Learning Objective #1: Name five alternatives to restraint use and the target behaviors for which they are used

Learning Objective #2: List the adverse effects of restraint use

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With increasing reports of restraint-related deaths and injuries, the findings of studies focusing on restraint practices, the efforts of advocacy groups, and recent regulatory requirements, restraint-free care in the United States is progressing, and is the emerging standard of care (Strumpf, 1999). When asked, most nurses will say that they do not like to restrain their patients. Yet data indicates that in long-term care settings in the U. S., 8.5%, and in Arkansas, 19 – 23 % of residents are physically restrained on a daily basis (AFMC, 2003). A local county-owned nursing facility offering comprehensive long-term care reported physical restraint use at 37.4%. In collaboration with the facility's medical director, director of nursing, and resident care coordinator, a restraint reduction/elimination program was developed and implemented. Due to the fact that willingness to change established customs is vital to the success of a restraint reduction/elimination program, an innovative theory by Perlman and Takacs, combined with the classic change theory proposed by Karl Lewin, resulted in a comprehensive framework of change accounting for beliefs, behaviors, emotions, and actions of employees faced with change used to facilitate change in employee behaviors in the facility. The restraint reduction team developed and implemented interventions and alternatives for the four target behaviors of exit-seeking, aggression, calling-out and interference with treatment for each resident. Restraint usage decreased in the first two weeks of implementation from 37.4 % to 30.8 %--a 6.6 % reduction. To date, restraint usage continues to decline in this ongoing study. Continuous evaluation and development of alternatives to restraints is a key factor to the success of this program. Individualized care teamed with this constant reevaluation, have been shown to improve resident quality of life in the long-term care setting.