Professionalism in Action - Part 1

  1. The Australian Commission on Safety and Quality in Healthcare (ACSQH) is an Australian Government agency that coordinates and leads national improvements in the quality and safety of health care, by working in partnership with health care organizations, clinicians, patients, and others (Laverty, McDermott, & Calma, 2017). Their role is to improve accountability and transparency in reporting on healthcare quality and safety, to improve quality and safety at local levels via encouraging supportive feedbacks, and enhance the safety and quality focus in national health data indicators and standards. According to Ahern, Evans, & Hopper et al. (2019), the other key roles include providing resources, information, and publications about quality and safety, working in coordination in specific areas to have improved patient health, implementation of evidence-based practices in healthcare by developing clinical and medical care standards and developing national quality and safety standards. The major areas of their working are: supporting professionals in healthcare to provide care that is organized, supportive, and informed safe care; value, cost, and quality; partnering with communities, consumers and patients; and patient safety. The main role is to ensure that the patients or consumers are getting their respective safe and quality care and the patients or consumers are also safe while they are receiving such care services.
  2. The current general principles of use of restraint in the Australian health care sector are as follows: The restraint is basically to reduce the clinical harm in healthcare sectors based on principles - the governing body should be informed or reported about the use of restraint, the use of restraint should be governed according to the legislation and the use of restraint should be either eliminated or minimized to a great extent (Richards, Cruickshank, & Cheng et al., 2017). According to Bellenger, Ibrahim, & Kennedy et al. (2019), the people who display behavior of concerns or have some disability subjected to medical intervention or restrictive practices in a variety of contexts, including rehabilitation centers, residential aged care facilities, and many others. The other general principles of use of restraint - change in the levels of behaviors, skills, attitudes, and awareness in relation to restraint across the aged care sector. Reduction in the inappropriate use of physical and chemical restraint in residential aged care. These restraints are responsible for following facts: well-being and safety of staff ensured dignity and safety of the patient, prevention of any risks of violence in healthcare sectors, and many others (Laverty et al., 2017).
  3. The situation one is – use of restraints in mental health care. The patients in mental health care centers often show aggressive, unexpected, and harmful behavior. So, the use of restraints in such cases can help in providing them with complete and safe care. The use of restraints also prevents the risk of harm due to the immediate harming attitude of the patient to medical staff and other members or patients either in health care centers or at the patient’s home (Richards et al., 2017). Situation two is – in the case of old age patients. The old aged patients often forget about their medical condition and might try to move, wander and remover their tubes, therefore, it is considered to use safe and comfortable restraints for them to ensure that their treatments are not affected. Situation 3 is – in child care. In the case of children, as they are pro-active and do not understand much about the medical procedure. So, to ensure they do not move their body during surgery or do not move their operated body part so that the recovery is fast and undisturbed, they are applied with restraints. According to Scheepmans, Milisen, & Vanbrabant et al. (2019), elbow restraints are used so that the patients do not reach their face, and hands are maintained in straight positions. In some cases, extremity restraints are used so that the patient’s hands or feet are tied up to restrict movements. There is a great risk of falls and related injuries in the case of aged patients so restraints are used to prevent unexpected harms or injuries to recovering patients. If the patient has undergone a serious medical operation of his abdominal sections that he/she is not supposed to move that region so that the stitching is not affected and the body is in a complete resting state for fast recovery. In such cases, restraints can be used to get expected results like no or minimum movements of wounded or operated regions. According to Ahern et al. (2019), chemical restraints are used in some cases to deal with the individual’s behavior. Such chemicals are not the medication dosages that are used in treatments but are used to manage the individual’s particular physical or mental condition that hinders his/her treatment processes.

Professionalism in Action - Part 2

1. Introduction: I am a 2nd year nursing student on a professional nursing experience placement in the surgical ward, mainly specializing in patients with musculoskeletal conditions. The patient is an 84 year old Italian woman named Mrs. Stella Cusaro.

Situation: I went to call out the registered nurse because of my concern about the patient. The concern was the patient felt restless due to the soft cuff restraint and I also wanted to know why the patient is tied up. 

Background: The patient sustained a fractured left neck of the femur and is fasting for emergency surgery to reduce the fracture. She currently has a peripheral intravenous line situated in her left antecubital fossa. This line was re-sited overnight as it was removed by the patient due to increasing confusion.

Assessment: The patient was so confused about whether she is fine and well or not so I looked into her eyes to make her feel assured that everything is fine with her.

Recommendation/response: The patient should be timely checked to assure that the old lady is fine with the restraint in her arm. The patient should be provided with fresh IV to ensure that there is no chance of infection and t should be regularly changed.

2. The assessment, planning, implementation, and evaluation process involved in the application of restraint to a patient in the Australian Health care system are as follows:

The patient should be provided with an effective, least restrictive, and safe method of restraint. There should be effective interference with patient care in removing dressings, pulling tubes, and others. The thoughts like suicidal feelings, high risk of falls, or wandering should be assessed by clinical justification. The assessment should be also for the violent, confused, or homicidal attempt with effective communication or vital signs like respiratory rate or heart rate assessments and observation of non-verbal signs and symptoms of the patients. The processes should be time-specific with timely monitoring and assessments and in accordance with the appropriate and safe use of techniques for the patient. The patient should be evaluated for his/her emotional and physical well-being, hydration, nutrition, and hygiene. According to Bellenger et al. (2018), the use of restraint should be in a proper position and it should prevent falls or movements during surgeries. A proper assessment and evaluation are very necessary as the patients might feel discomfort with their restraints and harm themselves. The other complications of the use of restraints are infections, social isolation, behavioral changes, serious injury, functional decline, and many others. To prevent such negative outcomes complete and proper monitoring and planning are required for using restraints in healthcare. In Australia, their laws state that there should be minimum use of chemical and physical restraints in the case of aged and old patients (Peisah, Jessop, & Breen, 2018). While using the restraints, it is also important that the consent from the patients should be taken and unless necessary, it should not be used. 

Professionalism in Action - Part 3

In the case of Mrs. Caruso who is an old aged lady if she will remove her IV again and again, then she might get the infection, air embolism, hematoma, infiltration, and many others. Her recovery will not be fast and this will impact her development soon, as she might acquire more health complications that will worsen her health and can lead her to a critical condition. In this case, she had no understanding of the medical restraints till her old age that led to her misconceptions about her IV and discomfort and confusion with it. Whereas, in the case of Oliver Simms who is an 11 years old boy. Being a young child he is proactive and if he tries to remove his IV, he might not get the proper nutrition that is required for his growing stage. According to Bellenger, Ibrahim, & Lovell et al. (2018), patients should be taught about the importance of each medical type of equipment that is applied to them, so that they can understand the significance of medical processes and their tools. Similarly, in this case, the boy will get the knowledge of IV and will understand its importance and in the future will have a responsible attitude towards safety and quality care. Thus, the development over the lifespan will be better.

Professionalism in Action - Part 4

I had less knowledge about the restraints that are used in healthcare for the patients. I felt very nice that through this assignment I can know about many important things and information that as a nurse I did not have earlier. I learned that in the case of old aged patients it is suggested not to use restraints until and unless it is necessary. The restraints are used to provide safe and quality care to the patients with minimum or less harm due to their unexpected behavior that is controlled by using restraints. In the future, I will always perform proper assessments, planning, monitoring, and evaluator of patients at the proper time to ensure that the patent is not facing any discomfort or difficulty with the restraints. The co-workers will be encouraged to ensure that while using restraints the patent’s well-being is maintained. I also learned that the old patients who have no information or experience with restraints or IV feel confused and scared. So, such patients should be informed about the medical treatment plans and types of equipment that are applied n them so that they get the information and with the development over the lifestyle with time they get comfortable with them which will ensure their fast recovery.

References for Restraints in Nursing

Ahern, S., Evans, S., Hopper, I., & Zalcberg, J. (2019). Towards a strategy for clinical quality registries in Australia. Australian Health Review43(3), 284-287. DOI: 10.1071/AH17201

Bellenger, E. N., Ibrahim, J. E., Kennedy, B., & Bugeja, L. (2019). Prevention of physical restraint use among nursing home residents in Australia: The top three recommendations from experts and stakeholders. International Journal of Older People Nursing14(1), e12218. DOI: 10.1111/opn.12218

Bellenger, E. N., Ibrahim, J. E., Lovell, J. J., & Bugeja, L. (2018). The nature and extent of physical restraint–related deaths in nursing homes: A systematic review. Journal of Aging and Health30(7), 1042-1061. DOI: 10.1177/0898264317704541

Laverty, M., McDermott, D. R., & Calma, T. (2017). Embedding cultural safety in Australia’s main health care standards. The Medical Journal of Australia207(1), 15-16. DOI: 10.5694/mja17.00328

Peisah, C., Jessop, T., & Breen, J. (2019). A missed opportunity to improve practice around the use of restraints and consent in residential aged care: Limitations of the quality of care amendment (minimising the use of restraints) principles 2019. Australasian Journal on Ageing. DOI: 10.1111/ajag.12757

Richards, M., Cruickshank, M., Cheng, A., Gandossi, S., Quoyle, C., Stuart, R., & Cooper, C. (2017). Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE): A guide for acute care health facilities: Australian commission on safety and quality in health care. Infection, Disease & Health22(4), 159-186. DOI: 10.1016/j.idh.2017.09.001

Scheepmans, K., Milisen, K., Vanbrabant, K., Paquay, L., Van Gansbeke, H., & de Casterlé, B. D. (2019). Factors associated with use of restraints on older adults with home care: A secondary analysis of a cross-sectional survey study. International Journal of Nursing Studies89, 39-45. DOI: 10.1016/j.ijnurstu.2018.07.019

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