CNO
According to the CNO's restraint guidelines, when should chemical restraints be used?
Only when all other measures have been exhausted, and with proper consent and documentation
What is the role of advocacy in the context of restraints?
Advocate for least restraint use for the patient!
As nurses, it is our ethical and professional responsibility to advocate for our patients, especially when we witness their health, wishes, or well-being compromised. What legislation respects the patient's right to refuse?
Health Care Consent Act of 1996
How do we balance the ethical implications of sedating a patient for safety versus respecting the family's wishes to avoid restraints?
Shared Decision-Making:
Engage in open and honest discussions with families about the risks and benefits of sedation and restraints
Respect the family’s values and preferences while providing evidence-based information to guide decisions
Ethical Frameworks:
Use ethical principles (autonomy, beneficence, non-maleficence, and justice) to guide decisions
Balance the patient’s rights to dignity and autonomy with the need to ensure their safety and well-being
Informed Consent:
Ensure families fully understand the implications of sedation and restraints, including potential side effects and alternatives
Document discussions and decisions to ensure transparency and accountability
Least Restraint Alternative:
Prioritize non-invasive and non-restrictive interventions whenever possible
Use sedation or restraints only as a last resort and for the shortest duration necessary
Advance Care Planning:
Encourage families to discuss and document their loved one’s preferences for care in advance
Use advance directives or living wills to guide care decisions when the patient cannot communicate their wishes
As mentioned, there are several alternative approaches from the RNAO BPG Alternative Approach to Restraints that would apply to this scenario; redirect with simple commands, increase social interactions, label the environment and...
Diversional activities, such as: pets, music, snacks etc.
What quality improvement initiatives can we implement to reduce the need for sedation and restraints in patients with dementia?
Person-Centered Care Plans:
Develop individualized care plans that focus on the patient's preferences, routines, and history to minimize agitation and confusion
Use non-pharmacological interventions (music therapy, or reminiscence therapy to address behavioral symptoms)
Staff Training and Education:
Train staff in dementia care, including de-escalation techniques, communication strategies, and recognising triggers for agitation
Educate caregivers on the risks of sedation and restraints and the benefits of alternative approaches
Behavioral and Psychological Interventions:
Implement structured activities and to provide a sense of purpose and reduce anxiety
Use validation therapy to acknowledge the patient's feelings and reduce distress
Medication Review:
Regularly review medications to minimize the use of sedatives and antipsychotics
Collaborate with healthcare providers to taper off unnecessary medications that may contribute to agitation or sedation
Family and Caregiver Involvement
Engage families in care planning to ensure their insights and preferences are considered
Provide education and support to families on managing challenging behaviours without sedation or restraints
Multidisciplinary Team Approach
Involve a team of healthcare professionals, to address the complex needs of dementia patients
In this scenario, the staff have chosen to use sedation as a means of managing the client's behaviour. What are some alternative, non-pharmacological strategies that could be employed to ensure both the client's safety and dignity? How might involving the family in care planning, despite their distance, influence these care decisions?
Alternative Non-Pharmacological Strategies: