Journal of Gerontological Nursing

BEGINNING NURSING STUDENTS CAN

Strategies must be developed to design programs that might change nursing attitudes so that the elderly can be seen in a more positive way.

<h4>EXCERPT</h4> <p>The use of physical restraints in health care institutions has been an acceptable and frequent aspect of care (Minnick, Mion, Leipzig, Lamb, &amp; Palmer, 1998; Whitman, Davidson, Rudy, &amp; Sereika, 2001). However, a growing body of knowledge calls to question the use of restraints because there is little evidence to support the assumption that restraints prevent injuries (Maccioli et al., 2003; Woo, Hui, Chan, Chi, &amp; Sham, 2004). Evidence has shown the adverse effects of restraint use and its ineffectiveness in preventing falls and injuries (Capezuti, 2004; Capezuti, Maislin, Strumpf, &amp; Evans, 2002). The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (JCAHO, 2000) has challenged the routine use of physical restraints and supported reduction in the use of restraints in hospitals.</p>

Physical restraints continue to be used in acute care settings, despite the challenges and calls to reduce this practice. The current guideline on restraint use is updated with evidence that includes critical care settings and issues related to restraint use in acute care units. Nurses play a significant role in the use of restraints. Factors such as nurse's knowledge and patient characteristics combined with the culture and resources in health care facilities influence the practice of physical restraint use. Nurses can identify patients at high risk for restraint use; assess the potential causes of unsafe behaviors; and target interventions in the areas of physiological, psychological, and environmental approaches to address those unsafe behaviors. Members of the interdisciplinary team can provide additional consultation, and institutions can provide resources and education and implement monitoring processes and quality improvement practices to help reduce the practice of physical restraint use. [ Journal of Gerontological Nursing, 42 (2), 17–26.]

ABSTRACT

Falls among elderly individuals have been significant sources of disability and death. Falls have affected as many as 10% of older adurtsduring an acute care inpatient stay. The acute care environment has contributed to elderly patient falls. Additionally, manifestations of acute illness, porypharmacy, and medication side effects have been risk factors for falls in the acute care setting. Individualized fall prevention strategies, initial patient assessments, and ongoing patient reassessments have been linked to a decrease in falls in the acute care setting. Approaches to fall prevention have included identification of high-risk patients, communication among staff and family members about an individual's risk of falls, and both case-specific and universal interventions for fall prevention. The purpose of this article is to describe a fall prevention program instituted in an acute care setting in southern Arizona that has produced encouraging results. Moreover, this article addresses individualizing interventions through a continuous clinical feedback loop, which provides patient care areas with relevant information about their patients who fell and recommendations for improving fall prevention.