Freedom from restraints & confidentiality.

[JasonValentine]

I'm taking a distance learning LPN refresher course to get my licence back after 15 years away, yes, it is accredited. I haven't done my clinical yet and two of the situations I have come across in talking with the few nurses I know are the changes in freedom from restrains and confidentiality.

Back when I worked in a nursing home, we could still put people in vest and belt restraints or in a sedan chair with a tray in front so they couldn't wander. Ditto with side rails and bed restraints. I realize things have changed, and I wouldn't mind a clinical discussion as to how you ensure patient safety now.

Also, not calling patients by their last name? I also have been told that being informed of a patients HIV status is now considered invasion of privacy? Wouldn't mind hearing from anyone who is in the trenches.....

~~~Thanks, Jase.

Former Army nurse and critical care pediatric LPN.

[Stethoscopes&Scrubs]

I wouldn't know from a nursing standpoint because I've only ever been an aide, I'll be starting my lpn course April 8th.. But during my time as a direct care aide to individual's whom are physically and mentally disabled, everything is considered a restsarint now, even adaptive equipment, such as splints and wedges with straps. Its really a catch 22 because yes restraining someone may not be the best idea but also, we cannot be everywhere all the time to ensure safety.. As far as not calling people by there first and last name, it's a major hippa violation because of privacy, but you can use last initial, such as Adam B. I am constantly fighting over the last issue of need to know health concern's and always told to treat everyone with preventive measures.. But regardless as a nurse and caregiver I still have a family and I want to ensure that I am extra careful to not bring home ANY disease.. I signed up to treat and care for ALL people but I still have rights too..

[JasonValentine]

You're constantly fighting over not being told why a patient is in any form of isolation? Do the nurses even know?...how can you take care of someone if you don't know what you need to look for? How do you keep a patient who is disoriented in bed at night? Are side rails even permitted?

[uRNmyway, ASN, RN]

Yes, you do need to get an order for restraints. However, where I used to work (not in the US), if we had someone start to get confused, sundowning, wtv, we could put on a posey or geriatric chair with table *temporarily* IE for the night without orders. Then we would get orders in the morning. Doctors just did not want to get woken up for a posey order. 4 point restraints however, you did need orders for immediately, but those were only used after code whites.

Names? Need to know. If this is someone I am caring for, I have NEVER heard of not being allowed to have their full name. That is just plain ridiculous. And the only patients I refer to by their first name are the young ones who specifically tell me to.

Infectious diseases, also on a need to know basis. Their HIV or Hepatitis status won't be posted by their door, but if you are directly assigned to them, I have always been told to let staff know. However, anyone who respects standard precautions to begin with should be ok either way.

Keeping a patient in bed at night...Hmmm, sometimes its just not gonna happen. Just get them up at the nurses station when someone is there. Give them something to do. And very strongly encourage day shift not letting them nap!!

[JasonValentine]

That sounds more like what I am used to as nursing. But from my understanding the US has gotten very very ..stringent regarding these regs.

[Esme12, ASN, BSN, RN]

You're constantly fighting over not being told why a patient is in any form of isolation? Do the nurses even know?...how can you take care of someone if you don't know what you need to look for? How do you keep a patient who is disoriented in bed at night? Are side rails even permitted?

In the past 15 years many, many things have changed. HIPAA, restraints are amongst the biggest. Side rails are considered a form of restraint. While restraints are still used....with a physician order and specific guidelines...in the acute care setting. Many LTC (long term care) have gone "restraint free". While they can still use them ....the regulations and documentation necessary to remain compliant is difficult to impossible with the staffing levels they maintain...so they just don't.

The utilize bed alarms....mattresses on the floor. Yet they (administrators) insist that it is the staff fault when patients do fall even though that nurse may have 30 patients.

It's become a scary world out there.

Not telling staff about isolation...that is not true everywhere....it is not a HIPAA violation to share patient information on a need to know basis. Yes they can share why a patient is in isolation. In some instances...the HIV status is protected and if they are admitted for something else you may not know their status unless it pertains to why they are there.

Some facilities have interpreted these regulations to the ninth degree and have gone a little over board. In HIPAA it talks about the use of identifiers to maintain confidentiality but you must have 2 identifiers....the patient full name and DOB to administer meds.

We have an entire forum about HIPAA that I think you would find interesting and informative!

HIPAA and Nursing Challenges

[DidiRN]

That sounds more like what I am used to as nursing. But from my understanding the US has gotten very very ..stringent regarding these regs.

Jason, try your question out too in our long term care forum. You may get some more feedback there. I know some posters there who were in LTC in the 90s or earlier and still are today.