Article Text

Clinical characteristics–behavioural phenotype
K07 Safety or freedom, dilemmas with the use of freedom restrictive measures
  1. M van Maanen,
  2. L van Gelder,
  3. K Lammertsen,
  4. E Hoffmann
  1. Huntington Expert Centre Atlant, Ocupational Therapy, Apeldoorn, The Netherlands


Background Inside nursing home Heemhof of Atlant Care Group there are 31 patients with Huntington's Disease. In order to prevent falls and injuries, freedom restrictive measures have been applied. This is because we've asked ourselves whether the advantages of the use of these measures outweigh their disadvantages and recently the use of some of these measures is prohibited. Also, we've examined alternative measures that will prevent falls and/or injuries without restricting freedom. What is more important: safety or freedom? We are responsible for the safety of our patients but we might have to accept that more falls occur.

Case history The use of freedom restrictive measures can prevent falls, but it can also have major psychic implications for patients. It is important for healthcare professionals to be aware about both the advantages and the disadvantages of these measures, and to know that there are alternative measures that might also provide enough protection but not restrict freedom. For each individual patient a decision has to be made between alternative measures. This decision is made by the physician, the nurse and other professionals of the multidisciplinary team and the patient and his family. They deliberate the exact problem and then explore the advantages and disadvantages of all available alternative measures that can be applied in order to solve the problem.

Conclusions Atlant Care Group has been applying less freedom restrictive measures. The major cause of this decline has been awareness about both the advantages and the disadvantages of these measures. Because of this awareness we are now able to take more conscious risks and clients have more freedom. Falls do still occur but are now more accepted then before. The growing believe is that the bigger degree of freedom that patients experience outweighs these incidents by far. Many freedom restrictive measures have been replaced by alternatives that offer protection but don't restrict freedom, like motion detectors, braces and helmets.

  • Freedom restrictive measures
  • safety and freedom

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