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Singh A, Gupta I, Wright SM, Harris CM. Outcomes among hospitalized patients with dementia and behavioral disturbances when physical restraints are introduced. J Am Geriatr Soc 2023; 71:2886-2892. [PMID: 37235512 DOI: 10.1111/jgs.18422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/07/2023] [Accepted: 05/14/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Physical restraint use among patients hospitalized with dementia and behavioral disturbances has not been studied nationally in the United States. METHODS National Inpatient Sample database years 2016 through 2020 were used to compare physically restrained and unrestrained patients with dementia and behavioral disturbances. Multivariable regression analyses were used to assess patient outcomes. RESULTS There were 991,605 patients coded for dementia with behavioral disturbances. Among these, physical restraints were used with 64,390 (6.5%) and not with 927,215 (93.5%). Patients in the restrained group were younger (mean age ± standard error: 78.7 ± 0.25 vs. 79.9 ± 0.34 ; p < 0.01) and more often male (59.0% vs. 45.8%; p < 0.01) compared to the unrestrained group. A higher proportion of Black patients were in the restrained group (15.2% vs. 11.8%; p < 0.01). Larger hospitals also made up a more significant proportion of restrained versus unrestrained patients (53.3% vs. 45.1%; p < 0.01). Those with physical restraints had longer lengths of stays (adjusted mean difference [aMD] = 2.6 days CI [2.2-3.0]; p < 0.01) and higher total hospital charges (aMD = $13,150 CI [10,827-15,472]; p < 0.01). There were similar adjusted odds for in-hospital mortality (adjusted odds ratio [aOR] = 1.0 [CI 0.95-1.1]; p = 0.28) and lower odds of being discharged to home after hospitalization (aOR = 0.74 [0.70-0.79]; <0.01) for patients with physical restraints compared to those without. CONCLUSION Among patients hospitalized with dementia and behavioral disturbances, those with physical restraints had greater hospital resource utilization outcomes. Attempts to limit physical restraint use whenever possible may improve outcomes in this vulnerable population.
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Affiliation(s)
- Amteshwar Singh
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Ishaan Gupta
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Scott Mitchell Wright
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Che Matthew Harris
- Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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Okumura Y, Sakata N, Ogawa A. Association of physical restraint duration and undesirable outcomes amongst inpatients comorbid with dementia and pneumonia in acute care settings. J Clin Nurs 2023; 32:6394-6402. [PMID: 36808667 DOI: 10.1111/jocn.16643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/17/2022] [Accepted: 01/20/2023] [Indexed: 02/22/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to examine the association between physical restraint duration and undesirable outcomes amongst inpatients comorbid with dementia and pneumonia in acute care hospitals. BACKGROUND Physical restraints are frequently used in the management of patients, especially amongst patients with dementia. No previous study investigated the potential undesirable effects of physical restraints in patients with dementia. METHODS This was a cohort study using a nationwide discharge abstract database in Japan. Patients aged ≥65 years with dementia hospitalised for pneumonia or aspiration pneumonia between April 1, 2016 and March 31, 2019 were identified. The exposure was physical restraint. The primary outcome was hospital discharge to the community. Secondary outcomes included hospitalisation costs, functional decline, in-hospital mortality, and institutionalisation for long-term care. RESULTS A total of 18,255 inpatients with pneumonia and dementia in 307 hospitals were included in this study. Of them, 21.5% and 23.7% had physical restraint during full and partial days of hospital stays, respectively. Discharge to the community incidence rates was lower in the full-restraint vs. the no-restraint group (27 vs. 29 per 1000 person-days; HR, 1.05 [95% CI, 1.01-1.10]) and the partial-restraint vs. the no-restraint group (17 vs. 29 per 1000 person-days; HR, 1.79 [95% CI, 1.71-1.87]). The risks of functional decline were higher in the full-restraint vs. the no-restraint group (27.8% vs. 20.8%; RR, 1.33 [95% CI, 1.22, 1.46]) and the partial-restraint vs. the no-restraint group (29.2% vs. 20.8%; RR, 1.40 [95% CI, 1.29, 1.53]). CONCLUSIONS The use of physical restraints was associated with a lower incidence rate of discharge to the community and an increased risk of functional decline at discharge. Further research is needed to judge the benefit-risk balance of physical restraints in acute care settings. RELEVANCE TO CLINICAL PRACTICE Understanding the risk of physical restraints allows medical staff to improve the process of decision making in everyday practice. No Patient or Public Contribution. REPORTING METHODS The reporting of this article conforms to the STROBE statement.
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Affiliation(s)
| | - Nobuo Sakata
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Department of Home Care Medicine, Setagaya Memorial Hospital, Tokyo, Japan
| | - Asao Ogawa
- Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan
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Ertuğrul B, Özden D. Physical Restraint Experiences of Family Caregivers of Patients With Stroke in Turkey: A Qualitative Study. Clin Nurs Res 2023; 32:499-509. [PMID: 36028990 DOI: 10.1177/10547738221115229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to explore the experiences and needs of family caregivers of stroke patients who require physical restraints. The themes and sub-themes that emerged included "the reason for the use of PR" (disruptive behaviors of the patient and personal reasons of caregivers), "the turmoil of having to use PR" (inevitableness, comparing benefits and harms, the emotional effect of PR, and physical effects), and "unmet needs and suggestions" (unmeet needs and suggestions). Nurses should take the experiences of patient relatives into account in the process of PR application, organize training programs, and determine application standards for PR.
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Prevalence, Risk Factors and Outcomes Associated with Physical Restraint in Acute Medical Inpatients over 4 Years-A Retrospective Cohort Study. Geriatrics (Basel) 2023; 8:geriatrics8010015. [PMID: 36826357 PMCID: PMC9957493 DOI: 10.3390/geriatrics8010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Physical restraints are frequently used in acute care hospitals. Their application is associated with negative outcomes, while their intended preventive effect is debated. OBJECTIVES To determine the prevalence of physical restraints and associated outcomes on medical wards in a tertiary care hospital. METHODS Retrospective cohort study (January 2018 to December 2021). We included all adult medical in-patients and excluded patients with admission to the intensive care unit, short stays (length of stay (LOS) < 48 h), and patients declining informed consent. RESULTS Of 11,979 admissions, the prevalence of patients with at least one restraint was 6.4% (n = 772). Sensor mats were used most frequently (73.0%, n = 666), followed by blanket restrictions (14.5%, n = 132), bedrails (8.8%, n = 80) and belts (3.7%, n = 34). On average, restraints were applied 19 h (standard deviation (SD) ± 161) before a fall. Average restraint duration was 42 h (SD ± 57). Patients with a restraint had longer LOS 8 days (IQR 5-14) vs. 5 days (IQR 3-9). Median nurses' time expenditure was 309 h (IQR 242-402) vs. 182 h (IQR 136-243) for non-restrained patients. Patients with restraints fell more often (22.5% vs. 2.7%) and were more likely to die (13.3% vs. 5.1%). These differences persisted after adjusting a regression model for important clinical confounders. We saw a decline in the duration of restraints over the years, but no variation between wards. CONCLUSION Approximately 6% of medical patients, mostly older and severely ill, were affected by restraint use. For the first time, we report data over 4 years up to ward-level granularity.
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Gottschalk S, Meyer G, Haastert B, Abraham J. Prevention of physical restraints in the acute care setting (PROTECT): study protocol for a cluster-randomised controlled pilot study. BMJ Open 2023; 13:e066291. [PMID: 36592997 PMCID: PMC9809259 DOI: 10.1136/bmjopen-2022-066291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Physical restraints (PR) are regularly used in acute care settings, although evidence for their effectiveness and safety (eg, for prevention of falls) is lacking. Their use is associated with adverse events, such as decreased mobility and injuries for patients. We developed a complex intervention to prevent PR in acute care settings according to the UK Medical Research Council Framework, and investigated the feasibility. The intervention comprised the qualification of key nurses as multipliers and a short interprofessional information session. The intervention has proven to be feasible. It also became apparent that further development of the intervention and the study procedures is necessary. Therefore, this study aims to refine and pilot the complex intervention. Furthermore, the objective of this pilot study is to improve study procedures. METHODS AND ANALYSIS In a preparatory phase, we will conduct focus groups and individual interviews with the target groups to explore the possibilities for adaption of the intervention and implementation strategies. Subsequently, a cluster-randomised controlled trial with a 6-month follow-up period will be conducted. It is planned to recruit eight general hospitals in Germany (area of Halle (Saale) and Leipzig) with 28 wards and 924 patients per observation period (2772 overall). Primary outcome is the proportion of patients with at least one PR after 6 months. Data will be collected by direct observation over a period of seven consecutive days and three times a day. Secondary outcomes are falls, interruptions in therapy and prescription of psychotropic medication. A comprehensive process evaluation will accompany the study. ETHICS AND DISSEMINATION The Ethics committee of the Medical Faculty of the University of Halle (Saale) approved the study protocol. Results will be published in a peer-reviewed journal and presented at conferences. Study information and additional material will be freely available on an already existing website. TRIAL REGISTRATION NUMBER DRKS00027989.
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Affiliation(s)
- Susan Gottschalk
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | | | - Jens Abraham
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
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Northcott A, Boddington P, Featherstone K. Pad cultures: An ethnography of continence care and its consequences for people living with dementia during a hospital admission. DEMENTIA 2022; 21:2191-2209. [PMID: 35861583 PMCID: PMC9483683 DOI: 10.1177/14713012221116490] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is little research examining how continence care is organised and delivered to people living with dementia across an acute hospital admission, despite the prevalence of this patient population and their vulnerability within these settings. OBJECTIVE To explore how continence care is delivered to people living with dementia during an acute hospital admission. DESIGN Ethnographic. SETTING(S) Acute medical units and wards within three hospitals across England and Wales. PARTICIPANTS People living with dementia and ward staff (registered nurses and care assistants) on participating wards. METHODS Ethnographic fieldwork collected over a period of 12 months (180 days of non-participant observation) focussing on the organisation and delivery of continence care to people living with dementia. Observations were supported with in situ ethnographic interviews (n = 562) with patients, visitors and staff within the six observed wards. Data collection and analysis drew on the theoretical sampling and constant comparison techniques of grounded theory. RESULTS The findings comprised of five overall themes: (1) visibility of continence; (2) rationales of continence care; (3) containment and contagion; (4) consequences of continence care and (5) supporting continence. CONCLUSIONS We introduce the term 'pad cultures' to refer to the established routine use of continence pads in the care of a wider group of people living with dementia (regardless of continence status and independence), with the rationale to provide safeguards, ensure containment and prevent 'accidents' or incontinent episodes. There was an expectation within acute wards that people living with dementia not only wear continence pads but that they also use them.
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Affiliation(s)
| | | | - Katie Featherstone
- Geller Institute of Ageing and Memory, 7364University of West London, Ealing, London, UK
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KILIÇ G, POLAT Ü. Yoğun Bakım Hemşirelerinin Yaşlılara Yönelik Tutumları ile Fiziksel Tespit Edici Kullanımları Arasındaki İlişki. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.953286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Yoğun bakım hemşirelerinin yaşlılara yönelik tutumları ile fiziksel tespit edici kullanımına ilişkin bilgi, tutum ve uygulamaları arasındaki ilişkiyi belirlemek.
Yöntem: Araştırma, kesitsel tipte olup, şubat-nisan 2016 tarihleri arasında iki üniversite hastanesi ve bir özel hastanenin yoğun bakım ünitelerinde çalışan 107 hemşire ile yapılmıştır. Araştırmada veriler, 'Anket Formu', ‘Hemşirelerin Fiziksel Tespit Edici Kullanımına İlişkin Bilgi Düzeyi, Tutum ve Uygulamaları Ölçeği’ ile 'Yaşlı Ayrımcılığı Tutum Ölçeği (YATÖ)' kullanılarak toplanmıştır.
Bulgular: Yoğun bakım hemşirelerin fiziksel tespit kullanımına ilişkin bilgi puan ortalaması 7.22±1.59, tutum puan ortalaması 31.60±5.80, uygulama puan ortalaması 37.64±2.99 olarak bulunmuştur. Yoğun bakım hemşirelerinin YATÖ toplam puan ortalaması 86.13±9.44 olarak bulundu. Hemşirelerin fiziksel tespit kullanımına ilişkin bilgi düzeyi, tutum ve uygulamaları ile yaşlılara yönelik tutumları arasında istatistiksel olarak anlamlı ilişki bulunmadı(p>0.05).
Tartışma ve Sonuç: Hemşirelerin fiziksel tespit edici kullanımına ilişkin bilgi düzeylerinin iyi, tutumlarının olumlu ve uygulamalarının yeterli düzeyde olduğu ve yaşlılara yönelik tutumlarının ise olumlu olduğu bulundu. Yoğun bakım hemşirelerinin fiziksel tespit uygulamasını, yaşlı hastanın güvenliğini sağlamada bakımın bir parçası olarak gördükleri düşünülmektedir.
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Sharifi A, Arsalani N, Fallahi-Khoshknab M, Mohammadi-Shahbolaghi F. The principles of physical restraint use for hospitalized elderly people: an integrated literature review. Syst Rev 2021; 10:129. [PMID: 33931096 PMCID: PMC8088072 DOI: 10.1186/s13643-021-01676-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Physical restraint (PR) is a routine care measure in many hospital wards to ensure patient safety. However, it is associated with many different professional, legal, and ethical challenges. Some guidelines and principles have been developed in some countries for appropriate PR use. The present study aimed to explore the principles of PR use for hospitalized elderly people. METHODS This was an integrative review. For data collection, a literature search was conducted in Persian and English databases, namely Magiran, Scientific Information Database (SID), Scopus, Google Scholar, Web of Science, and PubMed as well as the websites of healthcare organizations and associations. Eligibility criteria were publication in English or Persian between January 1, 2010, and January 1, 2021, and description of the principles of PR use for hospitalized elderly people. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for document screening and selection, while the critical appraisal tools of the Joanna Briggs Institute (JBI) and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument were used for quality appraisal. The data were analyzed through constant comparison. RESULTS Primarily, 772 records were retrieved, while only twenty were eligible for the study. The principles of PR use for hospitalized elderly people were categorized into six main categories, namely principles of education for PR use, principles of decision making for PR use, principles of implementing the PR procedure, principles of monitoring patients with PR, principles of PR use documentation, and principles of PR management. CONCLUSION PR should be used only by trained healthcare providers, with the consent of patient or his/her family members, with standard devices and safe techniques, based on clear guidelines, and under close managerial supervision. Moreover, elderly people with PR should continuously be monitored for any PR-related complications. The findings of the present study can be used for developing clear PR-related guidelines.
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Affiliation(s)
- Azam Sharifi
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Arsalani
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Masoud Fallahi-Khoshknab
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi-Shahbolaghi
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Soeno S, Takada T, Takeshima T, Kaneyama M, Sagawa M, Hayashi M, Miyashita J, Azuma T, Fukuma S, Fukuhara S. Association between the use of physical restraint and functional decline among older inpatients admitted with pneumonia in an acute care hospital: A retrospective cohort study. Arch Gerontol Geriatr 2020; 94:104330. [PMID: 33493952 DOI: 10.1016/j.archger.2020.104330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
AIM This study was conducted to investigate the association between the use of physical restraint and functional decline in older inpatients admitted with pneumonia in an acute care setting. Although several adverse effects related to restraint use have been reported, few researchers have examined this subject in acute care settings. METHODS This retrospective cohort study was conducted at a 471-bed, acute care hospital in Japan. Patients 65 years old and older who were admitted with pneumonia between April 2015 and September 2017 were included. The use of restraints (belts and/or mittens) was recorded for every 8-hour shift. The number of shifts during which each patient was restrained was used as an explanatory variable. The primary outcome was the Katz ADL score at discharge. We used multiple linear regression analysis to adjust for confounding factors. RESULTS Of 403 patients, 94 required physical restraints. The mean age was 84.5 years (standard deviation [SD] 8.2); 44.4% were women. The mean Katz score on admission was 2.7 (SD 2.4). For multiple linear regression analysis, the coefficient of the number of restraints used was -0.024 (95% confidence interval: -0.044, -0.003, p = .022). Consequently, the restraint use for 13.9 days was associated with the decrease in the Katz score by 1.0. CONCLUSIONS Results suggest that physical restraint use is associated with functional decline among older inpatients admitted with pneumonia in acute care settings.
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Affiliation(s)
- Shoko Soeno
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan.
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Mirei Kaneyama
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Manami Sagawa
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Shingo Fukuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Human Health Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Yu TK, Suen LKP, Liu YB, Wong ALY, Lai CKY. Patient safety and bedrail use as a global phenomenon: A prevalence study. Contemp Nurse 2020; 56:204-214. [PMID: 33121361 DOI: 10.1080/10376178.2020.1844576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Although bedrail use may increase the risk of accidents among patients, bedrails are still extensively used in healthcare facilities. Therefore, the field calls for a review of bedrail use in practice. Objective: This report examined the prevalence and implications of bedrail use in rehabilitation facilities in Hong Kong. The findings are compared with the current state of bedrail use worldwide. Design and methods: This work is a cross-sectional, observational study. A secondary analysis was conducted on the database of a prospective trial. Bilateral bedrail use was observed in two Hong Kong rehabilitation hospitals. Logistic regression was performed to examine the factors associated with bedrail use. Results: A total of 3,384 restraint observations were made. The bedrail rate was 31.34%, which revealed that bedrail use was the second most commonly used physical restraint. The fall history (OR: 2.84), cognitive impairment (OR: 0.91) and functional dependency (OR: 0.79) of patients were significant predictors of bedrail use, p < .05. Conclusion: This study examines bedrail prevalence through direct observation, which is the preferred method for examining bedrail use in practice. We found that actual bedrail use is higher than the numbers reported in previous studies in Hong Kong. In addition, our research reveals that bedrails are commonly used for vulnerable patients. This finding highlights the need to change nurses' beliefs on bedrail use through education. The management of these health facilities should also aim to create an institutional environment that promotes the reduction of bedrail use. Implementation strategies on restraint reduction should also fit the culture of the organisation and local nursing practices, as well as the staff's values. Impact Statement: This study provides preliminary information about the widespread use of bedrails in Hong Kong and other countries. The research also introduces effective ways to achieve the reduction of bedrail use.
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Affiliation(s)
- Tsz Kiu Yu
- Department of Social Work, The Chinese University of Hong Kong, Room 101, T.C. Cheng Building, Shatin, New Territories, HKSAR, Hong Kong
| | - Lorna Kwai-Ping Suen
- School of Nursing, The Hong Kong Polytechnic University, GH520, School of Nursing, Hung Hom, Kowloon, HKSAR, Hong Kong
| | - Yong-Bing Liu
- Department of Nursing, Yangzhou University, No. 88, South Road, Yangzhou, Jiangsu 225009, People's Republic of China
| | - Adrienne Lei Yung Wong
- Department of Social Work, The Chinese University of Hong Kong, Room 101, T.C. Cheng Building, Shatin, New Territories, HKSAR, Hong Kong
| | - Claudia Kam Yuk Lai
- School of Nursing, The Hong Kong Polytechnic University, GH520, School of Nursing, Hung Hom, Kowloon, HKSAR, Hong Kong
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Abraham J, Hirt J, Kamm F, Möhler R. Interventions to reduce physical restraints in general hospital settings: A scoping review of components and characteristics. J Clin Nurs 2020; 29:3183-3200. [PMID: 32558091 DOI: 10.1111/jocn.15381] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/26/2020] [Accepted: 06/05/2020] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe the characteristics of interventions for reducing physical restraints in general hospital settings. BACKGROUND Physical restraints, such as bedrails and belts in beds and chairs, are commonly used in general hospital settings. However, there is no clear evidence on their effectiveness but some evidence on potential risks for harm. DESIGN Scoping review. METHODS We conducted a systematic database search (MEDLINE via PubMed, CINAHL, Cochrane Library; March 2020) and snowballing techniques. We included both interventional studies and quality improvement projects conducted in general hospital settings and published in English or German language. Two reviewers independently performed the study selection and data extraction. The Scoping Reviews (PRISMA-ScR) Checklist was used. RESULTS We included 31 articles (published between 1989 and 2018), 15 quality improvement projects and 16 intervention studies. Only five studies used a controlled design. Most studies and quality improvement projects investigated multicomponent interventions including education (predominantly for nursing staff) and additional components (e.g. case conferences). Three studies examined simple educational programmes without additional components. CONCLUSIONS A large number of multicomponent interventions for preventing and reducing physical restraints in general hospital settings have been developed. The interventions differed widely regarding the components, contents and settings. Well-designed evaluation studies investigating the effects of such interventions are lacking. RELEVANCE TO CLINICAL PRACTICE Multicomponent educational interventions might be one approach to change clinical practice, but only insufficient information is available about potential effects of these approaches.
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Affiliation(s)
- Jens Abraham
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of Health, Center for Dementia Care, Institute of Applied Nursing Sciences, FHS St. Gallen, St. Gallen, Switzerland
| | - Friederike Kamm
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,School of Public Health, Bielefeld University, Bielefeld, Germany
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12
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Sharifi A, Arsalani N, Fallahi-Khoshknab M, Mohammadi-Shahbolaghi F, Ebadi A. Iranian nurses' perceptions about using physical restraint for hospitalized elderly people: a cross-sectional descriptive-correlational study. BMC Geriatr 2020; 20:233. [PMID: 32631236 PMCID: PMC7339549 DOI: 10.1186/s12877-020-01636-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/01/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Using physical restraint (PR) for hospitalized elderly people is a major nursing challenge. It is associated with different physical and mental complications and ethical dilemmas, though many nurses still use it to ensure patient safety. Nurses' perceptions are one of the most important factors affecting PR use. This study aimed to evaluate Iranian nurses' perceptions about PR use for hospitalized elderly people. METHODS This cross-sectional descriptive-correlational study was conducted from July to December 2019. Participants were 270 hospital nurses who were purposively recruited from intensive care units and medical and surgical wards of three teaching hospitals in Kermanshah, Iran. Data were collected using a demographic questionnaire and the Perceptions of Restraint Use Questionnaire (PRUQ). The SPSS software (v. 23.0) was used for data analysis through the independent-sample t test, the one-way analysis of variance, and the multiple regression analysis. RESULTS The total mean score of PRUQ was 4.08 ± 0.12 in the possible range of 1-5. The most important reasons for PR use were to prevent patients from falling out of bed and to prevent them from pulling out catheters. The total mean score of PRUQ had significant relationship with participants' age, work experience, and history of receiving PR-related educations (P < 0.05), but had no significant relationship with their gender, educational degree, and affiliated hospital ward (P > 0.05). CONCLUSION This study suggests that nurses attach high importance to PR use for hospitalized elderly people. Healthcare policy-makers at national and hospital levels are recommended to provide nurses with PR-related educations in order to reduce the rate of PR-related complications.
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Affiliation(s)
- Azam Sharifi
- Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Arsalani
- Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | | | | | - Abbas Ebadi
- Nursing School, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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13
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Walker K, Shearkhani S, Bai YQ, McGilton KS, Berta WB, Wodchis WP. The Impact of the Long-term Care Homes Act and Public Reporting on Physical Restraint and Potentially Inappropriate Antipsychotic Use in Ontario's Long-term Care Homes. J Gerontol A Biol Sci Med Sci 2020; 75:813-819. [PMID: 31356654 DOI: 10.1093/gerona/glz143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We report on the impact of two system-level policy interventions (the Long-Term Care Homes Act [LTCHA] and Public Reporting) on publicly reported physical restraint use and non-publicly reported potentially inappropriate use of antipsychotics in Ontario, Canada. METHODS We used interrupted time series analysis to model changes in the risk-adjusted use of restraints and antipsychotics before and after implementation of the interventions. Separate analyses were completed for early ([a] volunteered 2010/2011) and late ([b] volunteered March 2012; [c] mandated September 2012) adopting groups of Public Reporting. Outcomes were measured using Resident Assessment Instrument Minimum Data Set (RAI-MDS) data from January 1, 2008 to December 31, 2014. RESULTS For early adopters, enactment of the LTCHA in 2010 was not associated with changes in physical restraint use, while Public Reporting was associated with an increase in the rate (slope) of decline in physical restraint use. By contrast, for the late-adopters of Public Reporting, the LTCHA was associated with significant decreases in physical restraint use over time, but there was no significant increase in the rate of decline associated with Public Reporting. As the LTCHA was enacted, potentially inappropriate use of antipsychotics underwent a rapid short-term increase in the early volunteer group, but, over the longer term, their use decreased for all three groups of homes. CONCLUSIONS Public Reporting had the largest impact on voluntary early adopters while legislation and regulations had a more substantive positive effect upon homes that delayed public reporting.
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Affiliation(s)
- Kevin Walker
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
| | - Sara Shearkhani
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
| | - Yu Qing Bai
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Ontario, Canada
| | - Whitney B Berta
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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14
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de Bruijn W, Daams JG, van Hunnik FJG, Arends AJ, Boelens AM, Bosnak EM, Meerveld J, Roelands B, van Munster BC, Verwey B, Figee M, de Rooij SE, Mocking RJT. Physical and Pharmacological Restraints in Hospital Care: Protocol for a Systematic Review. Front Psychiatry 2020; 10:921. [PMID: 32184738 PMCID: PMC7058582 DOI: 10.3389/fpsyt.2019.00921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Physical and pharmacological restraints, defined as all measures limiting a person in his or her freedom, are extensively used to handle unsafe or problematic behavior in hospital care. There are increasing concerns as to the extent with which these restraints are being used in hospitals, and whether their benefits outweigh their potential harm. There is currently no comprehensive literature overview on the beneficial and/or adverse effects of the use of physical and pharmacological restraints in the hospital setting. METHODS A systematic review of the existing literature will be performed on the beneficial and/or adverse effects of physical and pharmacological restraints in the hospital setting. Relevant databases will be systematically searched. A dedicated search strategy was composed. A visualization of similarities (VOS) analysis was used to further specify the search. Observational studies, and if available, randomized controlled trials reporting on beneficial and/or adverse effects of physical and/or pharmacological restraints in the general hospital setting will be included. Data from included articles will be extracted and analyzed. If the data is suitable for quantitative analysis, meta-analysis will be applied. DISCUSSION This review will provide data on the beneficial and/or adverse effects of the use of physical and pharmacological restraints in hospital care. With this review we aim to guide health professionals by providing a critique of the available evidence regarding their choice to either apply or withhold from using restraints. A limitation of the current review will be that we will not specifically address ethical aspects of restraint use. Nevertheless, the outcomes of our systematic review can be used in the composition of a multidisciplinary guideline. Furthermore, our systematic review might determine knowledge gaps in the evidence, and recommendations on how to target these gaps with future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42019116186.
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Affiliation(s)
- Wendy de Bruijn
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joost G. Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - A. M. Boelens
- Department of Geriatrics, UMCG, Groningen, Netherlands
| | - Ellen M. Bosnak
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Barbara C. van Munster
- Department of Internal Medicine/Geriatrics, Gelre Hospitals and UMCG, Groningen, Netherlands
| | - Bas Verwey
- Department of Hospital Psychiatry, NVvP, Utrecht, Netherlands
| | - Martijn Figee
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, United States
| | | | - Roel J. T. Mocking
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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15
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Chou MY, Hsu YH, Wang YC, Chu CS, Liao MC, Liang CK, Chen LK, Lin YT. The Adverse Effects of Physical Restraint Use among Older Adult Patients Admitted to the Internal Medicine Wards: A Hospital-Based Retrospective Cohort Study. J Nutr Health Aging 2020; 24:160-165. [PMID: 32003405 DOI: 10.1007/s12603-019-1306-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the negative effect of physical restraint use on the hospital outcomes of older patients. DESIGN A retrospective cohort study. SETTING Internal medicine wards of a tertiary medical center in Taiwan. PARTICIPANTS Subjects aged 65 years and over who were admitted during April to Dec 2017 were recruited for study. MEASUREMENTS Demographic data, geriatric assessments (polypharmacy, visual impairment, hearing impairment, activities of daily living before and after admission, risk of pressure sores, change in consciousness level, mood condition, history of falls in the previous year, risk of malnutrition and pain) and hospital conditions (admission route, department of admission, length of hospital stay and mortality) were collected for analysis. RESULTS Overall, 4,352 participants (mean age 78.7±8.7 years, 60.2% = male) were enrolled and 8.3% had physical restraint. Results of multivariate logistic regression showed that subjects with physical restraints were at greater risk of functional decline (adjusted odds ratio 2.136, 95% confidence interval 1.322-3.451, p=0.002), longer hospital stays (adjusted odds ratio 5.360, 95% confidence interval 3.627-7.923, p<0.001) and mortality (adjusted odds ratio 4.472, 95% confidence interval 2.794-7.160, p<0.001) after adjustment for covariates. CONCLUSION The use of physical restraints during hospitalization increased the risk of adverse hospital outcomes, such as functional decline, longer length of hospital stay and mortality.
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Affiliation(s)
- M-Y Chou
- Dr. Chih-Kuang Liang, Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, 386, Ta-Chung 1st RD. Zuoying District 813, Kaohsiung, Taiwan, TEL: +886-7-3742121 ext 2091, FAX: +886-7-3468224,
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16
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Cui N, Long M, Zhou S, Zhang T, He C, Gan X. Knowledge, Attitudes, and Practices of Chinese Critical Care Nurses Regarding Physical Restraint. J Contin Educ Nurs 2019; 50:121-126. [PMID: 30835322 DOI: 10.3928/00220124-20190218-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND This multicenter cross-sectional study sought to determine the knowledge, attitudes, and practices regarding the use of physical restraints by Chinese nurses in intensive care units (ICUs) of tertiary hospitals. METHOD A scale technique was used to measure the knowledge, attitudes, and practices of 383 RNs from eight tertiary hospitals in Chongqing, China. RESULTS A total of 383 valid questionnaires were returned, for a response rate of 89.49%. Approximately 8.1% of the nurses were male, 67.1% had a bachelor's degree or above, and 55.09% were ICU specialists. The average age was 28.62 years (SD = 4.56). The mean scores were 74.33 of 111 (SD = 9.552), 24.41 of 40 (SD = 4.872), and 65.66 of 130 (SD = 20.880) regarding knowledge, attitudes, and nursing practices, respectively. For the attitude scale, the scores of nurses who were certified ICU specialists and had extensive working experience were higher than those with less experience; the difference was statistically significant (p < .05). CONCLUSION Results indicated that nurses employed in the ICUs of tertiary hospitals in Chongqing, China, have relatively insufficient knowledge, comparatively incorrect attitudes, and unreasonable means of practicing physical restraint. Continuing education should focus strongly on the relationship between physical restraint and unplanned extubation, and guidelines on physical restraint urgently need to be developed. [J Contin Educ Nurs. 2019;50(3):121-126.].
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Draganich C, Gerber D, Monden KR, Newman J, Weintraub A, Biggs J, Philippus A, Makley M. Disrupted sleep predicts next day agitation following moderate to severe brain injury. Brain Inj 2019; 33:1194-1199. [DOI: 10.1080/02699052.2019.1631484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Christina Draganich
- Craig Hospital, Englewood, CO, USA
- University of Colorado Department of PM&R, Aurora, CO, USA
| | - Don Gerber
- Craig Hospital, Englewood, CO, USA
- University of Colorado Department of PM&R, Aurora, CO, USA
| | - Kimberley R. Monden
- Craig Hospital, Englewood, CO, USA
- University of Colorado Department of PM&R, Aurora, CO, USA
| | | | - Alan Weintraub
- Craig Hospital, Englewood, CO, USA
- University of Colorado Department of PM&R, Aurora, CO, USA
| | | | | | - Michael Makley
- Craig Hospital, Englewood, CO, USA
- University of Colorado Department of PM&R, Aurora, CO, USA
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18
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Souza LMDS, Santana RF, Capeletto CDSG, Menezes AK, Delvalle R. Factors associated with mechanical restraint in the hospital environment: a cross-sectional study. Rev Esc Enferm USP 2019; 53:e03473. [PMID: 31215614 DOI: 10.1590/s1980-220x2018007303473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of mechanical restraint in the hospital environment and the factors associated with its performance. METHOD A cross-sectional, observational study with patients from a public hospital from the medical clinic, surgical clinic and intensive care unit evaluated by descriptive, univariate and multivariate analyses. RESULTS One hundred eleven (111) patients participated in the study. The prevalence of mechanical restraint was 51.4%; bilateral rails on the bed were used in 100% of the restraints, and bilateral wrist restraints were also observed in 29.8%. The most common justifications were the risk of falls (100.0%) and the risk of non-scheduled removal of invasive devices (57.9%). The restrained patients differ significantly from those not restrained by the following associated factors: male gender; age; stroke diagnosis; the hospitalization unit; ambulation capacity; the use of sedative medication; and the use of invasive devices. CONCLUSION This study estimated a high mechanical restraint prevalence in the hospital environment and determined factors associated with the risk of a patient being restrained. A medical restraint evaluation team is recommended for an in-depth analysis of indication and therapy.
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Affiliation(s)
| | | | | | | | - Romulo Delvalle
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil
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19
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Hasan AAH, Abulattifah A. Psychiatric nurses' knowledge, attitudes, and practice towards the use of physical restraints. Perspect Psychiatr Care 2019; 55:218-224. [PMID: 30430581 DOI: 10.1111/ppc.12335] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/07/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE This study examines the knowledge, attitudes, and practice of psychiatric nurses towards the use of physical restraint in Saudi Arabia. DESIGN AND METHODS Descriptive explanatory cross-sectional design, 101 participants were invited to complete a set of questionnaires to assess the knowledge, attitude, and practice towards the use of physical restraint. FINDINGS Participants had a moderate knowledge and attitude as well as practice in using physical restraint. Less than half reported that they recognized alternative approaches to physical restraint and most of them did not understand the reasons for the restraint. PRACTICE IMPLICATIONS This study highlights some important misunderstandings of nurses about using physical restraint. The findings serve as a supporting reason for recognizing the importance of educating nurses about its use.
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Bregar B, Skela-Savič B, Kores Plesničar B. Cross-sectional study on nurses' attitudes regarding coercive measures: the importance of socio-demographic characteristics, job satisfaction, and strategies for coping with stress. BMC Psychiatry 2018; 18:171. [PMID: 29866142 PMCID: PMC5987471 DOI: 10.1186/s12888-018-1756-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/22/2018] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Coercive measures are containment methods used in psychiatry to curb patients' disruptive and aggressive behaviours towards themselves, others or objects. The prevalence of the practice of coercive measures in psychiatry is directly related to the attitudes of the staff. When discussing these attitudes, nurses are often particularly singled out. The purpose of the study is to research the impact of individual factors on nurses' attitudes in the decision-making process for the use of coercive measures. METHODS A cross-sectional study among all psychiatric nursing staff in Slovenia (n = 367, 79%) was conducted over the years 2013/2014. Standardized questionnaires were used, including a survey of nurses' attitudes to the use of seclusion, the Job Descriptive Index, and the Folkman-Lazarus test. RESULTS Nurses' attitudes towards special coercive measures are predominantly negative ([Formula: see text] = 11.312, SD = 2.641). The factors that explain a positive attitude are as follows: female gender (β = - 0.236, p < 0.001), fewer years of service (β = - 0.149, p = 0.023), emotion-focused strategies of coping with stress (β = 0.139, p = 0.020), and less-threatening patient behaviour (β = 0.157, p = 0.012). CONCLUSIONS The effects of some known factors did not prove important in the model. Newly recognized factors are "less-threatening patient behaviour" and "emotion-focused strategies of coping with stress". Therefore, attitudes towards special coercive measures in psychiatry must be regarded as contextualized, interactive, and multidimensional phenomena that cannot be explained merely through a defined set of factors.
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Affiliation(s)
- Branko Bregar
- University Psychiatric Hospital Ljubljana, Studenec 48, 1260, Ljubljana Polje, Slovenia.
| | | | - Blanka Kores Plesničar
- grid.440807.fUniversity Psychiatric Hospital Ljubljana, Studenec 48, 1260 Ljubljana Polje, Slovenia
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Eskandari F, Abdullah KL, Zainal NZ, Wong LP. Use of physical restraint: Nurses' knowledge, attitude, intention and practice and influencing factors. J Clin Nurs 2017; 26:4479-4488. [PMID: 28233363 DOI: 10.1111/jocn.13778] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 10/20/2022]
Abstract
AIMS AND OBJECTIVES To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables. BACKGROUND A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals. DESIGN A cross-sectional study was used. METHODS A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur. RESULTS Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint. CONCLUSION This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint. RELEVANCE TO CLINICAL PRACTICE Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals.
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Affiliation(s)
- Fatemeh Eskandari
- Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Head of Department of Nursing Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Zuraida Zainal
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Head of Psychological Medicine Research Group of University of Malaya (PARADIGM), Kuala Lumpur, Malaysia.,Malaysian Psychiatric Association, Kuala Lumpur, Malaysia.,Malaysian J Psychiatry, Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Möhler R, Nürnberger C, Abraham J, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings. Hippokratia 2016. [DOI: 10.1002/14651858.cd012476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Ralph Möhler
- Faculty of Medicine and Medical Center, University of Freiburg; Cochrane Germany, Institute for Medical Biometry and Statistics; Breisacher Str. 153 Freiburg Germany 79110
- Martin Luther University Halle-Wittenberg; Institute of Health and Nursing Sciences; Magdeburger Strasse 8 Halle (Saale) Germany 06097
| | - Cäcilia Nürnberger
- Martin Luther University Halle-Wittenberg; Institute of Health and Nursing Sciences; Magdeburger Strasse 8 Halle (Saale) Germany 06097
| | - Jens Abraham
- Martin Luther University Halle-Wittenberg; Institute of Health and Nursing Sciences; Magdeburger Strasse 8 Halle (Saale) Germany 06097
| | - Sascha Köpke
- University of Lübeck; Nursing Research Group, Institute of Social Medicine and Epidemiology; Ratzeburger Allee 160 Lübeck Germany D-23538
| | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg; Institute of Health and Nursing Sciences; Magdeburger Strasse 8 Halle (Saale) Germany 06097
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