I am new to the forum so forgive me if this is not the appropriate place for my thread. I recently got promoted to the nurse manager of our state psych hospital's geripsych unit. Now that geri chairs are considered torture devices that are considered a form of restraint, several of our pts have been having some frequent falls. We now have these pts on 1:1 staffing, much to administrations dismay. Are there any geriatric nurses out there who can share some insight and wisdom with me? The meds alone cause hypotension
and the unit is basically a dementia unit of 18 patients.
Been an RN for 20 years (I'm 42) and still wet behind the ears. Thanks in advance for your help...
Apr 11, '05
Quote from Da Monk
I worked at a psych hospital who proudly touted their no-restraint geropsych unit. Unfortunately, there were numerous falls, and one that was fatal. There were numerous 1:1's ordered, but other patients suffered from lack of staff and the cost of the 1:1's eventually led the unit into the financial red. But, even after the death and a fractured budget, the administration clung to the belief that a restraint free environment was the only way to go, no matter what. The state regulatory agency, in reality works against the acute hospital setting, saying that any device is a restaint. This included the medications that helped the patients and enabled them to return to a nursing home setting. As soon as the patient returned to the nursing home, the agency started pushing the staff to decrease the medication down to a level that was nontherapeutic. The meds were considered a chemical restraint. You can guess what happened. The patient soon returned to the acute setting with the same symptoms or worse. I found these policies detrimental to patient well-being. I would rather see a relative of mine bouncing around in a Merry-Walker rather than lying in a bed with a hip fracture or in an ICU with a subdural. Even a simple lap belt is considered a a restraint. Common sense seems to have no place in these situations. It seems that regulatory agencies must find something to monitor simply to justify their existance. And I would rather see that demented relative in a calm state of mind rather that in an agitated state perpetuated by regulations that promote the belief that the elderly are better off without psychtropic medication, no matter what. Let's get real. I know that studies show decreased death and fall numbers when there are no restraints, but I wonder about the staffing ratios where these studies were done. In a few years when I'm in a nursing home and unsteady on my feet, I hope that someone cares enough to put a little more thought into my safe care.
Hi Da Monk,
Thanks...I agree with you wholeheartedly.
So is there an answer to keeping the patients safe and free from bone-fracturing falls while also keeping them out of restraints and ensuring their rights are not being compromised?
Last edit by gerilou on Apr 11, '05
: Reason: wrong reply