Historical Analysis of Siderail Use in American Hospitals

Brush, Barbara L.
Capezuti, Elizabeth

Barbara L. Brush, RN, PhD, CS, FAAN,is an associate professor and director of the family nurse practitioner program at the Boston College School of Nursing. Her areas of teaching include advanced health assessment, clinical decision-making in primary care practice, and health issues of vulnerable, communitybased populations. Dr. Brush is known nationally and internationally for her historical research pertaining to nurse workforce, immigration, diversity, and practice issues.
Elizabeth Capezuti, RN, PhD, CS, FAAN,is an associate professor and the Independence Foundation-Wesley Woods Chair in Gerontologic Nursing at the Nell Hodgson Woodruff School of Nursing of Emory University. Dr. Capezuti also serves as associate director for nursing science for the Emory Center for Health in Aging and adjunct associate professor of medicine in the Division of Geriatric Medicine and Gerontology. Over the last decade Dr. Capezuti has been an integral part of a team of researchers demonstrating the effectiveness of restraint reduction by advanced practice nurses in nursing homes and hospitals.

Editor's note:This article is reprinted with permission from Journal of Nursing Scholarship, 2001: 33:4,381-385.

Authors' note:This study was supported by a grant from the Xi Chapter of Sigma Theta Tau International. The authors thank Deborah J. Swedlow, MSS, MLSP, JD, associate with Foley Hoag LLP in Boston, for assistance with obtaining and interpreting legal sources.

Journal of Nursing Law 8(2):p 23-30, April 2002.

Purpose:

To explore the social, economic, and legal influences on siderail use in 20th century American hospitals and how use of siderails became embedded in nursing practice.

Design:

Social historical research.

Methods:

Numerous primary and secondary sources were collected and interpreted to illustrate the pattern of siderail use, the value attached to siderails, and attitudes about using siderails.

Findings:

The persistent use of siderails in American hospitals indicates a gradual consensus between law and medicine rather than an empirically driven nursing intervention. Use of siderails became embedded in nursing practice as nurses assumed increasing responsibility for their actions as institutional employees.

Conclusions:

New federal guidelines, based on reports of adverse consequences associated with siderails, are limiting siderail use in hospitals and nursing homes across the United States. Lowering siderails and using alternatives will depend on new norms among health care providers, hospital administrators, bed manufacturers, insurers, attorneys, regulators, and patients and their families.