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Moermans VRA, Hamers JPH, Verbeek H, de Casterlé BD, Milisen K, Bleijlevens MHC. District nurses' experiences with involuntary treatment in dementia care at home: a qualitative descriptive study. BMC Nurs 2023; 22:394. [PMID: 37853344 PMCID: PMC10585764 DOI: 10.1186/s12912-023-01553-w] [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: 01/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Research shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home. METHODS A qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven. RESULTS District nurses' experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate. CONCLUSIONS Our results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.
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Affiliation(s)
- Vincent R A Moermans
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands.
- Department of Nursing, White Yellow Cross Limburg, Genk, Belgium.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
| | - Jan P H Hamers
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
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Piirainen P, Pesonen HM, Kyngäs H, Elo S. Challenging situations and competence of nursing staff in nursing homes for older people with dementia. Int J Older People Nurs 2021; 16:e12384. [PMID: 34075711 DOI: 10.1111/opn.12384] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Dementia causes behavioural changes in people that often lead to earlier placement in a nursing home. Staff can find these behavioural changes challenging and require specific competencies to support and care of people living with dementia. However, there is little information regarding the competencies nurses require in dementia care. Thus, the aims of this study were to determine the prevalence of challenging situations in nursing homes of older people with dementia, characterise the nursing staff's responses to such situations and contribute to a model outlining competences that dementia care nurses require. METHODS Data were collected using mixed methods in a cross-sectional survey of views of nursing staff (n = 106) in two nursing homes in Finland during May to June 2018 using a structured questionnaire including open-ended questions. Quantitative data acquired were analysed statistically, and responses to the open-ended question were analysed using content analysis methodology. RESULTS Most nurses (98%) reported that challenging situations occurred daily or weekly. The most common reported forms of challenging behaviour were as follows: wandering, restlessness, constant leaving, repeated inquiries and requests and opposition to treatment (mentioned by 95%, 90%, 85%, 83% and 83% of respondents, respectively). Five key competencies were identified from their responses: practical knowledge, theoretical knowledge, therapeutic use of self, social competence and self-management. They also indicated significant correlations between leadership and both the impact of challenging behaviour on coping at work and use of physical restraints on older people with dementia. CONCLUSION Challenging situations in nursing homes of older people with dementia are very common. There is a need to identify specific competencies for caring for people with dementia in addition to updating official guidelines to handle such situations. The support of supervisors and competencies related to therapeutic use of self in nursing are highly important for nurses providing care for people with dementia.
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Affiliation(s)
- Paula Piirainen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | | | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
| | - Satu Elo
- Lapland University of Applied Sciences, Kemi, Finland
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The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards-A Brief Literature Review. Geriatrics (Basel) 2019; 4:geriatrics4030050. [PMID: 31487923 PMCID: PMC6787583 DOI: 10.3390/geriatrics4030050] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/12/2023] Open
Abstract
Restraint in modern non-psychiatric-based healthcare is often regarded as a rare occurrence. It is deemed to be used as a last resort to prevent patients from directly harming themselves. However, techniques are used in modern day practice which are considered direct and indirect restraints with the justification of maintaining patient safety, but they are often not classified as “restraints”. Examples of these include the use of bed rails or tables to prevent patients from “wandering” and to reduce the risk of falls and injuries. More indirect techniques would involve passive interactions with patients or leaving mobility aids out of reach. Staff subconsciously restrain patients and reduce their liberties despite agreeing that patient autonomy should be upheld—a necessary evil to maintain a duty of care. Whilst the use of restraints is often justified to ensure patient care and prevent injury, it is not without consequence. There are physical and psychological health risks such as pressure sores from the inability to mobilise, or the brewing of anger and frustration when denied access to everyday actions. The reasons why restraints are used, whilst stemming from maintaining patient safety, are often due to low staffing levels and the inability to constantly watch at-risk patients due to a large workload. Inadequate training is another factor; by improving education in direct and indirect restraint and providing alternative methods, more ethical decisions and positive outcomes can be implemented. Healthcare professionals are reluctant to use restraint but often conduct it without realising it; assessing their understanding of restraint and providing education to raise awareness of the consequences of direct and indirect methods would result in positive steps toward reducing their use at the same time as looking to provide alternatives to uphold patient care whilst maintaining their dignity and liberty.
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Haugland V, Reime M. Scenario-based simulation training as a method to increase nursing students' competence in demanding situations in dementia care. A mixed method study. Nurse Educ Pract 2018; 33:164-171. [DOI: 10.1016/j.nepr.2018.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/27/2018] [Accepted: 08/18/2018] [Indexed: 11/29/2022]
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Kuronen M, Kautiainen H, Karppi P, Hartikainen S, Koponen H. Physical restraints and associations with neuropsychiatric symptoms and personal characteristics in residential care: a cross-sectional study. Int J Geriatr Psychiatry 2017; 32:1418-1424. [PMID: 27910133 DOI: 10.1002/gps.4629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physical restraints are widely used in residential care. The objective was to investigate restraint use and its associations with neuropsychiatric symptoms and personal characteristics in residential care. METHODS Data were collected in the South Savo Hospital District from 66 of 68 public or private institutions providing long-term residential care. Nurses assessed the use of physical restraints and neuropsychiatric symptoms (NPS) included in the symptom list of the Neuropsychiatric Inventory (NPI). Drug use was obtained from medical records, and activities of daily living (ADL) were assessed by the nurses according to the Barthel Index. RESULTS The total number of persons in residential care was 1386. Any restraint was used for 721 patients (52%) in the preceding 24 h. Bedrails were the most common restraints. In the multivariate analysis, psychotic symptoms (OR 1.94, 95% CI 1.14-3.31) and use of benzodiazepines (OR 1.69, 95% CI 1.18-2.41) were positively associated with restraint use, whereas antipsychotic (OR 0.62, 95% CI 0.44-0.87) and antidepressant drug use (OR 0.64, 95% CI 0.45-0.90) and higher ADL score (OR 0.9, 95% CI 0.92-0.93) were negatively associated. Concomitant use of at least two restraints was associated with high prevalence of hyperactivity NPS symptoms. CONCLUSIONS More than half of the residents were exposed to some physical restraint, most frequently bedrails, within the last 24 h. Psychotic symptoms and benzodiazepine use increased while good ADL and antipsychotic or antidepressant use decreased the risk of restraint use. Bedridden persons were the most frequently restrained which may pose an ethical problem. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marja Kuronen
- South Savo Hospital District, Mikkeli Central Hospital, Mikkeli, Finland
| | - Hannu Kautiainen
- Primary Care, University of Helsinki and Helsinki University Hospital, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Mikkeli, Finland
| | - Pertti Karppi
- South Savo Hospital District, Mikkeli Central Hospital, Mikkeli, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, HUS, Finland
| | - Hannu Koponen
- Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
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Hynninen N, Saarnio R, Elo S. Care practices of older people with dementia in the surgical ward: A questionnaire survey. SAGE Open Med 2016; 4:2050312116676033. [PMID: 27895915 PMCID: PMC5117247 DOI: 10.1177/2050312116676033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 09/27/2016] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The objective of this study was to describe the care practices of nursing staff caring older people with dementia in a surgical ward. METHODS The data were collected from nursing staff (n = 191) working in surgical wards in one district area in Finland during October to November 2015. Data were collected using a structured questionnaire and analyzed statistically. The instrument consists of a total number of 141 items and four dimensions. The dimensions were as follows: background information (12 of items), specific characteristics of older people with dementia in a surgical ward (24 of items), specific characteristics of their care in a surgical ward (66 of items) and use of physical restraints and alternative models for use of restraints for people with dementia (39 of items). RESULTS The questions which measure the nursing staff's own assessment of care practices when caring for people with dementia in surgical wards were selected: counseling people with dementia, reaction when a surgical patient with dementia displays challenging behavior and use of alternative approach instead of physical restraints. Most commonly the nursing staff pay attention to patient's state of alertness before counseling older people with dementia. Instead of using restraints, nursing staff gave painkillers for the patient and tried to draw patients' attention elsewhere. The nursing staff with longer work experience estimate that they can handle the patients' challenging behavior. They react by doing nothing more often than others. They pretend not to hear, see or notice anything. CONCLUSION The findings of this study can be applied in nursing practice and in future studies focusing on the care practices among older people with dementia in acute care environment. The results can be used while developing patient treatments process in surgical ward to meet future needs.
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Affiliation(s)
- Nina Hynninen
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Reetta Saarnio
- Metropolia University of Applied Sciences, Espoo, Finland
| | - Satu Elo
- Metropolia University of Applied Sciences, Espoo, Finland
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Hynninen N, Saarnio R, Isola A. Treatment of older people with dementia in surgical wards from the viewpoints of the patients and close relatives. J Clin Nurs 2015; 24:3691-9. [DOI: 10.1111/jocn.13004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Nina Hynninen
- Department of Nursing Science and Health Administration; Faculty of Medicine; Oulu University Hospital; University of Oulu; Oulu Finland
| | - Reetta Saarnio
- Helsinki Metropolia University of Applied Sciences; Helsinki Finland
| | - Arja Isola
- Department of Nursing Science and Health Administration; Faculty of Medicine; University of Oulu; Kuopio Finland
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Gutiérrez-Herrera RF, Sierra-Ayala I, Riquelme-Heras HM, Padrón-López O. [Use of physical restraint in geriatric nursing homes in the metropolitan area of Monterrey, Mexico]. Rev Esp Geriatr Gerontol 2015; 51:180-1. [PMID: 26358532 DOI: 10.1016/j.regg.2015.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/19/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Raúl F Gutiérrez-Herrera
- Maestros del Departamento de Medicina Familiar, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, México
| | - Irasema Sierra-Ayala
- Maestros del Departamento de Medicina Familiar, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, México
| | - Héctor Manuel Riquelme-Heras
- Maestros del Departamento de Medicina Familiar, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, México.
| | - Olga Padrón-López
- MIR de Medicina Familiar, Hospital Universitario «Dr. José E. González», Universidad Autónoma de Nuevo León, Monterrey, México
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Gjerberg E, Lillemoen L, Pedersen R, Førde R. Coercion in nursing homes: Perspectives of patients and relatives. Nurs Ethics 2015; 23:253-64. [PMID: 25566815 DOI: 10.1177/0969733014564907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives. OBJECTIVES The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under which circumstances? METHODS The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives. ETHICAL CONSIDERATIONS Participation was based on written informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. RESULTS More than half of the patients and the majority of the relatives accepted the use of coercion, trusting the staff to act in the patient's best interest. However, the acceptance of coercion is strongly related to the patients' lack of understanding, to prevent health risks and to preserve the patient's dignity. CONCLUSION The majority of nursing home patients and relatives accepted the use of coercion in specific situations, while at the same time they emphasised the need to try alternative strategies first. There is still a need for good qualitative research on the use of coercion in nursing homes, especially with a closer focus on the perspectives and experiences of nursing home patients.
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Hynninen N, Saarnio R, Isola A. The care of older people with dementia in surgical wards from the point of view of the nursing staff and physicians. J Clin Nurs 2014; 24:192-201. [DOI: 10.1111/jocn.12669] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Nina Hynninen
- Department of Nursing Science and Health Administration; Faculty of Medicine; University of Oulu; Oulu University Hospital; Oulu Finland
| | | | - Arja Isola
- Department of Nursing Science and Health Administration; Faculty of Medicine; University of Oulu; Oulu University Hospital; Oulu Finland
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de Casterlé BD, Goethals S, Gastmans C. Contextual influences on nurses' decision-making in cases of physical restraint. Nurs Ethics 2014; 22:642-51. [PMID: 25099139 DOI: 10.1177/0969733014543215] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In order to fully understand nurses' ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified. RESEARCH QUESTIONS What is the influence of context on nurses' decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint? RESEARCH DESIGN A qualitative descriptive study inspired by the Grounded Theory approach was carried out. PARTICIPANTS AND RESEARCH CONTEXT In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium. ETHICAL CONSIDERATIONS The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven. FINDINGS Relationships with nursing colleagues and the patient's family form an inter-personal network. Nurses also point to the importance of the procedural-legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses' decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint. DISCUSSION The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making. CONCLUSION An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions.
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Iecovich E, Rabin B. Practices used in Israel by nurses who care during hospitalization for older patients with dementia or who are bedridden. Am J Alzheimers Dis Other Demen 2014; 29:166-76. [PMID: 24211869 PMCID: PMC10852597 DOI: 10.1177/1533317513511287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The study's purpose was to examine (a) bedside nurses' care practices when providing care to patients with dementia or those who are physically disabled and (b) the extent to which these actions vary by type of hospital, type of ward, and nurse's characteristics. The sample included 265 nurses in internal medicine and geriatric wards in 2 general hospitals in Israel. The results showed that the most prevalent practices were giving greater attention to these patients, locating them in a room near the nurses' station and asking family members to stay with the patient or to hire paid carers. Use of restraints was more prevalent in patients with dementia than those who were physically disabled. Use of specific practices significantly varied by type of ward and hospital, suggesting that nurses' care practices are more connected with organizational characteristics than other factors.
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Affiliation(s)
- Esther Iecovich
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, BeerSheva, Israel
| | - Barbara Rabin
- Social Services, Meir Medical Center, Kfar Saba, Israel
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Kinnunen-Luovi K, Saarnio R, Isola A. Safety incidents involving confused and forgetful older patients in a specialised care setting - analysis of the safety incidents reported to the HaiPro reporting system. J Clin Nurs 2013; 23:2442-50. [DOI: 10.1111/jocn.12364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2013] [Indexed: 11/30/2022]
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Huang HC, Huang YT, Lin KC, Kuo YF. Risk factors associated with physical restraints in residential aged care facilities: a community-based epidemiological survey in Taiwan. J Adv Nurs 2013; 70:130-43. [PMID: 23734585 DOI: 10.1111/jan.12176] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2013] [Indexed: 11/30/2022]
Abstract
AIM To identify the rate and risk factors of physical restraint in residential aged care facilities in Taiwan. BACKGROUND In Taiwan, physical restraint is commonly used in aged care facilities to prevent accidents. Many are unaware of the associated risks. Restrained residents cannot move freely, increasing the risk of atrophy and leading to reduced physical functioning. DESIGN A community-based epidemiological survey. METHODS Data were collected from June-December 2007 across 178 residential aged care facilities with 5,173 residential beds in the target city of Taiwan. Twenty facilities were sampled using probability proportional to size by beds and accreditation ranking. In all, 256 primary caregivers (78 nurses and 178 care aides) and 847 residents completed the study questionnaires and tests. A multilevel analysis approach was used to identify individual- and facility-level risk factors for physical restraint and assess the variation in physical restraint at the individual- and facility-level. RESULTS Of 847 residents, 62% (527) were restrained during the study period. The main reasons for restraint use were fall prevention and prevention of tube removal. Resident level risk factors for physical restraint included lower Barthel Index scores (more dependent) and an agreement allowing the use of physical restraint to avoid injury signed by a family member or social worker. A facility-level risk factor for physical restraint was younger primary caregivers. CONCLUSION To reduce the incidence of physical restraint in residential aged care facilities in Taiwan, educational programmes should target primary caregivers and families in facilities.
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Affiliation(s)
- Hui Chi Huang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu Tai Huang
- Information Science and Applications Alumni Association, Asia University, Taichung, Taiwan
| | - Kuan Chia Lin
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Yong Fang Kuo
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Process evaluation of a multicomponent intervention program (EXBELT) to reduce belt restraints in nursing homes. J Am Med Dir Assoc 2013; 14:599-604. [PMID: 23608527 DOI: 10.1016/j.jamda.2013.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/28/2013] [Accepted: 03/05/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The current study describes the process evaluation of a multicomponent intervention program (Expelling Belts [EXBELT]) to reduce the use of belt restraints in psychogeriatric nursing homes. The aim was to assess the feasibility and ascertain suggestions for optimization of the EXBELT program. DESIGN A descriptive study comprising longitudinal elements. SETTING Fifteen psychogeriatric nursing home wards in 6 Dutch nursing homes. PARTICIPANTS The study population consisted of 4 different groups of participants who took part in the intervention arm of the quasi-experimental study examining the effectiveness of EXBELT: nursing home staff who attended the final session of the educational program; 2 nurse specialists who delivered the educational program and did the consultations; 4 groups of delegates representing the nursing home associations where the EXBELT program was implemented; and the relatives of those residents in the intervention group who were restrained with a belt at the start of the study. MEASUREMENTS Both quantitative and qualitative data were collected from the study population. Data were assessed by means of self-administered questionnaires, recording forms, group interviews, telephone interviews, and monthly meetings. RESULTS The EXBELT study was largely performed according to protocol and very well received by nursing home staff as well as resident's relatives. Suggestions to improve the EXBELT program include the addition of examples of how to communicate about the policy change, improving the reach of the intended target population, adding more case-based learning strategies, and embedding the available consultants more proactively. CONCLUSIONS The implementation of EXBELT was highly successful in the current research population and is likely to be feasible in psychogeriatric nursing homes in general.
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Gjerberg E, Hem MH, Førde R, Pedersen R. How to avoid and prevent coercion in nursing homes. Nurs Ethics 2013; 20:632-44. [DOI: 10.1177/0969733012473012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home’s resources, by the organization of care and by the staff’s competence.
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Lejman E, Westerbotn M, Pöder U, Wadensten B. The ethics of coercive treatment of people with dementia. Nurs Ethics 2013; 20:248-62. [DOI: 10.1177/0969733012463721] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the present study was to describe how registered nurses in nursing homes ensure legal security, good and safe nursing care and uphold the dignity of nursing home residents with severe dementia without violating residents’ integrity. Semi-structured interviews were conducted with 10 charge nurses in a county in central Sweden. The transcribed interviews were examined using manifest and latent content analyses. The manifest analysis identified actual local routines involving coercive treatment and registered nurses’ descriptions of complications and alternative measures. The latent analysis resulted in three themes describing nursing strategies: one with coercive treatment, one with coercive treatment under specific circumstances and one to prevent coercive treatment. Interpretations of legal terms regarding coercive treatment and inadequate gerontological nursing training and understaffing seem to preserve the use of coercive treatment.
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Affiliation(s)
- Eva Lejman
- Uppsala University, Sweden; Sophiahemmet University College, Sweden
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Chiba Y, Yamamoto-Mitani N, Kawasaki M. A national survey of the use of physical restraint in long-term care hospitals in Japan. J Clin Nurs 2012; 21:1314-26. [PMID: 22300266 DOI: 10.1111/j.1365-2702.2011.03971.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To investigate the prevalence of physical restraints in the long-term care hospitals in Japan and to examine the factors of physical restraint use, including the specific skills/techniques that the staff use to minimise the restraints. Background. Despite the national efforts to nullify physical restraint, it is still prevalent in long-term care facilities in and out of Japan. More detailed information regarding what affects physical restraint is needed. DESIGN Cross-sectional mail survey. METHOD A questionnaire was sent to a nursing ward manager of the random sample of long-term care facilities in Japan. RESULTS The average rate of physical restraint was 25·5%. Altogether, 81·0% of the restrained clients were under restraint for more than one month. The most prevalent method of restraint was bilateral bedrails, followed by the use of coveralls and gloves. Factors of restraint were different depending on the type of restraint, suggesting specific approaches are needed for specific type of restraint. CONCLUSIONS Physical restraint is still prevalent in Japanese long-term care hospitals, and nurses need to develop effective intervention approach to redesigning practice related to physical restraints. Specialised intervention approach seems needed depending on the types of restraint. RELEVANCE TO CLINICAL PRACTICE Specific approach should be developed to minimise the physical restraint in long-term care hospitals in Japan.
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Affiliation(s)
- Yumi Chiba
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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De Bellis A, Mosel K, Curren D, Prendergast J, Harrington A, Muir-Cochrane E. Education on physical restraint reduction in dementia care: a review of the literature. DEMENTIA 2011; 12:93-110. [PMID: 24336665 DOI: 10.1177/1471301211421858] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.
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Habjanič A, Lahe D. Are frail older people less exposed to abuse in nursing homes as compared to community-based settings? Statistical analysis of Slovenian data. Arch Gerontol Geriatr 2011; 54:e261-70. [PMID: 21872349 DOI: 10.1016/j.archger.2011.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Revised: 07/15/2011] [Accepted: 07/19/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although international research in recent years has often focused on elder abuse, its extent is not clear in community-based settings and even bigger mystery in nursing homes. BACKGROUND Until now in the literature it has in most cases only been assumed that nursing homes offer better protection from abuse for frail older people. METHODS A cross-sectional research design was applied by use of structured interviews. Those involved were frail older people (n=300) who were in need of some sort of professional nursing assistance. RESULTS Nursing home accommodation was extracted as the strongest predictor, significantly reducing the risk of physical abuse (odds ratio, OR 0.1, 95% confidence interval, 95% CI 0.0-0.3) and financial abuse (OR 0.2, 95% CI 0.1-0.4). Spouses and sons were revealed as the most regular perpetrators of physical and financial abuse. The results showed no statistical significance between settings as predictors of the occurrence of mental abuse (OR 0.9, 95% CI 0.5-1.6). DISCUSSION Results of the statistical analysis add to the general assumption that nursing home accommodation offers protection for frail older people in escaping physical and financial abuse. CONCLUSION In their clinical practice, community nurses should give special attention to frail older people who, besides their healthcare needs, are also heavily dependent in the activities of daily living (ADLs). In order to combat elder abuse, conditions in the family should be regularly verified.
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Affiliation(s)
- Ana Habjanič
- University of Maribor, Faculty of Health Sciences, Žitna ulica 15, SI-2000 Maribor, Slovenia.
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Lane C, Harrington A. The factors that influence nurses' use of physical restraint: A thematic literature review. Int J Nurs Pract 2011. [DOI: 10.1111/j.1440-172x.2011.01925.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Saarnio R, Isola A. Nursing staff perceptions of the use of physical restraint in institutional care of older people in Finland. J Clin Nurs 2010; 19:3197-207. [PMID: 20726929 DOI: 10.1111/j.1365-2702.2010.03232.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES To describe the perceptions of nursing staff on the use of physical restraints in institutional care of older people. BACKGROUND Physical restraint of older people is a common practice in institutional care in many countries, including Finland. As the nursing staff plays a major role in deciding on physically restraining older patient and in the care the patient receives, new research information is needed on the nursing staff's attitudes towards the use of physical restraints. DESIGN A qualitative study. METHOD The data consisted of focus group interviews with staff and supervisors. There were four focus groups: nurses, practical nurses, institutional assistants and care supervisors. RESULTS In addition to traditional methods of restraint, such as belts and locked doors, the nursing staff also used indirect restraint by removing the patient's mobility aid. Factors contributing to the use of restraints included requests by the patient's family members to use restraint to ensure the patient's safety and social reasons, in the form of lack of legislation on the use of restraint. The use of restraints caused feelings of guilt among the nursing staff, but on the other hand, it was seen as a way of making older patient feel more secure. CONCLUSIONS There is a need for official guidelines on the use of physical restraints in care of older people. This would require the entire nursing team to make a joint decision on the use of restraints and constant reassessment of the need of using restraints. RELEVANCE TO CLINICAL PRACTICE The results of the study provide nursing staff and supervisors a chance to ethically deliberate and evaluate their own work. Alternative practices for physical restraint can also be directly applied to practical care of older people.
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Affiliation(s)
- Reetta Saarnio
- Faculty of Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland.
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Watson R. Commentary on Meyer G, Köpke S, Haasert B & Mühlhauser I (2009) Restraint use among nursing home residents: cross-sectional study and prospective cohort.Journal of Clinical Nursing18, 981-990 and Saarnio R, Isola A & Laukkala H (2009) The use of physical restraint in institutional care of older people in Finland: nurses’ individual, communal and alternative modes of action.Journal of Clinical Nursing18, 132-140. J Clin Nurs 2009; 18:1078-9. [DOI: 10.1111/j.1365-2702.2008.02621.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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