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

Richman, D. (1998). To restrain or not to restrain? RN, 61 (7), 55-60.

Janelli, L. (1995). Physical restraint use in acute care settings. Journal of Nursing Care Quality, 9 (3), 86-92.

The goals for a planned change project should include improving nursing education among medical-surgical nursing staff; evaluating knowledge and practice; discovering other methods to check compliance of staff in following restraint protocols.

Some of the reasons nurses restrain patients are to prevent them from harming themselves or others, to help maintain treatment plans, and to control confused or agitated patients (Stratmann, Vinson, Magee and Hardin, 1997). The most frequently used restraints are vests, wrist, belts/ties, mitten and ankle, in that order (Stratmann et al., 1997). Many research studies currently taking place are focused towards discovering alternatives to restraints. Identifying successful alternatives to restraints and educating nurses about alternatives has helped in reducing the use of restraints (Winston, Morelli, Bramble, Friday and Sanders, 1999; Weeks, 1997). There are times, however, when restraints are needed to protect patients (Richman, 1998; Dibartolo, 1998). Restraints would be indicated for an intubated patient who keeps pulling out his endotracheal tube. In such cases, failing to use restraints could result in a claim or lawsuit being brought on for negligence (Richman, 199!

Although the use of physical restraints has declined in nursing homes, the practice remains widespread in hospitals (Mion, 1996). Nursing staff (RNs, LPNs, and CNAs) from four hospitals completed a survey (Matthiesen, Lamb, McCann, Hollinger-Smith and Walton, 1996) regarding knowledge, practice, and attitudes about physical restraints. Nurses from both geriatric and geropsychiatric units reported significantly more educational activities about restraint use than did nurses on medical units.

Kobs, A. (1997). Patient restraints. Nursing Management, 28 (1), 14-15.

the restraint policy. New nursing employees should have to attend a restraint education class and demonstrate the ability to tie restraints on properly before working on the unit. It might be helpful to color code which patients are restrained on the unit, so that staff can easily remember which patients need to get assessments done every two hours (Winston et al., 1999). Perhaps, someone on the unit could be assigned the job of checking periodically that restraints are on properly and doing the assessments. The staff could alternate among themselves the assignment. The nurse manager will have to negotiate ideas with the staff on creating a solution to the problem.

Some common words found in the essay are:
Patient Restraint, Joint Commission, According Havelock, Patient Restraints, Drug Administration, Hollinger-Smith Walton, Bramble Sanders, Magee Hardin, Journal Medicine, Care Quality, nurse manager, patient restraint, yoder-wise 1999, et al, winston et al, janelli 1995, patient restraints, change agent, winston et, planned change, restraint protocols, et al 1999, al 1999 nurse, 1999 nurse manager, tie restraints properly,
Approximate Word count = 2070
Approximate Pages = 8 (250 words per page double spaced)