Long-Term Care Analysis

The NHRA sets the regulations for the use of retraints, in addition to these stated requirements the NHRA calls for an assessment of problematic behaviors, physician concurrence prior to the institution of restraints, use of restraints as a last resort, and explaining the restraints and why it is being used on the resident. The use of restraints is regulated by the NHRA and the practice is discouraged, however a majority of nursing home residents will be subjected to the use of them.

As baby boomers age and the demographic of the nation changes, it is with increasing frequency that the terms dementia, Alzheimer’s, and chronic cognitive decline are included in common vocabulary. Television viewers are inundated with advertisements for Alzheimer’s medications. Popular sitcoms include episodes about dealing with the stresses that can occur in a family dealing with cognitive decline issues. Entire movies, such as Still Alice, speak to these issues from the perspective of the patient. Chronic cognitive decline has been brought to the forefront of the American culture not only in homes across the country but in the healthcare system where the challenges of recognizing, treating, and managing these conditions while providing quality of care can be challenging.

Long Term Care (LTC) is an area where change is needed. According to the CDC, by 2030, older adults will account for roughly 72 million of the U.S. population. In 2030, when the last baby boomers turn 65, one in every five Americans will be over the age of 65, and will account for roughly 20% of the population. As the growing population of baby boomers continued to aged they will become more reliant on long term care services. Nurses will be at the forefront of providing care to this demographic of the population. Leadership and accountability are needed in long term care to provide efficient care to the aging population.

Subsequently other issues that plague the long term care facilities would be the concern for the safety of the elderly due to neglect. “Nursing home alert (2016) reports numerous deaths caused by strangulation or suffocation involve hospital beds, and many of these deaths go unreported. A resident may be suffocated if a mattress fits too loosely within the frame and leaves a gap large enough to trap his or her head between the mattress and side rail.” The concern is the unreasonable confinement has been a common issue within the long term care facilities for years and most cases unresolved due to unreported incidences amongst facility workers. Monitoring of all elderly residents should be the top priority within those facilities and not one

Ideal for use in acute care and long-term care facilities, the latex-free TABS Professional Fall Prevention Monitor uses multiple methods of alerting caregivers when a patient leaves their bed, chair, or wheelchair. The Long-Term Care Model includes a simple-to-use cord and clip assembly and also works with pressure sensitive pads, simultaneously or individually.

A restraint can be any device that is used to restrict a person’s right of movement (Singh, pg. 232). The different devices that are used include; vests, belts, hand mitts, bedrails, etc. Nursing homes have found that restraints come with more disadvantages then advantages. Restraint disadvantages include; increase in patients injuries, decrease in activities of daily living, and psychological problems. The main purpose of having restraints is to protect other patients and staff from any harm. These findings have lead to many nursing homes implementing a restraint free environment. Nursing homes believe that having a restraint free environment will also make patients have a safer environment.

One of the literature that was included in the project is a level 6 descriptive study that was written by Sujata and Kaur (2015), emphasizing that “the level of knowledge about restraints and the underlying attitudes of nurses toward the use of restraints should be identified because knowledge and attitudes can directly or indirectly affect practice” (p. 242). The article clearly explained how attitude, behavior, and sufficient knowledge about physical restraint affect the utilization of the device and the care provided. They emphasized that in providing care, understanding of self and ones’ competencies and skills create a domino effect which will generate a positive or negative patient outcome. As explained by King and Gerard (2016) that

I think you identified good areas in the hospital that could support your concerns of the recent increase in the use of physical restraints as well as the use of sedating medications. Patient safety is always our priority whether we are a bedside nurse or family nurse practitioner. The most up-to-date evidence-based research should remain in continuous efforts to identify the safest and most effective means of restraints. This can be achieved through the case-control study you mentioned in your post. In addition to the information you provided about this specific study design, Curley and Vitale (2016), identifies both its strengths and weakesses. Strengths of the case-control study design include, "inexpensive, shorter time to completion,

Falls are a major source of death and injury in elderly people. For example, they cause 90% of hip fractures and the current cost of hip fractures in the US is estimated to be about 10 billion dollars (Kato, Izumi, Hiramatsu, & Shogenji, 2006). Ensuring patient safety is one of the main reasons given for use of restraints. However, according to Jech (2006), the use of physical restraints is unlikely to prevent falls. Physical restraints, such as tie-down restraints, wheelchair belts, or bed rails are used to keep the patient safe, to keep patients from wandering off, falling, or if they are being combative. Also, it does not necessarily follow that using restraints in

Residents in long-term care facilities have access to 24-hour professional care because they tend to have complex care needs. Many residents living in these facilities have dementia or Alzheimer’s (Singer, 2003). Patients with advanced dementia often have behavioural and psychological symptoms. These symptoms are common and difficult to manage, which affects the quality of life for the patient and alters the level of care they require. Antipsychotics are a short-term solution to stabilize the resident’s mood, reduce tension and anxiety, but they have serious long-term side effects which may be causing more harm. As a caregiver, I believe that we should look at the long-term consequences of these medications, rather than using them as a short-term fix. I propose that strict rules and protocols be put in place regarding the use of antipsychotic drugs for off-label

As for risk factors, there is a huge amount of risk factors in aged care facilities. They are categorised 3 groups, which are environmental factors, physical factors and personal factors (Johnson & Chang 2014, p. 229). The most influential factors are physical ones because nearly a half of the residents have osteoporosis, from 50 to 70% of them have dementia, more than a half of them experience delirium and nearly 80% of them need assistance with toileting (Johnson & Chang 2014, p. 229). On this graph, a systematic review shows major risk factors of falls in those facilities and their evidence-based interventions. In order to prevent falls, reviewing their medication, avoiding use of restrains if the residents are agitated, regularly checking

The use of antipsychotic drugs on geriatric patients is astounding. The antipsychotic drugs are used on elderly patients for agitation, combative behavior and outbursts caused by dementia. The use of these drugs has risen in the last decade due to the prescriptions in nursing homes (Comes, 2014, pg482). The side effects of these drugs can often times be worse than the initial symptoms the patient experiences. The doctors are prescribing these medications due to family complaints of low functioning levels or hostility coming from their loved one. What makes matters worse is that nursing homes are usually understaffed and it is easier to sedate the patient. What makes matters even worse is insurance companies don’t pay for added medical

This study placed cameras throughout the long-term care facility with permission from the residents and provided 24-hour surveillance. What was found by this study was that residents displayed behavior changes and sleeping patterns 24 hours prior to their fall. Their fall was associated with unsteady balance or changes in balance, which lead to the fall. The video surveillance provided staff members with patterns a resident might partake in prior to a fall. It provided a teaching tool for staff members as well as a look at the layout of the facility, which may be contributing to the

Some of the reasons nurses restrain patients are to prevent them from harming themselves or others, to help maintain treatment plans, and to control confused or agitated patients (Stratmann, Vinson, Magee and Hardin, 1997). The most frequently used restraints are vests, wrist, belts/ties, mitten and ankle, in that order (Stratmann et al., 1997). Many research studies currently taking place are focused towards discovering alternatives to restraints. Identifying successful alternatives to restraints and educating nurses about alternatives has helped in reducing the use of restraints (Winston, Morelli, Bramble, Friday and Sanders, 1999; Weeks, 1997). There are times, however, when restraints are needed to protect patients (Richman, 1998; Dibartolo, 1998). Restraints would be indicated for an intubated patient who keeps pulling out his endotracheal tube. In such cases, failing to use restraints could result in a claim or lawsuit being brought on for negligence (Richman, 1998).

(Alzheimer’s Association, 2015) According to Botonis, “people with Alzheimer’s and dementia often exhibit behaviors that are unpredictable and may be outside the bounds of what others consider “normal” or socially acceptable.” (Botonis, 2015) This could mean that without effective intervention, a nurse cold have a patient on her hands that is disturbing other residents who’s anxiety level climb causing them discomfort or behaviors. There is also the problem of other residents of staff members becoming physically injured by a dementia patient who is agitated to the point of physical violence. Intertwined with the need to protect other residents and staff members is the reality that the patient displaying the behaviors has no control over what they are doing or thinking at any given time. These facts alone dictate that every staff member who works with patients who display these types of behaviors must employ realistic and effective means of managing a patient’s behaviors.