Restraint Knowledge, Attitudes and Beliefs

Purpose:
The purpose of this performance improvement project was to collect data on inpatient nurses knowledge, attitude and beliefs about restraint use and determine if there are differences between the high restraint rate units and low restraint rate units.

Significance:
The use of physical restraints is associated with patient injury and even death. Despite these negative effects and regulatory efforts of The Joint Commission and the Centers for Medicare and Medicaid, the use of physical restraints continues in U.S. hospitals.

Strategy and Implementation:
Nurses who care for patients in an acute care academic medical center participated in a Healthcare Personnel Questionnaire Survey to assess the knowledge, attitudes and beliefs regarding restraint use. There were 146 respondents from the low restraint rate units and 126 respondents from the high restraint rate units. The mean restraint rate for the low restraint rate units were 0.4% and the high restraint rate units were 11.8%. Survey results were summarized and compared to restraint rates for the preceding fiscal year, fall rates, and unplanned extubation rates. Units were grouped into high and low restraint rate and high and low fall rate units. Questions were grouped into categories of emotional items, attitude towards behaviors and opinion items. Both the grouping and single item questions were summarized for high and low restraint rate units and levels of significance between the mean scores were calculated.

Evaluation:
Statistically significant differences were found in attitudes and beliefs between units with a high and low restraint rates. Units with a lower restraint rate reported restraints were used more appropriately and felt strongly that reasonable alternative were tried than higher restraint rate units.

Implications for Practice:
It is important for high restraint rate units to understand the importance of alternatives to restraint. Further education on the complications associated with restraint use is needed on the high restraint rate units