Management of diabetes.

Scenario: Safety A 77, year old woman is hospitalized for management of her diabetes. She has a history of functional urinary incontinence and poor vision from the diabetes. The nursing staff observes her climbing over the side rails on numerous occasions at night en route to the bathroom. She is quite agitated during this time. The nursing assistant requests that you obtain an order for a body restraint at night to prevent her from falling out of bed.

Should this patient be restrained to prevent injury? Would you request the order for a body restraint? Why, or why not? What other information is relevant to this case? What nursing interventions could be tried before considering a restraint?

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Restraining to prevent injury is only to be requested after trying all the non-restraint methods first, if all fails, then a request for restraint can be initiated. I wouldn’t advise the patient to be restrained because the staff hasn’t applied any other interventions to prevent her from injury. I would assess for her bathroom preferences and let her know to press the call light if she ever needs help to go to the bathroom at night because she’s at risk for injury due to her poor vision at night. I would try to put a night lamp, maybe it’ll help the patient to see better at night when going to the bathroom. Or put a commode near the bedside so she can have easy access, or if she’s willing to put on a diaper at night so she doesn’t have to get up during nighttime.

I would educate her about her situation, that she is at risk for injury if she keeps climbing over the side rails. If all of these non-restraint methods did not work out, I would inform the patient that restraint may be used on her to prevent her from injury, I would convince the patient as much as possible to cooperate with the nursing staff about her bathroom issues so that we can prevent her from getting injured and also from getting a restraint.