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Nicoli EM, Silva FVCE, Assad LG, Cardinelli CC, Alves RA, de Oliveira SG. Nursing care for hospitalized older adults - fall accidents versus safe mobility: a scoping review. Rev Bras Enferm 2024; 77:e20230180. [PMID: 39045975 PMCID: PMC11259443 DOI: 10.1590/0034-7167-2023-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/24/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES to map the constituent elements of the safe mobility concept present in hospital care for older adults. METHODS a scoping review of 35 articles searched in databases and gray literature - BDENF/VHL, Scopus, CINAHL/EBSCO, Embase, Web of Science, PEDro, MEDLINE/PubMed and CAPES Theses and Dissertations Catalog. No time or language cut-off was established. RESULTS none of the studies presented a clear safe mobility concept, however its constituent elements involve factors related to patient (behavioral factors, conditions, diseases, signs and symptoms, nutritional status, age, balance, strength, gait quality, sleep), the institution (environment, treatment devices, guidelines, medications and polypharmacy, material and human resources and clothing/shoes) and the nature of the interventions (related to the patient, institution and family). FINAL CONSIDERATIONS the constituent elements of safe mobility express hospital units' capacity to guarantee care and protection from fall accidents for hospitalized older adults.
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Affiliation(s)
- Esther Mourão Nicoli
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Raquel Azevedo Alves
- Universidade do Estado do Rio de Janeiro. Rio de Janeiro, Rio de Janeiro, Brazil
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Kooken RWJ, Tilburgs B, Ter Heine R, Ramakers B, van den Boogaard M. A multicomponent intervention program to Prevent and Reduce AgItation and phySical rEstraint use in the ICU (PRAISE): study protocol for a multicenter, stepped-wedge, cluster randomized controlled trial. Trials 2023; 24:800. [PMID: 38082351 PMCID: PMC10712112 DOI: 10.1186/s13063-023-07807-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physical restraints remain to be commonly used in agitated intensive care unit (ICU) patients worldwide, despite a lack of evidence on efficacy and safety and reports of detrimental short and long-term consequences, such as prolonged delirium and a longer ICU length of stay. Physical restraint minimization approaches have focused mainly on educational strategies and other non-pharmacological interventions. Combining these interventions with goal-directed light sedation therapy if needed may play an important contributory role in further reducing the use of physical restraints. The aim of the study is to determine the effectiveness of a multicomponent intervention (MCI) program, combining person-centered non-pharmacological interventions with goal-directed light sedation, compared to physical restraints. METHODS A multicenter stepped-wedge cluster randomized controlled trial will be conducted in six Dutch ICUs. A power calculation based total of 480 (expected to become) agitated adult patients will be included in 26 months with a subsequent 2-year follow-up. Patients included in the control period will receive standard care with the current agitation management protocol including physical restraints. Patients included in the intervention period will be treated with the MCI program, consisting of four components, without physical restraints: education of ICU professionals, identification of patients at risk for agitation, formulation of a multidisciplinary person-centered care plan including non-pharmacological and medical interventions, and protocolized goal-directed light sedation using dexmedetomidine. Primary outcome is the number of days alive and outside of the ICU within 28 days after ICU admission. Secondary outcomes include length of hospital stay; 3-, 12-, and 24-month post-ICU quality of life; physical (fatigue, frailty, new physical problems), mental (anxiety, depression, and post-traumatic stress disorder), and cognitive health; and 1-year cost-effectiveness. A process evaluation will be conducted. DISCUSSION This will be the first multicenter randomized controlled trial determining the effect of a combination of non-pharmacological interventions and light sedation using dexmedetomidine compared to physical restraints in agitated ICU patients. The results of this study, including long-term patient-centered outcomes, will provide relevant insights to aid ICU professionals in the management of agitated patients. TRIAL REGISTRATION NCT05783505, registration date 23 March 2023.
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Affiliation(s)
- Rens W J Kooken
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands.
| | - Bram Tilburgs
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands.
| | - Rob Ter Heine
- Department of Pharmacy, Radboud university medical center, Nijmegen, The Netherlands
| | - Bart Ramakers
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - Mark van den Boogaard
- Department of Intensive Care Medicine, Radboud university medical center, Nijmegen, The Netherlands
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Atee M, Burley CV, Ojo VA, Adigun AJ, Lee H, Hoyle DJ, Elugbadebo O, Leon T. Physical restraint in older people: a statement from the Early Career Network of the International Psychogeriatric Association. Int Psychogeriatr 2023:1-12. [PMID: 37782041 DOI: 10.1017/s1041610223000728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The International Psychogeriatric Association (IPA) has expressed significant concerns over the use of physical restraints in older people across diverse aged care settings. Following an extensive analysis of the available literature, the IPA's Early Career Network (ECN) has formulated a collection of evidence-based recommendations aimed at guiding the use of physical restraints within various care contexts and demographic groups. Physical restraints not only infringe upon human rights but also raise significant safety concerns that adversely impact the physical, psychological, social, and functional well-being of older adults. Furthermore, their effectiveness in geriatric settings remains inadequate. Given these considerations, the IPA and its ECN firmly assert that the use of physical restraints should only be considered as a final recourse in the care of older people.
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Affiliation(s)
- Mustafa Atee
- The Dementia Centre, HammondCare, Osborne Park, WA, Australia
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Claire V Burley
- UNSW Medicine and Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, NSW, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia
| | - Victor Adekola Ojo
- Royal Perth and Bentley Group, Bentley, WA, Australia
- Nissi Healthcare Telehealth, Clyde, VIC, Australia
- Vita Healthcare, Mount Eliza, VIC, Australia
| | | | - Hayoung Lee
- Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Daniel Jake Hoyle
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Olufisayo Elugbadebo
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Tomas Leon
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Global Brain Health Institute, Trinity College, Dublin, Ireland
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Hakverdioğlu Yönt G, Kisa S, Princeton DM. Physical Restraint Use in Nursing Homes-Regional Variances and Ethical Considerations: A Scoping Review of Empirical Studies. Healthcare (Basel) 2023; 11:2204. [PMID: 37570444 PMCID: PMC10419255 DOI: 10.3390/healthcare11152204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Physical restraints are known to violate human rights, yet their use persists in long-term care facilities. This study aimed to explore the prevalence, methods, and interventions related to physical restraint use among the elderly in nursing homes. METHODS The method described by Joanna Briggs was followed to conduct a scoping review without a quality assessment of the selected studies. An electronic search was conducted to find eligible empirical articles using MEDLINE, PsycINFO, EMBASE, Web of Science, Scopus, Google Scholar, CINAHL, and grey literature. The database search was performed using EndNote software (version X9, Clarivate Analytics), and the data were imported into Excel for analysis. RESULTS The prevalence of physical restraint use was found to be highest in Spain (84.9%) and lowest in the USA (1.9%). The most common device reported was bed rails, with the highest prevalence in Singapore (98%) and the lowest (4.7%) in Germany, followed by chair restraint (57%). The largest number of studies reported the prevention and/or risk of falls to be the main reason for using physical restraints, followed by behavioral problems such as wandering, verbal or physical agitation, and cognitive impairment. Most studies reported guideline- and/or theory-based multicomponent interventions consisting of the training and education of nursing home staff. CONCLUSIONS This review provides valuable insights into the use of physical restraints among elderly residents in nursing homes. Despite efforts to minimize their use, physical restraints continue to be employed, particularly with elderly individuals who have cognitive impairments. Patient-related factors such as wandering, agitation, and cognitive impairment were identified as the second most common reasons for using physical restraints in this population. To address this issue, it is crucial to enhance the skills of nursing home staff, especially nurses, in providing safe and ethical care for elderly residents with cognitive and functional impairments, aggressive behaviors, and fall risks.
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Affiliation(s)
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Faculty of Nursing, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
| | - Daisy Michelle Princeton
- Department of Nursing and Health Promotion, Faculty of Nursing, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
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Thomas A, Burkholder I, Renaud D. [Physical restraints in acute hospitals: A quantitative observational study as a starting point for the further development of quality management]. Pflege 2023; 36:115-124. [PMID: 35549711 DOI: 10.1024/1012-5302/a000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Physical restraints in acute hospitals: A quantitative observational study as a starting point for the further development of quality management Abstract: Background: Despite the known associated risks and adverse events, physical restraints are mostly observed in daily care practice of long-term care. Comparatively few studies are available for normal wards. Research question/aim: The explorative cross-sectional study investigated prevalences, types and reasons of physical restraints in nine selected normal wards of a maximum care hospital. Methods: The prevalences and types of physical restraints were collected in the early and late shift in summer 2020 via direct observation using standardised observation forms. The reasons for the use were recorded via a standardised survey of the nursing staff. Results: In the early shift, 15 out of 167 patients had physical restraints (9%), in the late shift 23 out of 191 (12%). People over 80 years were most affected (n = 8; 23.5% and n = 14, 25.9%). The highest prevalence was found in the clinic for neurogeriatrics with 21.4% (n = 3) and 37.5% (n = 6). Bedside restraints were used particularly frequently (n = 14; 93.3% and n = 22, 95.7%, resp.). The physical restraints were predominantly justified with the protection against fall injuries (n = 8, 53.3% and n = 15, 65.2%). Conclusions: Raising awareness among nursing staff through training and other accompanying measures are starting points for reducing physical restraints. In order to achieve sustainable changes, the management level should initiate appropriate measures and consistently accompany their implementation.
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Affiliation(s)
- Annika Thomas
- Department Gesundheit und Pflege, htw saar, Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken, Deutschland
| | - Iris Burkholder
- Department Gesundheit und Pflege, htw saar, Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken, Deutschland
| | - Dagmar Renaud
- Department Gesundheit und Pflege, htw saar, Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken, Deutschland
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Guenna Holmgren A, von Vogelsang AC, Lindblad A, Juth N. Understanding nurses' justification of restraint in a neurosurgical setting: A qualitative interview study. Nurs Ethics 2023; 30:71-85. [PMID: 36266990 PMCID: PMC9902980 DOI: 10.1177/09697330221111447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. AIM To understand nurses' justifications for restraint use in neurosurgical care. RESEARCH DESIGN A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT Semi-structured interviews with 15 nurses working in three neurosurgical departments in Sweden. ETHICAL CONSIDERATIONS Approved by The Regional Ethics Committee, Stockholm, Sweden. FINDINGS The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses' weighed the pros and cons of different alternatives. DISCUSSION Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. CONCLUSION How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect.
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Affiliation(s)
- Amina Guenna Holmgren
- Amina Guenna Holmgren, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, Stockholm SE-171 77, Sweden.
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What factors contribute to the need for physical restraint in institutionalized residents in Taiwan? PLoS One 2022; 17:e0276058. [PMID: 36395117 PMCID: PMC9671315 DOI: 10.1371/journal.pone.0276058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 09/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background In Taiwan, physical restraint is commonly used in institutions to protect residents from falling or injury. However, physical restraint should be used cautiously to avoid side effects, such as worse cognition, mobility, depression, and even death. Objectives To identify the rate of physical restraint and the associated risk factors in institutionalized residents in Taiwan. Methods A community-based epidemiological survey was conducted from July 2019 to February 2020 across 266 residential institutions. Among the estimated 6,549 residents being surveyed, a total of 5,752 finished the study. The questionnaires were completed by residents, his/her family or social workers. The cognition tests were conducted by specialists and a multilevel analysis approach was used to identify cognition/disability/medical history/special nursing care/BPSD risk factors for physical restraints. Results Of the 5,752 included institutionalized residents, 30.2% (1,737) had been previously restrained. Older age, lower education level, lower cognitive function, higher dependence, residents with cerebrovascular disease, pulmonary disease, dementia, and intractable epilepsy, all contributed to a higher physical restraint rate, while orthopedic disease and spinal cord injury were associated with a lower physical restraint rate. Furthermore, residents with special nursing care had a higher restraint rate. Residents with most of the behavior and psychological symptoms were also associated with an increased restraint rate. Conclusions We studied the rate of physical restraint and associated risk factors in institutionalized residents in Taiwan. The benefits and risks of physical restraint should be evaluated before application, and adjusted according to different clinical situations.
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Scalise C, Cordasco F, Sacco MA, Aquila VR, Ricci P, Aquila I. Hospital Restraints: Safe or Dangerous? A Case of Hospital Death Due to Asphyxia from the Use of Mechanical Restraints. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8432. [PMID: 35886284 PMCID: PMC9322702 DOI: 10.3390/ijerph19148432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/03/2023]
Abstract
Asphyxia can be defined as an impediment to the influx of air into the respiratory tract, leading to tissue hypoxia. By restraint, we mean the use of physical, pharmacological and/or environmental means to limit the subject's ability to move. Fall prevention is the main reason restraint is used. Unfortunately, restraint can sometimes be fatal. There are few studies in the literature on this subject. We report the case of a man with Down syndrome in a psychiatric clinic found dead between the bed and the floor of the room where he was hospitalized. The analysis of the scene showed the presence of a means of a restraint, located around the man's chest and neck, which kept him tied to the bed and applied a constricting mechanical action. There was doubt as to the cause of death. For this reason, an inspection of the scene and an autopsy were carried out. Upon opening the chest, blood infiltration of the left intercostal muscles that was topographically compatible with external cutaneous excoriation (sign of restraint) became evident. In view of the danger of using restraint, it is necessary to evaluate the means of restraint as an extraordinary and not an ordinary procedure in patient management. Each patient undergoing restraint measures must be carefully monitored by specialized personnel. Greater surveillance of the nurse/patient ratio is necessary to reduce the use of restraints. In this case report, we highlight the lack of surveillance of patients subjected to restraint.
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Affiliation(s)
- Carmen Scalise
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (C.S.); (F.C.); (M.A.S.); (P.R.)
| | - Fabrizio Cordasco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (C.S.); (F.C.); (M.A.S.); (P.R.)
| | - Matteo Antonio Sacco
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (C.S.); (F.C.); (M.A.S.); (P.R.)
| | - Valerio Riccardo Aquila
- Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy;
| | - Pietrantonio Ricci
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (C.S.); (F.C.); (M.A.S.); (P.R.)
| | - Isabella Aquila
- Institute of Legal Medicine, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, 88100 Catanzaro, Italy; (C.S.); (F.C.); (M.A.S.); (P.R.)
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Autonomy conquers all: a thematic analysis of nurses’ professional judgement encountering resistance to care from home-dwelling persons with dementia. BMC Health Serv Res 2022; 22:749. [PMID: 35659660 PMCID: PMC9167050 DOI: 10.1186/s12913-022-08123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
Abstract
Background Adequate care support from home health care nurses is needed to meet the needs of an increasing number of home-dwelling persons with dementia and those who resist care. The decisions nurses make in home health care when encountering resistance from persons with dementia have an extensive impact on the quality of care and access to care. There is little research on what influences nurse’s encounters with resistance to care from home-dwelling persons with dementia. Research aim To get insight into how nurses experience resistance to care from home-dwelling persons with dementia. Methods A qualitative research design using a thematic analysis was conducted following the six steps by Braun and Clarke. Data was gathered from three focus group and three individual interviews, and a total of 18 nurses from home health care participated. The interviews took place over a period of 5 months, from December 2020 to April 2021. Ethical considerations Approved by the Norwegian Centre for Research, reference number 515138 and by the research advisers and home care managers in each section of the municipality. Results Two main themes were identified: 1) Challenged by complex and inadequate care structures and 2) Adapting care according to circumstances. There were three subthemes within the first main theme: lack of systematic collaboration and understanding, insufficient flexibility to care, and the challenge of privacy. In the second main theme, there were three subthemes: avoid forced treatment and care to protect autonomy, gray-areas of coercive care and reduced care. The two main themes seemed to be interdependent, as challenges and changes in organizational structures influenced how nurses could conduct their care practices. Conclusion Our findings indicate that nurses’ responsibility to decide how to conduct care is downplayed when facing resistance. Further, their professional judgement is influenced by contextual factors and characterized by a strong commitment to avoid forced treatment and care. A continuous challenge is to safeguard shared decision-making at the same time as it is balanced against risks of severe health damage in home-dwelling persons with dementia. A fundamental question to ask is whether autonomy does conquer all, even when severe health damage is at stake.
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Abstract
Restraint has been used within health care settings for many centuries. Initially physical restraint (PR) was the method of choice, in present times. Within critical care units PR and chemical restraint are used, frequently in tandem. Restraint is not a benign intervention and PR specifically is associated with physical and psychological trauma towards those receiving it. Healthcare staff also suffer psychological consequences. This paper has reviewed the literature (using the terms 'physical restraint'; 'hospital'; 'care home critical care'; 'intensive care' 'attitudes'; 'knowledge' 'use of'; 'healthcare') to investigate the reasons for the use of restraints, its consequences and the attitudes of healthcare professionals' attitudes towards physical restraint currently present in critical care. Restraint use remains common practice in Critical Care Units (for 'patient safety'), initiated outside of institutional protocols, despite evidence questioning its effectiveness and the resulting harm to patients and staff.
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Affiliation(s)
- David Smithard
- Geriatric Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Rhea Randhawa
- Medical School, King's College London School of Medical Education, London, UK
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Variation of the Occurrence of Physical Restraint Use in the Long-Term Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211918. [PMID: 34831674 PMCID: PMC8622316 DOI: 10.3390/ijerph182211918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 01/09/2023]
Abstract
Physical restraints in the long-term care setting are still commonly used in several countries with a prevalence ranging from 6% to 85%. Trying to have a broad and extensive overlook on the physical restraints use in long-term care is important to design interventions to prevent and/or reduce their use. Therefore, the aim of this scoping review was to analyze the range of occurrence of physical restraint in nursing homes, long-term care facilities, and psychogeriatric units. Pubmed, CINAHL, Ovid PsycINFO- databases were searched for studies with concepts about physical restraint use in the European long-term care setting published between 2009 and 2019, along with a hand search of the bibliographies of the included studies. Data on study design, data sources, clinical setting and sample characteristics were extracted. A total of 24 studies were included. The median occurrence of physical restraint in the European long-term care setting was still high (26.5%; IQR 16.5% to 38.5%) with a significant variability across the studies. The heterogeneity of data varied according to study design, data sources, clinical setting, physical restraint's definition, and patient characteristics, such as ADLs dependence, presence of dementia and psychoactive drugs prescription.
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Acevedo-Nuevo M, González-Gil MT, Martin-Arribas MC. Physical Restraint Use in Intensive Care Units: Exploring the Decision-Making Process and New Proposals. A Multimethod Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211826. [PMID: 34831583 PMCID: PMC8623552 DOI: 10.3390/ijerph182211826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022]
Abstract
Aim: The general aim of this study was to explore the decision-making process followed by Intensive Care Unit (ICU) health professionals with respect to physical restraint (PR) administration and management, along with the factors that influence it. Method: A qual-quant multimethod design was sequenced in two stages: an initial stage following a qualitative methodology; and second, quantitative with a predominant descriptive approach. The multicenter study was undertaken at 17 ICUs belonging to 11 public hospitals in the Madrid region (Spain) across the period 2015 through 2019. The qualitative stage was performed from an interpretative phenomenological perspective. A total of eight discussion groups (DG) were held, with the participation of 23 nurses, 12 patient care nursing assistants, and seven physicians. Intentional purposive sampling was carried out. DG were tape-recorded and transcribed. A thematic analysis of the latent content was performed. In the quantitative stage, we maintained a 96-h observation period at each ICU. Variables pertaining to general descriptive elements of each ICU, institutional pain-agitation/sedation-delirium (PAD) monitoring policies and elements linked to quality of PR use were recorded. A descriptive analysis was performed, and the relationship between the variables was analyzed. The level of significance was set at p ≤ 0.05. Findings: A total of 1070 patients were observed, amounting to a median prevalence of PR use of 19.11% (min: 0%–max: 44.44%). The differences observed between ICUs could be explained by a difference in restraint conceptualization. The various actors involved jointly build up a health care culture and a conceptualization of the terms “safety-risk”, which determine decision-making about the use of restraints at each ICU. These shared meanings are the germ of beliefs, values, and rituals which, in this case, determine the greater or lesser use of restraints. There were different profiles of PR use among the units studied: preventive restraints versus “Zero” restraints. The differences corresponded to aspects such as: systematic use of tools for assessment of PAD; interpretation of patient behavior; the decision-making process, the significance attributed to patient safety and restraints; and the feelings generated by PR use. The restraint–free model requires an approach to safety from a holistic perspective, with the involvement of all team members and the family.
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Affiliation(s)
- María Acevedo-Nuevo
- Transplant National Organization, Health Ministry, 28029 Madrid, Spain
- Correspondence:
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Thunborg C, Salzman-Erikson M, Olsson A. The Swedish translation of Perceptions of Restraint Use Questionnaire (PRUQ): A test-retest reliability study in two dementia nursing homes. BMC Geriatr 2021; 21:589. [PMID: 34686135 PMCID: PMC8539803 DOI: 10.1186/s12877-021-02486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Perceptions of Restraint Use Questionnaire measures perception of restraint in a 17-item questionnaire. The aim of this study was to assess the test-retest reliability of the PRUQ as a measure of staff attitudes to restraint in elderly older persons care for people with dementia from two different nursing homes, and its ability to produce reliable results. METHODS Twenty-six staff members from two different nursing homes completed the 17-item PRUQ twice with 14-21 days between time points. As the questionnaire has already been translated in another study, the current study evaluated total item scores, mean, internal consistency, and intraclass correlation for reliability purposes. RESULTS The internal consistency Cronbach's Alpha were ˃ ≥0.726. The Intraclass correlation (ICC) between test and retest was moderate to good for the three subscales, with ICC (A,1) and ICC (C,1) values approximately equal and in the range 0.480-0.962. A Bland-Altman plot of the PRUQ total mean scores illustrates no systematic change in the mean. CONCLUSIONS The Swedish version of the PRUQ shows mainly good reliability. Therefore, we suggest that researchers continue to develop the PRUQ to be an even higher reliable questionnaire of health care professionals' perceptions of measure for restraint use in nursing homes for persons with dementia.
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Affiliation(s)
- Charlotta Thunborg
- Karolinska Institutet Department of Neurobiology, Care Sciences and Society, Clinical Geriatrics, Stockholm, Sweden. .,School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden. .,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Martin Salzman-Erikson
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Annakarin Olsson
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
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14
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KILIÇ G, POLAT Ü. Yoğun Bakım Hemşirelerinin Yaşlılara Yönelik Tutumları ile Fiziksel Tespit Edici Kullanımları Arasındaki İlişki. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.953286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Yoğun bakım hemşirelerinin yaşlılara yönelik tutumları ile fiziksel tespit edici kullanımına ilişkin bilgi, tutum ve uygulamaları arasındaki ilişkiyi belirlemek.
Yöntem: Araştırma, kesitsel tipte olup, şubat-nisan 2016 tarihleri arasında iki üniversite hastanesi ve bir özel hastanenin yoğun bakım ünitelerinde çalışan 107 hemşire ile yapılmıştır. Araştırmada veriler, 'Anket Formu', ‘Hemşirelerin Fiziksel Tespit Edici Kullanımına İlişkin Bilgi Düzeyi, Tutum ve Uygulamaları Ölçeği’ ile 'Yaşlı Ayrımcılığı Tutum Ölçeği (YATÖ)' kullanılarak toplanmıştır.
Bulgular: Yoğun bakım hemşirelerin fiziksel tespit kullanımına ilişkin bilgi puan ortalaması 7.22±1.59, tutum puan ortalaması 31.60±5.80, uygulama puan ortalaması 37.64±2.99 olarak bulunmuştur. Yoğun bakım hemşirelerinin YATÖ toplam puan ortalaması 86.13±9.44 olarak bulundu. Hemşirelerin fiziksel tespit kullanımına ilişkin bilgi düzeyi, tutum ve uygulamaları ile yaşlılara yönelik tutumları arasında istatistiksel olarak anlamlı ilişki bulunmadı(p>0.05).
Tartışma ve Sonuç: Hemşirelerin fiziksel tespit edici kullanımına ilişkin bilgi düzeylerinin iyi, tutumlarının olumlu ve uygulamalarının yeterli düzeyde olduğu ve yaşlılara yönelik tutumlarının ise olumlu olduğu bulundu. Yoğun bakım hemşirelerinin fiziksel tespit uygulamasını, yaşlı hastanın güvenliğini sağlamada bakımın bir parçası olarak gördükleri düşünülmektedir.
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15
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Dasgupta M, Beker L, Schlegel K, Hillier LM, Joworski L, Crunican K, Coulter C. A Non-Pharmacologic Approach to Manage Behaviours in Confused Medically Ill Older Adults in Acute Care. Can Geriatr J 2021; 24:125-137. [PMID: 34079606 PMCID: PMC8137457 DOI: 10.5770/cgj.24.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Non-pharmacological interventions are recommended to manage challenging behaviours among cognitively impaired older adults, however few studies have enrolled patients in acute care. This study aimed to determine the feasibility of implementing non-pharmacological interventions to manage behaviours in hospitalized older adults. Method A self-identity approach was used to identify potentially engaging activities for 13 older medically ill adults admitted to acute hospital; these activities were trialed for a two-week period. Data were collected on frequency of intervention administration and assistance required, as well as frequency of behaviours and neuroleptic use in the seven days prior to and following the trial of activities. Results Per participant, 5–11 interventions were prescribed. Most frequently interventions were tried two or more times (46%); 9% were not tried at all. Staff or family assistance was not required for 27% of activities. The mean number of documented behaviours across participants was 4.8 ± 2.3 in the pre-intervention period and 2.1 ± 1.9 in the post-intervention period. Overall the interventions were feasible and did not result in increasing neuroleptic use Conclusion Non-pharmacologic interventions may be feasible to implement in acute care. More research in this area is justified.
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Affiliation(s)
- Monidipa Dasgupta
- Division of Geriatric Medicine, Shulich School of Medicine, Western University, London, ON.,Lawson Health Research Institute, London, ON
| | | | - Kim Schlegel
- London Health Sciences Centre, London, ON.,Fanshawe College, London, ON
| | - Loretta M Hillier
- GERAS Centre for Aging Research, Hamilton Health Sciences, Hamilton, ON
| | | | | | - Corrine Coulter
- Department of Family Medicine, Shulich School of Medicine, Western University, London, ON
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16
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Chieze M, Kaiser S, Courvoisier D, Hurst S, Sentissi O, Fredouille J, Wullschleger A. Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units. BMC Psychiatry 2021; 21:82. [PMID: 33557780 PMCID: PMC7869451 DOI: 10.1186/s12888-021-03095-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Coercion in psychiatry is legally tolerated as a last resort. The reduction of the use of coercion is a shared goal of hospital administrators, medical and nursing staff and representatives of patients and families but requires the identification of risk factors for coercion. These risk factors in geriatric psychiatric inpatient settings are not well known, especially regarding seclusion. Through examining the prevalence of coercion and patients' characteristics, this study aims to identify risk factors for coercion in elderly people. METHODS The use of coercion in the geriatric psychiatry division of Geneva University Hospital in 2017 was retrospectively analyzed. The incidence rate ratios were estimated with multivariable Poisson regressions to assess risk factors for coercion. RESULTS Eighty-one of 494 patients (16.4%) experienced at least one coercive measure during their stay (mainly seclusion). The risk factors for coercion were younger age, male gender, being divorced or married, cognitive disorders, high item 1 of the Health of the Nation Outcome Scales (HoNOS) score (overactive, aggressive, disruptive or agitated behavior) at admission, previous psychiatric hospitalizations and involuntary referrals from the emergency department. Other disorders and global HoNOS scores were not associated with the use of coercion. CONCLUSION Higher risks of coercion were outlined in men with cognitive disorders, agitated behaviors, and previous psychiatric hospitalizations. They differed from those observed in younger adults in terms of age, civil status, disorders, global HoNOS scores and referrals. Therefore, geriatric psychiatric populations should be specifically investigated for the development of interventions aiming coercion reduction.
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Affiliation(s)
- Marie Chieze
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226, Thônex, Switzerland.
| | - Stefan Kaiser
- grid.150338.c0000 0001 0721 9812Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Switzerland
| | - Delphine Courvoisier
- grid.150338.c0000 0001 0721 9812Quality of Care Service, University Hospital of Geneva, Geneva, Switzerland
| | - Samia Hurst
- grid.8591.50000 0001 2322 4988Institute for Ethics, History and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Othman Sentissi
- grid.150338.c0000 0001 0721 9812Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Switzerland
| | - Jérôme Fredouille
- grid.150338.c0000 0001 0721 9812Geriatric Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandre Wullschleger
- grid.150338.c0000 0001 0721 9812Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Chemin du Petit-Bel-Air 2, 1226 Thônex, Switzerland
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17
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Ferrão SADS, Bleijlevens MHC, Nogueira PJ, Henriques MAP. A cross-sectional study on nurses' attitudes towards physical restraints use in nursing homes in Portugal. Nurs Open 2021; 8:1571-1577. [PMID: 33438841 PMCID: PMC8186690 DOI: 10.1002/nop2.769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/18/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
Aim To explore nurses' opinions regarding restraint measures and attitudes towards physical restraints use in nursing homes. Design Cross‐sectional study. Methods Nursing staff of 33 Portuguese nursing homes was asked to complete the Portuguese version of the Maastricht Attitude Questionnaire (MAQ), an instrument on attitudes regarding physical restraints (reasons, consequences and appropriateness of restraint use) and opinions about restraint measures (restrictiveness and discomfort). Descriptive statistics and bivariate analysis were performed. Results Data from 186 nurses were included in the analysis. Overall, nurses expressed neutral to moderately positive attitudes towards physical restraints usage. Nurses with longer professional experience reported a more positive attitude regarding the appropriateness of restraint use in their clinical practice. Wrist and ankle restraints were the measures that nurses reported feeling most uncomfortable using, and the most restrictive. Bilateral bedrails were globally assessed as a slightly restrictive measure and nurses reported not feeling uncomfortable using them.
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Affiliation(s)
- Sónia Alexandra da Silva Ferrão
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Paulo Jorge Nogueira
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratório de Biomatemática, Faculdade de Medicina, Instituto de Medicina Preventiva e Saúde Pública, Universidade de Lisboa, Lisbon, Portugal
| | - Maria Adriana Pereira Henriques
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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18
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Cheung G, Mah TM, Barak Y, Hirdes JP. Determinants of Non-emergency Use of Control Interventions in Older Canadian Psychiatric Inpatients: Analysizing the InterRAI Mental Health Electronic Health Records. Front Psychiatry 2021; 12:744341. [PMID: 34616324 PMCID: PMC8488129 DOI: 10.3389/fpsyt.2021.744341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The use of control interventions (CIs; acute control medications, physical/mechanical restraint) is associated with negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. The aims of this study were to: (i) report the rates of CI use in older psychiatric inpatients (age 65 - 84 and age 85+), and compare them with younger age groups (18 - 44, age 45 - 64); and (ii) identify the factors associated with non-emergency CI use in older psychiatric inpatients. Methods: Routinely collected interRAI Mental Health assessments from 2005 - 2018 in Ontario, Canada, were analyzed to determine the rates of CI use. Logistic regression models were used to examine the sociodemographic and clinical determinants of non-emergency and any CI use. Results: There were 226,119 (female: 48.6%) interRAI assessments, and 85% of those assessed were under 65 years of age. The rates of non-emergency CI use in the four age groups were: 18 - 44 = 9.4%, 45 - 64 = 8.3%, 65 - 84 = 9.9%, 85+ = 13.2%. The most significant determinants of non-emergency CI use in older adults were highest impairments in activities of daily living (ADL Short Form score 8-16: OR = 2.72, 95% CI = 2.42 - 3.06), highest levels of aggression (Aggressive Behavior Scale score 4 - 6: OR = 1.76, 95% CI = 1.57 - 1.98), and highest levels of positive psychotic symptoms (Positive Symptoms Scale score 9+: OR = 1.65, 95% CI = 1.43 - 1.90). Delirium, cognitive disorder diagnosis, cognitive impairment, and falls were also associated with increased CI use odds, as were having the reasons for admission be danger to self, danger to others or inability to care for self. Females were less likely to have non-emergency CI use (OR = 0.84, 95% CI = 0.73 - 0.95). Patients admitted from long-term care homes had significantly greater odds of non-emergency CI use compared with community admissions (OR = 1.18; 95% CI = 1.07 - 1.29). Conclusion: The higher rates of non-emergency CI use in older psychiatric inpatients is concerning. Alternative non-pharmacological and person-centered management strategies should be considered to support older psychiatric inpatients with functional impairment, positive symptoms, aggressive behavior, cognitive impairment and delirium. The use of CIs could be incorporated as a quality improvement activity to monitor changes at various service provision levels.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tina M Mah
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Yoram Barak
- Department of Psychological Medicine, School of Medicine, University of Otago, Dunedin, New Zealand
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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19
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Soeno S, Takada T, Takeshima T, Kaneyama M, Sagawa M, Hayashi M, Miyashita J, Azuma T, Fukuma S, Fukuhara S. Association between the use of physical restraint and functional decline among older inpatients admitted with pneumonia in an acute care hospital: A retrospective cohort study. Arch Gerontol Geriatr 2020; 94:104330. [PMID: 33493952 DOI: 10.1016/j.archger.2020.104330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
AIM This study was conducted to investigate the association between the use of physical restraint and functional decline in older inpatients admitted with pneumonia in an acute care setting. Although several adverse effects related to restraint use have been reported, few researchers have examined this subject in acute care settings. METHODS This retrospective cohort study was conducted at a 471-bed, acute care hospital in Japan. Patients 65 years old and older who were admitted with pneumonia between April 2015 and September 2017 were included. The use of restraints (belts and/or mittens) was recorded for every 8-hour shift. The number of shifts during which each patient was restrained was used as an explanatory variable. The primary outcome was the Katz ADL score at discharge. We used multiple linear regression analysis to adjust for confounding factors. RESULTS Of 403 patients, 94 required physical restraints. The mean age was 84.5 years (standard deviation [SD] 8.2); 44.4% were women. The mean Katz score on admission was 2.7 (SD 2.4). For multiple linear regression analysis, the coefficient of the number of restraints used was -0.024 (95% confidence interval: -0.044, -0.003, p = .022). Consequently, the restraint use for 13.9 days was associated with the decrease in the Katz score by 1.0. CONCLUSIONS Results suggest that physical restraint use is associated with functional decline among older inpatients admitted with pneumonia in acute care settings.
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Affiliation(s)
- Shoko Soeno
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan.
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Mirei Kaneyama
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Manami Sagawa
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Shingo Fukuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Human Health Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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20
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Abraham J, Bake M, Berger-Höger B, Köpke S, Kupfer R, Meyer G, Möhler R. Process evaluation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A mixed methods study. J Adv Nurs 2020; 77:1465-1477. [PMID: 33270930 DOI: 10.1111/jan.14694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/15/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
AIMS To describe the implementation process and fidelity of two versions of a guideline-based, multicomponent intervention to reduce physical restraints in nursing homes and to identify factors that might explain the heterogeneity of effects between different clusters. DESIGN Mixed methods evaluation of the implementation process (dose delivered, dose received, response, and adaption) alongside a pragmatic three-arm cluster randomized controlled trial. METHODS Quantitative and qualitative process data were collected during the study period (February 2015-February 2017). Quantitative data from questionnaires and short surveys were analysed by descriptive statistics. Qualitative data from focus groups and semi-structured interviews were analysed using content analysis. An in-depth analysis was conducted by contrasting responding and non-responding clusters regarding the intervention goal and primary outcome. RESULTS Both interventions were implemented as planned in all clusters: we found no deviations from the protocol regarding the dose delivered to and received by the clusters. Satisfaction of staff targeted by the interventions was high. The in-depth analysis did not reveal any pronounced variation in the degree of implementation or adoption in clusters with a good or nearly no response to the interventions or factors explaining different study effects. CONCLUSION Although both versions of a guideline-based multicomponent intervention to prevent physical restraints in nursing homes were implemented as planned and the response was generally acceptable, the interventions' goal to change nursing practice towards a least-restraint policy was not achieved by the entire nursing staff in all of the clusters. No factors could be identified that might explain the different effects of the interventions. IMPACT For some nursing homes, different approaches than addressing nurses' attitudes and institutional policies might be needed to sustainably reduce the use of physical restraints; however, the process evaluation did not reveal characteristics that might have hampered or facilitated the effectiveness of the intervention.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mareike Bake
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Birte Berger-Höger
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Lübeck, Germany.,Institute of Nursing Science, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ramona Kupfer
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Lübeck, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,School of Nursing, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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21
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Brugnolli A, Canzan F, Mortari L, Saiani L, Ambrosi E, Debiasi M. The Effectiveness of Educational Training or Multicomponent Programs to Prevent the Use of Physical Restraints in Nursing Home Settings: A Systematic Review and Meta-Analysis of Experimental Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186738. [PMID: 32947851 PMCID: PMC7558973 DOI: 10.3390/ijerph17186738] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 01/07/2023]
Abstract
This review assesses the effectiveness of interventions to reduce physical restraint (PR) use in older people living in nursing homes or residential care facilities. A systematic search of studies published in four electronic databases (MEDLINE, CINHAL, PsycINFO, Cochrane Central Register of Controlled Trials). The review included individual and cluster randomized controlled trials that compared educational training and multicomponent programs to avoid PR use. Risk bias of randomized controlled trials (RCTs) was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. This review includes 16 studies in a qualitative synthesis that met the inclusion criteria, nine of them offered a multicomponent program and seven offered only educational training. The results of the 12 studies included in the meta-analysis showed a significant trend in favor of intervention over time and intensity of PR use tends to decrease. The review indicates that educational programs and other supplementary interventions should be effective, but the heterogeneous operative definition of physical restraints can make difficult data generalization.
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Affiliation(s)
- Anna Brugnolli
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Luigina Mortari
- Department of Human Sciences, University of Verona, 37134 Verona, Italy;
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Martina Debiasi
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
- Correspondence:
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22
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Palese A, Danielis M, Cicogna C, Grassetti L. Does missed nursing care influence the use of physical restraint and its duration in acute medical patients? Secondary analysis of a longitudinal study. Nurs Health Sci 2020; 22:929-940. [PMID: 32524669 DOI: 10.1111/nhs.12747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/26/2022]
Abstract
Missed nursing care and physical restraint have been identified as indicators of patient safety, but no studies to date have explored their relation. To explore the relation between these two phenomena, a secondary analysis of a longitudinal study on 1464 in-hospital patients and 314 registered nurses was performed. The use of physical restraint was assessed at the bedside on a daily basis; missed care was assessed with the MISSCARE survey. Individual, nursing care, and hospital-level variables were measured. A total of 184 (12.6%) patients were restrained for 20.33% of their in-hospital stay. No significant differences emerged in the occurrence of missed care between restrained and unrestrained patients. However, some common antecedents of these two phenomena emerged: in units where there is a lack of personnel, both an increase in missed care and physical restraint duration should be expected. As a consequence, patients are threatened in their right to receive the required care and they are at risk of being restrained. Moreover, a higher skill mix is a preventive factor, which suggests that the increased numbers of registered nurses on the team, may prevent routine forms of physical restraint use by analyzing the physical restraint in place critically and removing them as soon as possible, thus reducing the duration of the restraints.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Science, University of Udine, Udine, Italy
| | - Matteo Danielis
- Department of Medical Science, University of Udine, Udine, Italy
| | - Chiara Cicogna
- Department of Medical Science, University of Udine, Udine, Italy
| | - Luca Grassetti
- Department of Economics and Statistics, University of Udine, Udine, Italy
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23
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Van Gansbeke H, Milisen K. Reducing physical restraints by older adults in home care: development of an evidence-based guideline. BMC Geriatr 2020; 20:169. [PMID: 32380959 PMCID: PMC7204038 DOI: 10.1186/s12877-020-1499-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background Restraint use is a complex and challenging issue in home care. Due to socio-demographic trends, worldwide home healthcare providers are faced with an increasing demand for restraint use from informal caregivers, patients and healthcare providers, resulting in the use of various types of restraints in home care. Awareness and knowledge of restraint use in home care, its implications and the ethical challenges surrounding it are of crucial importance to its reduction. This research aimed to describe the development process of an evidence-based practice guideline to support caregivers to optimize home care. Method The practice guideline was developed according to the framework of the Belgian Centre for Evidence-Based Medicine and AGREE II. The guideline was developed over several stages: (1) determination of the target population and scope, (2) literature search, (3) drafting and (4) validation. A multidisciplinary working group determined the proposed purpose, target group, and six clinical questions for the guideline. A consensus procedure and consultation by experts were used to develop the guideline. Results The guideline provides an answer to six clinical questions and contains ten key recommendations based on the classification of GRADE, with the objective of increasing healthcare providers’ awareness, knowledge and competence to adequately deal with situations or questions related to restraint use. The guideline also includes a flowchart for dealing with complex situations where the use of restraints is requested, already present or considered. Conclusions The guideline was validated by the Belgian Centre for Evidence-Based Medicine. Increasing competence, awareness and knowledge related to restraint use are key objectives of the guideline for reducing restraint use in home care. A multicomponent intervention to support healthcare workers in implementing the guideline in clinical practice needs to be developed.
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Affiliation(s)
- Kristien Scheepmans
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium
| | - Louis Paquay
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium
| | - Hendrik Van Gansbeke
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium. .,Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Herestraat 49, 3000, Leuven, Belgium.
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Chou MY, Hsu YH, Wang YC, Chu CS, Liao MC, Liang CK, Chen LK, Lin YT. The Adverse Effects of Physical Restraint Use among Older Adult Patients Admitted to the Internal Medicine Wards: A Hospital-Based Retrospective Cohort Study. J Nutr Health Aging 2020; 24:160-165. [PMID: 32003405 DOI: 10.1007/s12603-019-1306-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the negative effect of physical restraint use on the hospital outcomes of older patients. DESIGN A retrospective cohort study. SETTING Internal medicine wards of a tertiary medical center in Taiwan. PARTICIPANTS Subjects aged 65 years and over who were admitted during April to Dec 2017 were recruited for study. MEASUREMENTS Demographic data, geriatric assessments (polypharmacy, visual impairment, hearing impairment, activities of daily living before and after admission, risk of pressure sores, change in consciousness level, mood condition, history of falls in the previous year, risk of malnutrition and pain) and hospital conditions (admission route, department of admission, length of hospital stay and mortality) were collected for analysis. RESULTS Overall, 4,352 participants (mean age 78.7±8.7 years, 60.2% = male) were enrolled and 8.3% had physical restraint. Results of multivariate logistic regression showed that subjects with physical restraints were at greater risk of functional decline (adjusted odds ratio 2.136, 95% confidence interval 1.322-3.451, p=0.002), longer hospital stays (adjusted odds ratio 5.360, 95% confidence interval 3.627-7.923, p<0.001) and mortality (adjusted odds ratio 4.472, 95% confidence interval 2.794-7.160, p<0.001) after adjustment for covariates. CONCLUSION The use of physical restraints during hospitalization increased the risk of adverse hospital outcomes, such as functional decline, longer length of hospital stay and mortality.
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Affiliation(s)
- M-Y Chou
- Dr. Chih-Kuang Liang, Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan, TEL: +886-7-3742121 ext 2091, FAX: +886-7-3468224,
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25
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Hendlmeier I, Bickel H, Heßler-Kaufmann JB, Schäufele M. Care challenges in older general hospital patients : Impact of cognitive impairment and other patient-related factors. Z Gerontol Geriatr 2019; 52:212-221. [PMID: 31628613 PMCID: PMC6821661 DOI: 10.1007/s00391-019-01628-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/11/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.
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Affiliation(s)
- Ingrid Hendlmeier
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany.
| | - Horst Bickel
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Johannes Baltasar Heßler-Kaufmann
- Working Group Psychiatric Epidemiology, Department of Psychiatry and Psychotherapy, Technical University of Munich (TUM), Klinikum rechts der Isar, Munich, Germany
| | - Martina Schäufele
- Faculty of Social Sciences, Hochschule Mannheim, University of Applied Sciences, Mannheim, Germany
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Ritzi S, Kruse A. [Dignity, freedom, embodiment : Ethical categories concerning the use of freedom-depriving measures in people with dementia in acute care settings]. Z Gerontol Geriatr 2019; 52:243-248. [PMID: 31602507 DOI: 10.1007/s00391-019-01622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
The use of freedom-depriving measures (physical and medicinal restraints) in people with cognitive impairment or dementia in clinical care settings is of ongoing importance. At the same time, these coercive measures are not only heavily debated but also in most cases ethically questionable from the perspective of the ethics of human dignity. Usually, the ethical evaluation of freedom-depriving measures follows classical paradigms of medical ethics, such as the Principles of Biomedical Ethics by Beauchamp and Childress. To enrich the debate at this point, the ethical category of embodiment ("Leiblichkeit" ) is introduced and discussed after a short summary of the ethical problem at hand. The phenomenon of the living body that has received increasingly more attention in several sciences since the proclaimed "corporeal turn" enables new perspectives towards human dignity, freedom and deprivation of freedom: freedom-depriving measures do not take place in an invisible realm of ideas but are directly applied to the psychophysical unity that is the living body of a person. Thus, freedom-depriving measures are an intervention into the bodily autonomy of the human being and the personal freedom that is manifested in the living body. The concept of the living body ("Leib") that is applied here, signifies more than just a physical object and is especially apt to capture the (inter)subjective dimension that has to be taken into account here. Finally, it will have to be investigated whether the use of medicinal restraints represents an especially serious interference into the sphere of human embodiment. Once introduced into the debate on freedom-depriving measures in clinical care, the category of embodiment can warrant decisive new emphases.
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Affiliation(s)
- S Ritzi
- Institut für Gerontologie, Universität Heidelberg, Heidelberg, Deutschland. .,Institut für Gerontologie, Netzwerk Alternsforschung (NAR), Bergheimer Straße 20, 69115, Heidelberg, Deutschland.
| | - A Kruse
- Institut für Gerontologie, Universität Heidelberg, Heidelberg, Deutschland
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The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards-A Brief Literature Review. Geriatrics (Basel) 2019; 4:geriatrics4030050. [PMID: 31487923 PMCID: PMC6787583 DOI: 10.3390/geriatrics4030050] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/12/2023] Open
Abstract
Restraint in modern non-psychiatric-based healthcare is often regarded as a rare occurrence. It is deemed to be used as a last resort to prevent patients from directly harming themselves. However, techniques are used in modern day practice which are considered direct and indirect restraints with the justification of maintaining patient safety, but they are often not classified as “restraints”. Examples of these include the use of bed rails or tables to prevent patients from “wandering” and to reduce the risk of falls and injuries. More indirect techniques would involve passive interactions with patients or leaving mobility aids out of reach. Staff subconsciously restrain patients and reduce their liberties despite agreeing that patient autonomy should be upheld—a necessary evil to maintain a duty of care. Whilst the use of restraints is often justified to ensure patient care and prevent injury, it is not without consequence. There are physical and psychological health risks such as pressure sores from the inability to mobilise, or the brewing of anger and frustration when denied access to everyday actions. The reasons why restraints are used, whilst stemming from maintaining patient safety, are often due to low staffing levels and the inability to constantly watch at-risk patients due to a large workload. Inadequate training is another factor; by improving education in direct and indirect restraint and providing alternative methods, more ethical decisions and positive outcomes can be implemented. Healthcare professionals are reluctant to use restraint but often conduct it without realising it; assessing their understanding of restraint and providing education to raise awareness of the consequences of direct and indirect methods would result in positive steps toward reducing their use at the same time as looking to provide alternatives to uphold patient care whilst maintaining their dignity and liberty.
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28
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Saito J, Suzuki H. [Factors associated with physical restraint use in acute care hospitals: A comparison of patient characteristics between patients with and without restraints]. Nihon Ronen Igakkai Zasshi 2019; 56:283-289. [PMID: 31366749 DOI: 10.3143/geriatrics.56.283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM Physical restraints are defined as limitations on patients' freedom of movement, such as bed/chair belts and/or the use of mittens. Such restraints may be harmful, and the predictors of or factors reducing physical restraint use are unclear. This study investigated the factors determining physical restraint use in patients with stroke admitted to an acute care hospital. METHODS This retrospective study analyzed patients' data obtained between August 2014 and September 2015. The variables analyzed were age, sex, physical restraint use, operations performed, presence of tubes, stroke severity, psychotropic medication use, disturbance of consciousness, motor paralysis, cognitive status, independence in activities of daily living, and presence of behavioral disorders. Patient characteristics associated with physical restraints were analyzed using the t-test, Fisher's exact test, and a logistic regression analysis. RESULTS The analysis included 253 patients (179 in the non-restraint group and 74 in the restraint group). The prevalence of physical restraint use was 29.2%. The age, cognitive status, stroke severity, operations performed, presence of tubes, disturbance of consciousness, motor paralysis, independence in the activities of daily living, presence of behavioral disorders, and psychotropic medication use significantly differed between the two groups. A logistic regression analysis showed that the age, cognitive status, stroke severity, and presence of behavioral disorders were risk factors. CONCLUSION Physical restraint use is more likely in elderly patients and those with cognitive impairment, behavioral disorders, or serious strokes. Physical restraints are also more likely to be applied in patients with cognitive impairment than in those with merely physical impairment.
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Affiliation(s)
- Jin Saito
- Department of Occupational Therapy, Showa University School of Nursing and Rehabilitation Sciences.,Showa University Koto Toyosu Hospital
| | - Hisayoshi Suzuki
- Department of Occupational Therapy, Showa University School of Nursing and Rehabilitation Sciences
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de Boer ME, Depla MFIA, Frederiks BJM, Negenman AA, Habraken JM, van Randeraad-van der Zee CH, Embregts PJCM, Hertogh CMPM. Involuntary care - capturing the experience of people with dementia in nursing homes. A concept mapping study. Aging Ment Health 2019; 23:498-506. [PMID: 29412696 DOI: 10.1080/13607863.2018.1428934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To avoid restraints and involuntary care caregivers should be aware if and how a patient resists care. This article focuses on behavioural expressions of people with severe dementia in nursing homes that are interpreted by their formal and informal caregivers as possible expressions of their experience of involuntary care. METHOD Concept mapping was used, following five steps: (1) brainstorming, (2) rating, (3) sorting, (4) statistical analysis & visual representation and (5) interpretation. Specialists (n = 12), nurses (n = 23) and relatives (n = 13) participated in separate groups . RESULTS The views generated are grouped into clusters of behaviour, presented in graphic charts for each of the respondent groups. The large variety of behavioural symptoms includes, in all groups, not only the more obvious and direct behavioural expressions like aggression, resistance and agitation, but also more subtle behaviour such as sorrow, general discomfort or discontent. CONCLUSION(S) In the interpretation of behavioural symptoms of people with severe dementia it is important to take into account the possibility of that person experiencing involuntary care. Increased awareness and understanding of the meaning and consequences of the behavioural expressions is an important step in improving dementia care by avoiding restraints and involuntary care to its maximum.
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Affiliation(s)
- Marike E de Boer
- a Department of General Practice and Elderly Care Medicine , Amsterdam Public Health Research Institute , VU University Medical Center , Amsterdam , The Netherlands
| | - Marja F I A Depla
- a Department of General Practice and Elderly Care Medicine , Amsterdam Public Health Research Institute , VU University Medical Center , Amsterdam , The Netherlands
| | - Brenda J M Frederiks
- b Department of Public and Occupational Health , Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | - Annemarieke A Negenman
- c Department of Tranzo, Tilburg School of Social and Behavioral Sciences , Tilburg University , Tilburg , The Netherlands.,d Dichterbij Innovation and Science , Gennep , The Netherlands
| | - Jolanda M Habraken
- c Department of Tranzo, Tilburg School of Social and Behavioral Sciences , Tilburg University , Tilburg , The Netherlands.,d Dichterbij Innovation and Science , Gennep , The Netherlands
| | | | - Petri J C M Embregts
- c Department of Tranzo, Tilburg School of Social and Behavioral Sciences , Tilburg University , Tilburg , The Netherlands.,d Dichterbij Innovation and Science , Gennep , The Netherlands
| | - Cees M P M Hertogh
- a Department of General Practice and Elderly Care Medicine , Amsterdam Public Health Research Institute , VU University Medical Center , Amsterdam , The Netherlands
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The use of involuntary treatment among older adults with cognitive impairment receiving nursing care at home: A cross-sectional study. Int J Nurs Stud 2018; 88:135-142. [DOI: 10.1016/j.ijnurstu.2018.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/30/2018] [Accepted: 09/04/2018] [Indexed: 11/17/2022]
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Mayerl H, Trummer T, Stolz E, Rásky É, Freidl W. Nursing professionals' attitudes toward use of physical restraints in Styrian nursing homes Austria. Pflege 2018; 32:57-63. [PMID: 30319045 DOI: 10.1024/1012-5302/a000649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals' attitudes toward this practice. AIM Since nursing professionals' views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals' attitudes concerning use of physical restraints in nursing homes of Styria (Austria). METHOD Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. RESULTS The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny "good reasons" for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals' views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. CONCLUSIONS Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.
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Affiliation(s)
- Hannes Mayerl
- 1 Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Tanja Trummer
- 1 Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Erwin Stolz
- 1 Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Éva Rásky
- 1 Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
| | - Wolfgang Freidl
- 1 Institute of Social Medicine and Epidemiology, Medical University of Graz, Austria
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Mengelers AMHJ, Bleijlevens MHC, Verbeek H, Capezuti E, Tan FES, Hamers JPH. Professional and family caregivers' attitudes towards involuntary treatment in community-dwelling people with dementia. J Adv Nurs 2018; 75:96-107. [PMID: 30168165 PMCID: PMC7379622 DOI: 10.1111/jan.13839] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/28/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Abstract
Aims The aim of this study was to gain insight into professional and family caregivers’ attitudes towards involuntary treatment in community‐dwelling people with dementia (PwD). Background The number of PwD with complex care needs living at home is increasing rapidly. In some situations, caregivers provide care against the will of PwD, referred to as involuntary treatment, which includes non‐consensual care, psychotropic medication and physical restraints. Design A cross‐sectional study. Methods A total of 228 professional (nursing staff, general practitioners (GPs) and other healthcare professionals such as physical therapists and psychologists) and 77 family caregivers of PwD completed the Maastricht Attitude Questionnaire—Home Care. This questionnaire measures attitudes towards involuntary treatment and perceived restrictiveness of and experienced discomfort in using involuntary treatment. Data were collected in the Netherlands between June and November 2016. Results Family caregivers and GPs had more positive attitudes towards involuntary treatment than nursing staff and other healthcare professionals, indicating that they are more accepting of involuntary treatment. A more positive attitude was associated with higher perceived caregiver burden and being a family caregiver. Family caregivers and GPs found the use of involuntary treatment less restrictive and indicated feeling more comfortable when using these measures. Conclusion It is important to account for the differences in attitudes and foster dialogue among professional and family caregivers to find common ground about alternatives to involuntary treatment. These results will inform the development of an intervention that aims to prevent involuntary treatment in home care.
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Affiliation(s)
- Angela M H J Mengelers
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Michel H C Bleijlevens
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Hilde Verbeek
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Elizabeth Capezuti
- Hunter College and the Graduate Center of City, University of New York, New York, United States
| | - Frans E S Tan
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Jan P H Hamers
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
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Scheepmans K, Milisen K, Vanbrabant K, Paquay L, Van Gansbeke H, Dierckx de Casterlé B. Factors associated with use of restraints on older adults with home care: A secondary analysis of a cross-sectional survey study. Int J Nurs Stud 2018; 89:39-45. [PMID: 30339954 DOI: 10.1016/j.ijnurstu.2018.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although there is evidence that use of restraints in home care is increasing, research into the factors associated with restraints in this setting is scarce. OBJECTIVE To gain insight into the factors associated with restraints in older adults receiving home care. DESIGN A secondary analysis of a cross-sectional survey about restraint use in home care. SETTINGS Older adults receiving home care in Belgium. PARTICIPANTS 8000 subjects were randomly selected from a total of 45,700 older adults. The mean age of the sample (n = 6397) was 80.6 years, 66.8% were women and 46.4% lived alone. METHODS A cross-sectional survey of restraint use on older adults receiving home care from a nursing organisation in Belgium was completed by the patients' primary care nurses. A binary logistic regression model with generalised estimating equations was used to evaluate factors associated with restraint use. Additional analyses focused on the subgroups with and without an informal caregiver and living alone / with others. Data from 6397 participants were analysed in detail. RESULTS Multivariate logistic regression indicated that restraint use was associated with supervision [OR = 2.433, 95% CI = 1.948-3.038]; dependency in activities of daily living (i.e. eating [OR = 2.181, 95% CI = 1.212-3.925], transfer [OR = 2.131, 95% CI = 1.191-3.812] and continence [OR = 1.436, 95% CI = 0.925-2.231]; perceived risk of falling in the nurses' clinical judgement [OR = 1.994, 95% CI = 1.710-2.324], daily behavioural problems [OR = 1.935, 95% CI = 1.316-2.846] and less than daily behavioural problems [OR = 1.446, 95% CI = 1.048-1.995]; decreased well-being of the informal caregiver [OR = 1.472, 95% CI = 1.126-1.925], the informal caregiver's dissatisfaction with family support [OR = 1.339, 95% CI = 1.003-1.788]; patient's cognitive impairment [OR = 1.398, 95% CI = 1.290-1.515]; and polypharmacy [OR = 1.415, 95% CI = 1.219-1.641]. The nurses' perception of risk of falling, cognitive impairment (observed with the Cognitive Performance Scale) and supervision are the only variables consistently associated with restraint use across all the analyses. CONCLUSION The study results provide insight into new and context-specific factors associated with restraint use in home care (e.g. supervision, informal caregiver's decreased well-being and dissatisfaction with family support). These insights could support the development of interventions to reduce restraint use in home care.
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Affiliation(s)
- Kristien Scheepmans
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Leuven, Belgium
| | - Koen Vanbrabant
- KU Leuven - University of Leuven & Universiteit Hasselt, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, B-3000 Leuven, Belgium
| | - Louis Paquay
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium
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Wang L, Zhu XP, Zeng XT, Xiong P. Nurses' knowledge, attitudes and practices related to physical restraint: a cross-sectional study. Int Nurs Rev 2018; 66:122-129. [PMID: 30039858 DOI: 10.1111/inr.12470] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To investigate nurses' knowledge, attitudes and practices related to physical restraint in tertiary hospitals and identify the factors that influence physical restraint use. BACKGROUND Physical restraint is used to maintain patient safety. Nurses play an important role in the restraint process. It is important to identify their understanding, feelings and approach regarding the use of physical restraint. INTRODUCTION Physical restraint is widely practiced in hospitals in China. However, it results in a range of serious negative consequences. This article provides a clear description of nurses' knowledge, attitudes and practices related to physical restraint. METHODS A cross-sectional survey was conducted. The participants were asked to complete a questionnaire examining their knowledge, attitudes and practices related to physical restraint use. A total of 200 questionnaires were distributed in four tertiary hospitals in Hubei Province, China between August and October 2014. RESULTS The nurses' responses indicated a good level of knowledge regarding physical restraint use. However, they held some misconceptions. The nurses' attitudes towards physical restraint tended to be neutral. The nurses were well experienced in the use of physical restraint. Nurses who had received on-the-job training performed better than those who had received no training related to knowledge and practices regarding physical restraint use. CONCLUSIONS AND IMPLICATION FOR NURSING/HEALTH POLICY In-service training is highly recommended for nursing managers to improve nurses' physical restraint related knowledge and practices. Regulations regarding the use of restraints should be established as soon as possible by healthcare administration system. IMPLICATIONS FOR NURSING Nurses should be open to evaluate and improve their views and attitudes regarding effective physical restraint use via multidimensional interventions.
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Affiliation(s)
- L Wang
- Department of Allergy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - X-P Zhu
- Department of Nursing, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - X-T Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - P Xiong
- Department of Respiration Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Investigating influencing factors of physical restraint use in China intensive care units: A prospective, cross-sectional, observational study. Aust Crit Care 2018; 32:193-198. [PMID: 30001953 DOI: 10.1016/j.aucc.2018.05.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 05/05/2018] [Accepted: 05/06/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE In this study, we characterised the use of physical restraints in three intensive care units (ICUs) in a general hospital in Nantong, China. Additionally, we explored risk factors potentially related to physical restraint use. BACKGROUND Despite their numerous harmful effects, physical restraints are frequently used in ICUs worldwide. Few studies have investigated the factors that contribute to physical restraint use in Chinese hospitals. METHODS We conducted a prospective, cross-sectional, observational study of 312 patients in three ICUs at a general hospital in China. The quantitative data were collected during a 5-month period using a physical restraint observation form and patient records. The data obtained were analysed using descriptive statistics. The independent risk factors for physical restraint use were assessed using a logistic regression model. RESULTS Of the 312 patients in the three ICUs, 191 (61.2%) were restrained, and physical restraints were used more than once for 46 (24.1%) patients during their ICU stay. The median length of physical restrain use was 20 shifts (interquartile range = 10-36 shifts). Physical restraints were applied in 6664 of 12374 (53.9%) nurse shifts. The most common time at which physical restraints were applied was the beginning of the evening shift. According to the forward stepwise logistic regression analysis, delirium (P < 0.001), mechanical ventilation (P < 0.001), and age (P < 0.001) were independent risk factors for physical restraint use. The use of analgesics (P = 0.001) exerted an independent protective effect against physical restraint use. CONCLUSIONS The overall prevalence of physical restraint use in Chinese ICUs was higher than that reported in previous investigations. The patients' nursing notes lacked complete physical restraint records, reflecting a need for standard guidelines and policies for physical restraint use in hospital ICUs in China. In addition, in this study, we explored the risk factors related to physical restraint use and found that age, delirium, mechanical ventilation, and analgesic use are associated with physical restraint use.
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Martínez-Ramírez A, Martinikorena I, Lecumberri P, Gómez M, Millor N, Casas-Herrero A, Zambom-Ferraresi F, Izquierdo M. Dual Task Gait Performance in Frail Individuals with and without Mild Cognitive Impairment. Dement Geriatr Cogn Disord 2018; 42:7-16. [PMID: 27459101 DOI: 10.1159/000447451] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Several studies have stated that frailty is associated with cognitive impairment. Based on various studies, cognition impairment has been considered as a component of frailty. Other authors have shown that physical frailty is associated with low cognitive performance. Dual task gait tests are used as a strong predictor of falls in either dementia or frailty. Consequently, it is important to investigate dual task walking tests in elderly populations including control robust oldest old, frail oldest old with mild cognitive impairment (MCI) and frail oldest old without MCI. METHODS Dual task walking tests were carried out to examine the association between frailty and cognitive impairment in a population with advanced age. Forty-one elderly men and women participated in this study. The subjects from control, frail with MCI and frail without MCI groups, completed the 5-meter walk test at their own gait velocity. Arithmetic and verbal dual task walking performance was also assessed. Kinematic data were acquired from a unique tri-axial inertial sensor. RESULTS The spatiotemporal and frequency parameters related to gait disorders did not show any significant differences between frail with and without MCI groups. CONCLUSIONS The evaluation of these parameters extracted from the acceleration signals led us to conclude that these results expand the knowledge regarding the common conditions in frailty and MCI and may highlight the idea that the impairment in walking performance does not depend of frailty and cognitive status.
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Lühnen J, Mühlhauser I, Richter T. Informed decision-making with and for people with dementia: Developing and pilot testing an education program for legal representatives (PRODECIDE). DEMENTIA 2017; 18:2303-2321. [PMID: 29271251 DOI: 10.1177/1471301217746751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background People living with dementia are often appointed a legal representative, to support and protect their ethical and legal rights to informed healthcare decisions. However, legal representatives usually have no qualifications in healthcare. Objective The aim of this study was to explore decision-making processes with participation of legal representatives and, resulting from this, to develop and pilot test an education program for legal representatives in Germany. Methods We conducted interviews with legal representatives and senior citizens about decision-making processes in healthcare, with special focus on percutaneous endoscopic gastrostomy, physical restraints, and prescription of antipsychotics for people with dementia. We generated a curriculum based on systematic literature searches and the results of these interviews. We tested the education program for comprehensibility, feasibility, usability, and acceptance. Results Personal interviews with voluntary ( n = 12) and professional ( n = 12) representatives, and senior citizens ( n = 14) were conducted. Preferences, attitudes, and wishes regarding percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics, and the process of decision-making, were heterogeneous. A structural approach is lacking. The education program proxy-decison-making (PRODECIDE) comprises four modules: (A) decision-making processes and methods; (B–D) evidence-based knowledge about percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics. We conducted eight trainings with 47 legal representatives. PRODECIDE was well accepted. Comprehensibility of contents and materials was rated high. The program seems feasible for implementation. Conclusion PRODECIDE seems suitable to improve the decision-making processes of legal representatives in Germany. Implementation will be appropriate if efficacy is proven; a randomized controlled trial is currently underway.
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Lam K, Kwan JS, Wai Kwan C, Chong AM, Lai CK, Lou VW, Leung AY, Liu JY, Bai X, Chi I. Factors Associated With the Trend of Physical and Chemical Restraint Use Among Long-Term Care Facility Residents in Hong Kong: Data From an 11-Year Observational Study. J Am Med Dir Assoc 2017; 18:1043-1048. [DOI: 10.1016/j.jamda.2017.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
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Kuronen M, Kautiainen H, Karppi P, Hartikainen S, Koponen H. Physical restraints and associations with neuropsychiatric symptoms and personal characteristics in residential care: a cross-sectional study. Int J Geriatr Psychiatry 2017; 32:1418-1424. [PMID: 27910133 DOI: 10.1002/gps.4629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physical restraints are widely used in residential care. The objective was to investigate restraint use and its associations with neuropsychiatric symptoms and personal characteristics in residential care. METHODS Data were collected in the South Savo Hospital District from 66 of 68 public or private institutions providing long-term residential care. Nurses assessed the use of physical restraints and neuropsychiatric symptoms (NPS) included in the symptom list of the Neuropsychiatric Inventory (NPI). Drug use was obtained from medical records, and activities of daily living (ADL) were assessed by the nurses according to the Barthel Index. RESULTS The total number of persons in residential care was 1386. Any restraint was used for 721 patients (52%) in the preceding 24 h. Bedrails were the most common restraints. In the multivariate analysis, psychotic symptoms (OR 1.94, 95% CI 1.14-3.31) and use of benzodiazepines (OR 1.69, 95% CI 1.18-2.41) were positively associated with restraint use, whereas antipsychotic (OR 0.62, 95% CI 0.44-0.87) and antidepressant drug use (OR 0.64, 95% CI 0.45-0.90) and higher ADL score (OR 0.9, 95% CI 0.92-0.93) were negatively associated. Concomitant use of at least two restraints was associated with high prevalence of hyperactivity NPS symptoms. CONCLUSIONS More than half of the residents were exposed to some physical restraint, most frequently bedrails, within the last 24 h. Psychotic symptoms and benzodiazepine use increased while good ADL and antipsychotic or antidepressant use decreased the risk of restraint use. Bedridden persons were the most frequently restrained which may pose an ethical problem. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marja Kuronen
- South Savo Hospital District, Mikkeli Central Hospital, Mikkeli, Finland
| | - Hannu Kautiainen
- Primary Care, University of Helsinki and Helsinki University Hospital, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Mikkeli, Finland
| | - Pertti Karppi
- South Savo Hospital District, Mikkeli Central Hospital, Mikkeli, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, HUS, Finland
| | - Hannu Koponen
- Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
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Eltaliawi AG, El-Shinawi M, Comer A, Hamazah S, Hirshon JM. Restraint use among selected hospitalized elderly patients in Cairo, Egypt. BMC Res Notes 2017; 10:633. [PMID: 29183388 PMCID: PMC5704368 DOI: 10.1186/s13104-017-2978-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
Objective This study’s primary objective was to investigate the prevalence of physical and chemical restraint use in selected elderly hospitalized patients. Results This study was conducted in April 2014 in four major acute care hospitals. Trained data collectors assessed the use of physical and chemical restraint among all admitted elderly patients. There were 287 elderly patients (median age 64 years, 46% women). 32 patients were restrained. The overall prevalence of restraints was 11.1%, with physical restraint use alone at 3.2% and chemical restraints use alone at 7.3%. Restraint use varied by hospital type, with the highest at the private hospital (22.9%) and the lowest at the two university hospitals (< 6%). In conclusion the prevalence of physical and chemical restraint use among admitted elderly patients in Egypt is comparable to that seen in developed countries. However, the use appears to vary widely by hospital type. The use of restraints in the elderly remains an important question considering the increasing number of elderly. Electronic supplementary material The online version of this article (10.1186/s13104-017-2978-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Angela Comer
- Charles McC. Mathias Jr., National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Hamazah
- Department of Geriatrics, Ain Shams University, Cairo, Egypt
| | - Jon Mark Hirshon
- Charles McC. Mathias Jr., National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Milisen K. Restraint use in older adults in home care: A systematic review. Int J Nurs Stud 2017; 79:122-136. [PMID: 29227873 DOI: 10.1016/j.ijnurstu.2017.11.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/16/2017] [Accepted: 11/21/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To get insight into restraint use in older adults receiving home care and, more specifically, into the definition, prevalence and types of restraint, as well as the reasons for restraint use and the people involved in the decision-making process. DESIGN Systematic review. DATA SOURCES Four databases (i.e. Pubmed, CINAHL, Embase, Cochrane Library) were systematically searched from inception to end of April 2017. REVIEW METHODS The study encompassed qualitative and quantitative research on restraint use in older adults receiving home care that reported definitions of restraint, prevalence of use, types of restraint, reasons for use or the people involved. We considered publications written in English, French, Dutch and German. One reviewer performed the search and made the initial selection based on titles and abstracts. The final selection was made by two reviewers working independently; they also assessed study quality. We used an integrated design to synthesise the findings. RESULTS Eight studies were reviewed (one qualitative, seven quantitative) ranging in quality from moderate to high. The review indicated there was no single, clear definition of restraint. The prevalence of restraint use ranged from 5% to 24.7%, with various types of restraint being used. Families played an important role in the decision-making process and application of restraints; general practitioners were less involved. Specific reasons, other than safety for using restraints in home care were noted (e.g. delay to nursing home admission; to provide respite for an informal caregiver). CONCLUSIONS Contrary to the current socio demographical evolutions resulting in an increasing demand of restraint use in home care, research on this subject is still scarce and recent. The limited evidence however points to the challenging complexity and specificity of home care regarding restraint use. Given these serious challenges for clinical practice, more research about restraint use in home care is urgently needed.
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Affiliation(s)
- Kristien Scheepmans
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | | | - Louis Paquay
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Leuven, Belgium.
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Marques P, Queirós C, Apóstolo J, Cardoso D. Effectiveness of bedrails in preventing falls among hospitalized older adults: a systematic review. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:2527-2554. [PMID: 29035965 DOI: 10.11124/jbisrir-2017-003362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Falls are a major problem today affecting adults of any age, but the elderly are a population that is more susceptible to falls. Falls are the leading cause of injury or death among older adults. Hospitalized older people are particularly vulnerable to falls. Falls cause direct injuries (minor injuries, severe wounds of the soft tissues and bone fractures) to patients and increased length of stay. The prevention of falls is commonly considered an indicator of the quality of care. Therefore, health institutions and professionals treat the identification and implementation of strategies to prevent or minimize their effects as a high priority. Fall prevention interventions involving physical restraints are still common and considered a primary preventative measure, despite controversy in their use. One of the most frequently used restraint interventions is bedrails. The question of the effectiveness of bedrails in preventing falls cuts across all societies and cultures and has with significant implications for the clinical practice of nurses. OBJECTIVES The objective of this review was to identify the effectiveness of the use of bedrails in preventing falls among hospitalized older adults when compared with no use of bedrails or any type of physical restraints. INCLUSION CRITERIA TYPES OF PARTICIPANTS The current review considered studies that included hospitalized adults (female and male), 65 years and over with any clinical condition in a non-intensive care unit (ICU). TYPES OF INTERVENTION(S) The current review considered studies that evaluated the use of bedrails as a restraint to prevent falls among older adults in non-ICUs compared to no use of bedrails or any type of physical restraints, for example, bedrails versus no bedrails, and bedrails versus no wrist or ankle ties. TYPES OF STUDIES The current review considered any randomized controlled trials (RCTs). In the absence of RCTs, other research designs such as non-RCTs, before and after studies, cohort studies, case-control studies, descriptive studies, case series/reports and expert-opinion were considered. OUTCOMES The current review considered studies that included primary outcomes (number of patients who fell or the number of falls per patient) and secondary outcomes (number of head trauma, bone fractures or soft tissue injuries). SEARCH STRATEGY The search strategy aimed to find both published and unpublished articles. A three-step search strategy was utilized in 13 databases. Articles published in Portuguese, English and Spanish beginning from 1980 were considered for inclusion. METHODOLOGICAL QUALITY Assessment of methodological quality was not conducted as no articles were identified that met the inclusion criteria. DATA EXTRACTION AND DATA SYNTHESIS Data extraction and synthesis was not performed, because no articles were included in this systematic review. RESULTS The search identified a total of 875 potentially relevant articles. Sixteen articles were identified through the reference lists of all identified articles. One hundred and thirteen full-text papers were assessed by two independent reviewers to determine eligibility. However, 11 articles were not found (despite all the efforts), and 102 articles did not meet the inclusion criteria. CONCLUSION There is no scientific evidence comparing the use of bedrails in preventing falls among hospitalized older adults to no use of bedrails or any type of physical restraints.
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Affiliation(s)
- Paulo Marques
- 1Center for Health Technology and Services Research (CINTESIS), Escola Superior de Enfermagem do Porto, Porto, Portugal 2Centro Hospitalar do Porto, Escola Superior de Enfermagem do Porto, ICBAS - UP, Porto, Portugal 3Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal 4Portugal Centre for Evidence Based Practice: a Joanna Briggs Institute Centre of Excellence, Coimbra, Portugal
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Lühnen J, Haastert B, Mühlhauser I, Richter T. Informed decision-making with and for people with dementia - efficacy of the PRODECIDE education program for legal representatives: protocol of a randomized controlled trial (PRODECIDE-RCT). BMC Geriatr 2017; 17:217. [PMID: 28915861 PMCID: PMC5603024 DOI: 10.1186/s12877-017-0616-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Germany, the guardianship system provides adults who are no longer able to handle their own affairs a court-appointed legal representative, for support without restriction of legal capacity. Although these representatives only rarely are qualified in healthcare, they nevertheless play decisive roles in the decision-making processes for people with dementia. Previously, we developed an education program (PRODECIDE) to address this shortcoming and tested it for feasibility. Typical, autonomy-restricting decisions in the care of people with dementia-namely, using percutaneous endoscopic gastrostomy (PEG) or physical restrains (PR), or the prescription of antipsychotic drugs (AP)-were the subject areas trained. The training course aims to enhance the competency of legal representatives in informed decision-making. In this study, we will evaluate the efficacy of the PRODECIDE education program. METHODS A randomized controlled trial with a six-month follow-up will be conducted to compare the PRODECIDE education program with standard care, enrolling legal representatives (N = 216). The education program lasts 10 h and comprises four modules: A, decision-making processes and methods; and B, C and D, evidence-based knowledge about PEG, PR and AP, respectively. The primary outcome measure is knowledge, which is operationalized as the understanding of decision-making processes in healthcare affairs and in setting realistic expectations about benefits and harms of PEG, PR and AP in people with dementia. Secondary outcomes are sufficient and sustainable knowledge and percentage of persons concerned affected by PEG, FEM or AP. A qualitative process evaluation will be performed. Additionally, to support implementation, a concept for translating the educational contents into e-learning modules will be developed. DISCUSSION The study results will show whether the efficacy of the education program could justify its implementation into the regular training curricula for legal representatives. Additionally, it will determine whether an e-learning course provides a valuable backup or even alternative learning strategy. TRIAL REGISTRATION TRN: ISRCTN17960111 , Date: 01/06/2017.
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Affiliation(s)
- Julia Lühnen
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences (MIN), University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany.
| | | | - Ingrid Mühlhauser
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences (MIN), University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany
| | - Tanja Richter
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences (MIN), University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany
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Bellenger EN, Ibrahim JE, Lovell JJ, Bugeja L. The Nature and Extent of Physical Restraint-Related Deaths in Nursing Homes: A Systematic Review. J Aging Health 2017; 30:1042-1061. [PMID: 28553823 DOI: 10.1177/0898264317704541] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to conduct a systematic review of the published research to examine the extent, nature, and risk factors of mortality due to physical restraint use. METHOD In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, this review examined all peer-reviewed studies published in English describing mortality due to physical restraint in nursing home residents. RESULTS The combined searches yielded 2,016 records of which eight articles were eligible for inclusion. There were 174 deaths due to physical restraint in nursing home residents across the eight studies. Neck compression ( n = 8) was the most common mechanism of harm resulting in death due to mechanical asphyxia. CONCLUSIONS Physical restraint is associated with deaths in nursing home residents. Further research is needed to investigate alternative interventions to restraint use.
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Van Gansbeke H, Milisen K. Restraint Use in Older Adults Receiving Home Care. J Am Geriatr Soc 2017; 65:1769-1776. [PMID: 28369736 DOI: 10.1111/jgs.14880] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application. DESIGN Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses. SETTING Homes of older adults receiving care from a home nursing organization in Belgium. PARTICIPANTS Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female). MEASUREMENTS For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions. RESULTS Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated. CONCLUSION Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings.
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Affiliation(s)
- Kristien Scheepmans
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | | | - Louis Paquay
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Leuven, Belgium
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Mahmoud AS. Psychiatric Nurses' Attitude and Practice toward Physical Restraint. Arch Psychiatr Nurs 2017; 31:2-7. [PMID: 28104053 DOI: 10.1016/j.apnu.2016.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/24/2016] [Accepted: 07/27/2016] [Indexed: 11/29/2022]
Abstract
AIM This study was to assess psychiatric nurses' attitude and practice toward physical restraint among mentally ill patients. METHODS A descriptive research design was used to achieve the study objective. The present study was carried out in three specialized governmental mental hospitals and two psychiatric wards in general hospital. A convenient purposive sample of 96 nurses who were working in the previously mentioned setting was included. The tool used for data collection was the Self-Administered Structured Questionnaire; it included three parts: The first comprised items concerned with demographic characteristics of the nurses, the second comprised 10 item measuring nurses' attitudes toward physical restraint, and the third was used to assess nurses' practices regarding use of physical restraint. RESULTS There were insignificant differences between attitudes and practices in relation to nurses' sex, level of education, years of experience and work place. Moreover, a positive significant correlation was found between nurses' total attitude scores, and practices regarding use of physical restraint. CONCLUSION Psychiatric nurses have positive attitude and adequate practice toward using physical restraints as an alternative management for psychiatric patients. It is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. The study recommended that it is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort.
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Affiliation(s)
- Amal Sobhy Mahmoud
- Psychiatric Nursing and Mental Health, Faculty of Nursing, Port Said University.
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Care dependency and nursing care problems in nursing home residents with and without dementia: a cross-sectional study. Aging Clin Exp Res 2016; 28:973-82. [PMID: 25527067 DOI: 10.1007/s40520-014-0298-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/19/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM Chronic diseases, like dementia, can lead to care dependency and nursing care problems. This study aims to compare the degree of care dependency and the prevalence of nursing care problems (pressure ulcer, incontinence, malnutrition, falls, restraints) between residents with and without dementia and between the stages of dementia. METHODS A cross-sectional design was chosen and a total of 277 residents with and 249 residents without dementia from nine Austrian nursing homes were assessed by staff using standardized instruments. RESULTS Significantly more residents with than without dementia are completely or to a great extent care dependent (54.5 vs. 16.9 %). The comparison of care dependency between the stages of dementia indicates a large difference between moderate and severe dementia (completely care dependent: 9.3 vs. 44.3 %). The comparison of the assessed nursing care problems between residents with and without dementia reveals a significant difference only with regard to incontinence (urinary: 84.2 vs. 53.2 %, fecal: 50.9 vs. 17.7 %, double: 49.1 vs. 14.9 %). Urinary incontinence is high even in early dementia at 64 %, reaching 94 % in severe dementia. Fecal- and double incontinence are comparatively much lower in early dementia (both types 12 %) and rise to more than 80 % (both types) in severe dementia. CONCLUSION These results highlight areas in which dementia care needs further improvements. The authors suggest maximizing residents' independence to stabilize care dependency and improve incontinence care. Furthermore, longitudinal studies are recommended to deepen insight into the development of care dependency and nursing care problems in dementia residents.
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Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints? Int Psychogeriatr 2016; 28:983-94. [PMID: 26830698 DOI: 10.1017/s1041610216000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints. METHODS Data were derived from the first wave (2008-2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ). RESULTS Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints. CONCLUSIONS Staff's job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making - especially role of physician, staff's knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.
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Hunt G, Merzeder C, Bischofberger I. A tool for the consensual analysis of decision-making scenarios. Nurs Ethics 2016; 25:359-375. [DOI: 10.1177/0969733016642628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors believe there is a need for novel ways of enhancing professional judgment and discretion in the contemporary healthcare environment. The objective is to provide a framework to guide a discursive analysis of an ongoing clinical scenario by a small group of healthcare professionals (4–12) to achieve consensual understanding in the decision-making necessary to resolve specific healthcare inadequacies and promote organisational learning. REPVAD is an acronym for the framework’s five decision-making dimensions of reasoning, evidence, procedures, values, attitudes and defences. The design is set out in terms of well-defined definitions of the dimensions, a rationale for using REPVAD, and explications of dimensions one at a time. Furthermore, the REPVAD process of application to a scenario is set out, and a didactic scenario is given to show how REPVAD works together with a sample case. A discussion is fleshed out in four real life student cases, and a conclusion indicates strengths and weaknesses and the possibility of further development and transferability. In terms of findings, the model has been tried, tested and refined over a number of years in the development of advanced practitioners at university healthcare faculties in two European countries. Consent was obtained from the four participating students.
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