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Nursing Changing the improper use of patient restraints

Running head: PATIENT RESTRAINT PROTOCOLS 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

Patient Restraint 3

years old. Many of the patients are at risk for falls due to neurological problems. There are at least two to three patien...

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Patient Restraint 9 References Annas, G. (1999). The last resort- the use of physical restraints in medical emergencies. The New England Journal of Medicine, 341(18), 1408-1412. Dibartolo, V. (1998). 9 steps to effective restraint use. RN, 61 (12), 23-24. Janelli, L. (1995). Physical restraint use in acute care settings. Journal of Nursing Care Quality, 9 (3), 86-92. Kobs, A. (1997). Patient restraints. Nursing Management, 28 (1), 14-15. Matthiesen, V., Lamb, K. V., McCann, J., Hollinger-Smith, L. & Walton, J. C. (1996). Hospital nurses' views about physical restraint use with older patients. Journal of Gerontological Nursing, 22 (6), 8-16. Mion, L. C., Minnick, A., Palmer, R., Kapp, M. & Lamb, K. (1996). Physical restraint use in the hospital setting: unresolved issues and directions for research. Milbank Quarterly, 74 (3), 411-433. Richman, D. (1998). To restrain or not to restrain? RN, 61 (7), 55-60. Stratmann, M., Vinson, M. H., Magee, R. & Hardin, S. B. (1997). The effects of research on clinical practice: the use of restraints. Applied Nursing Research, 10 (1), 39-43. Weeks, S. K. (1997). RAP: a restraint alternative protocol that works. Rehabilitation Nursing, 22 (3), 154-155. Winston, P. A., Morelli, P., Bramble, J., Friday, A. & Sanders, J. B. (1999). Improving patient care through implementation of nurse-driven restraint protocols. Journal of Nursing Care Quality, 13 (6), 32-46. Yoder-Wise, P. (1999). Leading and Managing in Nursing. Second Edition. Chapter 5, 74-88.

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