Weighted blanket "to prevent contractures"?!?!?

Nurses Safety

Published

Ok, so... Apparently a hospice nurse who sees a resident at a nursing home I work at told the wife that a weighted blanket would help prevent the man from getting contractures. Mind you, he's had a CVA and is up in a wheelchair and can propel himself around, albeit he is limited with that.

At our facility, restraints are prohibited/against policy. We are a nursing home. So his wife called the state and they agreed... the blanket is a restraint. The state called and spoke with our administrator and they agreed that we needed a meeting with the family and our medical director and we were to discuss this.

The blanket, in the mean time, was removed from the room and kept at the nurse's station. Meanwhile, the wife ignored the state, and us... and had a random doctor call us to give us an order to use the blanket "prn." No can do. The hospice nurse who told the wife to get the blanket (on what basis?!?!? and show me the studies on this blanket miracle!!!!!) got an order to use the blanket. It's still against our policy! So then the wife threatened to call the police and the news station unless we gave the blanket to the resident.

People are so out out of hand these days, I swear. If they don't want to follow our regulations and policies, why don't they take them home? God love these residents... but sometimes the families make you wonder why in the heck you chose this profession. If you want to disregard our policies, leave. I'm sorry.

What say you?????

Specializes in Family Nurse Practitioner.

To me, what seems to be "so out of hand these days" are not the people, but the beyond-ridiculous regulations and policies that prevent our patients from maximizing their quality of life.

Cases like this get me fired up because they showcase everything that's wrong with healthcare. In what rational world would a weighted blanket be considered a restraint?!? I would have loved to have been in on that discussion!

From what I can see in a brief literature search, weighted blankets are useful non-pharmacological tools for alleviating anxiety. If that's the case, the weighted blanket could very well soothe this patient in such a way as to prevent contractures. So, why on Earth would we withhold this intervention? Especially if a doctor wrote an order. We don't need to see randomized double-blind controlled trials to use our common sense and try an intervention if it does no harm and can potentially alleviate suffering and enhance patient comfort. At what point did we conveniently forget the Nightingale Oath here?

Of course, even ridiculous regulations, when they are truly on the books, put the facility in a difficult spot. This is a potential firestorm, for sure. It may be that the only way to change this is for the patient's family to call the media. I say let 'em. Honestly, I would encourage the family to do so to bring attention to the issue. No doubt there are other patients in the state (autistic kids, people with OCD, and PTSD sufferers, for example) who could benefit from weighted blankets. I would tell the family to contact their local political representatives as well. However it happens, it seems to me this asinine reg/policy needs to be changed as quickly as possible.

To be ready for media attention, I would suggest the leadership of the nursing home plan to proactively take the side of advocating for the regulation to be changed, as that appears to be the only ethically expedient thing to do in this case. If you support the idea of doing no harm, you'll recognize that the most harm comes from withholding the blanket in this case. If you support patient autonomy, the best way to put your money where your mouth is, is to allow the patient and family to choose for themselves what they want to do about using the weighted blanket or not, especially when reputable medical authorities (hospice and outside physician) have recommended the intervention.

I know from personal and professional experience that nursing homes are difficult places to live and work, and it's often not so easy for a patient to "just leave" once they're there. Nursing homes provide a valuable service to our aging population, and would all do well to remember that supporting quality of life should always be part of their mission.

P.S. And since you asked, here's a link that can point you to what some studies have shown about weighted blankets. The link is an overview, but can get you started on finding the actual studies.

Weighted Blanket for Anxiety and Insomnia: How to Make It Work

To me, what seems to be "so out of hand these days" are not the people, but the beyond-ridiculous regulations and policies that prevent our patients from maximizing their quality of life.

Cases like this get me fired up because they showcase everything that's wrong with healthcare. In what rational world would a weighted blanket be considered a restraint?!? I would have loved to have been in on that discussion!

From what I can see in a brief literature search, weighted blankets are useful non-pharmacological tools for alleviating anxiety. If that's the case, the weighted blanket could very well soothe this patient in such a way as to prevent contractures. So, why on Earth would we withhold this intervention? Especially if a doctor wrote an order. We don't need to see randomized double-blind controlled trials to use our common sense and try an intervention if it does no harm and can potentially alleviate suffering and enhance patient comfort. At what point did we conveniently forget the Nightingale Oath here?

Of course, even ridiculous regulations, when they are truly on the books, put the facility in a difficult spot. This is a potential firestorm, for sure. It may be that the only way to change this is for the patient's family to call the media. I say let 'em. Honestly, I would encourage the family to do so to bring attention to the issue. No doubt there are other patients in the state (autistic kids, people with OCD, and PTSD sufferers, for example) who could benefit from weighted blankets. I would tell the family to contact their local political representatives as well. However it happens, it seems to me this asinine reg/policy needs to be changed as quickly as possible.

To be ready for media attention, I would suggest the leadership of the nursing home plan to proactively take the side of advocating for the regulation to be changed, as that appears to be the only ethically expedient thing to do in this case. If you support the idea of doing no harm, you'll recognize that the most harm comes from withholding the blanket in this case. If you support patient autonomy, the best way to put your money where your mouth is, is to allow the patient and family to choose for themselves what they want to do about using the weighted blanket or not, especially when reputable medical authorities (hospice and outside physician) have recommended the intervention.

I know from personal and professional experience that nursing homes are difficult places to live and work, and it's often not so easy for a patient to "just leave" once they're there. Nursing homes provide a valuable service to our aging population, and would all do well to remember that supporting quality of life should always be part of their mission.

P.S. And since you asked, here's a link that can point you to what some studies have shown about weighted blankets. The link is an overview, but can get you started on finding the actual studies.

Weighted Blanket for Anxiety and Insomnia: How to Make It Work

Once again... This man *****doesn't***** have anxiety or insomnia. It was meant to be a tool used to prevent contractures. He moves his legs about freely but does bend them up sometimes. He doesn't keep them up. What about foot drop and pressure injuries ??? caused by the blanket that is pointless for what it was intended for: to prevent contractures....

I HAVE a weighted blanket on my bed right this moment. I use it nightly. I know exactly what they are for and I don't need to read about them. ;)

I know you're "fired up" about our policies and regulations and if I thought this man could benefit from this tool because he actually had insomnia or anxiety, I'd be the first in line to advocate for it. But it was designed to *****WEIGH HIM DOWN***** and when it didn't, she doubled the blanket onto the leg he was bending- Hmmmmmm... I'm thinking she's aiming to restrict movement and not SOOTHE HIM.

I have to keep repeating this to other posters on this thread. Not sure if people aren't reading all of these additional comments. We aren't trying to torture the man by withholding something he needs. I suppose 10-lb barbells laid out on his legs would be ok provided we used 2 per leg for a total of 40 lbs? Then we would be in trouble for pressure injuries to his heels that could have been prevented. Prevented how? Lack of barbells. Ugh. This is so silly. I think I'm done here. Thank you for your comments. I think our policies are fine (we try to prevent deficiencies that the STATE and FEDS regulate thanks to people who sue places like us) and the woman wanted to call the news station because she wanted the blanket back. She was given the blanket back and after the nurse had a long talk with her... she decided not to use it. Why? Because he didn't need it- it was a ridiculous and pointless idea. I'm GLAD people benefit for anxiety and insomnia. Like I said... I have one myself. But CONTRACTURES??????? Let's go back to RANGE OF MOTION like in the days of Florence Nightingale and 2018, shall we?

This whole deal with these people is because WE have again chosen to swing from one extreme to the other.

Not sure what you meant by that comment. One extreme to the other... We attempted to educate about the risks and gave her the blanket when she became irate when no administrative staff were there to handle it. We are trying to care for him. HE is our primary concern as a resident in our facility. The hospice nurse needs to undo the damage she did by talking to his wife about this blanket. He's not an autistic child nor is he suffering from insomnia. Geez.

If I had meant "you" (or your facility), I would've used that word "you" instead of "we."

What I meant is that "we" in the healthcare biz and related regulatory agencies, in our fervor to prevent abuse or solve some particular problem, appear quite prone to aiming for opposite extremes that often enough simply create different problems. When I posted I had in mind the latest victim of the whole siderail issue, whom I met recently. Patients aren't being restrained by siderails too much, and now not much is stopping them from rolling or accidentally hoisting themselves right onto the floor. Is that a win?

In an ideal world, "you" (your facility) would have been able to evaluate this individual situation and come to a reasonable conclusion. Now true, that conclusion may have been that the blanket is inappropriate - that's fine. But the conversation with the wife would've been way different, because the motivation for advising against the blanket would've been different.

If you say this lady is unreasonable beyond just a grief reaction, I'll take your word for it. Just the same, not every rule and policy we seem to put such faith in is as reasonable as "we" would sometimes like to believe and from time to time that is going to cause difficulty in dealing with patients.

I will also point out that you waited until post #9 to inform us that the wife actually did mean to restrain the patient with the blanket. My post was in reply to the fact that the only motivation you had mentioned up to that point was that she had been led to believe that it would prevent contractures.

Specializes in Family Nurse Practitioner.

Thank you for the clarification on the particulars of the case. When I hear the word "contractures," I'm equating them with chronic muscle spasms which can often be triggered by anxiety even if the anxiety is not acutely apparent. You mentioned the patient had a history of CVA, so I was assuming a certain level of disability or possibly brain damage. Of course it's always difficult to assess via written description. I do think if it was my patient, though, I would want the family to have the option to try any intervention that might possibly help, especially when the hospice professional recommended it, and the outside physician seconded the recommendation.

If I had meant "you" (or your facility), I would've used that word "you" instead of "we."

What I meant is that "we" in the healthcare biz and related regulatory agencies, in our fervor to prevent abuse or solve some particular problem, appear quite prone to aiming for opposite extremes that often enough simply create different problems. When I posted I had in mind the latest victim of the whole siderail issue, whom I met recently. Patients aren't being restrained by siderails too much, and now not much is stopping them from rolling or accidentally hoisting themselves right onto the floor. Is that a win?

In an ideal world, "you" (your facility) would have been able to evaluate this individual situation and come to a reasonable conclusion. Now true, that conclusion may have been that the blanket is inappropriate - that's fine. But the conversation with the wife would've been way different, because the motivation for advising against the blanket would've been different.

If you say this lady is unreasonable beyond just a grief reaction, I'll take your word for it. Just the same, not every rule and policy we seem to put such faith in is as reasonable as "we" would sometimes like to believe and from time to time that is going to cause difficulty in dealing with patients.

I will also point out that you waited until post #9 to inform us that the wife actually did mean to restrain the patient with the blanket. My post was in reply to the fact that the only motivation you had mentioned up to that point was that she had been led to believe that it would prevent contractures.

Understood. I was thinking it was a given that the "weighted blanket" was designed to "weight him down" to prevent the contractures... My bad.

Lane, if the hospice professional had discussed it with the staff first (since they are a part of the team), that would have also been conducive to avoiding this horrible experience for all.

Specializes in Family Nurse Practitioner.
if the hospice professional had discussed it with the staff first (since they are a part of the team), that would have also been conducive to avoiding this horrible experience for all.

Yessss! I agree wholeheartedly. This is a perfect example of what happens when collaborative communication breaks down.

To me, what seems to be "so out of hand these days" are not the people, but the beyond-ridiculous regulations and policies that prevent our patients from maximizing their quality of life.

Cases like this get me fired up because they showcase everything that's wrong with healthcare. In what rational world would a weighted blanket be considered a restraint?!? I would have loved to have been in on that discussion!

From what I can see in a brief literature search, weighted blankets are useful non-pharmacological tools for alleviating anxiety. If that's the case, the weighted blanket could very well soothe this patient in such a way as to prevent contractures. So, why on Earth would we withhold this intervention? Especially if a doctor wrote an order. We don't need to see randomized double-blind controlled trials to use our common sense and try an intervention if it does no harm and can potentially alleviate suffering and enhance patient comfort. At what point did we conveniently forget the Nightingale Oath here?

Of course, even ridiculous regulations, when they are truly on the books, put the facility in a difficult spot. This is a potential firestorm, for sure. It may be that the only way to change this is for the patient's family to call the media. I say let 'em. Honestly, I would encourage the family to do so to bring attention to the issue. No doubt there are other patients in the state (autistic kids, people with OCD, and PTSD sufferers, for example) who could benefit from weighted blankets. I would tell the family to contact their local political representatives as well. However it happens, it seems to me this asinine reg/policy needs to be changed as quickly as possible.

To be ready for media attention, I would suggest the leadership of the nursing home plan to proactively take the side of advocating for the regulation to be changed, as that appears to be the only ethically expedient thing to do in this case. If you support the idea of doing no harm, you'll recognize that the most harm comes from withholding the blanket in this case. If you support patient autonomy, the best way to put your money where your mouth is, is to allow the patient and family to choose for themselves what they want to do about using the weighted blanket or not, especially when reputable medical authorities (hospice and outside physician) have recommended the intervention.

I know from personal and professional experience that nursing homes are difficult places to live and work, and it's often not so easy for a patient to "just leave" once they're there. Nursing homes provide a valuable service to our aging population, and would all do well to remember that supporting quality of life should always be part of their mission.

P.S. And since you asked, here's a link that can point you to what some studies have shown about weighted blankets. The link is an overview, but can get you started on finding the actual studies.

Weighted Blanket for Anxiety and Insomnia: How to Make It Work

I worked for several years as a surveyor/regulator for my state and CMS (for acute care hospitals, not LTC), so I look at the issues around regulation from a different perspective.

Everyone complains about all the weird, specific, restrictive regulations in healthcare, and asks how anyone could possibly imagine that X, Y, or Z could be a problem and why all these bureaucrats who don't know what it's like in the real world just want to make our jobs harder. However, all these regulations are reactive, not proactive. I guarantee you that no one in state or federal government is sitting around trying to think of ways to make life better for people in nursing homes, or vulnerable populations. All of those regulations are in place because, somewhere, at some point, something bad happened to people in healthcare settings, and happened enough times in enough places that people in the legislatures and licensing/regulating agencies at the state or federal level eventually sat up and said, "Golly! We've got to make sure that doesn't happen anymore!" All those annoying, persnickety regulations regarding restraints are in place because, over time, lots of people got injured or killed in situations involving restraints. Ditto for all the specific, persnickety regulations regarding medications, food, building safety, etc., etc, etc.

If you had seen what I have seen in some of the facilities we surveyed, when they knew we were going to be showing up at some point to survey them, you would agree that we need more regulation and oversight in healthcare, not less. You may be waking up each morning wondering how you can do your job better today, and provide the best possible care to the individuals you serve, but lots of people in healthcare aren't. Lots of people in healthcare have to be required and forced to do right by people. It's a shame, but that's the way it is. And, even when people are sincerely trying to provide the best possible care, what they consider the best possible care often ends up having unintended consequences, which we continue to learn about over time. It's not a perfect system but it's the best we've got.

1 Votes
I worked for several years as a surveyor/regulator for my state and CMS (for acute care hospitals, not LTC), so I look at the issues around regulation from a different perspective.

Everyone complains about all the weird, specific, restrictive regulations in healthcare, and asks how anyone could possibly imagine that X, Y, or Z could be a problem and why all these bureaucrats who don't know what it's like in the real world just want to make our jobs harder. However, all these regulations are reactive, not proactive. I guarantee you that no one in state or federal government is sitting around trying to think of ways to make life better for people in nursing homes, or vulnerable populations. All of those regulations are in place because, somewhere, at some point, something bad happened to people in healthcare settings, and happened enough times in enough places that people in the legislatures and licensing/regulating agencies at the state or federal level eventually sat up and said, "Golly! We've got to make sure that doesn't happen anymore!" All those annoying, persnickety regulations regarding restraints are in place because, over time, lots of people got injured or killed in situations involving restraints. Ditto for all the specific, persnickety regulations regarding medications, food, building safety, etc., etc, etc.

If you had seen what I have seen in some of the facilities we surveyed, when they knew we were going to be showing up at some point to survey them, you would agree that we need more regulation and oversight in healthcare, not less. You may be waking up each morning wondering how you can do your job better today, and provide the best possible care to the individuals you serve, but lots of people in healthcare aren't. Lots of people in healthcare have to be required and forced to do right by people. It's a shame, but that's the way it is. And, even when people are sincerely trying to provide the best possible care, what they consider the best possible care often ends up having unintended consequences, which we continue to learn about over time. It's not a perfect system but it's the best we've got.

OH MY GOSHHHHHHHHH, EXACTLY, EXACTLY, EXACTLY!!!!! I worked in long-term care as a new grad back in 1996 for about a year. I worked night shift and never experienced the state surveyors but this year I did, as my first year returning to it again... (full circle career, I guess)... They watched me do 5 dressing changes and questioned me throughout and I really thought I did some things WRONG when they were simply asking questions to see if I knew the answer or got caught off guard. THANKFULLY I didn't cause any deficiencies but they sure do nit-pick a lot of things... for good reason. There are so many danged sue-happy people in this world and it's unfortunate but also... 20 years ago... people were NOT as well taken care of in a nursing home... there weren't as many regulations... that's in healthcare in general... but nursing home patients/residents DO need to have people looking out for them. Many of them have no voice as they are confused and many of them don't have people visiting them on a daily basis. Those who DO have people visiting on a daily basis get BETTER care because the staff knows people are watching more closely... That's unfortunate but it's fact.

But yes... you couldn't have said it better ON THE WHOLE if you had tried. You summed up exactly WHY there are so many regulations. People have made their beds in this country and unfortunately we have to lie in them and abide by them. The whole annoying side rail thing happening now... We have developed a way to deal with it and have people sign a waiver if they want 1, 2 or more up... But it's in place because people have DIED getting stuck in them. Yes, they can provide security for some and yes they can help people turn and pull themselves up in bed, etc... but what about the people who died and strangled in them and had no private sitter? Yep... this is why there are regulations. They are annoying much of the time but they are intended to look out for our sweet (and sometimes grumpy LOL) little older folks, God love 'em. I do love my profession and I'm happy to have chosen it whether it's given me some chronic back/neck pains or not. LOL ;) Good day, everyone. Great discussion here. Thank you!

Specializes in Family Nurse Practitioner.

Thank you so much, elkpark, for offering such a thoughtful, insightful post from your unique and relevant perspective as a CMS surveyor.

Admittedly, I'm an idealist, and I got into this line of work because I have other people's best interests at heart. It makes me very sad that far too many individuals in government and healthcare don't give a hoot about the people they're supposed to be serving.

You're right that abuses occur all the time and those abuses cost lives. Thank goodness we have mechanisms in place to stop them. And... what if we applied those mechanisms in a more positive, truly patient-focused way?

The idealist in me can't help but think how much better the world would be if more people involved in healthcare at all levels were willing to push back on impropriety by asking questions like, "is more regulation really the best solution to this problem" instead of jumping immediately on the bandwagon of "there ought to be a law."

You cut straight to the core of what fires me up when you said,

... all these regulations are reactive, not proactive.

Piling on more regulations as an instinctive reaction when something's wrong can be a lot like slapping an adhesive bandage on an arterial wound. It does very little, doesn't address the real problem(s), and can have unintended consequences.

Heavy sigh. It's not easy for those of us who got into nursing and healthcare for all the right reasons.

I also feel compelled to comment on the last sentence in your post, because it echoes a sentiment that I'm hearing more and more lately, even outside of healthcare. The more I think about the implications of it, the more uneasy I become. The sentence was:

It's not a perfect system but it's the best we've got.

The word that stops me cold is "best," -- because if we truly believe this is the best we've got, then we'll never improve. Believing this is the best is like giving up, or worse, giving ourselves permission to quit serving our patients' best interests. Our patients' true needs get lost when we throw up our hands, shrug our shoulders, or accept the unacceptable.

I agree with you wholeheartedly that we don't have a perfect system, and indeed, this is the system we've got. Parts of it work really well, and parts of it don't. That means there's an opportunity: This imperfect system we have now is not yet the best it can be. In other words, we can do better.

We have to want to do better, though, and we all have to do our part.

We can start by observing ourselves in practice and noticing whenever we're using regulation as an immediate go-to solution, a crutch, or a substitute for case-by-case critical thinking and collaborative conversation. Instead of merely reacting to a problem, and immediately thinking of regulation as our best and only tool for resolving it, or using existing regulations as excuses for shutting down conversations before they happen, what if our first response was to look more deeply at every aspect of the issue and uncover its root cause? And then talk about it...

Like we do on allnurses.com. Great discussion.:)

Thank you so much, elkpark, for offering such a thoughtful, insightful post from your unique and relevant perspective as a CMS surveyor.

Admittedly, I'm an idealist, and I got into this line of work because I have other people's best interests at heart. It makes me very sad that far too many individuals in government and healthcare don't give a hoot about the people they're supposed to be serving.

You're right that abuses occur all the time and those abuses cost lives. Thank goodness we have mechanisms in place to stop them. And... what if we applied those mechanisms in a more positive, truly patient-focused way?

The idealist in me can't help but think how much better the world would be if more people involved in healthcare at all levels were willing to push back on impropriety by asking questions like, "is more regulation really the best solution to this problem" instead of jumping immediately on the bandwagon of "there ought to be a law."

You cut straight to the core of what fires me up when you said,

Piling on more regulations as an instinctive reaction when something's wrong can be a lot like slapping an adhesive bandage on an arterial wound. It does very little, doesn't address the real problem(s), and can have unintended consequences.

Heavy sigh. It's not easy for those of us who got into nursing and healthcare for all the right reasons.

I also feel compelled to comment on the last sentence in your post, because it echoes a sentiment that I'm hearing more and more lately, even outside of healthcare. The more I think about the implications of it, the more uneasy I become. The sentence was:

The word that stops me cold is "best," -- because if we truly believe this is the best we've got, then we'll never improve. Believing this is the best is like giving up, or worse, giving ourselves permission to quit serving our patients' best interests. Our patients' true needs get lost when we throw up our hands, shrug our shoulders, or accept the unacceptable.

I agree with you wholeheartedly that we don't have a perfect system, and indeed, this is the system we've got. Parts of it work really well, and parts of it don't. That means there's an opportunity: This imperfect system we have now is not yet the best it can be. In other words, we can do better.

We have to want to do better, though, and we all have to do our part.

We can start by observing ourselves in practice and noticing whenever we're using regulation as an immediate go-to solution, a crutch, or a substitute for case-by-case critical thinking and collaborative conversation. Instead of merely reacting to a problem, and immediately thinking of regulation as our best and only tool for resolving it, or using existing regulations as excuses for shutting down conversations before they happen, what if our first response was to look more deeply at every aspect of the issue and uncover its root cause? And then talk about it...

Like we do on allnurses.com. Great discussion.:)

In my last sentence, I meant that the current system is the best we have at the moment. Not that there couldn't ever be a better system. I've heard many people say that government uses a hammer, not a scalpel (as an explanation of why regulations tend to be broad and general). However, it is also true that we (the healthcare community collectively) have only ourselves (the healthcare community collectively) to blame for the regulations, as they are an attempt to correct for abuses of the past.

It's clear that you consider yourself to be one of the "good guys," as I expect most of us do about ourselves, always working hard to do the best job you can and provide the highest level of care you can, but please do keep in mind my earlier mention that even things well-meaning people are doing because they consider them the "best," highest level of care often prove to have negative and even dangerous unintended consequences.

More regulation would not be necessary if there were not so many people in healthcare working at the level of "least effort that won't get me in trouble" or cutting every corner they can for financial reasons or simple laziness. However, as I noted, sadly, many people in healthcare do have to be required/forced to provide decent care and do the right thing for people. I think your rosy scenario of all of us just wanting to do the right thing and be creative about problem solving is 'way too optimistic. I doubt v. much that there is a "better way" in healthcare that involves less oversight and regulation.

Specializes in Psychiatry, Community, Nurse Manager, hospice.
Weighted blankets are legitimately used for certain indications, soothing autistic children for instance, you're correct there is no reason to believe it will prevent contractures, but It's not a restraint because it doesn't prevent movement, as you pointed out:

Agree. It could be a restraint if the patient was too frail to move against the blanket. But in this case, it is not a restraint.

Wife is likely grieving. I would suggest not engaging in a power struggle with her, if there is no true safety concern. When my husband was extremely ill, I was a pain in the ass for hospital staff too.

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