Bedrails and vulnerable older adults: how should nurses make 'safe and sound' decisions surrounding their use?

AIM AND
OBJECTIVES: This paper examines the available evidence and uses ethical principles to answer how nurses should make safe and sound decisions surrounding the use of bedrails.
BACKGROUND: Bedrails are frequently observed in practice. They are designed as safety devices but there is evidence of indiscriminate and misuse with vulnerable adults.
METHODS: The OVID MEDLINE, BNI and CINAHL databases were searched using key words dignity or autonomy and old[er] or elder[s/ly]), people, adult[s], patient[s], client[s] or user[s], and bed rails, bed guards, cot sides or side rails (and associated variations). Additionally United Kingdom legislation, professional codes of practice and national patient safety agency resources were also searched.
RESULTS: Bedrail use needs careful consideration. The published evidence can be confusing and contradictory. Nurses have a duty to provide care which promotes respect for patient's autonomy, integrity and dignity for which individualised assessment is essential. Additionally overt consideration of beneficence, non-maleficence and justice supports decision making.
CONCLUSIONS: Protection and promotion of respect for autonomy, integrity and dignity especially with older adults must be evidenced in practice. The use of an ethical framework can enable nurses to make transparent and defensible decisions about the appropriate use of bedrails, thereby fulfilling professional, moral, and legal requirements. IMPLICATIONS FOR PRACTICE: Bedrail use has implications beyond falls prevention. Protection and promotion of respect for autonomy, integrity and dignity with older adults must be considered in decision-making. Physical safety must be assessed as part of a holistic assessment. Nurses may need support and training to ensure 'safe and sound' surrogate decision-making in practice.