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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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2
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Bellenger E, Ibrahim JE, Bugeja L, Kennedy B. Physical restraint deaths in a 13-year national cohort of nursing home residents. Age Ageing 2017; 46:688-693. [PMID: 28049621 DOI: 10.1093/ageing/afw246] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/13/2022] Open
Abstract
Objective this paper aims to investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period. Methods the study comprised a retrospective cohort study of residents dwelling in accredited nursing homes in Australia whose deaths were reported to the Coroners between 1 July 2000 and 30 June 2013 and was attributed to physical restraint. Results five deaths in nursing home residents due to physical restraint were reported in Australia over a 13-year period. The median age of residents was 83 years; all residents had impaired mobility and had restraints applied for falls prevention. Neck compression and entrapment by the restraints was the mechanism of harm in all cases, resulting in restraint asphyxia and mechanical asphyxia, respectively. Conclusions this national study confirms that the use of physical restraint does cause fatalities, although rare. Further research is still needed to identify which alternatives strategies to restraint are most effective, and to examine the reporting system for physical restraint-related deaths.
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Affiliation(s)
- Emma Bellenger
- University of Notre Dame Australia, Darlinghurst Campus, Sydney, New South Wales, Australia
| | - Joseph Elias Ibrahim
- Monash University, Forensic Medicine, Victorian Institute Forensic Medicine, Southbank, Victoria 3006, Australia
| | - Lyndal Bugeja
- Monash University, Department Forensic Medicine, Victorian Institute Forensic Medicine, Southbank, Victoria, Australia
| | - Briohny Kennedy
- Monash University, Forensic Medicine, Victorian Institute Forensic Medicine, Southbank, Victoria 3006, Australia
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Capezuti E, Strumpf N, Evans L, Maislin G. Outcomes of nighttime physical restraint removal for severely impaired nursing home residents. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759901400302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is ample evidence that physical restraint reduction does not lead to increased falls or injuries. This study tests the effect of removing nighttime restraints by comparing two groups: Restrained in bed at pre- but not postintervention (n = 51), or restrained in bed at both pre- and post-intervention (n = 11). No differences in nighttime fall rates between the two groups were detected. Nighttime physical restraint removal does not lead to increases in falls from bed in older nursing home residents. Although markedly reduced in nursing homes, restraint use remains a common practice among hospitalized older adults. We should continue to focus efforts on developing new, individualized approaches to reduce risk of falling from bed among frail elders.
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Affiliation(s)
| | | | | | - Greg Maislin
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
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4
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The effect of a restraint reduction program on physical restraint rates in rehabilitation settings in Hong Kong. Rehabil Res Pract 2011; 2011:284604. [PMID: 22110972 PMCID: PMC3195393 DOI: 10.1155/2011/284604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 07/04/2011] [Accepted: 07/05/2011] [Indexed: 11/18/2022] Open
Abstract
Background. In view of the adverse effects of using restraints, studies examining the use of restraint reduction programs (RRPs) are needed. Objectives. To investigate the effect of an RRP on the reduction of physical restraint rates in rehabilitation hospitals. Methods. A prospective quasi-experimental clinical trial was conducted. Demographic data, medical and health-related information on recruited patients from two rehabilitation hospitals, as well as facility data on restraint rates were collected. Results. The increase in the restraint rate in the control site was 4.3 times greater than that in the intervention site. Changes in the restraint mode, from continuous to intermittent, and the type of restraint used were found between the pre- and postintervention periods in both the control site and the intervention site. Discussion. Compared with that in the control site, the RRP in the intervention site helped arrest any increase in the restraint rate although it had no effect on physical restraint reduction. The shift of restraint mode from continuous to intermittent in the intervention site was one of the positive outcomes of the RRP.
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5
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Luo H, Lin M, Castle N. Physical restraint use and falls in nursing homes: a comparison between residents with and without dementia. Am J Alzheimers Dis Other Demen 2011; 26:44-50. [PMID: 21282277 PMCID: PMC10845417 DOI: 10.1177/1533317510387585] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To estimate the use of different types of physical restraints and assess their associations to falls and injuries among residents with and without Alzheimer's disease (AD) or dementia in US nursing homes. METHODS Data were from the 2004 National Nursing Home Survey. AD or dementia was identified using International Classification of Diseases, Ninth Revision (ICD-9) codes. Analyses were conducted with the Surveyfreq and Surveylogistic procedures in SAS v.9.1. RESULTS Residents with either AD or dementia were more likely to be physically restrained (9.99% vs 3.91%, P < .001) and less likely to have bed rails (35.06% vs 38.43%, P < .001) than those residents without the disease. The use of trunk restraints was associated with higher risk for falls (adjusted odds ratio [AOR] = 1.66, P < .001) and fractures (AOR = 2.77, P < .01) among residents with the disease. The use of full bed rails was associated with lower risk for falls among residents with and without the disease (AOR = 0.67 and AOR = 0.72, Ps < .05, respectively). CONCLUSIONS The use of a trunk restraint is associated with a higher risk for falls and fractures among residents with either AD or dementia.
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Affiliation(s)
- Huabin Luo
- Department of Health Care Management, Mount Olive College, NC, USA.
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6
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Galik EM, Resnick B, Pretzer-Aboff I. 'Knowing what makes them tick': motivating cognitively impaired older adults to participate in restorative care. Int J Nurs Pract 2009; 15:48-55. [PMID: 19187169 DOI: 10.1111/j.1440-172x.2008.01721.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nursing home residents with dementia represent a majority of the most functionally impaired individuals residing in nursing homes. Although many perceive this population as having little restorative potential, maintaining resident functional abilities for as long as possible helps to optimize quality of life and decrease caregiver burden. This study used a qualitative design with a focus group methodology to explore facilitators and barriers to engaging cognitively impaired residents in functional activities and exercise. A purposive sample of seven geriatric nursing assistants who were experts in dementia care participated in the study. Twenty-seven codes were reduced to three themes: (i) knowing what makes them tick and move; (ii) teamwork and utilizing resources; and (iii) barriers to restorative care. The study findings were used to revise the Restorative Care for the Cognitively Impaired Intervention and could direct future implementation of programmes in nursing home settings.
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Affiliation(s)
- Elizabeth M Galik
- University of Maryland School of Nursing, Baltimore, Maryland 21201, USA.
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Fariña-López E, Estévez-Guerra GJ, Núñez González E, Montilla Fernández M, Santana Santana E. [Descriptive study of the attitudes of family caregivers to the use of physical restraints: preliminary results]. Rev Esp Geriatr Gerontol 2008; 43:201-207. [PMID: 18682140 DOI: 10.1016/s0211-139x(08)71183-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate the attitudes of families caring for elderly dependents to the use of physical restraints and to identify the factors that could influence these attitudes. MATERIAL AND METHODS A descriptive, cross sectional study was carried out in a consecutive sample of the population, using a questionnaire investigating the various aspects that influence attitudes to restraints. Responses were obtained from 50 family caregivers, of which seven were discarded due to lack of knowledge about restraints (N=43). The characteristics of the sample, frequencies, the main trends and dispersion measures were analyzed. RESULTS Most of the family caregivers considered the use of restrains to be appropriate and 90.7% were willing to use them with a relative; 41.9% believed that their use was unavoidable and were unaware of alternatives, while 23.3% were unaware that physical restraints can cause physical and psychological problems. None of the family caregivers believed that this method of restraint was a form of abuse. CONCLUSIONS Relatives had a positive attitude to physical restraints and considered their use appropriate. This finding could be related to their limited knowledge of alternatives and of the complications that can be caused by restraints. Training programmes on alternatives to these devices should be instigated.
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Affiliation(s)
- Emilio Fariña-López
- Departamento de Enfermería, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España.
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Wagner LM, Capezuti E, Brush BL, Clevenger C, Boltz M, Renz S. Contractures in Frail Nursing Home Residents. Geriatr Nurs 2008; 29:259-66. [DOI: 10.1016/j.gerinurse.2007.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Revised: 09/12/2007] [Accepted: 09/15/2007] [Indexed: 10/21/2022]
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Capezuti E, Wagner L, Brush BL, Boltz M, Renz S, Secic M. Bed and Toilet Height as Potential Environmental Risk Factors. Clin Nurs Res 2008; 17:50-66. [DOI: 10.1177/1054773807311408] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Seat height that is too high (> 120% of lower leg length [LLL]) or too low (< 80% of LLL) can impede safe transfer and result in falls. This study examines the difference between LLL of frail nursing home residents and the height of their toilets and beds in the lowest position, compares the patient or environmental characteristics of those able to transfer from the bed or toilet to those who cannot, and determines the relationship of patient or environmental characteristics to bed-related falls. A retrospective observational design using secondary data from 263 nursing home residents finds that bed height of three fourths of participants was greater than 140% of LLL, whereas toilet height of more than half was 100% to 120% of LLL. Increased fall risk is associated with increased age, shorter length of stay, normal lower extremity range of motion, less cognitive impairment, more behavioral symptoms, and no complaints of pain during exam.
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Affiliation(s)
| | - Laura Wagner
- Baycrest Centre for Geriatric Care, Toronto, Ontario,
Canada
| | | | - Marie Boltz
- New York University College of Nursing, New York
| | - Susan Renz
- RS Connection, Inc., West Chester, Pennsylvania
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10
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Wagner LM, Capezuti E, Brush B, Boltz M, Renz S, Talerico KA. Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes. Res Nurs Health 2007; 30:131-40. [PMID: 17380514 DOI: 10.1002/nur.20185] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Researchers have demonstrated that the use of physical restraints in nursing homes can be reduced, particularly where advanced practice nurses (APNs) are utilized. We examined the link between APN practice, siderail reduction, and the costs of siderail alternatives in 273 residents in four Philadelphia nursing homes. The majority of participants were cognitively and physically impaired with multiple co-morbidities. APNs recommended a total of 1,275 siderail-alternative interventions aimed at reducing fall risk. The median cost of siderail alternatives to prevent falls per resident was $135. Residents with a fall history experienced a significantly higher cost of recommendation compared to non-fallers. Findings suggest that an APN consultation model can effectively be implemented through comprehensive, individualized assessment without incurring substantial costs to the nursing home.
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Affiliation(s)
- Laura M Wagner
- Baycrest Centre for Geriatric Care, Kunin-Lunenfeld Applied Research Unit, 3560 Bathurst Street, Toronto, Ontario, Canada M6A 2E1.
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11
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Capezuti E, Wagner LM, Brush BL, Boltz M, Renz S, Talerico KA. Consequences of an intervention to reduce restrictive side rail use in nursing homes. J Am Geriatr Soc 2007; 55:334-41. [PMID: 17341234 DOI: 10.1111/j.1532-5415.2007.01082.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the effect of an advanced practice nurse (APN) intervention on restrictive side rail usage in four nursing homes and with a sample of 251 residents. A secondary question explored the association between restrictive side rail reduction and bed-related falls. DESIGN Pre- and posttest design. SETTING Four urban nursing homes. PARTICIPANTS All nursing home residents present in the nursing home at three time points (n=710, 719, and 707) and a subset of residents (n=251) with restrictive side rail use at baseline. INTERVENTION APN consultation with individual residents and facility-wide education and consultation. MEASUREMENTS Direct observation of side rail status, resident and nurse interview for functional status, mobility, cognition, behavioral symptoms, medical record review for demographics and treatment information, and incident reports for fall data. RESULTS At the institutional level, one of the four nursing homes significantly reduced restrictive side rail use (P=.01). At the individual participant level, 51.4% (n=130) reduced restrictive side rail use. For the group that reduced restrictive side rails, there was a significantly (P<.001) reduced fall rate (-0.053; 95% confidence interval (CI)=-0.083 to -0.024), whereas the group that continued restrictive side rail did not demonstrate a significantly (P=.17) reduced fall rate (-0.013; 95% CI=-0.056-0.030). CONCLUSION An APN consultation model can safely reduce side rail use. Restrictive side rail reduction does not lead to an increase in bed-related falls. Although side rails serve many purposes, routine use of these devices to restrict voluntary movement and prevent falls is not supported.
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Affiliation(s)
- Elizabeth Capezuti
- John A. Hartford Foundation Institute for Geriatric Nursing, New York University College of Nursing, New York, New York 10003, USA.
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12
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Harvath TA, Beck C, Flaherty-Robb M, Hartz CH, Specht J, Sullivan-Marx E, Archbold P. Best practice initiatives in geriatric nursing: Experiences from the John A. Hartford Foundation Centers of Geriatric Nursing Excellence. Nurs Outlook 2006; 54:212-8. [PMID: 16890040 DOI: 10.1016/j.outlook.2006.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2006] [Indexed: 11/22/2022]
Affiliation(s)
- Theresa A Harvath
- Oregon Health & Science University, School of Nursing, Portland, OR 97239-2941, USA.
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13
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Abstract
The authors describe an original patient Safety Platform Model. The model identifies the broad components involved in patient safety initiatives and outlines their relationship to one another. A case example of how the model can be used is given as the authors describe a falls-prevention program.
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Affiliation(s)
- Nancy Kruger
- Patient Care Services, Brigham and Women's Hospital, Boston, Mass, USA
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14
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Capezuti E. Minimizing the use of restrictive devices in dementia patients at risk for falling. Nurs Clin North Am 2004; 39:625-47. [PMID: 15331306 DOI: 10.1016/j.cnur.2004.02.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The accumulating empirical evidence demonstrates that restrictive devices can be removed without negative consequences. Most importantly, use of nonrestrictive measures has been correlated with positive patient outcomes and represents care that is dignified and safe for confused elders. Most of these nonrestrictive approaches promote mobility and functional recovery; however, testing of individual interventions is needed to further the science. As the research regarding restrictive devices has been translated into professional guidelines and regulatory standards, the prevalence of usage has declined dramatically. New institutional models of care discouraging routine use of restrictive devices also will foster innovative solutions to clinical problems associated with dementia.
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Affiliation(s)
- Elizabeth Capezuti
- John A. Hartford Foundation Institute for Geriatric Nursing, Division of Nursing, Steinhardt School of Education, New York University, 246 Greene Street, 6th Floor, New York, NY 10003-6677, USA.
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15
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Hoffman SB, Powell-Cope G, MacClellan L, Bero K. BedSAFE: A Bed Safety Project for Frail Older Adults. J Gerontol Nurs 2003; 29:34-42. [PMID: 14619316 DOI: 10.3928/0098-9134-20031101-09] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In response to heightened awareness of patient safety, restraint reduction, and the potential for life-threatening entrapment caused by bed rails, a quality improvement program entitled BedSAFE was conducted to systematically and safely decrease the use of bed rails in three nursing home care units. This article describes an interdisciplinary process of individualized patient assessment, selection of appropriate alternatives for residents, compliance monitoring, training, and monitoring of patient outcomes including falls and injuries related to falls from bed.
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Affiliation(s)
- Stephanie B Hoffman
- Interprofessional Team Training and Development, James A. Haley Veterans' Hospital (11J), 13000 Bruce B. Downs Blvd., Tampa, FL 32612, USA
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16
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Bower FL, McCullough CS, Timmons ME. A synthesis of what we know about the use of physical restraints and seclusion with patients in psychiatric and acute care settings: 2003 update. Worldviews Evid Based Nurs 2003; 10:1. [PMID: 12800050 DOI: 10.1111/j.1524-475x.2003.00001.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This article is an update of the January 19, 2000, Volume 7, Number 2 article of the synthesis of research findings on the use of restraint and seclusion with patients in psychiatric and acute care settings. CONCLUSIONS The little that is known about restraint/seclusion use with these populations is inconsistent. Attitudes and perceptions of patients, family, and staff differ. However, all patients had very negative feelings about both, whether they were restrained/secluded or observed by others who were not restrained. The reasons for restraint/seclusion use vary with no accurate use rate for either. What precipitates the use of restraint/seclusion also varies, but professionals claim they are necessary to prevent/treat violent or unruly behavior. Some believe seclusion/restraint is effective, but there is no empirical evidence to support this belief. Many less restrictive alternatives have been tested with varying outcomes. Several educational programs to help staff learn about different ways to handle violent/confused patients have been successful. IMPLICATIONS Until more is known about restraint/seclusion use from prospective controlled research, the goal to use least restrictive methods must be pursued. More staff educational programs must be offered and the evaluation of alternatives to restraint/seclusion pursued. When seclusion/restraint is necessary, it should be used less arbitrarily, less frequently, and with less trauma. As the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Health Care Financing Administration (HCFA) have prescribed, "Seclusion and restraint must be a last resort, emergency response to a crisis situation that presents imminent risk of harm to the patient, staff, or others" (p. 25) [99A].
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Affiliation(s)
- Fay L Bower
- Department of Nursing at Holy Names College.
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Gallinagh R, Nevin R, Mc Ilroy D, Mitchell F, Campbell L, Ludwick R, McKenna H. The use of physical restraints as a safety measure in the care of older people in four rehabilitation wards: findings from an exploratory study. Int J Nurs Stud 2002; 39:147-56. [PMID: 11755445 DOI: 10.1016/s0020-7489(01)00020-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We investigated the prevalence and type of physical restraint used with older persons on four rehabilitation wards in Northern Ireland. A longitudinal observational approach was used. One hundred and two patients were observed on four occasions over a three-day period. Most of the patients (68%) were subjected to some form of physical restraint, side-rails being the most commonly observed method. Those who were restrained were dependent on nursing care to meet their needs and received more drugs than those whose mobility was not restricted. No association was found between restraint use and nursing staffing levels, nor was there any association with the incidence of falls. Nurses rationalised their use of restraint as being linked to wandering and patient protection in cases of confusional type behaviours. An association was found between stroke and the maintenance of positional support through the use of restraints (side-rails and screw-on tabletops). Approximately, one-third of those restrained had this noted in their care plans, with concomitant evidence of patient/family involvement in the restraining decision.
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Affiliation(s)
- Róisín Gallinagh
- School of Health Sciences, United Hospitals and School of Health Sciences, University of Ulster, Jordanstown, BT37 0QB, Northern Ireland, UK.
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18
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Capezuti E, Maislin G, Strumpf N, Evans LK. Side rail use and bed-related fall outcomes among nursing home residents. J Am Geriatr Soc 2002; 50:90-6. [PMID: 12028252 DOI: 10.1046/j.1532-5415.2002.50013.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To analyze the effect of physical restraint reduction on nighttime side rail use and to examine the relationship between bilateral side rail use and bed-related falls/injuries among nursing home residents. DESIGN Secondary analysis of data collected in a longitudinal, prospective clinical trial designed to reduce restraint use. SETTING Three nonprofit nursing homes. PARTICIPANTS To examine the first question regarding the effect of physical restraint reduction on side rail usage, we included all nursing home residents who survived a 1-year data collection period (n = 463). To answer the second research question concerning the relationship between side rail status and bed-related falls, subjects' side rail status for each of the four data collection periods was compared. The sample for this analysis includes only those with consistent side rail status (n = 319) for the four observations periods: either 0/1 side rail (n = 188) or 2 (bilateral) side rails (n = 131). MEASUREMENTS Side rail and restraint status was directly observed by two research assistants, twice each night shift (10 p.m.-6 a.m.) for three nights at each of four data collection points. Nighttime fall-related outcome data were obtained from a review of nursing home incident reports during the entire 1-year data collection period (T1 through T4). Cognitive status was measured using the Folstein Mini-Mental State Examination. Functional and behavioral status was obtained using subscales of the Psychogeriatric Dependency Rating Scale. RESULTS Over a 1-year period, there was an increase in the proportion of bilateral side rail use for all three nursing homes. Based on the multiple logistic regression analysis, there was no indication of a decreased risk of falls or recurrent falls with bilateral side rail use, controlling for cognition and functional and behavioral status (adjusted odds ratio (AOR) = 1.13, 95% confidence interval (CI) = 0.45,2.03). Similarly, bilateral side rail use did not reduce the risk of recurrent falls, controlling for cognition and functional status (AOR = 1.25, 95% CI = 0.33,4.67). CONCLUSION Despite high usage of bilateral side rails, they do not appear to significantly reduce the likelihood of falls, recurrent falls, or serious injuries. Bed-related falls remain clinically challenging. The data from this study, coupled with increasing reports of side rail-related injuries and deaths, compel us to seek and empirically test alternative interventions to prevent bed-related falls.
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Affiliation(s)
- Elizabeth Capezuti
- School of Nursing and the Emory Center for Health in Aging, Emory University, Atlanta, GA 30329, USA
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19
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Gallinagh R, Nevin R, McAleese L, Campbell L. Perceptions of older people who have experienced physical restraint. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2001; 10:852-9. [PMID: 11927885 DOI: 10.12968/bjon.2001.10.13.852] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/01/2001] [Indexed: 11/11/2022]
Abstract
It is well documented that the use of physical restraints on older people has been linked to negative clinical outcomes. However, less is known about the personal perspective of those who have been restrained. This study examines the perceptions of older people who have experienced physical restraints in a rehabilitation ward. A purposive sample was used of 17 male and female patients who were restrained. The patients were interviewed using the Subjective Experience of Being Restrained instrument (Strumpf and Evans, 1988) which is a semi-structured interview schedule. The most commonly used restraint devices included side rails, screw-on tabletops and reclining chairs. The data were analysed using content analysis. The results indicate mixed feelings regarding physical restraints. Patients' impressions of physical restraints included indifference of the devices to their perceived safety value. Overall, a minority of patients (n = 4) had positive feelings about physical restraints as they provided a sense of security to them. However, the negative comments of the patients were more prevalent and their responses were categorized in terms of institutional control, ritualised care, entrapment and discomfort, and possible alternatives.
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Affiliation(s)
- R Gallinagh
- University of Ulster, Jordanstown and United Hospitals, Antrim, Northern Ireland
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20
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Affiliation(s)
- K A Talerico
- Department of Population-Based Nursing, Oregon Health and Sciences University, Portland, USA
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21
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Gallinagh R, Nevin R, Campbell L, Mitchell F, Ludwick R. Relatives' perceptions of side rail use on the older person in hospital. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2001; 10:391-2, 394, 396-9. [PMID: 12070368 DOI: 10.12968/bjon.2001.10.6.5349] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2001] [Indexed: 11/11/2022]
Abstract
With an increasing emphasis on improving standards in the care of older people, the use of physical restraints has received growing attention in the nursing literature. Physical restraint use has been likened to abuse as it impedes the movement of a person, encourages dependence on staff and denies autonomy. Side rails (cot sides, bed rails) can be considered as a physical restrain device. The therapeutic use of restraint has not previously been adequately explained. Furthermore, there is a dearth of literature examining the personal experience of physical restraint use. The Family Interview Guide (Strumpf and Evans, 1988) was used to explore perceptions of nine relatives whose family had side rails used during their care in an older person ward. The findings of the study suggest that while families place value on the perceived safety function of side rails, they nonetheless have worries about their use. These pertain to the risk of patient entrapment and possible injury. Patients' relatives associated side rails with ritualized practice in gerontology and make suggestions for the re-design of side rails. The study also highlights the potential for increased family participation in the decision to use side rails.
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Affiliation(s)
- R Gallinagh
- University of Ulster and United Hospitals, Antrim, Northern Ireland
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Bower FL, McCullough CS, Timmons ME. A Synthesis of What We Know About the Use of Physical Restraints and Seclusion with Patients in Psychiatric and Acute Care Settings. Worldviews Evid Based Nurs 2000. [DOI: 10.1111/j.1524-475x.2000.00022.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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