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Hospital patient restraint more likely with poor nursing skill mix


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”

Vincent Staggs

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.

Children’s Mercy Hospital and the University of Missouri-Kansas City

Use of patient restraint linked to nursing skill mix

Vincent Staggs

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.


Readers' comments (6)

  • Let's have one to one nursing shall we then the risk of falls will be nil

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  • What about the high rate of staff assaults when restraint doesn't happen? What about bias stats that indirectly support corporate untruth and assaults on staff? Is this another blame the staff and not bad management who use cost cutting under the guise of patient safety and not safe staff. Let me bring it home to everybody safer staffing doesn't necessarily equate safe staff and patient safety doesnt necessarily stop unsafe cost cutting.

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  • Steve Ford when some one runs at you've with a knife or a weapon then write something intelligent about skill mix & numbers. In situations of human free will most simply do there best. The question you should be asking is why government and NHS Management are hiding cost cutting, not necessarily leading to lack of skill but not having appropriate patients in the appropriate place with over worked staff and a business environment where it's okay to assault staff?

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  • The title should perhaps read, 'researchers and corporate reputation misusing safeguarding to support assaults on frontline care workers (the figures of assaults on staff continue to rise) - how care institutions scape goat vulnerable staff due to lack of regular numbers & used as a tool to promote indirect management violence against staff to lessen safe employee rights and cut costs. Also you fail to report the number of protests in America due to increasing safe staffing issues. Steve you don't seem to report on Washington D.C. Staff are fed up with the propaganda and the likes of Norman Lamb don't particularly have a good reputation amongst the frontline but corporate management seem to love him. Big news to your ego Norman is to whether you're are being used by a corporate agenda that continues to attack the frontline. It's not about education its about brain washing the frontline into total submission by a historical weak self congratulating NHS corporate managment. Whilst nurses continue to get hurt on the frontline and teams struggle, corporate management continue attedning delusional award ceremonies whilst sipping on champagne - YOU SHOULD BE ASHAMED OF YOURSELVES.

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  • No response from DoH? NHS England? Did you ask for one? Going by the article this research falls under the general title of "stating the bleedin' obvious". Of course the bigger question is why the NHS is tolerating a situation where the evidence pointing to the need for adequate skilled staffing at the appropriate level is just being ignored.

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  • michael stone

    I'm not paying much attention at the moment - but, I suspect that the CQC inspections re 'use of restraint' probably do NOT pay much attention to how many staff are available, or to the staff mix: I'm guessing the CQC inspects mainly against a measure based on 'is restraint unreasonably infringing the 'human rights' of the patient'.

    Which I accept is tricky, if you are a staff member, and there simply are not enough of you.

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