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Tresfon J, Langeveld K, Brunsveld-Reinders AH, Hamming J. Coming to Grips-How Nurses Deal With Restlessness, Confusion, and Physical Restraints on a Neurological/Neurosurgical Ward. Glob Qual Nurs Res 2023; 10:23333936221148816. [PMID: 36712230 PMCID: PMC9880574 DOI: 10.1177/23333936221148816] [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: 06/09/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 01/26/2023] Open
Abstract
Physical restraints are viewed as potentially dangerous objects for patient safety. Contemporary efforts mainly focus on preventing bad outcomes in restraint use, while little attention is paid under what circumstances physical restraints are applied harmlessly. The aim of this research was to understand how physical restraints are used by neurology/neurosurgery ward nurses in relation to the protocol. In ethnographic action research, the Functional Resonance Analysis Method (FRAM) was used to map and compare physical restraints as part of daily ward care against the protocol of physical restraints. Comparison between protocol and actual practice revealed that dealing with restlessness and confusion is a collective nursing skill vital in dealing with physical restraints, while the protocol failed to account for these aspects. Supporting and maintaining this skillset throughout this and similar nursing teams can prevent future misguided application physical restraints, offering valuable starting point in managing patient safety for these potentially dangerous objects.
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Affiliation(s)
- Jaco Tresfon
- Leiden University Medical Centre,
Zuid-Holland, The Netherlands,Jaco Tresfon, Department of Quality and
Safety, Leiden University Medical Centre, PO box 9600 Post Zone C1-R, Leiden,
Zuid-Holland 2300 RC, The Netherlands
| | | | | | - Jaap Hamming
- Leiden University Medical Centre,
Zuid-Holland, The Netherlands
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Abraham J, Hirt J, Richter C, Köpke S, Meyer G, Möhler R. Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings. Cochrane Database Syst Rev 2022; 8:CD012476. [PMID: 36004796 PMCID: PMC9404383 DOI: 10.1002/14651858.cd012476.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Physical restraints, such as bedrails, belts in chairs or beds, and fixed tables, are commonly used for older people in general hospital settings. Reasons given for using physical restraints are to prevent falls and fall-related injuries, to control challenging behavior (such as agitation or wandering), and to ensure the delivery of medical treatments. Clear evidence of their effectiveness is lacking, and potential harms are recognised, including injuries associated with the use of physical restraints and a negative impact on people's well-being. There are widespread recommendations that their use should be reduced or eliminated. OBJECTIVES To assess the best evidence for the effects and safety of interventions aimed at preventing and reducing the use of physical restraint of older people in general hospital settings. To describe the content, components and processes of these interventions. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register the International Clinical Trials Registry Portal on 20 April 2022. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials that investigated the effects of interventions that aimed to prevent or reduce the use of physical restraints in general hospital settings. Eligible settings were acute care and rehabilitation wards. We excluded emergency departments, intensive care and psychiatric units, as well as the use of restrictive measures for penal reasons (e.g. prisoners in general medical wards). We included studies with a mean age of study participants of at least 65 years. Control groups received usual care or active control interventions that were ineligible for inclusion as experimental interventions. DATA COLLECTION AND ANALYSIS Two review authors independently selected the articles for inclusion, extracted data, and assessed the risk of bias of all included studies. Data were unsuitable for meta-analysis, and we reported results narratively. We used GRADE methods to describe our certainty in the results. MAIN RESULTS We included four studies: two randomised controlled trials (one individually-randomised, parallel-group trial and one clustered, stepped-wedge trial) and two controlled clinical trials (both with a clustered design). One study was conducted in general medical wards in Canada and three studies were conducted in rehabilitation hospitals in Hong Kong. A total of 1709 participants were included in three studies; in the fourth study the number of participants was not reported. The mean age ranged from 67 years to 84 years. The duration of follow-up covered the period of patients' hospitalisation in one study (21 days average length of stay) and ranged from 4 to 11 months in the other studies. The definition of physical restraints differed slightly, and one study did not include bedrails. Three studies investigated organisational interventions aimed at implementing a least-restraint policy to reduce physical restraints. The theoretical approach of the interventions and the content of the educational components was comparable across studies. The fourth study investigated the use of pressure sensors for participants with an increased falls risk, which gave an alarm if the participant left the bed or chair. Control groups in all studies received usual care. Three studies were at high risk of selection bias and risk of detection bias was unclear in all studies. Because of very low-certainty evidence, we are uncertain about the effect of organisational interventions aimed at implementing a least-restraint policy on our primary efficacy outcome: the use of physical restraints in general hospital settings. One study found an increase in the number of participants with at least one physical restraint in the intervention and control groups, one study found a small reduction in both groups, and in the third study (the stepped-wedge study), the number of participants with at least one physical restraint decreased in all clusters after implementation of the intervention but no detailed information was reported. For the use of bed or chair pressure sensor alarms for people with an increased fall risk, we found moderate-certainty evidence of little to no effect of the intervention on the number of participants with at least one physical restraint compared with usual care. None of the studies systematically assessed adverse events related to use of physical restraint use, e.g. direct injuries, or reported such events. We are uncertain about the effect of organisational interventions aimed at implementing a least-restraint policy on the number of participants with at least one fall (very low-certainty evidence), and there was no evidence that organisational interventions or the use of bed or chair pressure sensor alarms for people with an increased fall risk reduce the number of falls (low-certainty evidence from one study each). None of the studies reported fall-related injuries. We found low-certainty evidence that organisational interventions may result in little to no difference in functioning (including mobility), and moderate-certainty evidence that the use of bed or chair pressure sensor alarms has little to no effect on mobility. We are uncertain about the effect of organisational interventions on the use of psychotropic medication; one study found no difference in the prescription of psychotropic medication. We are uncertain about the effect of organisational interventions on nurses' attitudes and knowledge about the use of physical restraints (very low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain whether organisational interventions aimed at implementing a least-restraint policy can reduce physical restraints in general hospital settings. The use of pressure sensor alarms in beds or chairs for people with an increased fall risk has probably little to no effect on the use of physical restraints. Because of the small number of studies and the study limitations, the results should be interpreted with caution. Further research on effective strategies to implement a least-restraint policy and to overcome barriers to physical restraint reduction in general hospital settings is needed.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), St. Gallen, Switzerland
| | - Christin Richter
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
- School of Public Health, Bielefeld University, Bielefeld, Germany
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Li Y, Wang Y, Gu Y, Gong D, Jiang S, Li J, Xu H. Knowledge, Attitude, and Practice of Nursing Home Staff Regarding Physical Restraint in China: A Cross-Sectional Multicenter Study. Front Public Health 2022; 10:815964. [PMID: 35602149 PMCID: PMC9120914 DOI: 10.3389/fpubh.2022.815964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/04/2022] [Indexed: 11/28/2022] Open
Abstract
Background Restraint is widely used in nursing homes to address safety concerns. However, many studies have shown that improper restraint can lead to many adverse outcomes. Nursing staff are the main practitioners of physical restraint in nursing homes and play an important role in restraint decision-making and management. In China, there is still a lack of large-scale surveys on the current situation regarding the use of restraint. This study aimed to identify this situation and the influencing factors of the knowledge, attitude, and practice of nursing staff regarding physical restraint in elderly care institutions. Methods A cross-sectional multicenter descriptive study was conducted. A total of 311 staff in 25 elderly care institutions in Zhejiang Province were recruited using a quota sampling method. A homemade questionnaire was administered to collect general information and information on knowledge, attitude and practice regarding physical restraint. Results The average scoring rates of the knowledge and attitude dimensions of the 311 staff were 48.7 and 75.6%, respectively. The average scoring rate of the practice dimension of 140 staff who implemented restraint was 80.1%. Educational background and training experience were the influencing factors of restraint knowledge. Training experience, educational background and professional title were the influencing factors of restraint attitude. Restraint knowledge and length of service were the influencing factors of restraint practice. Conclusions Knowledge of physical restraint among nursing staff is not promising. Their attitude toward restraint was inappropriate or irresponsible in some aspects. Restraint practice is not sufficiently standardized. It is necessary to strengthen restraint training for nursing staff to improve their overall level of restraint knowledge, attitude and practice.
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Affiliation(s)
- Yaqin Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - YaWen Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yechun Gu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | | | - Sisi Jiang
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Jufang Li
| | - Hongbo Xu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- Hongbo Xu
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Wang J, Liu W, Wang H, Zhao Q, Xiao M. Difference of Physical Restraint Knowledge, Attitudes and Practice Between Nurses and Nursing Assistants in Long-Term Care Facilities: A Cross-Sectional Study. Healthc Policy 2022; 15:243-255. [PMID: 35210886 PMCID: PMC8859256 DOI: 10.2147/rmhp.s349545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Purpose Methods Results Conclusion
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Affiliation(s)
- Jun Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Houwei Wang
- School of Mathematics & Physics and Big Data, Chongqing University of Science and Technology, Chongqing, People’s Republic of China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Qinghua Zhao; Mingzhao Xiao, Email ;
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Law J, Dahlke S, Butler JI, Hunter KF, Martin LS, Pietrosanu M. Improving practicing nurses' knowledge and perceptions of older people: a quasi-experimental study. Int J Nurs Educ Scholarsh 2022; 19:ijnes-2022-0090. [PMID: 36473144 DOI: 10.1515/ijnes-2022-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study aimed to determine if an e-learning module about understanding and communicating with older people can improve practicing nurses' ageist perceptions about older people. METHODS We used a quasi-experimental pre-post-test design. Participants completed a 13-item Ambivalent Ageism Scale before and after completing the Understanding and Communicating with Older People e-learning module as well as a Likert-style feedback survey with the option for written feedback on an open-ended question. RESULTS Pre-post-test comparisons indicated a statistically significant decrease in ageist attitudes and self-reported increases in knowledge and confidence in working with older people. Qualitative analysis of written feedback revealed that most participants felt the module enhanced their understanding of older people. CONCLUSIONS The e-learning activity has the potential to improve practicing nurses' knowledge and perceptions about working with older people and is likely to be associated with better patient-level outcomes.
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Affiliation(s)
- Joanna Law
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Jeffrey I Butler
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada.,School of Nursing, York University Centre for Aging Research and Education, Faculty of Health, York University, Toronto, ON, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Lori Schindel Martin
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Matthew Pietrosanu
- Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
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Palese A, Longhini J, Businarolo A, Piccin T, Pitacco G, Bicego L. Between Restrictive and Supportive Devices in the Context of Physical Restraints: Findings from a Large Mixed-Method Study Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312764. [PMID: 34886489 PMCID: PMC8657237 DOI: 10.3390/ijerph182312764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives'/patients' requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories 'Restrictive' and 'Supportive' devices aimed at 'Preventing risks' and at 'Promoting support', respectively, have emerged. Reasons triggering 'restrictive devices' involved patients' risks, the health professionals' and/or the relatives' concerns. In contrast, the 'supportive' ones were triggered by patients' problems/needs. 'Restrictive' and 'Supportive' devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with 'restrictive devices' (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
- Correspondence: ; Tel.: +39(0)-432-590926
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Angela Businarolo
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Tiziana Piccin
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Giuliana Pitacco
- Ethics Management for Clinical Practice Area, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy;
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Dahlke S, Hunter KF. Harnessing nursing to diminish ageism. Int J Older People Nurs 2021; 17:e12417. [PMID: 34420260 DOI: 10.1111/opn.12417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The common practice of making fun of aging and older people demonstrates that ageism towards older people is socially acceptable. It is so accepted that even those of us who are aging or have moved into the 'third act' believe and fear the negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Ageism is evident in work places, family relationships, when older people purchase goods and services, in health and social institutions and extends throughout professions that work with older people. OBJECTIVES We explore how nurses-the largest group of healthcare professions- may be inadvertently perpetuating negative perceptions about older people in nursing practice, nursing education, and through common misconceptions about what gerontological nursing means. METHODS This is discussion paper using the literature. RESULTS We suggest that nursing education is well situated to diminish negative perspectives of ageing by incorporating theories of life-course and harmonious aging into the holistic perspective of individuals that nursing is well known for. CONCLUSIONS Greater understanding about the diversity of ageing and the context that have influenced older persons could encourage nurses to treat them holistically with dignity, which would ultimately improve older people's experiences. Improving older persons' experiences is like paying it forward, as we all are ageing and if we are to have a different experience when we are old, it is necessary to diminish stereotypes about ageing, and work towards inclusion of older people in social and healthcare institutions. IMPLICATIONS FOR PRACTICE It is important for nurses, particularly those in nursing education, to support the incorporation of a life course and harmonious view of aging in which the social, political, and environmental context of individuals are viewed as part of the difference of ageing.
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Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, USA
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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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Capeletto CDSG, Santana RF, Souza LMDS, Cassiano KM, Carvalho ACSD, Barros PDFA. Physical restraint in elderly in home care: a cross-sectional study. ACTA ACUST UNITED AC 2021; 42:e20190410. [PMID: 33886921 DOI: 10.1590/1983-1447.2021.20190410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 07/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the prevalence of mechanical restraint and factors associated with its practice in elderly in Home Care. METHODS This was a cross-sectional study with 162 elderly randomly assigned to a home care program in Rio de Janeiro, from March 2018 to July 2018. Used as a technique for data collection and direct observation and structured interview of elderly clinical data. Data were analyzed descriptively and inferentially. RESULTS There was a 13% prevalence of mechanical restraint in elderly in home care. The most frequent restraints were the use of bandage, tissues and sheets in the arms/legs and chests of the elderly, and the justification for their use were control of aggressive behavior (28.6%), prevention of falls (19%) and protection (19%). Of the total elderly participants, 42.9% remained contained for more than 24 hours, and in 85.7% of the cases, the individuals were confined to a room. CONCLUSION It is necessary to expand the training of formal and informal caregivers, recommending the rehabilitation of care practices that preserve the elderly's autonomy, giving them dignity, respecting gerontological and home care principles.
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Thomann S, Zwakhalen S, Richter D, Bauer S, Hahn S. Restraint use in the acute-care hospital setting: A cross-sectional multi-centre study. Int J Nurs Stud 2020; 114:103807. [PMID: 33217663 DOI: 10.1016/j.ijnurstu.2020.103807] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/07/2020] [Accepted: 10/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Restraints are likely to negatively affect patients' health and therefore a reduction in their usage is recommended for all health-care settings. To date, research on restrictive practices has concentrated on mental health and long-term care settings. In the acute-care hospital setting few studies have been published and these studies mainly focus on physical/mechanical restraints in specific subpopulations and/or on intensive care units. However, to ensure restraints are used as little as possible in the acute-care hospital setting, it seems important to investigate more comprehensively the use of restraints, to include all types of restraints irrespective of ward type or subpopulations and to identify factors associated with restraint use. OBJECTIVE The aim of this study was to investigate restraint use regardless of ward type in the acute-care hospital setting, including restraint type, reasons for restraint use, process indicators when using restraints and restraint use-associated patient characteristics. METHODS Using a cross-sectional multi-centre design, data were collected by means of an annual international prevalence measurement in acute-care hospitals in Switzerland and Austria. All hospitalised patients aged 18+ who gave informed consent were included. Data were collected at three measurement points between 2016 and 2018. Descriptive and multivariate logistic regression analyses were performed. RESULTS A total of 29,477 patients hospitalised in 140 hospitals were included in this study. The prevalence rate for the use of at least one restraint over a 30-day period was 8.7% (n = 2577), with mechanical restraints representing the highest proportion of restraint type used (55.0%, n = 1417). The main reason for restraint use was fall prevention (43.8%, n = 1129), followed by confusion or delirious behaviour (20.4%, n = 525). In 64.3% of the cases (n = 1657), restraint use was documented in the patient file. Regular evaluation occurred in 42.9% of the cases (n = 1105). Care dependency had the strongest association with restraint use (odds ratio [OR] 25.00, 95% confidence interval [CI] 21.01-29.78 for completely dependant patients in comparison to completely independent patients), followed by mental and behavioural disorders (OR 2.36, 95% CI 2.15-2.59). CONCLUSIONS Restraints are often utilised in hospitals in complex care situations such as with patients at risk of falling or with delirium. When using restraints the consideration of processes like documentation and evaluation shows great potential for improvement. Standardisation of these processes and education of the interprofessional team could be beneficial for raising awareness and for the sustainable reduction of restraint use. Tweetable abstract: In hospitals restraints are often used in complex care situations. However, their use seems to be insufficiently documented and evaluated.
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Affiliation(s)
- Silvia Thomann
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland,.
| | - Sandra Zwakhalen
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, PO BOX 616, 6200 MD, Maastricht, the Netherlands.
| | - Dirk Richter
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland,; Center for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Murtenstrasse 46, 3008 Bern, Switzerland; University of Bern, University Hospital for Psychiatry and Psychotherapy, Bolligenstrasse 111, 3060 Bern, Switzerland.
| | - Silvia Bauer
- Medical University of Graz, Department of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| | - Sabine Hahn
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland,.
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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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12
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Gual N, García-Salmones M, Brítez L, Crespo N, Udina C, Pérez LM, Inzitari M. The role of physical exercise and rehabilitation in delirium. Eur Geriatr Med 2020; 11:83-93. [PMID: 32297245 PMCID: PMC7224129 DOI: 10.1007/s41999-020-00290-6] [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] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/15/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE This article aims to analyze the intersections between delirium, physical exercise and rehabilitation, to better understand their interrelation and to visualize future lines of research. METHODS In this narrative review, after an overview of brain neurophysiology and function, as common substrates to understand the relationship between delirium and physical function, we explore the scientific evidence in: (1) physical dysfunction as a risk factor for delirium; (2) physical dysfunction as a symptom of delirium and (3) functional consequences related to delirium. Later, we analyze the physical therapy as one of the main strategies in multicomponent interventions to prevent delirium, by examining intervention studies including rehabilitation, which have shown to be effective in managing delirium. Finally, we analyze how frailty, delirium and physical exercise interact with each other. RESULTS This review confirms the close relationship between delirium and physical dysfunction; therefore, it is not surprising that physical exercise is widely used in delirium preventive strategies. Although delirium is catalogued as a neurocognitive disorder, scientific evidence shows that it is also a motor disorder, which is to be expected, since a vast body of literature already supports an interaction between motor and cognitive function. CONCLUSION The motor component of delirium should be taken into account when designing interventions or strategies to address delirium. These interventions may have a special importance in frail older adults.
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Affiliation(s)
- N Gual
- Parc Sanitari Pere Virgili, Carrer d'Esteve Terradas 30, 08023, Barcelona, Spain. .,REFiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Barcelona, Spain. .,Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - M García-Salmones
- Parc Sanitari Pere Virgili, Carrer d'Esteve Terradas 30, 08023, Barcelona, Spain
| | - L Brítez
- Parc Sanitari Pere Virgili, Carrer d'Esteve Terradas 30, 08023, Barcelona, Spain
| | - N Crespo
- Parc Sanitari Pere Virgili, Carrer d'Esteve Terradas 30, 08023, Barcelona, Spain
| | - C Udina
- Parc Sanitari Pere Virgili, Carrer d'Esteve Terradas 30, 08023, Barcelona, Spain.,REFiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - L M Pérez
- Parc Sanitari Pere Virgili, Carrer d'Esteve Terradas 30, 08023, Barcelona, Spain.,REFiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Barcelona, Spain
| | - M Inzitari
- Parc Sanitari Pere Virgili, Carrer d'Esteve Terradas 30, 08023, Barcelona, Spain.,REFiT Barcelona Research Group, Vall d'Hebrón Institute of Research (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
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13
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Dahlke SA, Hunter KF, Negrin K. Nursing practice with hospitalised older people: Safety and harm. Int J Older People Nurs 2019; 14:e12220. [PMID: 30628753 DOI: 10.1111/opn.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nursing teams work with hospitalised older people in institutions, which prioritise a biomedical model of care. This model does not fit the needs of older people because it emphasises efficacy and a narrow definition of patient safety, but does not prioritise functional needs. Nursing care is provided around the clock within the context of fiscal restraints as well as negative societal and nursing perspectives about ageing and old people. Yet, nursing perceptions of managing safety and potential harms to older patients within these hospital institutions are not well understood. METHODS An integrative review was conducted to examine nursing perspectives of safety and harm related to hospitalised older people. RESULTS The majority of included papers focused on restraint use. Findings reveal that nurses are using restraints and limiting mobility as strategies to manage their key priority of keeping older patients safe, reflecting a narrow conceptualisation of safety. Policy, administrative support and individual nurse characteristics influence restraint use. Safety policies that nurses interpret as preventing falls can encourage the use of restraints and limiting mobility, both of which result in functional losses to older people. CONCLUSIONS This complex issue requires attention from clinical nurses, leaders, policy makers and researchers to shift the focus of care to preservation and restoration of function for older people in hospital as a safety priority. IMPLICATIONS FOR PRACTICE Clinical leaders and nursing teams should engage in developing processes of care that incorporate maintaining and restoring older people's function.
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Affiliation(s)
- Sherry Ann Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Negrin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Ziaei M, Massoudifar A, Rajabpour-Sanati A, Pourbagher-Shahri AM, Abdolrazaghnejad A. Management of Violence and Aggression in Emergency Environment; a Narrative Review of 200 Related Articles. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2018; 3:e7. [PMID: 31172118 PMCID: PMC6548084 DOI: 10.22114/ajem.v0i0.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
CONTEXT The aim of this study is to reviewing various approaches for dealing with agitated patients in emergency department (ED) including of chemical and physical restraint methods. EVIDENCE ACQUISITION This review was conducted by searching "Violence," "Aggression," and "workplace violence" keywords in these databases: PubMed, Scopus, EmBase, ScienceDirect, Cochrane Database, and Google Scholar. In addition to using keywords for finding the papers, the related article capability was used to find more papers. From the found papers, published papers from 2005 to 2018 were chosen to enter the paper pool for further review. RESULTS Ultimately, 200 papers were used in this paper to conduct a comprehensive review regarding violence management in ED. The results were categorized as prevention, verbal methods, pharmacological interventions and physical restraint. CONCLUSION In this study various methods of chemical and physical restraint methods were reviewed so an emergency medicine physician be aware of various available choices in different clinical situations for agitated patients.
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Affiliation(s)
- Maryam Ziaei
- Department of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ali Massoudifar
- Department of Psychiatry, School of Medicine, Hormozgan University of Medical Sciences, Bandarabbas, Iran
| | | | | | - Ali Abdolrazaghnejad
- Department of Emergency Medicine, Khatam-Al-Anbia Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
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