Caring for the Critical Patient
Most of my medical experience has been in the operating room. However, there have been occasions when I've sat with patients in my hospital's critical/long-term care ward. Caring for these patients can be a daunting task. Sometimes, I would just sit with them by the bedside for many hours. Other times, a patient would flail his arms uncontrollably, and I would have to intervene in such a way as to prevent him from hurting himself or me.
I remember one patient in particular who was in a palliative setting as he was suffering from terminal brain cancer. It was a challenge to redirect his hands to a resting position. He was heavily sedated, but he still had a lot of pain. I don't claim to have much experience in this area of healthcare, and I have to say, I don't think I'm cut out for it. I feel for the nurses that do this job day in and day out. It is stressful and exhausting. It is also difficult for family members.
Patient Restraints: A Medical Controversy
It's hard enough having to watch a loved one deteriorate in the last stages of life, but it is an added (but sometimes necessary) indignity to see them subdued by restraining devices. Restraints have become controversial in the healthcare field, where they were once the norm. Now, providers do everything they can to avoid restraining patients.
Restraints have been known to cause serious—even deadly—injuries to patients. Such trauma can occur if a patient is attached to an adjacent structure, such as a bed rail. If the bed is elevated or lowered without consideration for the fact that the patient is, for all intents and purposes, tied to the bed, the results can be devastating. Shoulders have literally been pulled out of joint under these instances.
Finding Less Risky Methods of Injury Prevention
For obvious reasons, providers are adopting more creative, less harmful ways of handling patients who would have traditionally been candidates for restraints. Among these methods is sedation, which is currently used as a means to control difficult patients. And when I say "difficult," I should give a more precise definition. I am not talking about "violent" patients that may be criminals or psychotic. I am talking about the following:
- Confused patients, which could include patients suffering from Alzheimer's or dementia
- Comatose patients with retained movements
- Patients who have been surgically sedated
- Surgical patients with life-threatening injuries wherein they are sedated for their protection
This patient population is at especially high risk for the following self-inflicted injuries:
- Pulling out catheters
- Pulling out PICC lines
- Pulling out IVs
- Pulling out colostomy bags
A Real-Life Example of Why Safety Devices Are Necessary
In the course of researching this subject, I came across this sad story in a forum post on AgingCare, "How can we prevent my Mother, who has dementia, from pulling out her IV?" This man's mother had pulled out several IVs and was becoming dangerously dehydrated.
The post reads:
My mother is in a nursing home and suffering from severe dehydration. Apparently the staff has not been monitoring her fluid intake. She was diagnosed with a UTI a month ago. Her doctor put her on an IV but she keeps pulling the IV line out. Now the staff is asking us to come and stay with her to make sure she does not continue to do that. My sister and I are the only ones who live in the same state and we both work full-time. We cannot just leave our jobs whenever we want. We both go to the nursing home after work and stay until 9 p.m. but we cannot do that during the day. The nursing home is insisting we hire a visiting nurse to monitor her and this is at the family's expense. Has anyone dealt with this before? I suggested putting a mitt on her hand or a glove of some sort. Surely the nursing home can come up with a solution.
Safety Devices for the Hands
"Restraint" is a broad term. Some nurses, I discovered, become defensive just at the mention of the word. Such is their concern regarding restraining a patient. However, it should be understood that a "restraint" doesn't always refer to straps or tie-downs.
For example, a bed rail is technically considered a restraint but does not need a physician's order to be employed. Some of the manufacturers of the following products claim that their devices are not restraints and, therefore, do not need a physician's order to be employed.
Some say the term only applies if a patient's restraining device is attached to an adjacent structure. When it comes right down to it, it may be a matter of hospital policy. Regardless, the following products I've researched appear to offer a safe alternative to traditional restraints while offering similar if not equal protection for the patient, visitors, and caregivers.
- Glovy Patient Safety Device by GlovyMed
- 2819 Posey Double Security Mitts by Posey
- Mesh Padded Mitts
Read More From Healthproadvice
Glovy Patient Safety Device
Glovy is made of transparent plastic, allowing caregivers to assess the skin without removing them and disturbing the patient. They also allow monitoring devices to be hooked up. The top is perforated for breathability and comfort. The device is spacious enough to move the wrists and fingers through full ranges of motion.
Posey Double Security Mitts
The 2819 Posey Double Security Mitts are made in Arcadia, California. While the mitts are soft and do prevent patients from pulling and scratching, they must be removed frequently for skin assessment, which often disturbs the patient.
Mesh Padded Mitts
These mitts appear to have the same faculty as the Posey mitts. Multiple manufacturers make similar products with a padded interior and mesh lining for breathability and comfort. The one pictured here is made by a company in the Republic of Korea.
Hope This Helps
Researching this subject was not enjoyable. Seeing hurting, deteriorating, confused human beings is gut-wrenching, to say the least. I at least found encouragement in the fact that there are products currently being employed to both protect patients and safeguard their dignity. I hope you are encouraged as well.
This content is for informational purposes only and does not substitute for formal and individualized diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed medical professional. Do not stop or alter your current course of treatment. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.
© 2019 Leland Johnson
Leland Johnson (author) from Midland MI on January 03, 2019:
Lorna- Thank you for reading and commenting :)
Lorna Lamon on January 03, 2019:
Excellent informative article Leland.
Leland Johnson (author) from Midland MI on January 02, 2019:
very difficult to manage. I read that there are thousands of injuries to nurses every year because of patients grabbing their necks, clothing, hair, etc. It's really rough.
FlourishAnyway from USA on January 02, 2019:
I have some relatives with dementia and sure don't like the thought of this. One is in a home and lashes out at her caregivers. Not a good situation. I didn't know that comatose patients and heavily sedated patients may flail. It's got to be difficult on caregivers and healthcare workers.