Physical Abuse

It is hard to imagine a situation where nursing home staff would intentionally cause active, physical harm to a patient, but sadly it does occur. If an attendant has slapped, pinched, kicked or in any other way physically harmed a nursing home resident, this is physical abuse that must be reported to management and may be serious grounds for pursuing a nursing home abuse lawsuit.

Restraint or Strangulation Injuries

Ethics plays a huge role in the use of physical restraints. There are many concerns here, including social and psychological considerations, and all should be thought through completely by the medical professionals considering this course of action. This is especially important considering that one study recorded a prevalent use of restraints–up to an 85% use of physical restraints in nursing homes.

Examples of physical restraints are: use of a secure vest, limb ties, tucking sheets in too tightly, wheelchair bars, bedside rails, chairs that tip backwards, and straps. The essential points of a physical restraint are a device or material that cannot be easily removed by the person and that it is intended to stop free bodily movement by that person.

There are a number of consequences from the use of physical restraints and these hazards are increased when an elderly patient is involved. For example, the use of restraints may increase health related issues to the patient. These could include:

• Under nutrition
• Incontinence or constipationphysical-abuse
• Bruises
• Complications in respiration
• Ulcers
• Loss of balance and muscle strength
• Loss of cardiovascular health
• Agitation

Generally, the use of physical restraints causes a feeling of dependency, and a loss of self-respect and dignity. There are exceptions. For instance, bedrails and wheelchair bars have been reported to make the patient feel safer and more secure. However, agitation, aggression, and anxiety may increase and are not uncommon results.

A number of ethical considerations should be addressed when evaluating the use of physical restraints. Some of these are:

• A person’s autonomy
• Dignity
• Self-reliance
• Considering the overall health and welfare of the patient

The staff should conduct an analysis to make certain the final decision to restrain the patient outweighs the potential negatives involved. The items considered should include the current drug therapy, emotional state, health, mobility, prior history, and the current psychological state. The first choice of restraints should always be the least restrictive method available. If that choice proves ineffective, a more restrictive method could be tried next. It is important that the family is made aware of the intent to restrain the patient in any way for legitimate reasons.

A policy should be in place for escalating restrictive methods used on patients, beginning with the least restrictive; further, each escalation should prompt another, albeit shorter, cost-benefit analysis to ensure that the next escalation is the right decision for the patient.

This is a difficult decision that should involve all the parties concerned, including the management staff of the nursing home, caregivers, doctors, relatives, and as much as possible, the patient. Of course, some patients will be unable to provide any meaningful input because of their mental state. This is where the relatives should actively participate in the decisions that are being made. By involving the relatives in such decisions, there is a mutual understanding of why restrictive methods may be necessary, which serves to clarify any misunderstandings.

National Center for Biotechnology
European Academy for Medicine of Ageing