Date of Award

Winter 2018

Project Type

Clinical Doctorate

College or School




Program or Major

Doctor of Nursing Practice

Degree Name


First Advisor

Susan J. Fetzer

Second Advisor

Donna Pelletier



Application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care in order to assure patient safety and expedite release at the earliest opportunity. While current regulations require that trained staff continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. This project builds on research that demonstrated a regulatory change requiring more frequent registered nurse assessments led to decreased duration of mechanical restraint episodes in an acute psychiatric hospital.


The purpose of this project was to implement and evaluate a practice change that required increased frequency of registered nurse assessment and surveillance during mechanical restraint episodes.


The nursing department standard requirement for frequency of face-to-face registered nurse assessment and surveillance of patients during episodes of mechanical restraint was increased on pilot units from once every thirty minutes to continuous assessment and surveillance throughout the duration of the restraint application. Quantitative data was collected on hours of duration of restraint episodes on four pilot units for three months before and three months after the intervention and mean duration of episodes was compared before and after the practice change.


Mean duration of episodes on pilot units decreased 44% in the three months post intervention: 15% on adult units and 70% on the adolescent unit.

Conclusion and Recommendation

Increasing the frequency of registered nurse assessment and surveillance during mechanical restraint has been shown to decrease duration of restraint episodes. Nurses are encouraged to change practice standards for mechanical restraint, which is a high-risk emergency measure, to provide continuous psychiatric intensive care by a registered nurse.

Keywords: mechanical restraint, physical restraint, psychiatric patients