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More nurses could reduce need for hospital restraints, study says

Although the use of restraints has dropped significantly over time, researchers found it was less likely if more registered nurses were on duty.

By Stephen Feller
More nurses could reduce need for hospital restraints, study says
Restraints, such as the wrist restraints pictured, are often used to prevent patients from falling or harming themselves, but a new study suggests they are less necessary with more registered nurses on duty in a hospital unit. Photo by Kim M Smith/Shutterstock

WASHINGTON, Aug. 24 (UPI) -- Some patients' movement needs to be restricted in order to prevent them from hurting themselves or falling, or disrupting their own treatment. New research suggests, however, that restraints are used less when more nurses are on duty.

The use of hospital restraints has declined steadily, at least partially because doctors and patients prefer they not be used, but in hospitals with more registered nurses on shifts restraints are far less likely to be used, according to the new study, published in the Journal of General Internal Medicine.

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Physical restraint is relatively common in hospitals and nursing homes, often including the use of belts, mittens, vests, bedrails and geriatric chairs that restrict patient movement. While they can help protect patients and staff, they also can lead to agitation, confusion and other adverse psychological and health effects.

Many hospitals compensate for a shortage of registered nurses with other staff, but researchers involved with the new study say the skill sets staff members possess appears to make a difference in how often restraints are used.

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"The findings suggest that patient care quality may suffer when unit staffing models cannot respond to changes in patient volume or registered nurse availability except by increasing the hours of staff who are not registered nurses," Dr. Vincent Staggs, an assistant professor at the University of Missouri-Kansas City, said in a press release. "This is further evidence that the type of nursing staff, not just the number of staff per patient, can be important for patient outcomes."

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For the study, researchers analyzed data on more than 923,000 patients at 869 hospitals in the United States collected between 2006 and 2010 as part of the National Database of Nursing Quality Indicators.

The data revealed restraints were used on 1.6 percent of patients, with 51 percent of instances to prevent patients from falling. During the four-year study period, the use of restraints dropped by about 50 percent, the researchers report.

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The significance of staff skills was apparent in the data, the researchers say, as the more registered nurses were on a shift, the less likely it was that restraints would be used. When the presence of registered nurses was low or very low relative to a specific hospital, the odds of using a restraint were 11 percent and 18 percent higher, and the odds of using restraints to prevent falls were 9 percent and 16 percent higher.

"Nurses must obtain a physician order for restraint, and having an adequate proportion of RNs apparently reduces the likelihood of nursing staff requesting such an order, perhaps because RNs are better trained to find alternatives to restraint," researchers wrote in the study. "In any case, restraint involves both nurses and physicians, and reduction in restraint use must be a collaborative effort."

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