in the narrative describe a CNA who does not recognize signs of a pressure ulcer, does not implement repositioning, and a RN/CNA team who do not advocate for the discontinuation of restraints in an oriented patient. Further, the concerns of Mr J’s daughter for the condition of his skin as well as a dietary mistake are not investigated and resolved. In the case of Mr J’s risk for pressure ulcer, a RN/CNA team with an understanding of NSI would be empowered to minimise the use of restraints to allow Mr J as much...
Words: 1274 - Pages: 6
...appropriate nursing interventions and job satisfaction of nurses. (American Nurses Association). Finally, outcomes of nursing care according to the American Nurses Association, measures the quantity and quality of nursing care, for example, prevention of pressure ulcers, prevention of patient falls, and IV infiltration to name a few. Given the scenario in this case, there were several nursing sensitive indicators present that could have been prevented provided that the staff involved received proper training and had a strong foundational understanding of nursing-sensitive indicators. To begin the case of Mr. J, there was no definite explanation of why the restraints were applied. This is an appropriate opportunity for education related to restraint use. Although Mr. J was given pain medication, he obviously knew where he was by being able to answer simple questions when asked. The question then becomes why was restraints applied. Restraints require a physician’s order was there an order? It seems that the staff in this scenario has not been properly trained in regards to restraint use. Restraints are used as a last resort only. While in restraints staff must provide proper patient care and documentation....
Words: 1381 - Pages: 6
...and Outcomes are determined when greater levels of nursing care and quantity are involved with better patient outcomes (ANA, 2015). Nursing-Sensitive Indicators The scenario paints a picture of multiple areas that should be approved on and addressed by management. The use of restraints, as described by the scenario, indicates a clear lack of knowledge in regards to nursing-sensitive indicators, the use of restraints and subsequent pressure ulcer formation is directly related and reflects on all 3 aspects of the indicators. The American Nurses Association, ANA, recommends that restraints only be used when no other viable options are available and this is also the case with the organization that I am involved with as a RN, Seton Health. While reading the scenario, it did not mention patient behavior that would justify the use of restraints; there is no mention of medical or behavioral interference that could possibly require the need to use restraints. The patient is elderly, has a history of mild dementia and a fractured hip, none of these should require the use of restraints but they all create conditions that place the patient at higher risk of developing secondary injuries due to being confined to a bed. The scenario of a patient with dementia is familiar to me, taking care of these patients can be stressful and place greater pressure of nursing staff and these patients...
Words: 1321 - Pages: 6
...possessing a Bachelor Degree in nursing result in improved patient outcomes. The process indicators measure nursing care such as patient assessment, patient care and intervention. These are the organizational policies and procedures of nursing. The patient outcomes are indicators directly related to nursing care and quality of care provided. Patient satisfaction, pain management or infections rates are some examples of patient outcome indicators. In the case provided, knowledge of nursing sensitive indicators would have assisted the nurses in several ways to provide a positive patient outcome. First, if the nursing assistant had knowledge of pressure ulcer prevention, sign and symptoms and treatment of pressure ulcers, the pressure ulcer on the patient’s sacrum may have been prevented. In this case, the nurse assistant did not recognize the patient had the first stages of a pressure ulcer developing. When the assistant got the patient up for toileting she should have checked his bottom and upon seeing the red area on his sacrum, she should have immediately notified the nurse of the beginning stages of a pressure ulcer. Also, when she returned the patient to bed the appropriate and correct action would have been to reposition the patient of his back to prevent further staging. Along this same line, with the correct education and understanding of pressure ulcer prevention the assistant should have been repositioning the patient...
Words: 944 - Pages: 4
...indicators are important in all aspects of patient care. A great deal of bedside care is given by nurses. Nursing-sensitive indicators are factors that rely directly on the nursing care of the patient. Quality nursing care improves patient care and therefore patient outcomes. Nursing-sensitive quality indicators promote patient safety and quality patient care. Since these quality indicators are reflective primarily on bedside care provided by nursing staff it is important that all nursing staff be aware of these indicators and their role in promoting quality patient care. There are specific indicators that could have been taken into account to promote patient care in the example for this task. The patient in this example was in restraints. There should be a restraint policy at this healthcare facility. Promotion of a restraint free environment would be ideal. Education on ways to redirect the patient and promote relaxation might help. Wrapping IV catheters and positioning any tubes, drains, or urinary catheters out of the patient's view may also help. Nurses should also help the patient with toileting on a regular basis. The use of distraction and alarms should also be implemented. When there is staff available a sitter may also help in the prevention of the necessity of restraints. Joint Commission states, “the hospital uses restraint or seclusion only when less restrictive interventions are ineffective,” (CPI, 2009). If restraints are deemed necessary staff should follow...
Words: 1179 - Pages: 5
...slightly sleepy. Restraints reapplied with family present. Dtr notices red, depressed area over lower spine (CNA blew it off, “it will go away”) Diet: Regular, Kosher, chopped meat Given pork chop (nurse notified supervisor, supervisor notified kitchen supervisor, kitchen supervisor notified kitchen staff) Kitchen staff apologized to dtr. Dtr asked nurse, who blew itoff. Nursing Sensitive Indicators….Discuss how an understanding of nursing-sensitive indicators could assist the nurses in this case in identifying issues that may interfere with patient care. (pressure ulcers, patient satisfaction, “paucity of scientific evidence linking nursing with hospital patient outcomes”, nursing-sensitive performance measures are processes and outcomes – and structural proxies for these processes and outcomes {skill mix, nurse staffing hours} that are affected, provided, and/or influenced by nursing personnel, but for which nursing is not exclusively responsible. Patient-Centered Outcome Measures: Failure to rescue, Pressure ulcer prevalence, Falls prevalence, Falls with injury, Restraint prevalence (vest and limb only), Urinary catheter-assoc UTI rate. System-Centered Measures: Skill mix Mix of nurses and unlicensed staff caring for patients in the acute-care setting • Total nursing-care hours provided per patient day • Nosocomial infections •Patient falls •Pressure ulcer rate •Patient satisfaction with overall care •Patient satisfaction with nursing care •Patient satisfaction...
Words: 1505 - Pages: 7
...Sensitive Indicators: Organizational Systems The knowledge of nursing sensitive indicator can be helpful in providing the patient care which meets the quality and ethical standards. Nursing sensitive indicators rely on evidence to take patient care decisions (Patrician, 2010). According to Patrician (2010), Evidence Based Nursing is the use of personal expertise and research to take decisions on patient care. In case of Mr. J, there is a clear lack of evidence based nursing. Mr. J was kept in restraint without considering that Mr. J was not trying to get out of bed by himself. When the pressure ulcer was identified, the nurse neglected evidence which should have been a basis of removing restraint. Even if the risk of falling was high, a sound alarm could have been placed at the bedside, which Mr. J could have used when he wanted to use the bathroom. The body of Mr. J was in unnecessary discomfort due to restraint and constant pressure was causing ulcer in the back. Mr. J was diagnosed with mild dementia and was drowsy, so the nursing staff had put him in restraint. Although, there are very flexible guidelines for the use of restraint in the National Quality Forum (2004), but, in case of Mr. J, the nurse is rigidly focused on keeping the patient in restraint to reduce risk of falling. The restraint makes the patient’s body immobile and can also make the patient feel imprisoned; leading to depression and other psychological disorders (Foster, 2012). A clear lack of ignorance of nursing...
Words: 962 - Pages: 4
...A) There are several issues in the case of Mr. J that need to be examined. Using nurse sensitive indicators “reflect patient outcomes that are determined to be nursingsensitive because they depend on the quality or quantity of nursing care” (American Sentinel University, 2011). Mr. J. was not receiving acceptable care, because his daughter noticed a red, depressed area over Mr. J’s lower spine, similar to a severe sunburn. This skin condition is the first stage of a developing pressure ulcer. a. Nurses should be aware that a patient with limited mobility is at risk for skin breakdown, and pressure ulcers. Anyone with limited mobility should be assisted to change positions by the care providers on a regular schedule to help circulation and prevent skin breakdown. b. Providers should also consider that the patient is 72, and has fragile skin due to aging skin. This also places the patient at further risk for pressure ulcers. c. The patient is also on restraints, which limits mobility even further. While restraints can help confused patients from falling, they can also cause skin damage. Care providers should continually access the need for using restraints, and remove them as soon as possible. B) Using hospital data on nursing sensitive indicators could advance quality care throughout the hospital. In this case, the hospital should examine the incidence of pressure ulcers, the use of restraints, and dietary requests. a. When examining the pressure...
Words: 682 - Pages: 3
...effective the care environment is. These nursing sensitive indicators include complications such as urinary tract infection, patient falls, surgical complications, length of hospital stay, restraint prevalence, incidences of failure to rescue, patient satisfaction, pressure ulcers and nursing satisfaction. In the case of Mr. J, the demented rabbi, who as a nurse supervisor I am responsible for, nursing sensitive indicators are crucial in monitoring the level of care and making adjustments so that the patient will recover as quickly as possible. Modern nursing, aided by linear flowcharts uses the Pareto principle that states 80% of process or system problems come from 20% of the possible causal factors (Cherry, 2011). This means that by identifying the key and most obnoxious causal factors and focusing effort on relieving them, the problems can have viable solutions. An example of the need to focus on nursing sensitive indicators is the fact that restraints were used on the patient despite only having mild dementia and no previous incident as well as the restraints causing a pressure ulcer would indicate that the patient isn’t receiving the care he deserves. From these two metrics I would assign a CNA to watch over him periodically and release the restraints during that period and help him sit up to relieve the pressure on the ulcer. The discomfort from the restraints and the pressure ulcer could seriously impede Mr. J’s ability to recover or potentially cause new problems, such as sepsis...
Words: 1097 - Pages: 5
...when determining what contributes to quality care of patients in a healthcare setting. The use of nursing sensitive indicators assists healthcare workers in providing the highest quality of care possible to their patients. When these indicators are used, and followed by those providing care, higher standards are met, allowing for patients to receive a much higher quality of care while being involved in the healthcare system. A. Nursing Sensitive Indicators By learning and understanding nursing sensitive indicators, a nurse is given the opportunity to identify factors that may affect the quality of care being delivered to a patient. In the scenario given, Mr J., a 72-year-old rabbi with dementia, has fractured a hip following a fall in his home. He has been given pain medications, which have made him sleepy, but he is still able to communicate effectively. Mr J’s daughter has come to visit, and found him lying in his bed, on his back, restrained. The first nursing sensitive indicator that could be implemented by the nursing staff is regarding the use of restraints. The use of restraints in this case is most likely unnecessary. Although the patient has previously been diagnosed with dementia, he is able to recognize his daughter upon her arrival, and notify her of his need to use the restroom. Regarding the use of restraints, patient restraint should be considered when a careful assessment establishes that the patient is a danger to self or others by virtue of a medical...
Words: 1104 - Pages: 5
...hospitalization for a fall with injury. Because of this recent fall and his dementia he is quickly labeled as a fall risk while in the hospital. Despite his dementia, Mr. J is able to answer questions appropriately. Mr. J appears to have not been given any alternative to restraints. Alternatives to restraints would include medication to help calm him, bed alarms, and distractions such as games, music, or television. Another alternative would be to offer a sitter at the bedside. Last resort would be to restrain Mr. J. In this case Mr. J appears to have not been offered any alternative to restraints. (Hinshaw, 2010) Another quality nursing indicator is the prevalence of pressure ulcers. He was found to have an area on his lower spine that was reddened and depressed, indicating the development of a possible pressure ulcer. The nurse in this case was not notified by the CNA that found the reddened area and the daughters concern was ignored by the CNA. Assessing skin, especially given Mr. J’s immobility would be a priority for the nursing staff. Developing a turn schedule and making all staff aware of this schedule would also have been helpful in this situation. (Wurster, 2007) In addition to the restraints Mr. J has also been in the hospital for a week which may be a factor in the prevalence of the pressure ulcer. One indicator that may not be immediately apparent would be the risk of a nosocomial infection and development of pneumonia (Duffy, 2002). Mr. J would be at...
Words: 934 - Pages: 4
