Final answer:
The most appropriate action for the 85-year-old patient Mary, who has cognitive impairment and has fallen twice, is to initiate a multidisciplinary and family meeting to focus on her care. This aligns with the least restraint practice and helps develop a comprehensive care strategy, including applied behavior analysis, occupational therapy, and potential medication options.
Step-by-step explanation:
An appropriate action in the situation where Mary, an 85-year-old patient with cognitive impairment and gross instability who wanders continuously and has fallen twice, would be: initiating a multidisciplinary and family meeting to focus on Mary's needs. This approach aligns with the least restraint practice that has been initiated and is intended to explore comprehensive care strategies that both address Mary's safety and honor her dignity. During such a meeting, topics of discussion might include applied behavior analysis (ABA), occupational therapy, and possible medication options as part of a personalized care plan.
The use of restraints is a complex and sensitive issue in elder care, often subject to ethical, legal, and medical considerations. A solution that balances patient safety with their rights and quality of life requires collaboration between healthcare professionals, the patient (as much as possible), and their family members. Case management strategies often focus on goal setting and implementing suitable strategies for mobility and safety, considering any potential barriers, such as untreated trauma or family dysfunction. When dealing with such situations, it is key to note that aggression and conflict, verbal or physical, can be a sign of deeper issues, requiring a considerate and well-informed approach to care. It is also important to educate family members about cognitive impairment and its effects on behavior and to involve them in the care-planning process.