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Nursing interventions for patient safety and fall prevention often include restrictive physical restraints. Enclosure beds may be a safe, minimally restrictive, cost-effective alternative for fall prevention. In this study, nurses' experience with enclosure beds had a positive effect on their attitude toward bed use.
Prevention of patient falls, especially falls with injury, is a nursing care priority. Patient falls with serious injury are one of the top 10 sentinel events reported to The Joint Commission (2015). Bouldin and colleagues (2013) reported 3.56 falls per 1,000 patient days in the United States, and 26.1% resulted in an injury. Deficiency in the physical environment is a common contributing factor to patient falls (The Joint Commission, 2015).
The Code of Federal Regulations (Medicare and Medicaid Programs; Hospital Conditions of Participation: Patients' Rights; Final Rule, 2006) defined a physical restraint as "any manual method or physical or mechanical device, material or equipment that immobilizes or reduces the ability of a person to move his or her arms, legs, body or head freely" (p. 71387). Physical restraints are used to alter the physical environment to decrease risk of patient falls. Hospital physical restraint use has been reported in 23% of patients; it is highest for patients who have numerous lines and tubes, are at risk for falls, or identified as a danger to self and others (van der Kooi et al., 2015). Physical restraints used to decrease risk of falls in nonviolent patients include vests, soft wrist restraints, and enclosure beds. These restraints can benefit as well as harm patients. Nurses historically have felt assured that an agitated or confused patient in restraints would not fall out of bed (Luk, Burry, Rezaie, Mehta, & Rose, 2015). However, restraints present additional risk for patient harm, including skin breakdown, complications of immobilization, psychological sequelae (Hoffman & Hahn, 2013), and even death in rare instances (Bellenger, Ibrahim, Bugeja, & Kennedy, 2017).
The American Nurses Association (2012) position statement on the reduction of patient restraint use supports the least restrictive option that treats patients with dignity. Enclosure beds are an alternative to vest and wrist restraints. An enclosure bed restrains patients without restricting their movement by placing them in a medically safe enclosed environment. Enclosure beds allow confused and agitated patients to enjoy...