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Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints for older people in all long-term care settings. Cochrane Database Syst Rev 2023; 7:CD007546. [PMID: 37500094 PMCID: PMC10374410 DOI: 10.1002/14651858.cd007546.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Physical restraints (PR), such as bedrails and belts in chairs or beds, are commonly used for older people receiving long-term care, despite clear evidence for the lack of effectiveness and safety, and widespread recommendations that their use should be avoided. This systematic review of the efficacy and safety of interventions to prevent and reduce the use of physical restraints outside hospital settings, i.e. in care homes and the community, updates our previous review published in 2011. OBJECTIVES To evaluate the effects of interventions to prevent and reduce the use of physical restraints for older people who require long-term care (either at home or in residential care facilities) SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid Sp), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register, the International Clinical Trials Registry Portal, on 3 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that investigated the effects of interventions intended to prevent or reduce the use of physical restraints in older people who require long-term care. Studies conducted in residential care institutions or in the community, including patients' homes, were eligible for inclusion. We assigned all included interventions to categories based on their mechanisms and components. DATA COLLECTION AND ANALYSIS Two review authors independently selected the publications for inclusion, extracted study data, and assessed the risk of bias of all included studies. Primary outcomes were the number or proportion of people with at least one physical restraint, and serious adverse events related to PR use, such as death or serious injuries. We performed meta-analyses if necessary data were available. If meta-analyses were not feasible, we reported results narratively. We used GRADE methods to describe the certainty of the evidence. MAIN RESULTS We identified six new studies and included 11 studies with 19,003 participants in this review update. All studies were conducted in long-term residential care facilities. Ten studies were RCTs and one study a CCT. All studies included people with dementia. The mean age of the participants was approximately 85 years. Four studies investigated organisational interventions aiming to implement a least-restraint policy; six studies investigated simple educational interventions; and one study tested an intervention that provided staff with information about residents' fall risk. The control groups received usual care only in most studies although, in two studies, additional information materials about physical restraint reduction were provided. We judged the risk of selection bias to be high or unclear in eight studies. Risk of reporting bias was high in one study and unclear in eight studies. The organisational interventions intended to promote a least-restraint policy included a variety of components, such as education of staff, training of 'champions' of low-restraint practice, and components which aimed to facilitate a change in institutional policies and culture of care. We found moderate-certainty evidence that organisational interventions aimed at implementation of a least-restraint policy probably lead to a reduction in the number of residents with at least one use of PR (RR 0.86, 95% CI 0.78 to 0.94; 3849 participants, 4 studies) and a large reduction in the number of residents with at least one use of a belt for restraint (RR 0.54, 95% CI 0.40 to 0.73; 2711 participants, 3 studies). No adverse events occurred in the one study which reported this outcome. There was evidence from one study that organisational interventions probably reduce the duration of physical restraint use. We found that the interventions may have little or no effect on the number of falls or fall-related injuries (low-certainty evidence) and probably have little or no effect on the number of prescribed psychotropic medications (moderate-certainty evidence). One study found that organisational interventions result in little or no difference in quality of life (high-certainty evidence) and another study found that they may make little or no difference to agitation (low-certainty evidence). The simple educational interventions were intended to increase knowledge and change staff attitudes towards PR. As well as providing education, some interventions included further components to support change, such as ward-based guidance. We found pronounced between-group baseline imbalances in PR prevalence in some of the studies, which might have occurred because of the small number of clusters in the intervention and control groups. One study did not assess bedrails, which is the most commonly used method of restraint in nursing homes. Regarding the number of residents with at least one restraint, the results were inconsistent. We found very-low certainty evidence and we are uncertain about the effects of simple educational interventions on the number of residents with PR. None of the studies assessed or reported any serious adverse events. We found moderate-certainty evidence that simple educational interventions probably result in little or no difference in restraint intensity and may have little or no effect on falls, fall-related injuries, or agitation (low-certainty evidence each). Based on very low-certainty evidence we are uncertain about the effects of simple educational interventions on the number of participants with a prescription of at least one psychotropic medication. One study investigated an intervention that provided information about residents' fall risk to the nursing staff. We found low-certainty evidence that providing information about residents' fall risk may result in little or no difference in the mean number of PR or the number of falls. The study did not assess overall adverse events. AUTHORS' CONCLUSIONS Organisational interventions aimed to implement a least-restraint policy probably reduce the number of residents with at least one PR and probably largely reduce the number of residents with at least one belt. We are uncertain whether simple educational interventions reduce the use of physical restraints, and interventions providing information about residents' fall risk may result in little to no difference in the use of physical restraints. These results apply to long-term care institutions; we found no studies from community settings.
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Affiliation(s)
- Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tanja Richter
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Downe S, Nowland R, Clegg A, Akooji N, Harris C, Farrier A, Gondo LT, Finlayson K, Thomson G, Kingdon C, Mehrtash H, McCrimmon R, Tunçalp Ö. Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001594. [PMID: 37093790 PMCID: PMC10124898 DOI: 10.1371/journal.pgph.0001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for 'othered' groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against 'othered' groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.
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Affiliation(s)
- Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebecca Nowland
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Naseerah Akooji
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Cath Harris
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Alan Farrier
- Healthy and Sustainable Settings Unit, University of Central Lancashire, Preston, United Kingdom
| | | | - Kenny Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Carol Kingdon
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rebekah McCrimmon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Wang J, Liu W, Li X, Li L, Tong J, Zhao Q, Xiao M. Effects and implementation of a minimized physical restraint program for older adults in nursing homes: A pilot study. Front Public Health 2022; 10:959016. [PMID: 36148339 PMCID: PMC9486015 DOI: 10.3389/fpubh.2022.959016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose Physical restraint (PR) reduction interventions are currently exploring in developed regions with well-established welfare systems, whereas developing countries with fast population aging have not attracted enough attention. This China's pilot study evaluated the effects of a minimized PR program on restraint reduction and nursing assistants' knowledge, attitudes, intention, and practice toward PR and explored nursing assistants' experience of the program. Patients and methods This was a one-group, pretest, and posttest pilot trial with a nested qualitative descriptive study. A minimized PR program was obtained by summarizing the best evidence and was implemented in one Chinese nursing home with 102 older adults from December 18, 2020, to March 21, 2021. An educational program including three theoretical lectures and one operation training was first conducted for nursing assistants one-month period. The primary outcome was PR rate at 3 months. The secondary outcomes contained duration of restraints, types of restraints, the rate of correct PR use, the incidence of falls and/or fall-related injuries, and antipsychotics use at 3 months. Data on PR use and older adults' characteristics were collected through physical restraints observation forms and older adults' medical records. Nursing assistants' knowledge, attitude, intention, and practice toward PR were measured using the Staff Knowledge, Attitudes, and Practices Questionnaire regarding PR at 1 month. A semi-structured interview for two administrative staff and a focus group discussion with 13 nursing assistants were analyzed using content analysis to explore perspectives of intervention implementation at 3 months. Results There were a significant increase in knowledge, attitude, and practice and a decrease in intention of nursing assistants after 1-month educational intervention (P < 0.001). Furthermore, only the rate of correct PR increased and the duration of restraint in the daytime decreased significantly at 3 months (P < 0.05). There were no significant effects on PR rate and other secondary outcomes at follow-up. Qualitatively, nursing assistants demonstrated overtly supportive perspectives and that assistance from the program enhanced their knowledge and practice. They noted several challenges that impeded implementation. Conclusion The intervention has acknowledged some benefits and was valued by nursing assistants. Implementation barriers should be addressed before delivering in larger trials.
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Affiliation(s)
- Jun Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Luyong Li
- Chongqing Shanxing Nursing Home, Chongqing, China
| | - Jinyan Tong
- Chongqing Shanxing Nursing Home, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Qinghua Zhao
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Mingzhao Xiao
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Pu H, Zhang X, Luo L, Yu Q, Feng X, Yan L, Zhang Y. Use of physical restraints and its associated risk factors in the aged care facilities: A multicentre cross-sectional study. J Clin Nurs 2022. [PMID: 35718889 DOI: 10.1111/jocn.16406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/04/2022] [Accepted: 06/01/2022] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To investigate the use of physical restraints in aged care facilities(ACFs)and analyse its associated risk factors. BACKGROUND Physical restraints have been widely used in ACFs worldwide, but they can cause physical and mental harm to older people. It is important to regulate the use of physical restraint. DESIGN A cross-sectional observational and correlational multicentre study. METHODS By convenience sampling method, we selected eight ACFs in four representative regions of Hunan province, China, for this study. The ACF-related information was obtained by interviewing the managers and reviewing records. We conducted investigation and observation on the elderly in the ACFs to understand the use of physical restraints at three different times: 9:30-11:30, 16:00-18:00 and 19:30-21:30 on a working day. The STROBE checklist was followed for this cross-sectional study. RESULTS This study found that the utilisation rate of physical restraints was 23.2%. The critical risk factors affecting the use of physical restrains include the following: (1) the ratio of nursing staff to the elderly residents; (2)whether there is a dementia care unit at the facility; (3) the number of elderly residents in each room; (4) the elderly residents' age, degree of education, marital status, care dependence and cognitive impairment; (5) whether the elderly has suffered from a stroke or senile dementia; (6) whether the elderly carries medical catheters. CONCLUSION There is a lack of standardisation in the use of physical restraints in ACFs of central China. Chinese ACFs should develop guidelines and reduction measures to standardise the use of physical restraints, basing on the key factors affecting the use of physical restraints. RELEVANCE TO CLINICAL PRACTICE The use of physical restraints in ACFs is threatening the safety of the elderly residents. Understanding the implementation of physical restraint in ACFs can provide reference for reducing the use of physical restraint.
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Affiliation(s)
- Haixu Pu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoqin Zhang
- School of Marxism, Hunan University of Chinese Medicine, Changsha, China
| | - Liangchu Luo
- Clinical School of Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Qian Yu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaolin Feng
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Lichun Yan
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yinhua Zhang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
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Definition and Measurement of Physical and Chemical Restraint in Long-Term Care: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073639. [PMID: 33807413 PMCID: PMC8037562 DOI: 10.3390/ijerph18073639] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022]
Abstract
This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions.
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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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Rietbergen T, Spoon D, Brunsveld-Reinders AH, Schoones JW, Huis A, Heinen M, Persoon A, van Dijk M, Vermeulen H, Ista E, van Bodegom-Vos L. Effects of de-implementation strategies aimed at reducing low-value nursing procedures: a systematic review and meta-analysis. Implement Sci 2020; 15:38. [PMID: 32450898 PMCID: PMC7249362 DOI: 10.1186/s13012-020-00995-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/29/2020] [Indexed: 11/11/2022] Open
Abstract
Background In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures. Methods PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the ‘Cochrane Effective Practice and Organisation of Care’ (EPOC) taxonomy was used to categorize de-implementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel–Haenszel risk ratios (95% CI) were calculated using a random effects model. Results Twenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in low-value nursing procedures. Thirteen of these 14 studies included an educational component within their de-implementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20). Conclusions The majority of the studies with a positive significant effect used a de-implementation strategy with an educational component. Unfortunately, no conclusions can be drawn about which strategy is most effective for reducing low-value nursing care due to a high level of heterogeneity and a lack of studies. We recommend that future studies better report the effects of de-implementation strategies and perform a process evaluation to determine to which extent the strategy has been used. Trial registration The review is registered in Prospero (CRD42018105100).
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Affiliation(s)
- Tessa Rietbergen
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Denise Spoon
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | - Jan W Schoones
- Leiden University Medical Center, Walaeus Library, Leiden, The Netherlands
| | - Anita Huis
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maud Heinen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke Persoon
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hester Vermeulen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Nursing Science, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
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Guenna Holmgren A, Juth N, Lindblad A, von Vogelsang AC. Restraint in a Neurosurgical Setting: A Mixed-Methods Study. World Neurosurg 2019; 133:104-111. [PMID: 31568917 DOI: 10.1016/j.wneu.2019.09.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the extent to which restraint is used in neurosurgical care, under what circumstances, and how it is documented. METHODS A cross-sectional study with a mixed-methods approach was used to identify neurosurgical inpatients subjected to restraint. The data were collected in 2 phases: (1) a study-specific questionnaire was distributed to nurses in which they identified if restraints had occurred during their shifts, and if so, which restraint and to which patient; and (2) scrutinizing of electronic medical records of patients identified by the questionnaires. Numeric data were analyzed using descriptive and analytic statistical methods, and textual data were analyzed using qualitative content analysis. The findings from the different data sources were compared and merged. RESULTS Of the 517 patients admitted to the studied department during the study period, 58 (11%) were reported to have been subjected to restraint and most of the restraining events occurred in the neurointensive care unit. Most restraint measures were not documented in the electronic medical records. The identified patients were predominantly diagnosed with traumatic brain injury or subarachnoid hemorrhage. The qualitative content analysis showed the circumstances when restraints were used: when patients were considered a danger to self or others (theme) and which symptoms and behaviors (categories) were observed in relation to the use of restraint. CONCLUSIONS Restraint in neurosurgical care is mostly used to prevent patients from harming themselves or others. Because of the lack of documentation, restraint measures cannot be openly assessed, thus putting patients' safety at risk.
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Affiliation(s)
- Amina Guenna Holmgren
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
| | - Niklas Juth
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Use of physical restraint in nursing homes in Spain and relation with resident characteristics: a retrospective multi-centre cohort study with a self-organised maps approach. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis is a retrospective cohort study based on data from five nursing homes which aims to appraise how physical and cognitive characteristics of nursing home residents were associated with the use of restraints, and to provide information on their prevalence in Spain. The goal was to assess, in a visual way, the possible interactions between the nursing homes residents’ characteristics and their association with the use of restraints. Motivation, risk factors, characteristics of the residents analysed by validated rating systems that assess mobility, level of dependence, cognitive condition and nutritional status, and their association with the use of restraints, were described by means of linear and non-linear multivariate approaches in the form of self-organised maps. Findings showed that the prevalence of restraints was high when compared to other developed countries. The visual analysis reinforced the knowledge that a greater impairment was associated with the use of restraints and vice versa. However, the residents’ characteristics were not always associated with the use of restraints. Subjective factors seem to play a relevant role in decision-making, so it is important to assess risk factors continuously and determine the actual need for the use of restraints from an individual perspective by basing the criteria on specific objectives, and on consistent, reproducible and reliable methods. Initiatives to minimise these subjective factors should be promoted. Likewise, a clear definition of physical restraints should be offered at each centre. In addition, effective legislation that clearly states the need, alternatives and motivation for the use of restraints is needed.
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Villar F, Celdrán M, Vila-Miravent J, Serrat R. Involving institutionalised people with dementia in their care-planning meetings: lessons learnt by the staff. Scand J Caring Sci 2017; 32:567-574. [PMID: 28901562 DOI: 10.1111/scs.12480] [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: 04/06/2017] [Accepted: 04/23/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Applying a person-centred care (PCC) approach is an aspiration for many services attending people with dementia (PwD). However, the implementation and assessment of PCC practices represent a challenge to health professionals. AIM To evaluate the impact on staff of a programme aiming to involve people with dementia (PwD) in their individualised care-planning (ICP) meetings in long-term residential settings; specifically, to explore the lessons that staff perceived they had learned from the experience. METHODS Twenty-one staff members working in residential facilities for older people were interviewed after the programme. Responses to two questions ('Do you think that your work has been affected in any way by the attendance of PwD at ICP meetings?' and 'Have you learnt something new as a result of these meetings?') were submitted to thematic analysis. RESULTS Eighteen of the 21 participants identified at least one lesson they had learned from the experience. The lessons could be grouped under three main headings: (i) an increase in their understanding of PwD, (ii) questioning of their own care practices, and (iii) an improvement in teamwork. CONCLUSION The involvement of PwD in ICP meetings had a positive impact on staff. They stated that the experience encouraged them to develop PCC-compatible attitudes and modify the way they treat PwD, thus improving the quality of care they deliver. The experience also seemed to empower staff (particularly the lesser trained members) and increase the cohesion of working teams.
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Affiliation(s)
- Feliciano Villar
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Montserrat Celdrán
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain
| | - Josep Vila-Miravent
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain.,Alzheimer Catalonia Foundation, Barcelona, Spain
| | - Rodrigo Serrat
- Department of Cognition, Development, and Educational Psychology, University of Barcelona, Barcelona, Spain
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11
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Lan SH, Lu LC, Lan SJ, Chen JC, Wu WJ, Chang SP, Lin LY. Educational intervention on physical restraint use in long-term care facilities - Systematic review and meta-analysis. Kaohsiung J Med Sci 2017; 33:411-421. [PMID: 28811011 DOI: 10.1016/j.kjms.2017.05.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/26/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022] Open
Abstract
"Physical restraint" formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities. DESIGN A systematic review with meta-analysis and meta-regression. Eight databases, including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, Ovid Medline and Physiotherapy Evidence Database (PEDro), were searched up to January 2017. Eligible studies were classified by intervention and accessed for quality using the Quality Assessment Tool for quantitative studies. Sixteen research articles were eligible in the final review; 10 randomize control trail studies were included in the analysis. The meta-analysis revealed that the use of physical restraint was significantly less often in the experimental (education) group (OR = 0.55, 95% CI: 0.39 to 0.78, p < 0.001) compared to the control group. Meta-regression revealed the period of post education would have decreased the effect of the restraint educational program (β: 0.08, p = 0.002); instead, the longer education period and more times of education would have a stronger effect of reducing the use of physical restraint (β: -0.07, p < 0.001; β: -0.04, p = 0.056). The educational program had an effect on the reduced use of physical restraint. The results of meta-regression suggest that long-term care facilities should provide a continuous education program of physical restraint for caregivers.
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Affiliation(s)
- Shao-Huan Lan
- Institute of Medicine, Chung Shan Medical University, Taiwan
| | - Li-Chin Lu
- Department of Information Management, National Yunlin University of Science and Technology, Taiwan
| | - Shou-Jen Lan
- Healthcare Administration, Asia University Department, Taiwan
| | - Jong-Chen Chen
- Department of Information Management, National Yunlin University of Science and Technology, Taiwan
| | - Wen-Jun Wu
- Institute of Medicine, Chung Shan Medical University, Taiwan
| | - Shen-Peng Chang
- Department of Pharmacy, Chi Mei Medical Center, Liouying, Taiwan
| | - Long-Yau Lin
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan.
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12
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Bleijlevens MHC, Wagner LM, Capezuti E, Hamers JPH. Physical Restraints: Consensus of a Research Definition Using a Modified Delphi Technique. J Am Geriatr Soc 2016; 64:2307-2310. [PMID: 27640335 DOI: 10.1111/jgs.14435] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop an internationally accepted research definition of physical restraint. DESIGN Comprehensive literature search followed by a web-based, three-round, modified Delphi technique comprising reviews and feedback. SETTING Clinical care settings. PARTICIPANTS An international group of 48 experts consisting of researchers and clinicians from 14 countries who have made sustained contribution to research and clinical application in the field of physical restraint in clinical care. MEASUREMENTS Data were collected using an online survey program and one in-person meeting. Results of the online survey and the in-person meeting were used for distribution in subsequent rounds until consensus on a definition was reached. Consensus was defined as 90% of the participating experts agreeing with the proposed definition of physical restraint. RESULTS Thirty-four different definitions were identified during the literature search and served as a starting point for the modified Delphi technique. After three rounds, 45 (95.7%) of 47 remaining experts agreed with the newly proposed definition: "Physical restraint is defined as any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person's body that he/she cannot control or remove easily." CONCLUSION A multidisciplinary, internationally representative panel of experts reached consensus on a research definition for physical restraints in older persons. This is a necessary step toward improved comparisons of the prevalence of physical restraint use across studies and countries. This definition can further guide research interventions aimed at reducing use of physical restraints.
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Affiliation(s)
- Michel H C Bleijlevens
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Laura M Wagner
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California
| | | | - Jan P H Hamers
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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13
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Briones-Peralta MÁ, Rodríguez-Martín B. [Effectiveness of training interventions aimed at reducing physical restraints in institutionalised older people: A systematic review]. Rev Esp Geriatr Gerontol 2016; 52:93-101. [PMID: 27166508 DOI: 10.1016/j.regg.2016.02.005] [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] [Received: 07/29/2015] [Revised: 01/19/2016] [Accepted: 02/22/2016] [Indexed: 11/30/2022]
Abstract
There is some controversy about the use of physical restraints in institutionalised elderly people. The aim of this review is to analyse studies that evaluated the effectiveness of training interventions targeting interdisciplinary teams aimed at preventing, reducing or eliminating the use of physical restraints in nursing homes. A systematic search was performed in the Cochrane Library, PubMed, PsycINFO, EMBASE, and Web of Science to find clinical trials, published in English or in Spanish, that examined training sessions for interdisciplinary teams aimed at preventing, minimising or eliminating the use of physical restrains in institutionalised people over 65 years. Ten papers fulfilled the inclusion criteria. The findings show conflicting results on the effectiveness of training sessions. Furthermore, they lack sufficient empirical evidence to be able to assert that training sessions brought about a reduction in the use of physical restraints. More studies are needed that analyse the effectiveness of these interventions to prevent or eliminate the use of physical restraints in these institutions.
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Affiliation(s)
- María Ángeles Briones-Peralta
- Área Psicosocial, Servicios Sociales, Diputación de Cuenca, Cuenca, España; Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España
| | - Beatriz Rodríguez-Martín
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, España; The School of Nursing and Midwifery, The University of Sheffield, Sheffield, Reino Unido.
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Ayalon L, Lev S, Green O, Nevo U. A systematic review and meta-analysis of interventions designed to prevent or stop elder maltreatment. Age Ageing 2016; 45:216-27. [PMID: 26744361 DOI: 10.1093/ageing/afv193] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/03/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND elder maltreatment is a major risk for older adults' mental health, quality of life, health, institutionalisation and even mortality. OBJECTIVES to perform a systematic review and meta-analysis of interventions designed to prevent or stop elder abuse. METHODS Studies that were posted between January 2000 and December 2014, written in English, specifically designed to prevent or stop elder maltreatment were included. RESULTS overall, 24 studies (and four records reporting on the same participants) were kept for the systematic review and the meta-analysis. Studies were broadly grouped into three main categories: (i) interventions designed to improve the ability of professionals to detect or stop elder maltreatment (n = 2), (ii) interventions that target older adults who experience elder maltreatment (n = 3) and (iii) interventions that target caregivers who maltreat older adults (n = 19). Of the latter category, one study targeted family caregivers, five targeted psychological abuse among paid carers and the remaining studies targeted restraint use. The pooled effect of randomised controlled trials (RCTs)/cluster-RCTs that targeted restraint use was significant, supporting the effectiveness of these interventions in reducing restraint use: standardised mean difference: -0.24, 95% confidence interval = -0.38 to -0.09. INTERPRETATION the most effective place to intervene at the present time is by directly targeting physical restraint by long-term care paid carers. Specific areas that are still lacking evidence at the present time are interventions that target (i) elder neglect, (ii) public awareness, (iii) older adults who experience maltreatment, (iv) professionals responsible for preventing maltreatment, (v) family caregivers who abuse and (vi) carers who abuse.
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Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Sagit Lev
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Ohad Green
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Uziel Nevo
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
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15
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Australian and New Zealand Society for Geriatric Medicine Position Statement Abstract: Physical restraint use in older people. Australas J Ageing 2016; 35:225. [PMID: 26810105 DOI: 10.1111/ajag.12224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Testad I, Mekki TE, Førland O, Øye C, Tveit EM, Jacobsen F, Kirkevold Ø. Modeling and evaluating evidence-based continuing education program in nursing home dementia care (MEDCED)--training of care home staff to reduce use of restraint in care home residents with dementia. A cluster randomized controlled trial. Int J Geriatr Psychiatry 2016; 31:24-32. [PMID: 25845462 DOI: 10.1002/gps.4285] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 01/30/2015] [Accepted: 02/17/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of a tailored 7-month training intervention "Trust Before Restraint," in reducing use of restraint, agitation, and antipsychotic medications in care home residents with dementia. METHODS This is a single-blind cluster randomized controlled trial in 24 care homes within the Western Norway Regional Health Authority 2011-2013. RESULTS From 24 care homes, 274 residents were included in the study, with 118 in the intervention group and 156 in the control group. Use of restraint was significantly reduced in both the intervention group and the control group despite unexpected low baseline, with a tendency to a greater reduction in the control group. There was a significant reduction in Cohen-Mansfield Agitation Inventory score in both the intervention group and the follow-up group with a slightly higher reduction in the control group, although this did not reach significance and a small nonsignificant increase in use of antipsychotics (14.1-17.7%) and antidepressants (35.9-38.4%) in both groups. CONCLUSIONS This study reports on the statistically significant reduction in use of restraint in care homes, both prior and during the 7-month intervention periods, in both intervention and control groups. When interpreted within the context of the current climate of educational initiatives to reduce restraint and a greater focus on the importance of person-centered care, the study also highlights the potential success achieved with national training programs for care staff and should be further evaluated to inform future training initiatives both in Norway and internationally.
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Affiliation(s)
- Ingelin Testad
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Health Studies, Stavanger University, Stavanger, Norway
| | - Tone Elin Mekki
- Centre for Care Research-Western Norway, Bergen University College, Norway
| | - Oddvar Førland
- Centre for Care Research-Western Norway, Bergen University College, Norway.,Haraldsplass Deaconess University College, Bergen, Norway
| | - Christine Øye
- Centre for Care Research-Western Norway, Bergen University College, Norway.,Stord/Haugesund University College, Norway
| | - Eva Marie Tveit
- Centre for Care Research-Western Norway, Bergen University College, Norway
| | - Frode Jacobsen
- Centre for Care Research-Western Norway, Bergen University College, Norway.,Betanien University College, Bergen, Norway
| | - Øyvind Kirkevold
- Norwegian Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway.,Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Norway.,Gjøvik University College, Faculty of Health, Care and Nursing, Norway
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17
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Fariña-López E, Estévez-Guerra GJ, Gandoy-Crego M, Polo-Luque LM, Gómez-Cantorna C, Capezuti EA. Perception of spanish nursing staff on the use of physical restraints. J Nurs Scholarsh 2014; 46:322-30. [PMID: 24754778 DOI: 10.1111/jnu.12087] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the perception of registered nurses and nursing assistants regarding the use of physical restraints with residents of nursing homes located in four of the regions of Spain; and to evaluate the relationship of these perceptions to the staff respondents' level of training. DESIGN Cross-sectional multicenter and correlational study. The research was conducted in 2013 in 19 Spanish nursing homes with 2,940 residential beds. A total of 785 nurses (170 registered nurses and 615 nursing assistants) participated in the study. METHODS The Perception of Restraint Use Questionnaire (PRUQ), consisting of 17 of the most cited reasons for using these devices, was used, as was a questionnaire capturing the sociodemographic characteristics and educational or experience level of staff respondents. FINDINGS Nurses reported the most important uses for restraints as prevention of falls and avoidance of medical device interference. As indicated by an average PRUQ score of 3.47, staff respondents supported restraint use, especially nursing assistants (3.59) as compared to registered nurses (3.00). With regard to training: 83.7% had participated in little, if any, training and only 29.2% had read three or more documents related to restraint use; 66.6% believed that their training was inadequate. No correlation was found between the results of the PRUQ and the respondents´ sociodemographic characteristics or participation in training activities. No differences were found among nurses by region. CONCLUSIONS In contrast to papers published in other countries, nurses in this study still consider it necessary to apply restraints in everyday practice. The education of nursing staff regarding restraint and knowledge of alternatives is needed; they should at least be aware of international standards of care regarding physical restraint use. CLINICAL RELEVANCE Most of the staff perceived their training related to the use of these devices as insufficient. Nursing assistants considered the use of restraints more important than did the registered nurses.
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Affiliation(s)
- Emilio Fariña-López
- Associate Professor, Nursing Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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18
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Keys to Successfully Embedding Scientific Research in Nursing Homes: A Win-Win Perspective. J Am Med Dir Assoc 2013; 14:855-7. [DOI: 10.1016/j.jamda.2013.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/04/2013] [Indexed: 11/19/2022]
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19
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Hamers JPH, Gulpers MJM, Bleijlevens MHC, Capezuti E, van Rossum E. [A Dutch roadmap for care without belts usage]. Tijdschr Gerontol Geriatr 2013; 44:253-260. [PMID: 24203379 DOI: 10.1007/s12439-013-0047-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of physical restraints still is highly prevalent in institutional long term care settings for older people. We know that the use of restrictive measures, such as belt restraints, do have many negative consequences for residents, and even can be harmful to their health. However, this knowledge does not result in a reduction of physical restraints. This paper describes the search for an intervention (EXBELT) aiming to safely reduce and prevent the use of belt restraints in nursing homes. EXBELT consists of a promotion of institutional policy change that discourages use of belt restraints, nursing home staff education, availability of alternative interventions, and consultation by a nurse specialist. Effect evaluations show that EXBELT is effective on the short and long term. According to a process evaluation, EXBELT was largely performed according to protocol and very well received by nursing home staff and resident's relatives. However, concurrently it is stated that the reduction of physical restraints in Dutch nursing home care runs slowly. The conclusion is that continuing focus is needed to reduce physical restraints in nursing homes and to prevent its use in home care.
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Affiliation(s)
- J P H Hamers
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands,
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20
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Huang HC, Huang YT, Lin KC, Kuo YF. Risk factors associated with physical restraints in residential aged care facilities: a community-based epidemiological survey in Taiwan. J Adv Nurs 2013; 70:130-43. [PMID: 23734585 DOI: 10.1111/jan.12176] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2013] [Indexed: 11/30/2022]
Abstract
AIM To identify the rate and risk factors of physical restraint in residential aged care facilities in Taiwan. BACKGROUND In Taiwan, physical restraint is commonly used in aged care facilities to prevent accidents. Many are unaware of the associated risks. Restrained residents cannot move freely, increasing the risk of atrophy and leading to reduced physical functioning. DESIGN A community-based epidemiological survey. METHODS Data were collected from June-December 2007 across 178 residential aged care facilities with 5,173 residential beds in the target city of Taiwan. Twenty facilities were sampled using probability proportional to size by beds and accreditation ranking. In all, 256 primary caregivers (78 nurses and 178 care aides) and 847 residents completed the study questionnaires and tests. A multilevel analysis approach was used to identify individual- and facility-level risk factors for physical restraint and assess the variation in physical restraint at the individual- and facility-level. RESULTS Of 847 residents, 62% (527) were restrained during the study period. The main reasons for restraint use were fall prevention and prevention of tube removal. Resident level risk factors for physical restraint included lower Barthel Index scores (more dependent) and an agreement allowing the use of physical restraint to avoid injury signed by a family member or social worker. A facility-level risk factor for physical restraint was younger primary caregivers. CONCLUSION To reduce the incidence of physical restraint in residential aged care facilities in Taiwan, educational programmes should target primary caregivers and families in facilities.
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Affiliation(s)
- Hui Chi Huang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu Tai Huang
- Information Science and Applications Alumni Association, Asia University, Taichung, Taiwan
| | - Kuan Chia Lin
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Yong Fang Kuo
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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21
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Gulpers MJM, Bleijlevens MHC, Ambergen T, Capezuti E, van Rossum E, Hamers JPH. Reduction of belt restraint use: long-term effects of the EXBELT intervention. J Am Geriatr Soc 2013; 61:107-12. [PMID: 23301773 DOI: 10.1111/jgs.12057] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the long-term effects of the EXBELT intervention program, which was designed to reduce belt restraint use and was found to be effective immediately after implementation, after 24 months. DESIGN Quasi-experimental longitudinal design. SETTING Thirteen nursing homes: seven assigned to control group and six to intervention group. PARTICIPANTS A panel group (n = 225) of residents present at baseline and 24 months after baseline and a survey group (n = 689) of all residents present 24 months after baseline. The survey group included the panel group. INTERVENTION EXBELT included four components: a policy change, an educational program, consultation, and availability of alternative interventions. MEASUREMENTS The use of belt restraints 24 months after baseline was the primary outcome measure. Secondary outcomes included other types of physical restraints. An independent observer collected data four times during a 24-hour period. RESULTS EXBELT resulted in a 65% decrease in belt use between baseline and 24 months after baseline in the panel group (odds ratio 0.35, 95% confidence interval = 0.13-0.93; P = .04). In the survey group, the proportion of residents using belts was 13% in the control and 3% in the intervention group (P < .001) 24 months after baseline. The use of the most restrictive types of restraints was significantly lower in the intervention group than the control group in the panel and survey groups. CONCLUSION The EXBELT intervention was associated with long-term minimization of belt restraint usage in older nursing home residents. A multicomponent intervention including institutional policy change, education, consultation, and the availability of alternative interventions had an enduring effect on successful restraint reduction.
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Affiliation(s)
- Math J M Gulpers
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
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22
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Hamers JPH, Visser AP. Editorial: Societal impact - an important performance indicator of nursing research. J Clin Nurs 2012; 21:2997-9. [DOI: 10.1111/jocn.12038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jan PH Hamers
- Department of Health Services Research, Research School Caphri; Maastricht University; Maastricht The Netherlands
| | - Adriaan Ph Visser
- Centre of Expertise for Innovation in Care, University of Applied Sciences; Rotterdam The Netherlands
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23
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Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints in long-term geriatric care - a Cochrane review. J Clin Nurs 2012; 21:3070-81. [PMID: 22978254 DOI: 10.1111/j.1365-2702.2012.04153.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people requiring long-term nursing care. BACKGROUND Physical restraints are commonly used in geriatric long-term care. However, they are associated with adverse outcomes. Therefore, freedom from physical restraints should be the aim of high-quality nursing care. DESIGN Systematic review of randomised controlled trials. METHODS This review followed the methods of the Cochrane Handbook of systematic reviews of interventions. The systematic search (September 2009) covered the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO and LILACS. RESULTS Six cluster-randomised controlled trials met the inclusion criteria. All studies investigated educational approaches targeting nursing staff. In addition, two studies offered consultation, two guidance and one support and free access to technical aids. Five studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Overall, the methodological quality of studies was low. Their results were inconsistent. One study with good methodological quality in the nursing home setting documented an increase in physical restraints use in both groups, while the other four studies with lower quality found reduced use of physical restraints in the intervention group. The single study in group dwelling units found no change in physical restraints use in the intervention group but a significant increase in the control group. CONCLUSIONS There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in geriatric long-term care. Relevance to clinical practice. Our findings indicate that educational programmes targeting nursing staff might not be effective in reducing the use of physical restraints in geriatric long-term care. It remains unclear which components should be included in educational programmes aiming to reduce physical restraints.
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Affiliation(s)
- Ralph Möhler
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
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24
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Gulpers MJM, Bleijlevens MHC, Capezuti E, van Rossum E, Ambergen T, Hamers JPH. Preventing belt restraint use in newly admitted residents in nursing homes: a quasi-experimental study. Int J Nurs Stud 2012; 49:1473-9. [PMID: 22917966 DOI: 10.1016/j.ijnurstu.2012.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 07/16/2012] [Accepted: 07/18/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physical restraints are commonly used in psychogeriatric nursing home residents despite reports of negative consequences. Most research has focused on restraint reduction without addressing methods to prevent initiation of restraints in nursing homes. EXBELT has been found to decrease belt restraint use but should also be evaluated for its use in preventing restraints. OBJECTIVE To investigate the effectiveness of the EXBELT intervention to prevent the use of belt restraints on psychogeriatric residents newly admitted to nursing homes. DESIGN Quasi-experimental study design. SETTING Twenty-six nursing home wards from thirteen Dutch nursing homes. PARTICIPANTS Newly admitted residents (n=104) during a four month period. INTERVENTIONS Fifteen wards (intervention group) implemented the EXBELT intervention, which consisted of four components: a policy change, education, consultation and the availability of alternative interventions. METHODS Data on the use of belt restraints, other types of physical restraints, falls and fall-related injuries and psychoactive drug use were collected at T2 (4 months) and T3 (8 months) after baseline (T1) for those resident who were newly admitted after baseline and before T2 (4 months). Physical restraint use data were collected by a trained, blinded observer four times during a 24-h period. RESULTS A total of 104 residents were newly admitted after baseline (T1) and before T2. Of those, 82 were present on T2 and T3. Informed consent was obtained from legal representatives of 49 out of the 82 residents. In the control group (n=20), 15% and 20% used belts at T2 (4 months) and T3 (8 months), respectively. In the intervention group (n=29), these proportions were 3% and 0%, respectively (OR=0.08; 95% CI (0.01-0.76); p=0.03). There was no increase in the intervention group in the use of other physical restraints, falls and fall-related injuries or psychoactive drug use. CONCLUSION The EXBELT intervention effectively seems to prevent the use of belt restraints in newly admitted residents in psychogeriatric nursing homes.
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Affiliation(s)
- Math J M Gulpers
- School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, The Netherlands.
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25
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Chiba Y, Yamamoto-Mitani N, Kawasaki M. A national survey of the use of physical restraint in long-term care hospitals in Japan. J Clin Nurs 2012; 21:1314-26. [PMID: 22300266 DOI: 10.1111/j.1365-2702.2011.03971.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To investigate the prevalence of physical restraints in the long-term care hospitals in Japan and to examine the factors of physical restraint use, including the specific skills/techniques that the staff use to minimise the restraints. Background. Despite the national efforts to nullify physical restraint, it is still prevalent in long-term care facilities in and out of Japan. More detailed information regarding what affects physical restraint is needed. DESIGN Cross-sectional mail survey. METHOD A questionnaire was sent to a nursing ward manager of the random sample of long-term care facilities in Japan. RESULTS The average rate of physical restraint was 25·5%. Altogether, 81·0% of the restrained clients were under restraint for more than one month. The most prevalent method of restraint was bilateral bedrails, followed by the use of coveralls and gloves. Factors of restraint were different depending on the type of restraint, suggesting specific approaches are needed for specific type of restraint. CONCLUSIONS Physical restraint is still prevalent in Japanese long-term care hospitals, and nurses need to develop effective intervention approach to redesigning practice related to physical restraints. Specialised intervention approach seems needed depending on the types of restraint. RELEVANCE TO CLINICAL PRACTICE Specific approach should be developed to minimise the physical restraint in long-term care hospitals in Japan.
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Affiliation(s)
- Yumi Chiba
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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Gulpers MJM, Bleijlevens MHC, Ambergen T, Capezuti E, van Rossum E, Hamers JPH. Belt restraint reduction in nursing homes: effects of a multicomponent intervention program. J Am Geriatr Soc 2011; 59:2029-36. [PMID: 22092189 DOI: 10.1111/j.1532-5415.2011.03662.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To test the effects of a multicomponent intervention program to reduce the use of belt restraints in psychogeriatric nursing homes. DESIGN A quasi-experimental longitudinal design. Study duration was 8 months. SETTING Twenty-six psychogeriatric nursing home wards in 13 Dutch nursing homes were assigned to intervention or control groups. PARTICIPANTS Seven hundred fourteen residents were selected for participation. Legal representatives of 520 residents agreed on participation; complete data are available for 405 residents. INTERVENTION The intervention program included four major components: promotion of institutional policy change that discourages use of belt restraint, nursing home staff education, consultation by a nurse specialist aimed at nursing home staff, and availability of alternative interventions. MEASUREMENTS The primary outcome measure was the frequency of belt restraint use. Secondary outcomes included other types of physical restraints, psychoactive drug use, falls, and fall-related injuries. These data were collected at baseline and after 4 and 8 months. A trained, blinded observer measured the use of belts and other physical restraints types four times during a 24-hour period. RESULTS The intervention resulted in a 50% decrease in belt use (odds ratio = 0.48, 95% confidence interval = 0.28-0.81; P = .005). No increase occurred in the use of other types of restraints. No marked differences between the groups were found regarding psychoactive drugs, falls, and fall-related injuries. CONCLUSION A multicomponent intervention program led to a substantial reduction in use of belts, full-enclosure bedrails, and sleep suits without increasing the use of other physical restraints, psychoactive drugs, or falls and fall-related injuries.
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Affiliation(s)
- Math J M Gulpers
- Department of Health Services Research, Maastricht University, Maastricht, the Netherlands.
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Haut A, Kolbe N, Strupeit S, Mayer H, Meyer G. Attitudes of relatives of nursing home residents toward physical restraints. J Nurs Scholarsh 2011; 42:448-56. [PMID: 21091628 DOI: 10.1111/j.1547-5069.2010.01341.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Attitudes of nursing home staff, residents, and their relatives determine the decision-making process about the use of physical restraints. Knowledge of staffs' attitudes toward physical restraints is sparse; even less is known about relatives' attitudes. Therefore, we surveyed relatives' attitudes and opinions toward physical restraints and compared the results to a survey of nursing home staff. DESIGN Cross-sectional survey comparing 177 nursing home residents' relatives from 13 German facilities in 2008 to 258 nursing home nurses from 25 German facilities in 2007. METHODS The German version of the Maastricht Attitude Questionnaire was administered. Part I contains 22 items with three subscales (reasons, consequences, and appropriateness of restraints); Part II contains 16 items evaluating restrictiveness and discomfort of restraint measures, respectively. Descriptive and explorative inferential statistics were used for data analyses. FINDINGS Response rate in both samples was above 90%. Mean age was 62 years (SD 12.60; range 24-93) in relatives and 44 years (SD 11.40; range 19-65) in nurses; 72% and 82% were female, respectively. Relatives assess physical restraints a little more positively compared to nurses, with an average of 3.40 (SD 0.60) versus 3.07 (SD 0.48) on a 5-point scale (5=strongly positive attitude). Relatives assess physical restraints as slightly less restrictive, with 2.11 (SD 0.33), and as less discomforting, with 2.10 (SD 0.38) points, compared to nursing staff, who assess the restraints' restrictiveness with 2.19 (SD 0.29) points and its discomfort with 2.17 (SD 0.32) on a 3-point scale (3=very restrictive/discomforting). Both groups consider wrist and ankle belts as most restrictive and uncomfortable, while sensor mats, infrared systems, and unilateral bedrails were rated as the lowest for restrictiveness and discomfort. CONCLUSIONS Attitudes of nursing home residents' relatives toward physical restraints are rather positive and generally comparable with nursing home staffs' attitudes. CLINICAL RELEVANCE Interventions aimed to reduce physical restraints need to include education of both staff and relatives of nursing home residents.
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Affiliation(s)
- Antonie Haut
- University of Witten/Herdecke, Faculty of Medicine, Institute of Nursing Science, Stockumer Strasse 12, Witten, Germany
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Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints in long-term geriatric care. Cochrane Database Syst Rev 2011; 2011:CD007546. [PMID: 21328295 PMCID: PMC8978305 DOI: 10.1002/14651858.cd007546.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Physical restraints (PR) are commonly used in geriatric long-term care. Restraint-free care should be the aim of high quality nursing care. OBJECTIVES To evaluate the effectiveness of interventions to prevent and reduce the use of physical restraints in older people who require long-term nursing care (either in community nursing care or in residential care facilities). SEARCH STRATEGY The Cochrane Dementia and Cognitive Improvement Group's Specialized Register, MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, a number of trial registers and grey literature sources were searched on 7 September 2009. The following search terms were used: "physical restraint*", bedrail*, bedchair*, "containment measure*, elderly, "old people", geriatric*, aged, "nursing home*", "care home*", "geriatric care", "residential facilit*". SELECTION CRITERIA Individual or cluster-randomised controlled trials comparing an intervention aimed at reducing the use of physical restraints with usual care in long-term geriatric care settings. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the retrieved articles for relevance and methodological quality and extracted data. Critical appraisal of studies addressed risk of bias through selection bias, performance bias, attrition bias, and detection bias, as well as critera related to cluster designa. We contacted study authors for additional information where necessary. PR were defined heterogeneously throughout the studies. Not all studies offered sufficient data for aggregated data meta-analysis, and therefore study results are presented in a narrative form. MAIN RESULTS Five cluster-randomised controlled studies met the inclusion criteria. All of them investigated educational approaches. Two studies offered consultation in addition and two other studies offered guidance for nursing staff in addition. Four studies examined nursing home residents and one study residents in group dwelling units. No studies in community settings were included. Three studies included only one or two nursing homes per study condition. Overall, methodological quality of studies was low.The studies revealed inconsistent results. One study in the nursing home setting documented an increase of PR use in both groups after eight months, while the other three studies found reduced use of PR in the intervention groups after seven and 12 months of follow up respectively. The single study examining residents in group dwelling units found no change in PR use in the intervention group after six months whereas PR use increased significantly in the control group. AUTHORS' CONCLUSIONS There is insufficient evidence supporting the effectiveness of educational interventions targeting nursing staff for preventing or reducing the use of physical restraints in geriatric long-term care.
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Affiliation(s)
- Ralph Möhler
- Witten/Herdecke UniversityDepartment of Nursing Science, Faculty of HealthStockumer Straße 12WittenGermany58453
| | - Tanja Richter
- University of HamburgUnit of Health Sciences and EducationMartin‐Luther‐King‐Platz 6HamburgGermanyD‐20146
| | - Sascha Köpke
- University of HamburgUnit of Health Sciences and EducationMartin‐Luther‐King‐Platz 6HamburgGermanyD‐20146
| | - Gabriele Meyer
- Witten/Herdecke UniversityDepartment of Nursing Science, Faculty of HealthStockumer Straße 12WittenGermany58453
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Gulpers MJM, Bleijlevens MHC, van Rossum E, Capezuti E, Hamers JPH. Belt restraint reduction in nursing homes: design of a quasi-experimental study. BMC Geriatr 2010; 10:11. [PMID: 20184771 PMCID: PMC2837872 DOI: 10.1186/1471-2318-10-11] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 02/25/2010] [Indexed: 12/05/2022] Open
Abstract
Background The use of physical restraints still is common practice in the nursing home care. Since physical restraints have been shown to be an ineffective and sometimes even hazardous measure, interventions are needed to reduce their usage. Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. However, the success rate of these interventions has been inconsistent. We developed a new multi-component intervention (EXBELT) comprising an educational intervention for nursing home staff in combination with a policy change (belt use is prohibited by the nursing home management), availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes. However, the reduction of belts should not result in an increase of other restrictive restraints (such as a chair with locked tray table) or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes. Methods and design Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement. Furthermore, changing attitudes will become an important addition to the educational part of EXBELT. Discussion A quasi-experimental study is presented to investigate the effects of EXBELT on the use of belts on wards in psychogeriatric nursing homes. The study will be conducted in 26 wards in 13 psychogeriatric nursing homes. We selected the wards in a manner that contamination between control- and intervention group is prevented. Trial registration (NTR2140)
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Affiliation(s)
- Math J M Gulpers
- School for Public Health and Primary Care (Caphri), Department of Health Care and Nursing Science, Maastricht University, Maastricht, the Netherlands.
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Haut A, Köpke S, Gerlach A, Mühlhauser I, Haastert B, Meyer G. Evaluation of an evidence-based guidance on the reduction of physical restraints in nursing homes: a cluster-randomised controlled trial [ISRCTN34974819]. BMC Geriatr 2009; 9:42. [PMID: 19735564 PMCID: PMC2749852 DOI: 10.1186/1471-2318-9-42] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2009] [Accepted: 09/07/2009] [Indexed: 11/11/2022] Open
Abstract
Background Physical restraints are regularly applied in German nursing homes. Their frequency varies substantially between centres. Beneficial effects of physical restraints have not been proven, however, observational studies and case reports suggest various adverse effects. We developed an evidence-based guidance on this topic. The present study evaluates the clinical efficacy and safety of an intervention programme based on this guidance aimed to reduce physical restraints and minimise centre variations. Methods/Design Cluster-randomised controlled trial with nursing homes randomised either to the intervention group or to the control group with standard information. The intervention comprises a structured information programme for nursing staff, information materials for legal guardians and residents' relatives and a one-day training workshop for nominated nurses. A total of 36 nursing home clusters including approximately 3000 residents will be recruited. Each cluster has to fulfil the inclusion criteria of at least 20% prevalence of physical restraints at baseline. The primary endpoint is the number of residents with at least one physical restraint at six months. Secondary outcome measures are the number of falls and fall-related fractures. Discussion If successful, the intervention should be implemented throughout Germany. In case the intervention does not succeed, a three-month pre-post-study with an optimised intervention programme within the control group will follow the randomised trial. Trial registration ISRCTN34974819
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Affiliation(s)
- Antonie Haut
- University of Witten/Herdecke, Faculty for Medicine, Institute of Nursing Science, Stockumer Str. 12, 58453 Witten, Germany.
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Hamers JPH, Meyer G, Köpke S, Lindenmann R, Groven R, Huizing AR. Attitudes of Dutch, German and Swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study. Int J Nurs Stud 2008; 46:248-55. [PMID: 18656876 DOI: 10.1016/j.ijnurstu.2008.06.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/27/2008] [Accepted: 06/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the attitudes of nursing staff towards restraint measures and restraint use in nursing home residents, and to investigate if these attitudes are influenced by country of residence and individual characteristics of nursing staff. METHODS A questionnaire on attitudes regarding restraints (subscales: reasons, consequences, and appropriateness of restraint use) and opinions regarding the restrictiveness of restraint measures and discomfort in using them was distributed to a convenience sample of nursing staff in The Netherlands (n=166), Germany (n=258), and Switzerland (n=184). RESULTS In general, nursing staff held rather neutral opinions regarding the use of physical restraints, but assessed the use of restraints as an appropriate measure in their clinical practice. Gender and age were not related to attitudes of nursing staff, but we did find some differences in attitudes between nursing staff from the different countries. Dutch nursing staff were most positive regarding the reasons of restraint use (p<0.01), but were less positive than German and Swiss nursing staff regarding the appropriateness of restraint use (p<0.01). Swiss nursing staff were less positive than German nursing staff regarding the appropriateness of restraint use (p<0.01). Nursing staff with longer clinical experience showed a more negative attitude towards restraint use than nursing staff with less experience (p<0.05) and charge nurses had the least positive attitude towards restraint use (p<0.05). Opinions regarding restraint measures differed between the three countries. The use of bilateral bedrails was considered as a moderate restrictive measure; the use of belts was rated as the most restrictive measure and nursing staff expressed pronounced discomfort on the use of these measures. CONCLUSIONS Nursing staff from three European countries have different attitudes and opinions regarding the use of physical restraints. The results underline the importance of more tailored, culturally sensitive interventions to reduce physical restraints in nursing homes.
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