Balance, Falls, and the Decision to Use Restraints. Video tape.
This film delimits one of the most constant problems in the life of the older adult: falling and its concomitant dangers. Both dramatic and lecture formats are used to show some of the common factors and features of falls, to wit, common failures of visual acuity, lower extremity weakness, postural instability, medications, and illness. Each of the above aspects is examined for the benefit of health-care personnel by two physicians. Sitting balance, balance upon arising, walking, picking up small objects from the floor, and placing those objects on a high hook are analyzed, as are the appropriate assessments and strategies to use when falls occur.
The problematic question of when to initiate the use of restraints is only discussed in a cursory manner, although a somewhat more detailed discussion of the effects of restraints on patients is presented. Three main points are made, namely that restraints threaten patient autonomy, limit patient freedom, and may harm the patient both physically and emotionally. Speaking on the subject of the nurse's willingness to initiate the use of restraints, Marian Sheafor, RN, suggests that studies have shown that use of restraints has been found to be correlated with educational and clinical background. She reminds us that the use of restraints prevents freedom of movement, causing, in turn, loss of strength in muscles, and thereby becoming a contributing factor in future falls. Furthermore, as she states, "having people in restraints causes caregivers to think of the patient as someone who needs to be in restraints."
On the whole, this film is instructive with respect to elders' problems in the physiology of movement, but emphasis on nursing and nursing judgment does not occur until the last third of the film. Additionally, the viewer is unsure as to whether the staff "nurses" giving care are really nurses (as opposed to actresses), and if so, what their credentials are. In addition, in terms of recommendations to prevent falls, the film urges environmental safety and teaching the patient the proper use of handrails, canes, and walkers, but fails to mention exercise regimens for the elderly that could increase strength of upper and lower extremities, enabling them to better deal with mobility problems.