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CLINICAL INTEREST BOX 26.

5
Suggestions to promote restraint minisation
Reducing risk of wandering

Bed, chair or wrist alarms


Exit door alarm
Electronic movement sensors
Planned night-time activities for those who wonder at night
Daytime recreational and social activities
Activity areas at the end of each corrid

Reduce incidence of agitation and aggression

Easy accesto safe outdor areas


Structural desgin of units modified to enhance visibility of residents
Rocker and recliner chairs
Outles for industrious or anxious behavoir; for example, physical,
occupational and recreational therapies
Shooting music
Diversions such as television or radio
(adapted from joanna briggs institute 2002b)
This includes the selection of what may be watched on television or
with whom they can sicialise. In addition, medication that interferes
with a persons behaviour or functioning, such as those reduce
agitation, delusional thoughts, manic behaviour or sexual desire,
can be viewed as a chemical from of restraint (Clinical interest box
26.6 outlines froms of restraint in order of degree of restrictiviness)
The intervention should always be the least possible restraining
measure necessary to prevent harm to the client.
General guidelines forthe use of restraint or restrictive measures
include the following:
The least restrictive measure possible should be implemented
The client should be cared for in the least restrictive
environment possible

CLINICAL INTEREST BOX 26.6


Froms of restraint, in order of restrictiveness
1. Restricting body extremities; for example; securing hands, wrists or
ankles to the arms or legs of a chair or to bed rails, using body
restraining vests
2. Restricting body movement by other means; for example, safety
belts or vests
3. Restricting movement in the environment by secluding a client in a
dedicated seclusion room. The western Australian Mental Health Act
1996 (p. 64) describes this as a room that is not within the control of
the person to leave
4. Restricting movement in the environment by restriction within a
ward or unit
A medical officer must regulary review the need for the restraint to
continue and the review should be timely; for example, the Victorian
Mental Health Act 1986 states that a client who is physically restrained or
in a seclusion room must be reviewed as clinically appropriate, but at least
every 15 minutes by an RN , and reviewed by the medical officer at least
every 4 hours
Family members must be consulted obtained
Supporting mecical and nursing documentation must be provided.
Residents or clients requiring long-term support from the health care
system, for example people with learning or other intellectual disabilities,
need and should have, as far is possible, the same things in life that are
importantto other people (Marsland 2003)
Nurses have a responbility to develop care plants for these clients or
residents that include opportunities to make friends, meet and socialise
with a range of different people and to be stimulated by a range of
experiences.
Nurses can protect the rights of clients to enjoy the least possible
restrictive enviroment by promoting, planning and participating in visits to
places that provide such stimulation, such as a park, the ocean, the zoo or
places to enjoy music or other perfomances.
OCCUPATIONAL HEALTH AND SAFETY
In new Zealand the health and safety in employment act 1992 serves the
same purpose.

Employers are required to:


Promote the health and safety of all employes in the workplace
Provide methods of doing the required work that are safe and
without risk to health
Prevent industrial accidents, injures, and diseases
Protect the health and safety of employeesin relation to any work
activity undertaken
To support the Acts and Regulations there are codes of practice that give
employers practical guildelines about how to implement and therefore
comply with them.

The committee and associated subcommites collectively work towards


setting and maintaining high standars of safety for staff and clients (see
Chapter 25 on the pecise role of the infection prevention and control
committee, for example). Personnel who are accountable for safety
programs have an obligation to;
Identify existing and potential hazards
Determine measure to eliminate or minimise and control the level of
risk
Ensure that all staff are aware of the measures and carry out their
personal responsibilities
Nurses can also expect that they will receive information during their
nurse aducation and at their place of employment concerning how to lift
and move clients without risking their health or safety.
THE NO-LIFT POLICY
Injury caused by the manual lifting of clients was identified as a workplace
hazard for nurses several years ago.
The aim of the program was to eliminate the manual lifting of clients in all
but expectional or life threatening circumstances. A no-lift policy has been
systematically introduced thorught health care facilities in Australia and
New Zeland, with significant succes in reducing both the incidence and
the severity of injuries to nurses caused by lifting clients in the workplace.

Halaman 377
IMMUNISATION FOR NURSES
Nurses are advised to take advantage of every opportunity provided to
enahance their safety in the workplace.
It is recommended that nurses accept these offers or contact their own
general practitioner to protect themselves from risk against any disease
that poses a potential threat, such as hepatitis or tuberculosis. It is also
recommended that any possibility of contamination by infectious body
fluids or material of any sort be reported promptly and the suggested
post-incident precautions be implemented as soon as possible (see
Chapter 25)

AGGRESSION IN THE WORKPLACE


It is recommended that nurses undertake these specialised programs
because the risk created by aggression in the workplace is reduced when
staff have specific training in preventing aggression and developing
conflict resolution skills (Essex 2001; Grenade & Macdonald 1995).
Nurses are sometimes faced with aggresion in the from of workplace
bullying and harassment.

Protective measure for nurses include:

The Commonwealth Equal Opportunity Act 1984 offers some legal


protection from acts of workplace discrimination. This cover bullying
or harassment in relation to acts of racism or sexism and situations
in which there is excessive scrutiny of a persons work, denial of
access to training, being set up to fail or unfarirly being denied
opportunities for promotion.
The ability to make a Work Cover claim if able to prove that personal
stress has resuleted from verbal abuse, intimidation or humiliation,
all of which are deemed occupational violence.

SUMMARY
Nurses have a professional responbility to ensure that they are aware
of policies and practices relating to safety and the prevention of harm
in the workplace.
Safety is a basic need of every individual throughout each stage of life.
It is the role of the nurses to asses each client for factors that may
increase their risk of harm and to asses any enviroment in which client
care occurs for potential hazards.
Employers have a responbility to ensure that nurses and all staff are
informed about every area of safety concern, including infection
prevention and control, fire prevention and management, the use of
correct bofy mechanics and no-lift techniques.
Nurses also have a role in health promotion and can achieve this by
educating clients about actions for personal protection, minimising
hazards in the home and keeping the environnment free from pollution.
Quality nursing care incorporates consideration of safety and
protection from harm in all anvironment and in all interactions with
clients or residents.
REVIEW EXERCISES
1) What are five factors that may compromise the abilities of clients
to protect themselves from health hazards in the home or in the
health care environment?
2) State six nursing interventions that will reduce the risk of a client
with impaired mobility from falling in the acure care hospital
environment.

3) What action could you recommended to a daughter caring for a


mother of a toddler that will reduce the childs risk of suffering a
burn or scald in the home environment?
4) What actions could you recommended to a daughter caring for a
mother who has dementia, which will reduce the risks to her
mother from medications and other hazardous subtances that are
in the home enviroment?
5) What activities could you suggest to a client who wants to
contribute to reducing the global problem of air pollution?
6) What are nursing responbilitie in the event of a fire in the work
environment?
7) What are the main pricinples guiding the safe moving and lifting
of clients in the health caresetting?

CRITICAL THINGKING EXERCISES\


1. Mr. Cladell, 83,lives, in an aged-care facility. He has
Alzheirmers dementia but ambulates freely within the unit
despite considerable physical frailty. Over the past 2 weeks he
has fallen there times, but, fortunately, suffered relatively
minor injures (bruising) he had never fallen previously.
a. What phlysical reasons might there be for Mr Cladell
falling?
b. Ountline aspecilic interventions that may be reeded to
reduce Mr Cladells risk of injury from falls.
2. Mrs Kingsley, 72, is in an acute care hospital after a collapse
at home. She is reveiving intravenos fluids to improve her
hydratin status. It has suggested that an extremity restraint
be used.
a. Consider the merits of this acting and consider what better
alternatives there might be.
b. What are the nursing responsibilities in relation to caring
for Mrs Kingsly if the restraint is applied?

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