Restraint-Free Care

This book is designed to help clinicians, administrators, students, and families attain the goal of restraint-free care of the elderly.

Written by leading experts in the field, the book contains specific strategies for understanding behavior, making constructive changes in the individual's environment, and managing the risk of falls and interference with necessary treatments. It is organized in outline form to highlight critical material and to be readily adaptable as a quick reference.

The authors use individualized care as the book's underlying philosophy. The goals of individualized care include promoting comfort and safety, optimizing function and independence, and achieving the greatest possible quality of life. Such care requires clinicians to make sense of behavior rather than to control responses of clients.

Numerous case studies, tables, and figures illustrate this practical and information-packed manual. Lists of resources are also included.

The book contains black-and-white illustrations.

This book is designed to help clinicians, administrators, students, and families attain the goal of restraint-free care of the elderly.

Written by leading experts in the field, the book contains specific strategies for understanding behavior, making constructive changes in the individual's environment, and managing the risk of falls and interference with necessary treatments. It is organized in outline form to highlight critical material and to be readily adaptable as a quick reference.

The authors use individualized care as the book's underlying philosophy. The goals of individualized care include promoting comfort and safety, optimizing function and independence, and achieving the greatest possible quality of life. Such care requires clinicians to make sense of behavior rather than to control responses of clients.

Numerous case studies, tables, and figures illustrate this practical and information-packed manual. Lists of resources are also included.

Anna L. Bower

This manual is designed to assist organizations and professionals in the paradigm shift to restraint-free care in acute and long term care facilities for elders. The authors provide research-based best practices for older adults with an emphasis upon individualized approaches to meet patient needs in response to patient behaviors. The purpose is to share information with anyone who is seeking data on individualized restraint-free care. The manual is organized as a primer for restraint-free care and offers a stated purpose, detailed content outline, bibliography, and appendix with each chapter. The authors have directed the information to assist organization-wide disciplines. Chapters 1, 2, and 7 are pertinent not only to the healthcare professional delivering direct patient care, but also to administrators and other leaders who must participate in supporting and guiding such a change process. The text speaks of ""individualized approaches"" to restraint-free care rather than ""alternatives"" to restraints. Chapters 3 through 6 provide specific interventions and information to the healthcare professional delivering direct care. Since an outline of the purpose and a summary of each chapter is provided, the reader can better identify the critical information within each area discussed. While the first chapter offers no new information regarding patient restraints to the experienced healthcare professional, the myths and attitudes of patients and healthcare professionals regarding restraints can be very helpful to administrators and novices in direct healthcare delivery to the elderly. Chapter 2 describes what is necessary from each level of the organization in order to make thechange to restraint-free care. Probably the crowning jewel is found within the chapters on understanding and responding to patient behaviors. This information sets the stage for the presentation of specific interventions and care plans to respond to a patient's individualized care needs and behaviors. While texts have been written on assessment of patients for falls, this manual goes further to include external interventions such as types of furniture and environmental concerns. ""Care for the Person who Interferes with Treatment"" is a welcome addition in that the authors speak directly to the care of patients with tubes, dressing, IV's etc. for which, on many acute hospital units, ""protective restraints"" are being used without thoughts or plans of responding to individualized interventions. A strength of this text is that novices through experts in healthcare delivery to the elderly can read it and benefit from the authors' research based information on restraint-free care. For the expert, more information on the prevalence of restraints in the acute and long term healthcare settings, and the legal cases stemming from the use of (or failure to use) restraints would have been helpful. The authors alluded to these, but did not demonstrate or offer references. This information would have been most helpful to help set external benchmarks for the institution wishing to assess baseline practice of restraint usage with the elderly as well as monitor the organization's progress in decreasing restraint use.

Lois K. Evans is Viola MacInnes/Independence Professor at the University of Pennsylvania School of Nursing where she facilitated the development of the School's network of community based nursing practices - the Penn Nursing Network and provided leadership for the School's evolving agenda to integrate its missions for research, education and clinical care. She also co-directed the Penn-Macy Initiative to Advance Academic Nursing Practice. In addition to models of health care, Dr. Evans research interests focus on individualized care for frail elders, including restraint reduction and behavior in dementia; culture, environments, and quality of care and quality of life in nursing homes, and recognition and management of depression in older adults. She has received numerous awards for her research on individualized care and restraint use with frail elders and is an elected Fellow in the American Academy of Nursing and the Gerontological Society of America. Dr. Evans is Co-Director of the School's Center for Gerontologic Nursing Science and the John A. Hartford Center o f Geriatric Nursing Excellence, Chairs the Family and Community Health Division, Co-Directs the Delaware Valley Geriatric Education Center and teaches in the geropsychiatric graduate nursing program.