The purpose of this paper was to understand what the best practice was for the utilization and application of restraints in the cognitively impaired. For this paper’s purpose, “cognitively impaired” will be defined as “altered cognitive function”, either temporary or permanent (Craven, 2013, p. 1214). The use and surrounding knowledge of restraints has undergone critical changes that affect nurses’ care plans and the patients’ therapeutic outcomes. According to the Joint Commission, all licensed healthcare professionals are to adhere to the guideline “that require restraints to be a part of the medical treatment after all less other appropriate disciplines have been consulted, and supporting documentation for their use has been provided” (Craven et. al, 2013, p. 584). This means that nurses must provide optional methods to defer the use of restraints, but if it is not possible, they must receive providers’ orders and approval for application.
The significance of the correct utilization and application of restraints is upheld by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) stating that physical restraints are applied only after other methods and options have proved unsuccessful in controlling disruptive behaviors (Smith et, al, 2003, p. 27). JCAHO and the Center for Medicare and Medicaid Services (CMS) have strict focus on patient rights as studies have shown that restraints can cause more harm than good. The definition of restraints is any physical method of reducing normal ability or freedom of movement, activity, or access of the patients’ body (Craven et. al, 2013, p. 584).
The present barriers to applying this evidence-based practice are due primarily to deficient knowledge. Although JCAHO and CMS have successfully strengthened the regulations and guidelines, facilities’ protocols do not always match up. Organizational change and philosophy shifts are needed to base the spread of knowledge to the units and staff. Extensive research studies have shown that the most common reason restraints are used by nurses is to prevent falls or patient disruption of medical equipment, and the same research is pointing to the knowledge that restraints in fact do not prevent these from happening, and can actually cause more harm than the initial reasoning. Besides deficient knowledge, data collection is necessary to analyze interventions’ efficacy compared to restraint use.
The implications of the utilization and application of restraints are richly backed by studies. The use of restraint devices can cause serious physical and psychological issues and can also have the opposite effect, such as increased agitation and aggression (Smith et. al, 2003, p. 27). Providing other options before proper use of applications, as outlined by JCAHO and CMS, can lead to a more therapeutic treatment of the patient and more effective response. The following reviewed articles expand on these barriers and implications.