Nurses' Physical Restraint Knowledge, Attitudes, and Practices: The Impact of a Restraint Reduction Education Program

Purpose:
Examine the effectiveness of an educational program designed to improve nurses' knowledge, attitude, and practices related to physical restraint use. Goal: Implementation of a clinical practice change related to reducing the use of physical restraints to improve patient outcomes.

Significance:
More than 100 deaths or injuries due to restraint use occur each year to patients. Despite the negative outcomes associated with the use of restraints, many nurses still consider restraint use as a necessary and acceptable intervention to maintain patient safety.

Strategy and Implementation:
Simultaneous hospital-wide initiatives were undertaken to reduce restraint use and reduce patient falls. Early in the process we recognized the interface between restraints and falls and agreed that fall rate would be one of the restraint reduction outcomes. Our campaign “Rethinking Restraints” began with a staff nurse on-line survey (n=232) about restraint knowledge, attitudes, reasons for use, and nurse concerns about the impact of reducing restraints. An evidence-based educational program was prepared to update nurses' knowledge and address concerns identified in the survey. The program was widely disseminated first through the Shared Governance Councils followed by hospital-wide dissemination. Creative alternatives to restraints were implemented, including engagement of the Advanced Practice Nurses as clinical allies with staff nurses to identify alternatives to restraints. Deming's Plan, Do, Check, Act (PDCA) model was used to guide implementation.

Evaluation:
Achieved a reduction in physical restraint use without an increase in our patient fall rates. To date we have seen a linear reduction in restraint use with no increase in patient falls. Rate of restraint use is defined as the total number of restraint episodes per 1000 patient days.

Implications for Practice:
The implementation of restraint alternatives has enabled nurses to effectively use less restrictive measures to maintain patient safety, which has lead to a decrease in restraint use and positive patient outcomes. The educational sessions produced an attitudinal change related to restraint use.