Having enough registered nurses on a hospital ward may reduce the use of patient restraining devices, according to a US study.
Researchers found a “strong negative correlation” between nursing skill mix and “undesirable” use of physical restraint, such as belts, bedrails and other devices.
“Type of nursing staff, not just the number of staff per patient, can be important”
The findings indicated that their use may be reduced by ensuring that the nursing staff includes a sufficient number of registered nurses, said lead study author Dr Vincent Staggs, from the Children’s Mercy Hospital and the University of Missouri-Kansas City.
The researchers evaluated information on both restraints and nurse staffing levels, which was collected by a national nursing quality database between 2006 and 2010.
It involved 869 US hospitals and more than 923,000 patients, including the proportion of nursing units’ total nursing care hours worked by registered nurses.
Restraints were used on 1.6% of patients. In around half of cases restraint was used to prevent them from falling.
The higher the average percent of registered nurses on a shift, the less likely it was that restraint would be used, said the researchers in the Journal of General Internal Medicine.
When a unit’s percentage of registered nurses was low or very low relative to its average, the odds of restraint were 11% and 18% higher, respectively, and the odds of fall prevention restraint were 9% and 16% higher.
Use of patient restraint linked to nursing skill mix
The researchers suggested that the proportion of nursing care provided by the registered nurses mix, rather than the total staffing level, was the more important predictor of restraint use.
Dr Staggs said: “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.
“This is further evidence that the type of nursing staff, not just the number of staff per patient, can be important for patient outcomes,” he said.