Policy Regulation and Organizational Behavior, Capstone Project Example

Executive Summary

An organization requires an applicable strategic approach in order to be effective in meeting the needs of its patients and to improve its operations as a whole. This reflects a critical need to identify specific core measures that serve as standards of excellence to support patient outcomes. For example, the use of restraints has been a topic of much controversy and confusion in recent years, particularly for nurses, as their roles in managing patient safety have increased. The original belief that restraints were helpful for patients to improve safety outcomes has translated into a number of challenging conditions, whereby the use of restraints has been minimized due to its impact on patient care quality and autonomy (American Nurses Association, 2012).

Program Outcome 4

Restraints in the hospital setting were once viewed as a critical measure to promote patient safety; however, they are now considered to be a liability in many respects and influence the quality of patient care that is administered in many organizations (American Nurses Association, 2012). In addition, the use of restraints has created a tremendous burden for nurses due to lack of adequate staffing to monitor patients and to ensure that their rights are not compromised (American Nurses Association, 2012). Restraints fall into two categories: physical and chemical, with the former being the most common and most frequently used type (Springer, 2015). Physical restraints are used for a variety of purposes that restrict patient movement and which may be imposed on persons with violent tendencies; however, when behaviors are nonviolent, this is not the most feasible or ethically responsible option (Springer, 2015).

From an economic perspective, the costs of using restraints may pose a burden on nursing units and requires additional support in order to monitor patients to improve their overall safety; therefore, this method is not cost effective and requires increased costs associated with labor and time (LeBel & Goldstein, 2005). An organization must examine its own compliance rates related to the use of restraints in order to ensure that it has fully cooperated with the mandates required to improve patient safety; therefore, minimizing the use of restraints will go a long way in improving quality of care and the perceptions of the organization and its nursing staff members (McCabe et.al, 2011). For vulnerable populations such as older adults, it is necessary to evaluate the conditions under which restraints are used and how this impacts length of stay and other concerns (Bai et.al, 2014). Restraints promote a poor culture of patient safety and a somewhat fear-based belief system, and this represents a challenge for an organization and its reputation for meeting standards of quality-based care (Tzeng & Yin, 2012).

Program Outcome 6

It is expected that an organization will be required to apply specific nursing practice theories to support patient safety that will be aligned with the intended objectives. With the ever-changing perspectives regarding the use of restraints, it is necessary for leaders to adopt methods that have the best interests of patients in mind and that support an environment in which patient care quality is the most critical priority (Sacks & Walton, 2014). These issues also reflect a need to further examine how to promote patient safety without the use of restraints and to prohibit exceptions to this rule, except under extreme circumstances (Sacks & Walton, 2014). This process also demonstrates the importance of the development of new methods to replace restraints that will have a positive and meaningful impact on patient care (Sacks & Walton, 2014). For example, the use of patient bed alarms is one alternative that has been considered and adopted in some organizations, but other options must also be identified that may impact patient wellbeing more effectively (Schneider, 2013).

The use of physical restraints does not coincide with improving patient safety in many cases; therefore, other options must be considered. This reflects the importance of shaping an environment in which recognizing patient needs will have the most feasible impact on patient care quality and support for improving this process (Yuh et.al, 2015). Most importantly, nurses must be able to recognize how patient characteristics impact decision-making in the area of patient safety so that these individuals are able to receive the appropriate interventions to meet their needs (Yuh et.al, 2015). Nursing-based objectives within an organization must be aligned with the perspectives set forth by The Joint Commission and improve quality through the decisions that are made (Wagner, McDonald, & Castle, 2012).

Conclusion and Recommendations

The use of patient restraints, which was once a common practice for some at-risk patients, is now considered to be an ethical violation of patient rights and poses a threat to the integrity of the patient experience. Therefore, nurses’ roles in promoting patient safety have evolved and have created new challenges in how to best manage patients who are at risk of falls through staff support, yet without additional resources to accommodate these needs in many organizations.

From an organizational perspective, it is important to identify the tools and resources that impact patient safety and to recognize the risks associated with the use of restraints on a frequent base, including how they may compromise patient health. Older adults, for example, must be treated with the utmost respect and professionalism at all times, and nurses must not compromise the rights of their patients in favor of harmful restraints. With the counterproductive and cost prohibitive use of restraints, it is important for nurses to have full input and involvement in organizational decision-making to protect patients and optimize patient safety.

References

American Nurses Association (2012). Reduction of patient restraint and seclusion in health care  settings. Retrieved from            http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/Reduction-of-Patient-Restraint-and-Seclusion-in-Health-Care-Settings.pdf

Bai, X., Kwok, T. C., Ip, I. N., Woo, J., Chui, M. Y., & Ho, F. K. (2014). Physical restraint use and older patients’ length of hospital stay. Health Psychology and Behavioral Medicine: an Open Access Journal, 2(1), 160-170.

LeBel, J., & Goldstein, R. (2014). Special section on seclusion and restraint: the economic cost of using restraint and the value added by restraint reduction or elimination. Psychiatric Services.

McCabe, D. E., Alvarez, C. D., McNulty, S. R., & Fitzpatrick, J. J. (2011). Perceptions of physical restraints use in the elderly among registered nurses and nurse assistants in a single acute care hospital. Geriatric Nursing, 32(1), 39-45.

Sacks, M. H., & Walton, M. F. (2014). Seclusion and restraint as measures of the quality of hospital care: any exceptions?. Psychiatric Services.

Schneider, M. E. (2013). Joint Commission Issues Alert on ‘Alarm Fatigue’.Caring for the Ages, 14(8), 7.

Springer, G. (2015). Focus on… Safe Use of Restraints.

Tzeng, H. M., & Yin, C. Y. (2012). Physical restraint use rate and total fall and injurious fall rates: An exploratory study in two US acute care hospitals.

Wagner, L. M., McDonald, S. M., & Castle, N. G. (2012). Joint Commission accreditation and quality measures in US nursing homes. Policy, Politics, & Nursing Practice, 13(1), 8-16.

Yuh, A. S., Aloweni, F. A. B., Perera, K., Li, W. S., Manickam, A., Lee, J., … & Kai, C. J. (2015). Physical restraints among the elderly in the acute care setting: Prevalence, complications and its association with patients’ characteristics. Proceedings of Singapore Healthcare, 2010105815596092.