Expertise of Siegfried Huhn


Freedom, protection and safety made possible by new technology

Hardly anyone can remember the time around 25 to 30 years ago when care beds had no integrated bed rails fitted. Falling out of bed was regarded as falling off a chair or stumbling when walking and was considered to be an unforeseeable risk of everyday life. However, if patients were particularly restless through the night, continuous bed rails were fetched out of storage and fitted onto the bed between the head and foot end.

Later on, care beds fitted with integrated bed rails arrived on the scene. Ideas on safety had changed, bed rails started to be used with increasing frequency. But the main reason for the developing of integrated bed rails was to be able to have these to hand at all times and consequently to be able to use them without delay. Their handling, too, was significantly easier and less strenuous for nursing staff. The result: Bed rails were pulled up unthinkingly more and more often, it became part of the routine and the whole operation was justified on the basis of safety first. Studies reveal that up to 59% of patients in nursing homes come in contact with bed rails.

Reflecting on care methods

Bed rails are in actual fact not without risks or dangers. A whole range of unanticipated accidents often results from their use. The head and extremities can be trapped between the crossbars during restless sleeping patterns, patients become wedged between the mattress and the bed rails and fractures of the finger, arm or leg are not unusual. There have even been cases of strangulation. In the final analysis, bed rails are not suitable as the only means of preventing patients from falling out of bed or from exiting the bed. Most restless or agitated patients are perfectly capable of climbing over bed rails. As a result of the higher drop during a potential fall and the body posture while climbing, much more serious injuries are sustained than would be the case without the presence of bed rails. The expert standard on fall prevention endorsed by the DNQP (German Network for Quality Development in Nursing) therefore advises against the use of bed rails as a form of fall
prevention. At the same time alternatives are offered: the use of partial bed rails is one of these. These reach to the middle of the bed which means that patients can leave the bed while benefiting from sufficient protection.

A sea change in the caring culture demands the right solutions

Nursing staff have to meet the patient‘s right of physical integrity and also his right of self-determination in an appropriate and acceptable way. The safety/freedom dilemma can be resolved by means of professional assessment. If side protection is deemed to be the sensible procedure, it is necessary to have a partial protection system that can be swiftly implemented. This degree of protection usually suffices so that the unrestrained patient can recognise the edge of the bed. Side protection is often not needed because the patient, provided the bed is positioned low enough, can touch the floor with his hand and thus find his bearings. The same applies to the legs if they are first put out of the bed where there is side protection at the top end.

All this means that the design of a care bed can help carers to take a sound and professional decision and to move away from rigid notions of safety that focus too much on freedom-restraining measures.


Siegfried Huhn
Male Nurse, Healthcare Professional and Social Scientist, Member of the Expert Group on Fall Prevention at the DNQP (German Network for Quality Development in Nursing), Specialist Author