Purpose/Objectives:
The purpose of the restraint-free/safe care initiative this hospital embraced was to provide quality care while maintaining safety and financial stability.
Significance:
The federal regulations for restraints continue to increase in number and restriction. Documentation was frustrating for the staff nurse as well as the data abstractors and restraint performance improvement team. This community hospital desired to provide evidence-based nursing care to each patient. Patient safety was a desired goal. Decreasing and/or eliminating restraints has assisted the staff in meeting the desired goal.
Design/Background/Rationale:
Research indicates that patients are safer unrestrained. Hospitals across the United States report struggles that are encountered with the regulations for restraints. Some hospitals report the use of sitters to keep the patient safe and unrestrained. This community hospital began a journey of restraint-free/safe care for excellence in patient care without creating a financial burden.
Methods/Description:
The clinical nurse specialist in a community hospital believed in restraint-free/safe care. After completing research regarding restraint care and safety, the clinical nurse specialist was empowered to change the environment. Education was developed year after year. However, restraint use continued to increase. Restraint documentation was frustrating and many times incomplete. The Restraint Performance Improvement Team began to believe in the possibility of restraint safe care. After the goal of restraint safe care was met, the reality of restraint-free care became a reality on several units in the hospital.
Findings/Outcomes:
A community hospital is offering restraint-free/safe care in an effective manner. The financial effect has not created a burden on the hospital's outcomes.
Conclusions:
A restraint-free/safe environment creates effective nursing management of the confused and agitated patient. The hospital's outcomes have improved because the patient is safer. Restraint documentation frustrations have also decreased because paperwork required has been decreased.
Implications for Practice:
Restraint-free care is possible in a hospital setting. Patients will be safer and happier. The outcomes will be rewarding for the nurse and administration.
Section Description
The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.
Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.
The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.