Once upon a time I worked at a LTC. There was a resident postCVA, many years. R sided paralysis, R arm elbow, wrist and hand contractures. She had come in due to family inability to care for her anymore. She would insist on sitting on toilet or bedside commode for every void or bm. Not a problem in my book, she was keeping her dignity. And I would much rather use one or the either myself. But CNA's and nurse on the floor working 3-11 would get tired of her ringing her call bell to get on and off commode. We had beds with 4 rails. She had 2 up on one side to assist her with turning, and she would actually lay up against them when in bed. The aides took her call bell away, and closed her door, so that they wouldn't have to hear her call out, which she couldn't do very well, since she was aphaisic. (sp?) Anyway, she tried to get out of bed herself, broke her hip, not found until midnite. When 11-7 started their checks. They did not know that she didn't have her call bell, and sometimes her door would be closed at her insistence. Anyway, hip replacement surgery, returns to us, same needs as before, but no longer bears weight well, now requires 2 assist for stand and pivot. 3-11 shift did not learn their lesson last time, put up all 4 rails, no call bell within reach, door closed. She climbed thru the bed rails, fell, leg caught in between rail and bed, twisted and broken at an angle, stayed that way for ? hours, lost leg above the knee. Needless to say, the nurse and aides on duty that night lost their jobs. Side rails can be useful to keep people from falling, but you need to make sure that your patient understands their use. Hope this was helpful.