Page 437 - Encyclopedia of Nursing Research

404 n PHYSIOlOGY

team practice; environmental features that the feasibility of achieving the same changes
support independent, safe functioning; in hospitals, where a disproportionately high
P involvement of family and community; and incidence of iatrogenesis occurs, much of
administrative and caregiver sanction and it exacerbated by immobilization from the
support for change. The presence of profes- use of physical restraints and adverse reac-
sional expertise, particularly expert nurses tions to psychoactive drugs. The resulting
and physicians with education and skill in complications—especially delirium, pres-
geriatrics, is crucial for sustained cultural sure ulcers, infections, and fall-related seri-
change. ous injuries—add dramatically to the cost of
Although legislation and other forms care, increased lengths of stay, and further
of external regulation or control do not in loss of function.
and of themselves change beliefs or entirely Although professional organizations in
alter entrenched practice, the Nursing Home nursing and medicine have endorsed non-
Reform Act, part of the Omnibus Budget use of physical restraints and appropriate
Reconciliation Act of 1987 (enacted in 1990), use of psychoactive drugs as the standard
helped to raise standards in nursing homes of care in all health care settings, the debate
(Castle & Mor, 1998). The Food and Drug surrounding physical restraint use in hospi-
Administration, in response to the known tals continues unabated (Jones et al., 2007).
risks of physical restraints and reports of Clinicians caring for specialty populations,
restraint-related deaths, mandates that all such as those found in critical care, trauma,
devices carry a warning label concerning and neurology, are urged to identify, test,
potential hazards. implement, and disseminate evidence-based
Following a decade of emphasis on interventions that reduce reliance on physical
restraint reduction/elimination in nursing restraints. A standard of least restrictive care
homes, clinicians, researchers, and regu- challenges professionals to use comprehen-
lators began to focus attention on these sive assessment to make sense of individual
practices in acute-care settings. As with behavioral symptoms and to employ a range
nursing homes, the Joint Commission on of interventions that enhance physical, psy-
Accreditation of Healthcare Organizations chological, and social function, as well as to
and the Centers for Medicare and Medicaid acknowledge, affirm, and protect the unique-
Services define restraint use as both phys- ness and dignity of each older person under
ical and chemical. Standards mandate that their care.
restraints be used only to improve well-
being in cases where less restrictive mea- Lois K. Evans
sures have failed to protect the patient or Meg Bourbonniere
others from harm. In addition, continual Neville E. Strumpf
individualized assessment and reevalua-
tion of the patient by clinicians and consul-
tation with the patient’s own provider must
occur with restraint use. Direct care staff
must also be trained in proper and safe use Physiology
of restraining devices.
Current approaches to restraint reduc-
tion vary along a continuum from promotion Physiology is the study of the function
of restraint-free care to an attitude of toler- of living organisms. Human physiology
ance for restraint use under certain circum- encompasses function at the molecular,
stances. Successful reduction of physical and cellular, tissue, organ, and system levels.
chemical restraints in nursing homes suggests Physiological investigations usually seek to