Do Physical Restraining Patients with Dementia Make them More Agitated or Aggressive - Research Paper Example

? Do physical restraining patients with dementia make them more agitated/aggressive? Inserts Grade Inserts 24thAugust 2012 Research Proposal The current research study will focus on one of the basic issues in the field of nursing. It will undertake to discuss the subject of patients with dementia by extending it further to talk about the effects of physical restraint on them. The research proposal will outline the background, research aims, and the data collection techniques to be used in the completion of this research study. Background of the Study There is a vast amount of population, which is suffering from the cognitive impairment, ultimately having the dementias or the Alzheimer’s disease. This population comprises of a minimum of half of all residents in nursing homes and in assisted living. These people diagnosed with dementia undergo a distinctive constellation of symptoms that results from a drastic decline in the functioning of their brains, making the individual a victim to disorientation, loss of memory, and having diminished capability to perform everyday activities and communicate. These patients also depict behavioral and psychiatric symptoms (Qizilbash et al., 2002). One of the major issues of concern for the dementia patients is the quality of care for the reason that they have constant, documented concerns with care in residential settings. The treatment of various psychological problems and dementia has been historically overshadowed with techniques and devices that restrain and restrict the patients’ movements. Many different forms of restraint have been utilized which may include wrist restraint, chairs with lap barriers, being tied up to padded cells and others. The concept of physical restraint pertains to attaching or keeping any device with the body of patient, which cannot be removed easily by the patient and which is likely to limit the patient’s freedom of movement and access to body (Miles and Meyers 1994). The use of the physical restraint has long been made to manage the agitations and aggressiveness of patients, particularly those who are mentally ill. The utilization of physically restraining measures have remained popular and applicable for old age people and is justified as guaranteeing ‘prevention’ to them (Castle and Mor 1998). The patients with dementia are normally treated with in various ways including medication, consultancy, coaching, etc. Dementia is not a diseases; it is rather a severe lack of cognitive ability in a person who is mostly likely to be previously unimpaired. This non-specific illness syndrome affects certain cognitive areas such as attention, memory, problem solving, and language. People with dementia depict a threateningly aggressive behavior; they verbally abuse, overreact to situations, show unnecessary agitation or aggression, feel frustrated most of the times, and subject themselves to physical hurting (Alzheimer's Society, 2010). During the early1960s, the medical practitioners challenged the use of physical restraint towards the patients suffering from dementia. According to them, it tended to intensify the patients’ disorganized behavior (Castle and Mor 1998). Later, in 1979, they did not recommend the application of physical constraints on the patients who were diagnosed dementia (Evans and Strumpf 1989). All this time, the use of restraint was considered to be affected by numerous external elements, which were centered on the unethical nature of the practice and its potential negative consequences. Moreover, this method has been thought to be creating more aggression and agitation in the patients already suffering from dementia. Problem Statement With the passage of time, the utilization of physical restraints has widely been seen and experienced as both abusive and undesirable. The application of physical restraints has been viewed in connection with the frustrated, agitated, violent and aggressive patients diagnosed with dementia. This study undertakes to examine the uses of physical restraints as increasing the agitation and aggression of the people with dementia. It will discuss the fundamentals of subject along with its background, a well- researched literature review, methodology and analysis. Research Objectives The current study is conducted with the basic objectives to research upon the fact whether the people with dementia become more agitated and aggressive with the use of physical restraints. This topic can be broken down in various smaller objectives, which include: Studying the people with dementia; Examining several types of physical restraints that are possibly applied to treat the people suffering from dementia; Elaborating upon the fact that the physical restraints make the people with dementia more aggressive and agitated. Research Questions The literature review search and attainment of the objectives will be performed through a systematic research study. For this purpose, the objectives of the study will be broken down in the form of smaller research questions. They will include: 1. What is dementia and what are its symptoms? 2. Discuss different types of physical restraints that are normally utilized to treat the people suffering from dementia. 3. How do people with dementia feel more aggressive and agitated? Research Methods This study will utilize the qualitative method of research. Different articles regarding the application of physical restraints and their affects on dementia patients will be reviewed. In order to state the potentially useful references and sources, the current research will depend upon an elaborated search of CINHAL, PubMed, Ageline, PsychInfo, and Ebscohost databases. The process of the study and research will be facilitated further by using a blend of different connected search terms, such as dementia, restraints, falls, nursing, aggressive, agitated, physical, and others including the manual searches for the reference sections of the articles. The articles will be reviewed and included in the literature review only if they dealt with the dementia patients being treated with methods involving physical restraint. The articles researched will also contain the application of quasi-experimental or experimental research, and will mention the findings, analysis and their statistical significance. Moreover, the trials having lesser than 10 participants, interventions that are poorly defined, or having no control condition will not be included in the study. Contributions from the Study The literature review discussed in the current research study refers to the provision of information regarding the application of restraints on dementia patients. However, it would be too early to provide any particular recommendations related to these practices, the current research could still contribute to the nursing practices. The literature review will be useful in pointing out the importance and the need for continuity for further research on the subject of the usage of physical restraint and its contribution in the creation of aggression in the dementia patients. It will also indicate the attention needs, which are to be provided to the alternatives to the routine practice of restraint. At the same time, the current study will mention the requirement to encourage attention on the paucity issues like the direction and nature of changes in practices and attitudes of nurses with the passage of time. Finally, this literature review will provide the readers, and medical practitioners, a good opportunity for the illustration and discussion regarding the uses and adverse effects of the physical restraints on patients of dementia. The information provided here might be useful for the strengthening of the understanding of nurses regarding the history, usage and contribution of physical restraint in boosting aggression and agitation in the people with dementia. REFERENCES Alzheimer's Society, (2010), Dealing with aggressive behavior, Alzheimer's Society Factsheet, Accessed online, Retrieved on August 24, 2012 Castle, N.G. and Mor, V. 1998. Physical restraints in nursing homes: A review of the literature since the Nursing Home Reform Act of 1987. Medical Caren Research and Review. 55(2):139-170. Evans, L.K. and Strumpf, N.E. 1989. Tying down the elderly: A review of the literature on physical restraint. Journal of the American Geriatrics Society, 37(1):65-74. Miles, S.H. and Meyers, R. (1994). Untying the elderly. Clinics in Geriatric Medicine. 10 (3):513-525. Read More