Culture and the use of patient restraints

Prevalence and variability in use of physical and chemical restraints in residential aged care facilities: A systematic review and meta-analysis

BACKGROUND

Use of physical and chemical restraints are common in residential aged care facilities worldwide. Restraint use can pose harm to residents even causing deaths.

OBJECTIVE

To synthesize the prevalence and variability in physical and chemical restraint use, and examine factors that may contribute to this variability of prevalence rates.

METHODS

Six health science databases were searched from inception up to 21st January 2020. Quantitative studies investigating restraint use in residential aged care facilities that reported data from year 2000 onwards were included. Meta-analyses of binomial data using a random effect model were performed to pool proportions of physical or chemical restraints with 95% confidence intervals. Univariable meta-regression analyses were used to assess factors that may contribute to the variability in physical and chemical restraint prevalence. Multiple meta-regression analyses were performed where possible to construct models of factors contributing to these variations.

RESULTS

Eighty-five papers were included. The pooled proportion of physical and chemical restraint use in residential aged care facilities were 33% and 32% respectively. Bedrails (44%) and benzodiazepines (42%) were the most prevalent forms of physical and chemical restraint respectively. Studies from North America (lower prevalence) [coefficient (95% CI): -0.15 (-0.27, -0.03)], measurement approaches using direct observation (higher prevalence) [0.17 (0.02, 0.33)] and a combination of multiple measurement approaches (higher prevalence) [0.17 (0.05, 0.29)] explained 25.5% of variability in the prevalence of physical restraint. Multiple meta-regression analyses were not performed to identify factors that may explain the observed variability in chemical restraint prevalence due to the small number of studies with data available.

CONCLUSION

Variability in prevalence of physical restraint could be explained partly by different measurement approaches and geographical regions. Valid and reliable measurement approaches across different regions is required to understand cultural differences due to geographical region effects on the prevalence of physical restraint use.

[Descriptive study of the attitudes of family caregivers to the use of physical restraints: preliminary results]

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.

Perceptions regarding the use of physical restraints with elderly persons: comparison of Israeli health care nurses and social workers

In view of the difficulty involved in decision-making regarding the use or removal of physical restraints and the recent pattern encouraging the use of interdisciplinary teams for elder care issues, the present study compared the perceptions of Israeli nurses and social workers in health care settings regarding the use of physical restraints. Data were collected from a convenience sample of 50 nurses and 69 social workers working in long-term and acute care settings. The findings indicated that participants in all professions attributed moderate to low importance towards the use of physical restraints. Social workers' perceptions were similar to those of nurses in psychiatric hospitals and slightly more favourable to the use of physical restraints than those of nurses in nursing homes. Patients' safety (as reflected in the scores of the items related to protecting an older person from falling and protecting an older person from pulling out a catheter) was the most important reason for using physical restraints for both groups. Increased attention should be given to the role of social workers as team members in the process of decision-making regarding the use or removal of physical restraints, especially as mediators between the elderly person, family members and staff members.