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Physical restraints: has OBRA made a difference?

L M Janelli, G W Kanski, M A Neary

    Journal of Gerontological Nursing
    |June 1, 1994
    PubMed
    Summary
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    Nursing home residents have the right to be free from unnecessary physical or chemical restraints. Reducing restraint use is achievable without increasing staff, requiring a planned approach to change facility practices.

    Area of Science:

    • Gerontology
    • Healthcare Policy
    • Nursing Home Care

    Background:

    • The Omnibus Budget Reconciliation Act of 1987 established residents' rights to be free from non-medically indicated physical or chemical restraints.
    • Existing literature indicates that the use of restraints negatively impacts the caregiving process, limiting staff creativity and personalized resident treatment.

    Purpose of the Study:

    • To explore strategies for decreasing the reliance on physical and chemical restraints in nursing home settings.
    • To demonstrate that reduced restraint use can be achieved without necessitating an increase in nursing home staffing levels.

    Main Methods:

    • This study synthesizes findings from existing literature and policy analysis regarding restraint reduction in nursing homes.
    • The approach focuses on the organizational and cultural shifts required for successful implementation of restraint-free care.

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    Main Results:

    • A significant body of evidence suggests that nursing homes can successfully decrease restraint use.
    • Achieving reduced restraint reliance does not require additional staffing resources.
    • The transition necessitates a comprehensive, planned initiative to modify facility-wide attitudes, beliefs, practices, and policies.

    Conclusions:

    • Implementing restraint-free care in nursing homes is feasible and beneficial for resident well-being.
    • Organizational commitment and strategic planning are crucial for overcoming barriers to restraint reduction.
    • Shifting from a restraint-dependent model to one that prioritizes individualized, creative care is attainable and improves the quality of care.