The Improper Use of Patient Restraints
Running head: PATIENT RESTRAINT PROTOCOLS
Patient restraints have been a hot issue within the past ten to fifteen years in nursing. There have been numerous studies done on the adverse affects restraints have on patients, physiologically and psychologically. Anger, fear, impaired mobility, bladder and bowel incontinence, eating difficulty, skin breakdown, and nosocomial infections have all been associated with the use of restraints (Weeks, 1997; Janelli, 1995). Therefore, there has been a move to limit the use of restraints and develop safer protocols for the times that they are used.
All hospitals, today, have restraint protocols that nursing staff should follow when implementing the use of restraints. However, the nursing staff does not always follow these protocols. Protocols often include making sure that the restraints have been tied safely, for easy removal, and doing frequent checks, at least every two hours, to assess for circulation and skin breakdown under and around restraints. This author has observed that the restraints are not always tied correctly. There have been times that restraints had to be cut off with scissors because they have been knotted very tightly to the beds. It has also been observed that some patients have not been assessed every two hours. However, it is frequently documented on restraint sheets that patients are being assessed every two hours when they really are not.
This clinical problem has been identified to be taking place on a 44 bed medical-surgical unit in an inner city hospital. It is a very busy unit with only 4-5 RNs, 1-2 LPNs and 2-3 PCAs working on the unit. The unit, for the most part, receives patients with neurological and respiratory problems. The patients can range in age from 18 to 100
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years old. Many of the patients are at risk for falls due to neurological problems. There are at least two to three patients restrained on the unit on a daily basis.
Some of the reasons nurses restrain patients are to prevent them from harming themselves or others, to help maintain treatment plans, and to control confused or agitated patients (Stratmann, Vinson, Magee and Hardin, 1997). The most frequently used restraints are vests, wrist, belts/ties, mitten and ankle, in that order (Stratmann et al., 1997). Many research studies currently taking place are focused towards discovering alternatives to restraints. Identifying successful alternatives to restraints and educating nurses about alternatives has helped in reducing the use of restraints (Winston, Morelli, Bramble, Friday and Sanders, 1999; Weeks, 1997). There are times, however, when restraints are needed to protect patients (Richman, 1998; Dibartolo, 1998). Restraints would be indicated for an intubated patient who keeps pulling out his endotracheal tube. In such cases, failing to use restraints could result in a claim or lawsuit being brought on...