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The Fear of Liability and the Use of Restraints in Nursing Homes

Published online by Cambridge University Press:  29 April 2021

Sandra H. Johnson
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Extract

The routine use of chemical and physical restraints in nursing homes is bad care. Medical and nursing literature on the care of nursing home patients consistently criticizes the use of restraints when that use is unrelated to diagnosis and treatment considerations. Federal and state laws have included restrictions on the use of restraints for some time. The criticisms of inappropriate and indiscriminate use of chemical and physical restraints are not new. What, then, supports their continued misuse despite the ordinarily powerful combination of professional and governmental approbation?

The use of restraints responds to generally quite acceptable and desirable patient-oriented goals. Restraints are used in an attempt to protect the patient with physical or mental disabilities from avoidable injury caused by falling or wandering away from the facility. In the social context of nursing homes, restraints are also used to protect residents from injury by threatening, violent patients. When the rationale is measured against the known effects of restraints, however, the self-evident nature of the justification begins to break down.

Type
Article
Information
Law, Medicine and Healthcare , Volume 18 , Issue 3 , Fall 1990 , pp. 263 - 273
Copyright
Copyright © 1990 American Society of Law, Medicine & Ethics

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References

Routine use of restraints is that which is not supported by a diagnosis of the cause of the behavior to be restrained, by an assessment of the effectiveness of the restraint in modifying that behavior, the risks posed by the restraint and a consideration of alternatives that pose less risk to the patient. The Institute of Medicine study of nursing home care identified excessive use of restraints (judged by the number of residents restrained in a facility in light of the number of the facility's residents “at risk” for restraints) as a measurement of poor care. Institute of Medicine, Improving the Quality of Care in Nursing Homes 84, 116, 118, 121 (1986).Google Scholar
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