Management leave you hanging?

  1. deleted
    Last edit by adrienurse on Sep 17, '08
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  2. 7 Comments

  3. by   Youda
    Most LTCs I've worked in adopted the "no restraint" rule, too. But, we still had lots of restraints. They'd get an OT or PT eval to say that the resident needed the lap buddy "for positioning" or the side rail as an "assistive device for self repositioning." The others we used a lot of "personal alarms" and "bed alarms." According to the MDS's, a restraint is not a restraint unless it is used to limit or restrain. If the restraint is used to enable the person to greater independence, then the restraint isn't a restraint. HOw's that for double-talk? Anyway, all restraints were just rewritten to sound like an assistive device. (Wouldn't want to hire enough staff to watch these people!)

    As for training? We were left to our own devices (if you'll excuse the pun) to figure out how to do it.
  4. by   adrienurse
    So in other words, you're not coping well with the restrictions that have been imposed on you because they look good on paper.

    Don't get me wrong, I don't want it sound like I'm advocating that restraints be used -- I'm just in the mindset that you cannot make rules without providing proper education to acompany it. Too may managers take the half-assed route.
  5. by   Youda
    In the ideal nursing world, there are many, many interventions that allow a resident freedom from restraints. They all cost money in the form of equipment and staff. My experience has been that the corporations want the paperwork to look good, and aren't particularly interested in actually being restraint free.

    And you're right. At least in my experience, training was certainly lacking. Some residents are such Houdini's that no matter what you do, they find a way to fall. They almost need 1-1 monitoring. For those people, you throw away the book and use that "critical thinking" we're all suppose to have. But, again, the solution often involves trial and error until you find something that works, and increased costs to the corporation.

    What I get is, 'don't let them fall; don't use restraints, and by the way, since census is down, we aren't replacing Mary, Jane, Jackie, and Bob who quit yesterday in protest of staffing.'

    Sorry to be so morose. But try asking for a bicycle helmet for a MR patient who keeps falling. See if the "budget" allows the $40. Try asking for a specialty low bed and the $500 to buy it. Try asking for cushioned mats next to the bed so when someone falls out, they don't break a hip, and the $200 for the mats. Try asking for a laser device to sound an alarm when someone starts to get out of a w/c, and the $150 to buy it.

    I am so unhappy with "budget" always being the answer to everything, I must apologize because that feeling surely doesn't help my outlook on things.
  6. by   adrienurse
    Don't I know it sister!
  7. by   nakitamoon
    Deal with the same issues on daily basis,,,, adrienurse,,, youda you have said all that needs saying,,,, but we still don't have an answer,,,,,,,

    Between patient safety,,, staffing,,,, administration,,, and $$$$ we are stuck,,, once again,,,, with the task of assuring safety without the devises we need,,,, training the staff needs,,, and an attorney outside the door waiting~~~~~~~~

    Would really love to work one week with the 'powers that be,, creating laws,,," then let them go back to the table fully informed,,, pinch me,,, I must of fallen asleep,,, dreaming again,,, lol

    ~~~~kitamoon
  8. by   adrienurse
    Yes Management is in love with gettings things looking real good on paper.

    For the little guy (us) I have found some excellent literature.

    Marx, E.M.S. (2001) Achieving Restraint-Free Care of Acutely Confused Older Adults. Journal of Gerontological Nursing, 27(4) 56-61.

    Capezuti, E. et. al (1999) Individualized Interventions to Prevent Bed-Related Falls and Reduce Siderail Use. Journal of Gerontological Nursing, 25(11) 26-34.

    Tideiksaar, R. (1998) Falls in Older Persons: Prevention and management (2nd ed.) Health Professions Press Inc. pp. 125-137.

    Talerico, K. A. & Capazuti, E. (2001) Myths and Facts About Siderails. American Journal of Nursing, 101(7). 43-48.

    Strumpf, N. E. (et al.) (1998) Restraint-Free Care: Individualized approaches for frail elders. Springer Publications.
  9. by   jevans
    Adrienne
    I work in a stroke unit - we have a no restraint policy BUT we do use bedrails
    On admission we explain to both patient and family that although they may look like restraints they are there to prevent falls.
    We also ask them to sign consent for their use. However if we do have a confused pt who is likely to climb we don't use them.

    j

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