One challenging and debatable area of concern in gerontological nursing is the application of restraints during care services for aged patients. While the primary aim of installation restraints may be to ensure patient safety, thorough deliberation on ethical and practical aspects surrounding their use is necessary. However, the moral dilemma is achieving a fair compromise between respecting the seniors and breaching their dignity or autonomy. It needs a thorough evaluation of every patient’s case, including the short-term and long-term risks to the overall health status. There is also a delicate line that healthcare professionals need to tread between supporting the safety of older adults and their rights. To minimize the necessity for restraints, many alternative methods like individualized care plans and also environmental alterations should be explored. In response to the challenges of constraint use in geriatric care, an overall strategy emphasizing a customization fit approach focusing on open sharing and ethical considerations is ultimately essential.
Overview of Gerontological Nursing Issue
Restraint use among older patients is a very controversial issue in medicine that has left many discussions. Gerontological nursing specializes in the treatment of seniors. Others have contended that this chemical and physical practice is crucial for preventing any falls or accidents among older people, especially in those with conditions such as brain diseases affecting the awareness level of their surroundings or suffering from cognitive deficits (Sharifi et al., 2021). However, a large number of medical professionals oppose the use of restraints because they think that older adults can have some unwanted physical and mental results like increased agitation, pressure ulcers or motor dysfunction. The major challenge lies in finding a good compromise between protecting older patients’ safety and their feeling of dignity and independence. This is more than an ethical issue with significant implications for older patients’ quality of life and well-being (Sharifi et al., 2021). The moral dilemma that follows the use of constraint stems from gerontological nurses’ need to address each patient individually in supporting safety within the care (Chou et al., 2020).
Restraints are justified as a significant preventative action, especially for older individuals who are more likely to fall or have other kinds of accidents. People with dementia, cognitive disabilities or any other disease diminishing their cognition could unknowingly find themselves in many dangerous situations. They argue that the limb shackles act as a shield, ensuring these fragile beings’ physical safety (Sharifi et al., 2021). This approach aligns with the ultimate goal of healthcare, which seeks as little harm through promoting patient safety. On the other hand, those who are against using restraints illustrate the possible adverse effects they can cause on the physical and emotional well-being of older patients (Lachance & Wright, 2019). Restriction of mobility due to pharmacological interventions such as sedative drugs or physical restraints in the form of belts may lead elderly individuals into an agitation and troubled state. Moreover, continued restraints are also associated with pressure ulcers, compromising old patient’s skin integrity and, consequently, other health issues. There is also a concern about the future health and autonomy of older people, whose functional capacities are reduced due to restraints (Chou et al., 2020).
This issue is very complex and multifaceted ethically. The main challenge facing gerontological nurses is walking the line between patient security, autonomy, and dignity in care values. Constraints inevitably limit mobility and decision-making by subtracting some freedom, an essential part of personhood. Balancing the safety of the older patients and their rights is an endless quest in the gerontological nursing profession (Sharifi et al., 2021).
In order to adequately deal with this particular challenge, gerontological nurses must take a patient-centered approach and develop an individual care plans for every older adult that is supervised by them. This involves a very critical assessment of the person s physical and also mental health as well an understanding of their individual values. To establish a partner decision-making process that ensures the safety and autonomy of the older adult, communication with the patient and their family is very necessary (Sharifi et al., 2021). In addition, various complications arising from the utilization of restraints in gerontological care should be addressed through an interdisciplinary approach. Cooperation with the physicians, physical therapists, occupational therapies and also other medical professionals may contribute to establishing a comprehensive care package that minimizes the use of restraints while ensuring security and health for senior people (Lachance & Wright, 2019). This approach follows the principles of person-centered care, with an emphasis on personal preferences and seeking a thorough understanding of each the patient’s individual situation.
Literature Review
The literature review on the use of restraints with old people provides a detailed understanding of many aspects involved in this practice. In different studies, the incidence of application restraint in the various healthcare settings and its relationship with adverse outcomes are considered. One of the most remarkable studies in this area is that by Sharifi et al. (2021), which demonstrated a strong statistical relationship between using restraints and an increased rate of falls and related injuries among the seniors. This conclusion implies that the harm these restraints inflict upon those individuals whom they are supposed to safeguard significantly outweighs any purported advantages of using them (Lachance & Wright, 2019).
On the other hand, those who are in favor of utilization restraints argue that if used rightly they might act as effective preventive measures against mishaps and injuries offering protection to the older persons considered a danger group. The literature also emphasizes the importance of individualized care plans and the nurses in particular should adjust their practice to tailor it for any patient’s need. It is claimed that this tailored approach should be very critical in balancing autonomy and also security (Sharifi et al., 2021). The increasing number of studies shows that the problems that nurses experience when using evidence-based practices are and incorporating this knowledge into their decision process. Nurses are placed in an uncomfortable position of struggling to balance the changing evidence and the desire or need for quality care, as research on restrain issues goes on (Lachance & Wright, 2019). The literature demonstrates the dynamic nature of healthcare environment and encourages the nurses to be informed in their methods to adapt with changes currently emerged on how restraints really affects older patients (Chou et al., 2020).
Moreover, the study underscores the importance of it is a multi-disciplinary approach to address complex problems on restraint utilization in geriatric care. However, professionals in the area of health have to cooperate and make care plans that not only secure safety but also respect the people’s dignity. Thus, this collaborative method acknowledges that the treatments should be tailored to the specific demands and preferences of every older adult satisfactorily following this movement toward person-centered care (Möhler et al., 2019). From the literature, it is evident that a monadic approach does not work and reveals discussion around restriction on which use persists. The need for personalized and patient-focused care is demonstrated by the great diversity of health concerns, preferences, and also responses to therapeutic restraint amongst the elderly individuals (Möhler et al., 2019). However, integrate these data into their daily practice where nurses ensure that the decisions are evidence-based on the most current findings as well as based upon autonomy dignity and patient focus (Lachance & Wright, 2019).
Nursing Implications
Other than the basic safety concerns, there are many more complications related to the restraint use in gerontological nursing. It is vital that the nursing staff become aware of the moral aspects surrounding the use of restraints to safeguard senior residents’ dignity and also autonomy (Andrade et al., 2020). Thus, in order to account for the uniqueness of their senior patients, healthcare providers should seek non-restraining options towards managing the difficult behaviors and preventing falls. For dealing with the issue of restraint use in gerontological nursing, education and training are very necessary. The nurses must be provided with extensive training to assess the fall risks, undertake preventive measures and rely on non-restraints alternatives (Andrade et al., 2020). With this knowledge behind them, they are in a much better position to make decisions that prioritize the older people under their care’s freedom and also welfare. In addition, healthcare providers also need to work in the multidisciplinary settings. This joint approach facilitates a comprehensive care plans that address the broad range of needs seniors have while taking social, psychological and also medical issues into consideration (Andrade et al., 2020). Eventually, the subfield of gerontological nursing can develop to deliver empathetic and individualized care that could promote older adults’ overall well-being by creating an environment based on respect, learning opportunities as well as collaborative efforts.
Conclusion
In conclusion, the implementation of restraints in gerontological nursing should be done very judiciously. The disparate stances on the use of different restraints reveal that a customized evidence-based approach to treatment is required. To address this complex problem efficiently, gerontological nurses should be very familiar with the recent research related to the topic and also establish moral consequences of restraints. Being knowledgeable empowers the health professionals to negotiate the thin balance between safety and also respecting older patients’ dignity and autonomy more skillfully. In addition, it is very necessary to replace many other measures of behavioral control and also fall prevention. Nurses can use innovative approaches, have an ethical consciousness and also pursue continuous learning to enhance the quality of care that is given to older people. They seek to create a kind and safe environment.
References
Chou, M. Y., Hsu, Y. H., Wang, Y. C., Chu, C. S., Liao, M. C., Liang, C. K., … & Lin, Y. T. (2020). The adverse effects of physical restraint use among older adult patients admitted to the internal medicine wards: a hospital-based retrospective cohort study. The journal of nutrition, health & aging, 24, 160-165. https://link.springer.com/article/10.1007/s12603-019-1306-7
Lachance, C., & Wright, M. D. (2019). Avoidance of physical restraint use among hospitalized older adults: a review of clinical effectiveness and guidelines.
Sharifi, A., Arsalani, N., Fallahi-Khoshknab, M., & Mohammadi-Shahbolaghi, F. (2021). The principles of physical restraint use for hospitalized elderly people: an integrated literature review. Systematic Reviews, 10(1), 1-10. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-021-01676-8
Möhler, R., Nürnberger, C., Abraham, J., Köpke, S., & Meyer, G. (2019). Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings. The Cochrane Database of Systematic Reviews, 2016(12).
Andrade, M. R. D. S., Couto, M. B., Carvalho, A. C. S. D., Barros, P. D. F. A., DelValle, R., & Santana, R. F. (2020). Perception of a multidisciplinary team on physical restraint use on older adults: care paradoxes. Geriatrics, Gerontology and Aging, 14(3), 181-188. https://www.ggaging.com/details/1633/en-US/percepcao-da-equipe-multiprofissional-sobre-a-contencao-mecanica-de-idosos–paradoxos-do-cuidado
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