So I am on a hospice unit, my preceptor boasts that they are a zero restraint unit.
We go into a pt room and the pt is restless and half way out of bed and very disoriented.
We help him back in to bed.
Preceptor says, "Hey take those pads that are on the floor and stand them up on each side of the bed, then unlock those two high back recliners and use them to push the pads against the bed and be sure to lock the brakes on each chair."
Specializes in Gerontology, Med surg, Home Health.
Anything that restricts a person's free access to their body is a restraint. Anything that keeps them from getting up out of a chair ( seat belt, tray,lap buddy ) is a restraint. Four side rails are usually considered to be a restraint...also considered to be so dangerous that we don't even have 4 side rails on any of our beds. We have 1/4 rails. I've never seen or read that an alarm is a restraint. Again we need to remember the setting we work in and the state ( and I don't mean the state of confusion ) we are practicing in.
I was told when I was a volunteer in hospice that they don't normally interfere with the body's own system shutting down. They don't force feed, they encourage movement if possible, etc. I wonder if they don't adress the BM issue d/t the same protocol. If this is the natural process for the body, then maybe they let nature take its course and provide comfort as able? Anyone work hospice that can give some insight?
I was told when I was a volunteer in hospice that they don't normally interfere with the body's own system shutting down. They don't force feed, they encourage movement if possible, etc. I wonder if they don't adress the BM issue d/t the same protocol. If this is the natural process for the body, then maybe they let nature take its course and provide comfort as able? Anyone work hospice that can give some insight?
you're right, we do not force anything for that matter...
and don't give it a 2nd thought when pt stops eating/drinking.
now, if they stop r/t mouthsores or some other physical deterrant, then we do what we can.
but if anorexia is r/t the disease process (vs a complication of the disease process), we expect it.
however...
opioid-induced constipation is an adverse effect and we treat aggressively.
constipation/impaction is painful, stressful, and interferes with attaining full comfort.
not only painful, but it stops pts from eating, mostly causing n/v and only gets worse and worse.
any hospice that would allow that, should be shut down.
i cannot emphasize this enough.
whenever a pt starts on a narcotics, senna et al, should be an integral part of this regimen.
if pt is actively dying, that's the only time we won't always intervene.
it's at this time, that nsg judgment is critical in determining whether we try to get pt to evacuate or not.
if it doesn't happen, it can really interfere with dying a peaceful death.
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CapeCodMermaid, RN
6,092 Posts
Anything that restricts a person's free access to their body is a restraint. Anything that keeps them from getting up out of a chair ( seat belt, tray,lap buddy ) is a restraint. Four side rails are usually considered to be a restraint...also considered to be so dangerous that we don't even have 4 side rails on any of our beds. We have 1/4 rails. I've never seen or read that an alarm is a restraint. Again we need to remember the setting we work in and the state ( and I don't mean the state of confusion ) we are practicing in.