A study in the March 2012 issue of the Western Journal of Nursing Research, titled “Nursing Home Deficiency Citations for Physical Restraints and Restrictive Side Rails” brings attention to the use of physical restraints in skilled nursing facilities. The study is unique because it includes restrictive bed rails in its definition of a physical restraint, whereas most studies conducted previously have not.
Nursing homes often justify the use of physical restraints by making the claim that they prevent falls. However, the study confirms that restraints do not actually prevent falls. Instead, they actually pose a safety hazard to patients who often become entangled in or strangled by these devices.
Furthermore, they are often linked to health complications such as pressure sores and incontinence. Physical restraints can also be emotionally damaging to elder adults who already feel embarrassed by their loss of independence in activities of daily living. The use of physical restraints can also lead to psychological problems such as depression, isolation, agitation, and a loss of dignity.
In its analysis of the facility’s staffing levels, the study broke down the different types of caregivers. High staffing levels of Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) were correlated to fewer deficiencies for physical restraints and bed rails. However, when the facility employed a high number of nurse aides, with a relatively low level of RN and LPN staffing, it was found that the nursing home was more likely to receive deficiency citations for physical restraints. These results show that merely looking at overall staffing levels is not always sufficient in determining the quality of care that a nursing home will be able to provide. In addition to looking at numbers and ratios, one must also consider the types of staffing before making a decision to reside at a skilled nursing facility. Previous studies have also proven the importance of direct care from RNs, specifically, to prevent pressure ulcers and other health complications.
The study also showed that homes with large bed sizes were more likely to receive deficiencies for physical restraints. In discussion, the study suggested that this is due to the fact that communication between staff and patients is better in smaller homes because they allow for a tight-knit community that fosters interaction between patient and staff. However, this does not mean that larger nursing homes cannot provide the care that your loved one needs. It simply means that larger nursing homes need to employ a sufficient amount of staff to replicate the one-on-one, individualized care that is provided by smaller facilities.
Our belief, as supported by this study, that the use of physical restraints can be significantly reduced through proper staffing is also recognized by the Code of Federal Regulations. Title 42 part 483 has prohibited physical restraint use for purposes of discipline or convenience and maintains that restraints may only be used for medical reasons.