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Deciding to restrain medical patients
D S Macpherson1, R P Lofgren, R Granieri
1Department of Medicine, University of Minnesota, Minneapolis.
Journal of the American Geriatrics Society
|May 1, 1990
Summary
Nurses frequently initiate mechanical restraints, often during evening shifts, with physicians sometimes unaware. Poor communication between nurses and physicians regarding restraint use highlights a need for improved hospital policies.
Area of Science:
- Medical-Surgical Nursing
- Patient Safety
- Healthcare Communication
Background:
- Mechanical restraints are utilized in acute-care settings for patient management.
- Understanding the indications and timing of restraint use is crucial for patient safety.
- Existing literature suggests potential communication gaps in healthcare settings.
Purpose of the Study:
- To investigate the timing and reasons for mechanical restraint use in an acute-care hospital.
- To assess the agreement between nurses and physicians regarding restraint indications.
- To identify communication deficits between nurses and physicians concerning patient restraints.
Main Methods:
- A survey was administered to nurses and physicians caring for 102 restrained patients on general medical floors.
- Data collected included shift of restraint initiation, initiator, physician awareness, and perceived reasons for restraint.
- Statistical analysis, including kappa statistics, was used to assess agreement.
Main Results:
- Over half of patients were restrained during the evening shift, with nurses initiating 75% of cases.
- 15% of physicians were unaware of their patients being restrained.
- Common reasons for restraint included fall prevention (69%) and protection of medical devices (36%), but agreement on reasons between nurses and physicians was poor (kappa range .02–.43).
Conclusions:
- Significant communication gaps exist between nurses and physicians regarding the use of mechanical restraints.
- Nurses are the primary initiators of restraints, often without full physician awareness.
- Hospitals should implement policies to enhance nurse-physician communication to ensure judicious use of restraints.