Case Study #19

Case Study : CNA and Vest Restraints

When picturing the inhabitants of a residential nursing facility , the average person typically conjures up an image of sad-looking older people shuffling around dingy corridors in hospital gowns and foam slippers--when they can walk , that is . In the same average person 's imagination , those who are not shuffling around are restrained in beds chairs , or wheelchairs , calling out desperately for someone to release them . Not too many years ago this image , while exaggerated , would have had some basis in fact . Recently , however , research has shown that

br residential facilities can be both restorative and supportive , rather than merely being storage facilities for people waiting to die . One important method of creating a restorative and supportive atmosphere is the removal of restraints . A nurse or nursing assistant that does not recognize this fact or a staff member who uses the restraint for ease or for time management is working against the needs of the patient , rather than simply ignoring those needs

The only viable use for a vest restraint , or any restraint , is to provide a safe environment to the patient or , arguably , provide a safe environment for those individuals around that patient . If the restraint is used for purposes other than safety , then the ethical nature of that use comes into question . However , some nurses continue to use restraints for other purposes , despite the negative outcomes associated with their use (Evans Cotter , 2008 . These uses are more or less intended to make the workday easier for the caregiver , rather than due to any need

Time Management and Restraints

At first , it would appear to be effective time management to use restraints for individuals who wander , for those who fall out of bed and for those unable to care for themselves . Using a restraint enables the nurse or CNA to know precisely where that patient is at all times It also enables the nurse or CNA to have control over when , or at least where , the patient eliminates . By enabling the caregiver to have more control over the patient 's body and bodily functions , it would appear that the caregiver 's time is not only better managed , but that the patient is also safer and better cared for

However , the opposite can also be true . A patient that is left restrained in a bed or in a chair can easily be neglected in favor of caring for more ambulatory patients . In addition , a patient that is restrained may be prone to either direct or indirect deleterious effects ' caused by the restraints themselves . Examples of direct deleterious effect would be strangulation or nerve injury from improper use of the restraints an example of an indirect deleterious effect would be a pressure sore (National Institute of Nursing Research , 2006 While the direct effects are clearly the more serious of the two , in that they permanently affect the patient 's quality of life , indirect effects can lead to prolonged care for an extended period . And , while indirect injuries might...