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Boggatz T, Schimböck F. [Validation for people with dementia: innovation without evidence? : Systematic review]. Z Gerontol Geriatr 2024; 57:13-20. [PMID: 38157032 DOI: 10.1007/s00391-023-02263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Validation was an innovative approach to dealing with people with dementia that was supposed to reduce the incidence of challenging behavior. This effect, however, remains unclear to this day. OBJECTIVE Does validation reduce challenging behaviour in people with dementia? MATERIAL AND METHOD Systematic review according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Literature search in PubMed, CINAHL, PsycInfo and Web of Science. Description and critical appraisal of identified studies by two reviewers using the revised Cochrane risk of bias tool for randomized controlled trials. RESULTS A total of five studies were identified. Only one showed a significant reduction in challenging behavior compared to the control group. All studies had a moderate to high risk of bias. CONCLUSION Despite the negative results, a positive effect of validation cannot be ruled out as the trials tested validation as an isolated treatment and not as an integrated part of daily care. In addition, blinding, which is common in clinical trials, is not an appropriate criterion for evaluating trials investigating interventions where the effects result exclusively from interpersonal interaction.
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Affiliation(s)
- Thomas Boggatz
- Fakultät für Pflegewissenschaft, Vinzenz Pallotti University, Pallottistraße 3, 56179, Vallendar, Deutschland.
| | - Florian Schimböck
- Medizinische Fakultät, Institut für Allgemeinmedizin, Arbeitsgruppe Didaktik der Pflege und Gesundheitsberufe, Christian-Albrechts-Universität zu Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Deutschland
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Aguglia A, Corsini GP, Berardelli I, Berti A, Conio B, Garbarino N, Gnecco GB, Magni C, Venturini E, Costanza A, Amerio A, Amore M, Serafini G. Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1847. [PMID: 37893565 PMCID: PMC10607962 DOI: 10.3390/medicina59101847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: mechanical restraint (MR) is a controversial issue in emergency psychiatry and should be better studied to implement other alternative therapeutic interventions. The aim of this study was to estimate the prevalence of MR in an Italian psychiatric unit and identify the sociodemographic and clinical characteristics as well as the pharmacological pattern associated with MR. Materials and Methods: all subjects (N = 799) consecutively admitted to an Italian psychiatric inpatient unit were recruited. Several sociodemographic and clinical characteristics were recorded. Results: The prevalence of MR was 14.1%. Males, a younger age, and a single and migrant status were associated with the MR phenomenon. MR was more prevalent in patients affected by other diagnoses and comorbid illicit substance use, in patients with aggressive behaviors, and those that were involuntary admitted, leading significantly to hospitalization over 21 days. Furthermore, the patients that underwent MR were taking a lower number of psychiatric medications. Conclusions: Unfortunately, MR is still used in emergency psychiatry. Future research should focus on the dynamics of MR development in psychiatry, specifically considering ward- and staff-related factors that could help identify a more precise prevention and alternative intervention strategies.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Giovanni Pietro Corsini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Andrea Berti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Benedetta Conio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Nicolò Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Giovanni Battista Gnecco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Caterina Magni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Enrico Venturini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service, University Hospitals of Geneva (HUG), 1207 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
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Hakverdioğlu Yönt G, Kisa S, Princeton DM. Physical Restraint Use in Nursing Homes-Regional Variances and Ethical Considerations: A Scoping Review of Empirical Studies. Healthcare (Basel) 2023; 11:2204. [PMID: 37570444 PMCID: PMC10419255 DOI: 10.3390/healthcare11152204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Physical restraints are known to violate human rights, yet their use persists in long-term care facilities. This study aimed to explore the prevalence, methods, and interventions related to physical restraint use among the elderly in nursing homes. METHODS The method described by Joanna Briggs was followed to conduct a scoping review without a quality assessment of the selected studies. An electronic search was conducted to find eligible empirical articles using MEDLINE, PsycINFO, EMBASE, Web of Science, Scopus, Google Scholar, CINAHL, and grey literature. The database search was performed using EndNote software (version X9, Clarivate Analytics), and the data were imported into Excel for analysis. RESULTS The prevalence of physical restraint use was found to be highest in Spain (84.9%) and lowest in the USA (1.9%). The most common device reported was bed rails, with the highest prevalence in Singapore (98%) and the lowest (4.7%) in Germany, followed by chair restraint (57%). The largest number of studies reported the prevention and/or risk of falls to be the main reason for using physical restraints, followed by behavioral problems such as wandering, verbal or physical agitation, and cognitive impairment. Most studies reported guideline- and/or theory-based multicomponent interventions consisting of the training and education of nursing home staff. CONCLUSIONS This review provides valuable insights into the use of physical restraints among elderly residents in nursing homes. Despite efforts to minimize their use, physical restraints continue to be employed, particularly with elderly individuals who have cognitive impairments. Patient-related factors such as wandering, agitation, and cognitive impairment were identified as the second most common reasons for using physical restraints in this population. To address this issue, it is crucial to enhance the skills of nursing home staff, especially nurses, in providing safe and ethical care for elderly residents with cognitive and functional impairments, aggressive behaviors, and fall risks.
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Affiliation(s)
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Faculty of Nursing, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
| | - Daisy Michelle Princeton
- Department of Nursing and Health Promotion, Faculty of Nursing, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
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Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints for older people in all long-term care settings. Cochrane Database Syst Rev 2023; 7:CD007546. [PMID: 37500094 PMCID: PMC10374410 DOI: 10.1002/14651858.cd007546.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Physical restraints (PR), such as bedrails and belts in chairs or beds, are commonly used for older people receiving long-term care, despite clear evidence for the lack of effectiveness and safety, and widespread recommendations that their use should be avoided. This systematic review of the efficacy and safety of interventions to prevent and reduce the use of physical restraints outside hospital settings, i.e. in care homes and the community, updates our previous review published in 2011. OBJECTIVES To evaluate the effects of interventions to prevent and reduce the use of physical restraints for older people who require long-term care (either at home or in residential care facilities) SEARCH METHODS: We searched ALOIS, 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 (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register, the International Clinical Trials Registry Portal, on 3 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that investigated the effects of interventions intended to prevent or reduce the use of physical restraints in older people who require long-term care. Studies conducted in residential care institutions or in the community, including patients' homes, were eligible for inclusion. We assigned all included interventions to categories based on their mechanisms and components. DATA COLLECTION AND ANALYSIS Two review authors independently selected the publications for inclusion, extracted study data, and assessed the risk of bias of all included studies. Primary outcomes were the number or proportion of people with at least one physical restraint, and serious adverse events related to PR use, such as death or serious injuries. We performed meta-analyses if necessary data were available. If meta-analyses were not feasible, we reported results narratively. We used GRADE methods to describe the certainty of the evidence. MAIN RESULTS We identified six new studies and included 11 studies with 19,003 participants in this review update. All studies were conducted in long-term residential care facilities. Ten studies were RCTs and one study a CCT. All studies included people with dementia. The mean age of the participants was approximately 85 years. Four studies investigated organisational interventions aiming to implement a least-restraint policy; six studies investigated simple educational interventions; and one study tested an intervention that provided staff with information about residents' fall risk. The control groups received usual care only in most studies although, in two studies, additional information materials about physical restraint reduction were provided. We judged the risk of selection bias to be high or unclear in eight studies. Risk of reporting bias was high in one study and unclear in eight studies. The organisational interventions intended to promote a least-restraint policy included a variety of components, such as education of staff, training of 'champions' of low-restraint practice, and components which aimed to facilitate a change in institutional policies and culture of care. We found moderate-certainty evidence that organisational interventions aimed at implementation of a least-restraint policy probably lead to a reduction in the number of residents with at least one use of PR (RR 0.86, 95% CI 0.78 to 0.94; 3849 participants, 4 studies) and a large reduction in the number of residents with at least one use of a belt for restraint (RR 0.54, 95% CI 0.40 to 0.73; 2711 participants, 3 studies). No adverse events occurred in the one study which reported this outcome. There was evidence from one study that organisational interventions probably reduce the duration of physical restraint use. We found that the interventions may have little or no effect on the number of falls or fall-related injuries (low-certainty evidence) and probably have little or no effect on the number of prescribed psychotropic medications (moderate-certainty evidence). One study found that organisational interventions result in little or no difference in quality of life (high-certainty evidence) and another study found that they may make little or no difference to agitation (low-certainty evidence). The simple educational interventions were intended to increase knowledge and change staff attitudes towards PR. As well as providing education, some interventions included further components to support change, such as ward-based guidance. We found pronounced between-group baseline imbalances in PR prevalence in some of the studies, which might have occurred because of the small number of clusters in the intervention and control groups. One study did not assess bedrails, which is the most commonly used method of restraint in nursing homes. Regarding the number of residents with at least one restraint, the results were inconsistent. We found very-low certainty evidence and we are uncertain about the effects of simple educational interventions on the number of residents with PR. None of the studies assessed or reported any serious adverse events. We found moderate-certainty evidence that simple educational interventions probably result in little or no difference in restraint intensity and may have little or no effect on falls, fall-related injuries, or agitation (low-certainty evidence each). Based on very low-certainty evidence we are uncertain about the effects of simple educational interventions on the number of participants with a prescription of at least one psychotropic medication. One study investigated an intervention that provided information about residents' fall risk to the nursing staff. We found low-certainty evidence that providing information about residents' fall risk may result in little or no difference in the mean number of PR or the number of falls. The study did not assess overall adverse events. AUTHORS' CONCLUSIONS Organisational interventions aimed to implement a least-restraint policy probably reduce the number of residents with at least one PR and probably largely reduce the number of residents with at least one belt. We are uncertain whether simple educational interventions reduce the use of physical restraints, and interventions providing information about residents' fall risk may result in little to no difference in the use of physical restraints. These results apply to long-term care institutions; we found no studies from community settings.
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Affiliation(s)
- 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
| | - Tanja Richter
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, 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
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Hodgson G, Pace A, Carfagnini Q, Ayanso A, Gardner P, Narushima M, Ismail Z, Faught BE. Risky Business: Factors That Increase Risk of Falls Among Older Adult In-Patients. Gerontol Geriatr Med 2023; 9:23337214231189930. [PMID: 37533770 PMCID: PMC10392204 DOI: 10.1177/23337214231189930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 08/04/2023] Open
Abstract
In hospitals, older patients are at increased risk of falling multiple times. This study incorporated an epidemiologic cross-sectional design consisting of 4,348 older patients (≥65-year-old). Eight hundred eighty five (20.4%) in-patients experienced multiple falls while remaining participants had one fall incident. A patient fall event was recorded with age, sex, incident date, type of fall, and location. Logistic regression assessed risk factors found in patients with multiple falls compared to those with one fall. Significant differences were observed in the proportion of multiple falls: in a bed with no rails, standing, walking, and using a wheel/Geri chair (p < .05). Overall, sex, type of fall, and location were significant in predicting multiple falls (p < .05). Male patients were at 16.1% greater risk of multiple falls, when compared to females (p < .05). A fall in complex care, mental health, or respirology were more likely to experience multiple falls (OR = 2.659, 3.620, 1.593 respectively), while season had no impact.
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Affiliation(s)
| | - Alex Pace
- Brock University, St. Catharines, ON, Canada
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Mazzetti G, Sciolino L, Guglielmi D, Mongardi M, Nielsen K, Dawson J. Organizational citizenship behaviour as a protective factor against the occurrence of adverse nursing-sensitive outcomes: A multilevel investigation. J Nurs Manag 2022; 30:4294-4303. [PMID: 36190738 PMCID: PMC10092892 DOI: 10.1111/jonm.13827] [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: 06/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIMS This study aimed to investigate the association between organizational citizenship behaviour enacted by nurses and the occurrence of adverse nursing-sensitive patient outcomes. BACKGROUND Managing psychosocial factors (i.e., aspects concerning the work environment) is key to ensure patient safety, to prevent exacerbation of case complexity and to cope with critical shortages in human and financial resources. METHODS Self-report measures of nurses' organizational citizenship behaviour were combined with objective data on the incidence of adverse nursing-sensitive outcomes (i.e., pressure ulcers and restraint use) collected through patients' medical records. Participants were 11,345 patients and 1346 nurses across 52 teams working in 14 Italian hospitals. Data were analysed using multilevel binary logistic regression models. RESULTS A negative relationship between nurses' organizational citizenship behaviour and restraint use was identified, with an odds ratio of 0.11. Thus, for a one-unit higher organizational citizenship behaviour score, the odds of using restraints shrink to about one eighth of the previous level. CONCLUSIONS Intervention strategies to foster the implementation of organizational citizenship behaviour among nurses may inhibit the occurrence of critical outcomes affecting patients' health and well-being (i.e., using restraint devices). IMPLICATIONS FOR NURSING MANAGEMENT In health care organizations, shaping a psychosocial environment encouraging organizational citizenship behaviour can mitigate the occurrence of adverse nursing-sensitive outcomes such as restraint use on patients.
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Affiliation(s)
- Greta Mazzetti
- Department of Education Studies, University of Bologna, Bologna, Italy
| | - Lorenzo Sciolino
- Hospital Care Service, General Direction for People Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Dina Guglielmi
- Department of Education Studies, University of Bologna, Bologna, Italy
| | - Maria Mongardi
- Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, Verona, Italy
| | - Karina Nielsen
- Sheffield University Management School, The University of Sheffield, Sheffield, UK
| | - Jeremy Dawson
- Sheffield University Management School, The University of Sheffield, Sheffield, UK.,School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
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Dunbar P, McMahon M, Durkan C, Walsh KA, Keyes LM. Incidence and type of restrictive practice use in nursing homes in Ireland. BMC Geriatr 2022; 22:802. [PMID: 36243703 PMCID: PMC9569185 DOI: 10.1186/s12877-022-03450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Use of restrictive practices (RP) in care settings may sometimes be warranted but can also conflict with human rights. Research to date has focused primarily on physical and chemical RP, however other forms are also used. Better understanding of practice can inform RP reduction. This study describes the incidence of all types of RP use reported from nursing homes in Ireland. Methods RP notifications from nursing homes reported in 2020 were extracted from the Database of Statutory Notifications from Social Care in Ireland. The primary outcome measurement was the national incidence of use (frequency of RP/occupancy per 1000 residents) of categories and types of RP. Secondary outcome measurements such as percentage of facilities reporting use and quarterly median incidence of use in these facilities were calculated. Results Seventy thousand six hundred sixty-three RP uses were notified from 608 facilities (33,219 beds). National incidence of RP use per 1000 residents was, all categories: 2465.1, environmental: 1324.5, physical: 922.5, chemical: 141.1; ‘other’: 77.0. The most frequently used RPs per category were, environmental: door locks; physical: bedrails; chemical (where drug specified): antipsychotics; ‘other’: privacy. 90.5% of nursing homes reported using at least one type of RP in the 12-month period. Quarterly incidence of any RP use in these facilities was median 1.642 (IQR: 0.018 to 18.608) per bed. Conclusions Nursing homes in Ireland regularly use RP; only 9.5% reported no RP use in the 12-month period. A wide variety of types of RP were reported. Environmental and ‘other’ (largely psychosocial) RP contributed notably to total RP use and warrant attention alongside the traditional focus on physical and chemical RP. Policy implications include the need for more comprehensive RP definitions. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03450-4.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Unit 1301, City Gate, Mahon, Cork, T12 Y2XT, Ireland
| | - Martin McMahon
- Health Information and Quality Authority, Unit 1301, City Gate, Mahon, Cork, T12 Y2XT, Ireland
| | - Ciara Durkan
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Kieran A Walsh
- Health Information and Quality Authority, Unit 1301, City Gate, Mahon, Cork, T12 Y2XT, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Unit 1301, City Gate, Mahon, Cork, T12 Y2XT, Ireland.
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Variation of the Occurrence of Physical Restraint Use in the Long-Term Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211918. [PMID: 34831674 PMCID: PMC8622316 DOI: 10.3390/ijerph182211918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 01/09/2023]
Abstract
Physical restraints in the long-term care setting are still commonly used in several countries with a prevalence ranging from 6% to 85%. Trying to have a broad and extensive overlook on the physical restraints use in long-term care is important to design interventions to prevent and/or reduce their use. Therefore, the aim of this scoping review was to analyze the range of occurrence of physical restraint in nursing homes, long-term care facilities, and psychogeriatric units. Pubmed, CINAHL, Ovid PsycINFO- databases were searched for studies with concepts about physical restraint use in the European long-term care setting published between 2009 and 2019, along with a hand search of the bibliographies of the included studies. Data on study design, data sources, clinical setting and sample characteristics were extracted. A total of 24 studies were included. The median occurrence of physical restraint in the European long-term care setting was still high (26.5%; IQR 16.5% to 38.5%) with a significant variability across the studies. The heterogeneity of data varied according to study design, data sources, clinical setting, physical restraint's definition, and patient characteristics, such as ADLs dependence, presence of dementia and psychoactive drugs prescription.
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Holthoff-Detto V, Nienaber A, Bötel N, Rapp M. [Complex treatment of severe mental illnesses in old age]. DER NERVENARZT 2021; 92:948-954. [PMID: 34142165 DOI: 10.1007/s00115-021-01150-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The needs for assistance, support and treatment of older people with severe mental illnesses (SMI) are very high and linked to additional age-associated somatic diseases and impairments. Old people prefer to live independently in their own homes and to receive necessary treatment and support there; however, a resettlement in a residential nursing home is often necessary due to a lack of alternatives. OBJECTIVE What is the current treatment reality in Germany for old people with SMI in their own homes and in residential nursing homes? How can coercive measures in this context be prevented? METHODS Selected results from the scientific literature on psychogeriatric care models in older people with SMI are summarized and discussed. RESULTS Multiprofessional psychogeriatric complex treatment models for older patients that include home visits and are adapted to the severity of mental disease are not available in Germany due to the lack of cross-sectoral network structures. Around 30% of the 730,000 nursing home residents in Germany experience coercive practices, whereas person-centered nursing concepts as well as guideline conform and individualized nonpharmacological treatment strategies and milieu therapeutic concepts are not sufficiently available. CONCLUSION The German healthcare system is in urgent need of multiprofessional psychogeriatric home treatment models in old people with severe mental illness in order to prevent worsening of psychiatric and somatic symptoms, to maintain individual social involvement, to strengthen individual autonomy and participative decision making and to protect from coercion. Multiprofessional expertise is essential as well as effective age-appropriate service models with multiprofessional teams delivering domiciliary visits and connecting complementary services for individual treatment requirements as part of the German health care system.
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Affiliation(s)
- Vjera Holthoff-Detto
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Hedwig Kliniken, Krankenhaus Hedwigshöhe, Höhensteig 1, 12526, Berlin, Deutschland.
- Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland.
| | - André Nienaber
- Münster School of Health (MSH), FH Münster - University of Applied Sciences, Münster, Deutschland
| | - Nora Bötel
- Friedrich-Husemann-KLinik, Buchenbach, Deutschland
| | - Michael Rapp
- Professur Sozial- und Präventivmedizin, Universität Potsdam, Potsdam, Deutschland
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Definition and Measurement of Physical and Chemical Restraint in Long-Term Care: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073639. [PMID: 33807413 PMCID: PMC8037562 DOI: 10.3390/ijerph18073639] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022]
Abstract
This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions.
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Lee DCA, Robins LM, Bell JS, Srikanth V, Möhler R, Hill KD, Griffiths D, Haines TP. Prevalence and variability in use of physical and chemical restraints in residential aged care facilities: A systematic review and meta-analysis. Int J Nurs Stud 2020; 117:103856. [PMID: 33601305 DOI: 10.1016/j.ijnurstu.2020.103856] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Use of physical and chemical restraints are common in residential aged care facilities worldwide. Restraint use can pose harm to residents even causing deaths. OBJECTIVE To synthesize the prevalence and variability in physical and chemical restraint use, and examine factors that may contribute to this variability of prevalence rates. METHODS Six health science databases were searched from inception up to 21st January 2020. Quantitative studies investigating restraint use in residential aged care facilities that reported data from year 2000 onwards were included. Meta-analyses of binomial data using a random effect model were performed to pool proportions of physical or chemical restraints with 95% confidence intervals. Univariable meta-regression analyses were used to assess factors that may contribute to the variability in physical and chemical restraint prevalence. Multiple meta-regression analyses were performed where possible to construct models of factors contributing to these variations. RESULTS Eighty-five papers were included. The pooled proportion of physical and chemical restraint use in residential aged care facilities were 33% and 32% respectively. Bedrails (44%) and benzodiazepines (42%) were the most prevalent forms of physical and chemical restraint respectively. Studies from North America (lower prevalence) [coefficient (95% CI): -0.15 (-0.27, -0.03)], measurement approaches using direct observation (higher prevalence) [0.17 (0.02, 0.33)] and a combination of multiple measurement approaches (higher prevalence) [0.17 (0.05, 0.29)] explained 25.5% of variability in the prevalence of physical restraint. Multiple meta-regression analyses were not performed to identify factors that may explain the observed variability in chemical restraint prevalence due to the small number of studies with data available. CONCLUSION Variability in prevalence of physical restraint could be explained partly by different measurement approaches and geographical regions. Valid and reliable measurement approaches across different regions is required to understand cultural differences due to geographical region effects on the prevalence of physical restraint use.
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Affiliation(s)
- Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Lauren M Robins
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Royal Parade, Parkville, VIC 3052, Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston Hospital, Frankston, VIC 3199, Australia
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Keith D Hill
- School of Primary and Allied Health Care, Rehabilitation, Ageing and Independent Living (RAIL) research centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - Debra Griffiths
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
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12
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Abraham J, Bake M, Berger-Höger B, Köpke S, Kupfer R, Meyer G, Möhler R. Process evaluation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A mixed methods study. J Adv Nurs 2020; 77:1465-1477. [PMID: 33270930 DOI: 10.1111/jan.14694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/15/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
AIMS To describe the implementation process and fidelity of two versions of a guideline-based, multicomponent intervention to reduce physical restraints in nursing homes and to identify factors that might explain the heterogeneity of effects between different clusters. DESIGN Mixed methods evaluation of the implementation process (dose delivered, dose received, response, and adaption) alongside a pragmatic three-arm cluster randomized controlled trial. METHODS Quantitative and qualitative process data were collected during the study period (February 2015-February 2017). Quantitative data from questionnaires and short surveys were analysed by descriptive statistics. Qualitative data from focus groups and semi-structured interviews were analysed using content analysis. An in-depth analysis was conducted by contrasting responding and non-responding clusters regarding the intervention goal and primary outcome. RESULTS Both interventions were implemented as planned in all clusters: we found no deviations from the protocol regarding the dose delivered to and received by the clusters. Satisfaction of staff targeted by the interventions was high. The in-depth analysis did not reveal any pronounced variation in the degree of implementation or adoption in clusters with a good or nearly no response to the interventions or factors explaining different study effects. CONCLUSION Although both versions of a guideline-based multicomponent intervention to prevent physical restraints in nursing homes were implemented as planned and the response was generally acceptable, the interventions' goal to change nursing practice towards a least-restraint policy was not achieved by the entire nursing staff in all of the clusters. No factors could be identified that might explain the different effects of the interventions. IMPACT For some nursing homes, different approaches than addressing nurses' attitudes and institutional policies might be needed to sustainably reduce the use of physical restraints; however, the process evaluation did not reveal characteristics that might have hampered or facilitated the effectiveness of the intervention.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mareike Bake
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Birte Berger-Höger
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Lübeck, Germany.,Institute of Nursing Science, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ramona Kupfer
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Lübeck, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,School of Nursing, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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13
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Brugnolli A, Canzan F, Mortari L, Saiani L, Ambrosi E, Debiasi M. The Effectiveness of Educational Training or Multicomponent Programs to Prevent the Use of Physical Restraints in Nursing Home Settings: A Systematic Review and Meta-Analysis of Experimental Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186738. [PMID: 32947851 PMCID: PMC7558973 DOI: 10.3390/ijerph17186738] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 01/07/2023]
Abstract
This review assesses the effectiveness of interventions to reduce physical restraint (PR) use in older people living in nursing homes or residential care facilities. A systematic search of studies published in four electronic databases (MEDLINE, CINHAL, PsycINFO, Cochrane Central Register of Controlled Trials). The review included individual and cluster randomized controlled trials that compared educational training and multicomponent programs to avoid PR use. Risk bias of randomized controlled trials (RCTs) was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. This review includes 16 studies in a qualitative synthesis that met the inclusion criteria, nine of them offered a multicomponent program and seven offered only educational training. The results of the 12 studies included in the meta-analysis showed a significant trend in favor of intervention over time and intensity of PR use tends to decrease. The review indicates that educational programs and other supplementary interventions should be effective, but the heterogeneous operative definition of physical restraints can make difficult data generalization.
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Affiliation(s)
- Anna Brugnolli
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Luigina Mortari
- Department of Human Sciences, University of Verona, 37134 Verona, Italy;
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Martina Debiasi
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
- Correspondence:
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Van Gansbeke H, Milisen K. Reducing physical restraints by older adults in home care: development of an evidence-based guideline. BMC Geriatr 2020; 20:169. [PMID: 32380959 PMCID: PMC7204038 DOI: 10.1186/s12877-020-1499-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/27/2020] [Indexed: 01/08/2023] Open
Abstract
Background Restraint use is a complex and challenging issue in home care. Due to socio-demographic trends, worldwide home healthcare providers are faced with an increasing demand for restraint use from informal caregivers, patients and healthcare providers, resulting in the use of various types of restraints in home care. Awareness and knowledge of restraint use in home care, its implications and the ethical challenges surrounding it are of crucial importance to its reduction. This research aimed to describe the development process of an evidence-based practice guideline to support caregivers to optimize home care. Method The practice guideline was developed according to the framework of the Belgian Centre for Evidence-Based Medicine and AGREE II. The guideline was developed over several stages: (1) determination of the target population and scope, (2) literature search, (3) drafting and (4) validation. A multidisciplinary working group determined the proposed purpose, target group, and six clinical questions for the guideline. A consensus procedure and consultation by experts were used to develop the guideline. Results The guideline provides an answer to six clinical questions and contains ten key recommendations based on the classification of GRADE, with the objective of increasing healthcare providers’ awareness, knowledge and competence to adequately deal with situations or questions related to restraint use. The guideline also includes a flowchart for dealing with complex situations where the use of restraints is requested, already present or considered. Conclusions The guideline was validated by the Belgian Centre for Evidence-Based Medicine. Increasing competence, awareness and knowledge related to restraint use are key objectives of the guideline for reducing restraint use in home care. A multicomponent intervention to support healthcare workers in implementing the guideline in clinical practice needs to be developed.
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Affiliation(s)
- Kristien Scheepmans
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium
| | - Louis Paquay
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium
| | - Hendrik Van Gansbeke
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok d - bus 7001, B-3000, Leuven, Belgium. .,Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Herestraat 49, 3000, Leuven, Belgium.
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Fernández Ibáñez JM, Morales Ballesteros MDC, Montiel Moreno M, Mora Sánchez E, Arias Arias Á, Redondo González O. [Physical restraint use in relation to falls risk in a nursing home]. Rev Esp Geriatr Gerontol 2020; 55:3-10. [PMID: 31585682 DOI: 10.1016/j.regg.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUNDS AND OBJECTIVES The use of physical restraints (PR) is common in the care of the elderly. However, their efficacy and safety are not supported by scientific evidence. The aim of this study was to determine the role of PR in preventing falls. MATERIALS AND METHODS A retrospective cohort study design was used, in which each fall incident (n=575) was examined in the residents over 65 years of age who resided at the one nursing homes from February 2009 to September 2013. An analysis was made of the association between the use of PR and risk of falls using a multivariate logistic regression, adjusting for the characteristics of residents that were associated with the use of PR according to a bivariate analysis. RESULTS Risk factors for falls after accounting for PR use, include: risk of falling (Tinetti test) (OR 4.57; 95% CI 1.76-11.75); ability to walk (OR 6.40; 95% CI 2.78-14.74); hearing impairment (OR 2.12; 95% CI 1.05-4.29); and history of a previous fall (OR 17.81; 95% CI 8.83-35.93). The risk of falls was greater in restrained, ambulatory residents with cognitive impairment (OR 18.95; 95% CI 7.06-50.85). No differences were found in injuries between falls that occurred with and without PR. CONCLUSIONS Restraint use was not significantly associated with fewer falls and injuries. The risk of falls could increase in ambulatory residents with cognitive impairment. The study results suggest the need to consider whether restraints provide adequate protection against the risk of falls.
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Affiliation(s)
- José Manuel Fernández Ibáñez
- Sección de Geriatría, Servicio de Medicina Interna, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, España.
| | | | - Manuela Montiel Moreno
- Departamento de Enfermería. Residencia Dulcinea. Alcázar de San Juan. Ciudad Real, Alcázar de San Juan, Ciudad Real, España
| | - Eva Mora Sánchez
- Departamento de Enfermería. Residencia Dulcinea. Alcázar de San Juan. Ciudad Real, Alcázar de San Juan, Ciudad Real, España
| | - Ángel Arias Arias
- Unidad de Investigación, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | - Olga Redondo González
- Unidad de Investigación, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, España
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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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Use of physical restraint in nursing homes in Spain and relation with resident characteristics: a retrospective multi-centre cohort study with a self-organised maps approach. AGEING & SOCIETY 2019. [DOI: 10.1017/s0144686x19000680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis is a retrospective cohort study based on data from five nursing homes which aims to appraise how physical and cognitive characteristics of nursing home residents were associated with the use of restraints, and to provide information on their prevalence in Spain. The goal was to assess, in a visual way, the possible interactions between the nursing homes residents’ characteristics and their association with the use of restraints. Motivation, risk factors, characteristics of the residents analysed by validated rating systems that assess mobility, level of dependence, cognitive condition and nutritional status, and their association with the use of restraints, were described by means of linear and non-linear multivariate approaches in the form of self-organised maps. Findings showed that the prevalence of restraints was high when compared to other developed countries. The visual analysis reinforced the knowledge that a greater impairment was associated with the use of restraints and vice versa. However, the residents’ characteristics were not always associated with the use of restraints. Subjective factors seem to play a relevant role in decision-making, so it is important to assess risk factors continuously and determine the actual need for the use of restraints from an individual perspective by basing the criteria on specific objectives, and on consistent, reproducible and reliable methods. Initiatives to minimise these subjective factors should be promoted. Likewise, a clear definition of physical restraints should be offered at each centre. In addition, effective legislation that clearly states the need, alternatives and motivation for the use of restraints is needed.
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Nordhausen T, Abraham J, Kupfer R, Köpke S, Meyer G, Möhler R. Freiheitseinschränkung aus Sicht der Interessenvertretungen von Pflegeheimbewohnerinnen und -bewohnern − eine qualitative Studie. Pflege 2019; 32:147-156. [DOI: 10.1024/1012-5302/a000664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund: Freiheitseinschränkende Maßnahmen werden trotz fehlenden Belegs zum Nutzen und bekannter negativer Konsequenzen regelmäßig in Pflegeheimen eingesetzt. Neben Pflegenden können Angehörige, Betreuer / -innen, Vorsorgebevollmächtigte und Heimbeiräte als Interessenvertretungen der Bewohner / -innen den Einsatz der Maßnahmen beeinflussen. Ziel: Beschreibung der Sichtweise von Interessenvertretungen der Heimbewohner / -innen zur Anwendung und Reduktion von freiheitseinschränkenden Maßnahmen. Methodik: Für die Prozessevaluation einer pragmatischen cluster-randomisierten Studie wurden teilstrukturierte Einzel- (n = 4) und Fokusgruppeninterviews (n = 4) mit 22 Personen (vier Angehörige in der Rolle als Betreuer / -innen oder Vorsorgebevollmächtigte, eine Berufsbetreuerin, 16 Heimbeiräte) geführt und mittels qualitativer Inhaltsanalyse analysiert. Ergebnisse: Fünf Kategorien in Bezug auf freiheitseinschränkende Maßnahmen wurden gebildet: 1. Umgang im Setting Pflegeheim; 2. Bewertung der Anwendung bzw. Reduktion; 3. Information zur Anwendung bzw. Reduktion; 4. Entscheidungen zur Anwendung bzw. Reduktion; 5. Auswirkungen der Anwendung bzw. Reduktion. Interessenvertretungen sehen den Einsatz der Maßnahmen zur Sturzprophylaxe und Kontrolle von herausforderndem Verhalten als notwendig an und haben kaum Wissen zu Alternativen. Schlussfolgerungen: Angehörige, Berufsbetreuer / -innen und Heimbeiräte zeigen eher unkritische Haltungen und haben Informationsdefizite zu freiheitseinschränkenden Maßnahmen. Bei Interventionen zur Reduktion der Maßnahmen in Pflegeheimen könnte die Aufklärung dieser Gruppen unterstützend wirken.
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Affiliation(s)
- Thomas Nordhausen
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Jens Abraham
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Ramona Kupfer
- Sektion Pflegeforschung, Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | - Sascha Köpke
- Sektion Pflegeforschung, Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Ralph Möhler
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
- Institut für Evidenz in der Medizin (für Cochrane Deutschland Stiftung), Medizinische Fakultät, Universitätsklinikum Freiburg i. B
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Wilfling D, Dichter MN, Trutschel D, Köpke S. Prevalence of Sleep Disturbances in German Nursing Home Residents with Dementia: A Multicenter Cross-Sectional Study. J Alzheimers Dis 2019; 69:227-236. [DOI: 10.3233/jad-180784] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
| | - Martin N. Dichter
- German Center of Neurodegenerative Diseases, Witten, Germany and School of Nursing Science, Witten/Herdecke University, Germany
| | - Diana Trutschel
- German Center of Neurodegenerative Diseases, Witten, Germany
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Germany
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Zimmermann J, Swora M, Pfaff H, Zank S. Organizational factors of fall injuries among residents within German nursing homes: secondary analyses of cross-sectional data. Eur J Ageing 2019; 16:503-512. [PMID: 31798374 DOI: 10.1007/s10433-019-00511-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The present study explored risk factors for fall injuries among nursing home residents, with a specific focus on the influence of organizational structure within facilities and their environment, which have been insufficiently investigated in the European context. For the analyses, secondary data collected in 2016 from 220 nursing homes across Germany were used. As a risk adjustment, two separate models were calculated for fall injuries among residents without (N = 7320) and with cognitive impairment (N = 8633). Results showed that residents without cognitive impairment had a decreased risk of fall injuries by 40.1% (P < 0.01), while those with cognitive impairment were at an increased risk of 23.8% (P < 0.05) when living in facilities that had dementia care units. However, disparities were found between federal states for both groups of residents (P < 0.05 vs. P < 0.01, respectively). Similarly, a higher proportion of registered nurses were associated with decreased risk of fall injuries among cognitively impaired residents (45.6%), which differed between federal states (P < 0.01). Facilities with homelike environments had a 16.7% (P < 0.05) lower risk of fall injuries among cognitively impaired residents than did traditionally organized facilities. Further research is needed to explain the disparities between German federal states using representative samples.
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Affiliation(s)
- Jaroslava Zimmermann
- 1Graduate School GROW - Gerontological Research on Well-Being, University of Cologne, Cologne, Germany
| | - Michael Swora
- 2Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences & Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- 2Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences & Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Susanne Zank
- 3Rehabilitative Gerontology, Faculty of Human Sciences, University of Cologne, Cologne, Germany
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Abraham J, Kupfer R, Behncke A, Berger-Höger B, Icks A, Haastert B, Meyer G, Köpke S, Möhler R. Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A pragmatic cluster randomized controlled trial. Int J Nurs Stud 2019; 96:27-34. [PMID: 31014546 DOI: 10.1016/j.ijnurstu.2019.03.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite clear evidence for the lack of effectiveness and safety, physical restraints are frequently applied in nursing homes. Multicomponent interventions addressing nurses' attitudes and organizational culture have been effective in reducing physical restraints. OBJECTIVE To evaluate the effectiveness of two versions of a guideline and theory-based multicomponent intervention to reduce physical restraints in nursing homes. DESIGN Pragmatic cluster randomized controlled trial. SETTING The study was conducted in 120 nursing homes in four regions in Germany. PARTICIPANTS All residents living in the participating nursing home during follow-up, newly admitted residents were also included. A total of 12,245 residents included in the primary analysis (4126 and 3547 residents in intervention group 1 and 2 and 4572 residents in the control group). METHODS Intervention group 1 received an updated version of a successfully tested guideline-based multicomponent intervention (comprising brief education for the nursing staff, intensive training of nominated key nurses in each cluster, introduction of a least-restraint policy and supportive material), intervention group 2 received a concise version of the original program and the control group received optimized usual care (i.e. supportive materials only). Primary outcome was physical restraint prevalence at twelve months, assessed through direct observation by blinded investigators. Intervention and control groups were compared using baseline-adjusted linear regression on cluster level, Bonferroni-adjusted for double testing. Secondary outcomes included falls, fall-related fractures, and quality of life. We also described intervention costs and performed a comprehensive process analysis. RESULTS At baseline, mean physical restraint prevalence was 17.4% and 19.6% in intervention groups 1 and 2, and 18.8% in the control group. After twelve months, mean prevalence was 14.6%, 15.7%, and 17.6%. Baseline-adjusted differences between mean prevalences were 2.0% (97.5% CI, -5.8 to 1.9) lower in intervention group 1 and 2.5% (97.5% CI, -6.4 to 1.4) lower in intervention group 2 compared to controls. Physical restraint prevalence showed a pronounced variation between the different clusters in all study groups. We found no significant differences in the secondary outcomes. According to the process evaluation, the intervention was mainly implemented as planned, but the expected change towards a least restraint culture of care was not achieved in all clusters. CONCLUSIONS Neither intervention showed a clear advantage compared to control. The pronounced center variation in physical restraint prevalence indicates that other approaches like governmental policies are needed to sustainably change physical restraint practice and reduce center variations in nursing homes. TRIAL REGISTRATION ClinicalTrials.gov : NCT02341898.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Ramona Kupfer
- Health Sciences, MIN Faculty, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany.
| | - Anja Behncke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Birte Berger-Höger
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | | | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Ralph Möhler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; School of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Str. 12, 58453 Witten, Germany.
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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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Abstract
Zusammenfassung
Freiheitsentziehende Maßnahmen, wie Bettgitter oder Gurte an Stuhl und Bett, unterscheiden sich zwar von direkten körperlichen und psychischen Gewalthandlungen in der Pflege, sind aber aus pflegefachlicher und ethischer Perspektive prinzipiell ebenso unangemessen. Dieser Beitrag gibt einen Überblick zum aktuellen Stand der Forschung zu einer leitlinienbasierten komplexen Intervention zur Vermeidung von freiheitsentziehenden Maßnahmen in deutschen Pflegeheimen.
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Affiliation(s)
- Jens Abraham
- Martin-Luther-Universität Halle-Wittenberg , Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft
| | - Ralph Möhler
- Universität Bielefeld , Fakultät für Gesundheitswissenschaften, AG 6 Versorgungsforschung/Pflegewissenschaft
| | - Sascha Köpke
- Universität zu Lübeck, Institut für Sozialmedizin und Epidemiologie, Sektion für Forschung und Lehre in der Pflege , Ratzeburger Allee 160 , 23538 Lübeck
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Bellenger EN, Ibrahim JE, Kennedy B, Bugeja L. Prevention of physical restraint use among nursing home residents in Australia: The top three recommendations from experts and stakeholders. Int J Older People Nurs 2019; 14:e12218. [DOI: 10.1111/opn.12218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/08/2018] [Accepted: 11/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Emma N. Bellenger
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
| | - Joseph E. Ibrahim
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
| | - Briohny Kennedy
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
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Scheepmans K, Milisen K, Vanbrabant K, Paquay L, Van Gansbeke H, Dierckx de Casterlé B. Factors associated with use of restraints on older adults with home care: A secondary analysis of a cross-sectional survey study. Int J Nurs Stud 2018; 89:39-45. [PMID: 30339954 DOI: 10.1016/j.ijnurstu.2018.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although there is evidence that use of restraints in home care is increasing, research into the factors associated with restraints in this setting is scarce. OBJECTIVE To gain insight into the factors associated with restraints in older adults receiving home care. DESIGN A secondary analysis of a cross-sectional survey about restraint use in home care. SETTINGS Older adults receiving home care in Belgium. PARTICIPANTS 8000 subjects were randomly selected from a total of 45,700 older adults. The mean age of the sample (n = 6397) was 80.6 years, 66.8% were women and 46.4% lived alone. METHODS A cross-sectional survey of restraint use on older adults receiving home care from a nursing organisation in Belgium was completed by the patients' primary care nurses. A binary logistic regression model with generalised estimating equations was used to evaluate factors associated with restraint use. Additional analyses focused on the subgroups with and without an informal caregiver and living alone / with others. Data from 6397 participants were analysed in detail. RESULTS Multivariate logistic regression indicated that restraint use was associated with supervision [OR = 2.433, 95% CI = 1.948-3.038]; dependency in activities of daily living (i.e. eating [OR = 2.181, 95% CI = 1.212-3.925], transfer [OR = 2.131, 95% CI = 1.191-3.812] and continence [OR = 1.436, 95% CI = 0.925-2.231]; perceived risk of falling in the nurses' clinical judgement [OR = 1.994, 95% CI = 1.710-2.324], daily behavioural problems [OR = 1.935, 95% CI = 1.316-2.846] and less than daily behavioural problems [OR = 1.446, 95% CI = 1.048-1.995]; decreased well-being of the informal caregiver [OR = 1.472, 95% CI = 1.126-1.925], the informal caregiver's dissatisfaction with family support [OR = 1.339, 95% CI = 1.003-1.788]; patient's cognitive impairment [OR = 1.398, 95% CI = 1.290-1.515]; and polypharmacy [OR = 1.415, 95% CI = 1.219-1.641]. The nurses' perception of risk of falling, cognitive impairment (observed with the Cognitive Performance Scale) and supervision are the only variables consistently associated with restraint use across all the analyses. CONCLUSION The study results provide insight into new and context-specific factors associated with restraint use in home care (e.g. supervision, informal caregiver's decreased well-being and dissatisfaction with family support). These insights could support the development of interventions to reduce restraint use in home care.
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Affiliation(s)
- Kristien Scheepmans
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Leuven, Belgium
| | - Koen Vanbrabant
- KU Leuven - University of Leuven & Universiteit Hasselt, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, B-3000 Leuven, Belgium
| | - Louis Paquay
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium
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Dörks M, Herget-Rosenthal S, Hoffmann F, Jobski K. Combined use of drugs inhibiting the renin-angiotensin system: prescribing patterns and risk of acute kidney injury in German nursing home residents. Clin Interv Aging 2018; 13:1035-1042. [PMID: 29872281 PMCID: PMC5973467 DOI: 10.2147/cia.s159715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background/aims In 2012, the European Medicines Agency reviewed the safety of dual renin-angiotensin system (RAS) blockade because of potentially increased risks for inter alia acute kidney injury (AKI). Since residents of nursing homes are particularly vulnerable to adverse drug outcomes, the aims of our study were to describe RAS-inhibiting drug use in German nursing home residents and examine the risk of AKI associated with dual RAS blockade. Methods Based on claims data, a nested case-control study within a cohort of RAS-inhibiting drug users was conducted. Using conditional logistic regression, confounder-adjusted odds ratios (aORs) and 95% confidence intervals (CI) were obtained for the risk of AKI associated with dual RAS blockade. Subgroup analyses were performed in patients with diabetes or chronic kidney disease and both comorbidities. Results Of all 127,227 nursing home residents, the study cohort included 64,567 (50.7%) who were treated with at least one RAS-inhibiting drug. More than three quarters of the study population were female (77.1%). Mean age was 86.0 ± 6.8 years. Most residents were treated with angiotensin-converting enzyme inhibitors (77.8%), followed by angiotensin II receptor blockers (21.6%) and aliskiren (0.2%). Annual prevalence of dual RAS blockade declined from 9.6 (95% CI 7.8-11.8) in 2010 to 4.7 (95% CI 4.0-5.4) per 1,000 users in 2014. In the overall cohort, AKI was not significantly associated with dual RAS blockade (aOR 1.99; 0.77-5.17). However, significantly increased aORs were observed when considering patients with diabetes (3.47; 1.27-9.47), chronic kidney disease (4.74; 1.24-18.13) or both (11.17; 2.65-47.15). Conclusions Prescribing of drugs inhibiting the RAS is common in German nursing homes. Though the prevalence of dual RAS blockade declined, our study showed an increased risk of AKI in patients with diabetes and/or chronic kidney disease. Therefore, cautious use is warranted in these vulnerable patients.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Kathrin Jobski
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Lockwood C, Stannard D, Munn Z, Porritt K, Carrier J, Rittenmeyer L, Bjerrum M, Salmond S. The patient/significant other experience of physical restraint in acute care settings: a qualitative systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:622-627. [PMID: 29521861 DOI: 10.11124/jbisrir-2017-003457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The overarching question for this qualitative systematic review is: What meanings are attributed to the experience of physical restraint among adult patients or their significant others in acute care hospitals? Specifically the review will seek to answer two questions.
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Affiliation(s)
- Craig Lockwood
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | | | - Zachary Munn
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kylie Porritt
- The Joanna Briggs Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Judith Carrier
- The Wales Centre for Evidence Based Care: a Joanna Briggs Institute Centre of Excellence
| | - Leslie Rittenmeyer
- Indiana Center for Evidence Based Nursing Practice: a Joanna Briggs Institute Centre of Excellence
| | - Merete Bjerrum
- Department of Public Health, Section for Nursing Science, Aarhus University, Aarhus, Denmark, and Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Department of Medicine and Technology, University of Aalborg, Aalborg, Denmark
| | - Susan Salmond
- The Northeast Institute for Evidence Synthesis and Translation (NEST): a Joanna Briggs Institute Center of Excellence
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Leahy-Warren P, Varghese V, Day MR, Curtin M. Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants. Int Nurs Rev 2018; 65:327-335. [PMID: 29424421 DOI: 10.1111/inr.12434] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIM To examine the perceptions of nurse managers, registered nurses and healthcare assistants of physical restraint use on older people in a long-term care setting in the Republic of Ireland. BACKGROUND The use of physical restraint, although controversial, persists in long-term care settings, despite recommendations for restraint-free environments. Perception and attitude of staff can influence use of physical restraint. METHODS A descriptive cross-sectional design was used. A total of 250 nursing and healthcare assistant staff were recruited. A questionnaire incorporating demographics and the Perceptions of Restraint Use Questionnaire was used. Descriptive and inferential statistical analyses were conducted. RESULTS Mean age of respondents (n = 156) was 41 years, and the majority were female. Overall, a low level of importance was attached to the use of restraint. Nurse managers and registered nurses compared favourably with healthcare assistants who attached a higher importance to use of restraint. Across all three staff groups, greatest importance was attached to the use of physical restraint for reducing falls, followed by prevention of treatment interference. Restraint was least favoured as a means of impairment management. Education was not an explanatory factor in perceived importance of physical restraint use. CONCLUSION Nurse managers and registered nurses are unlikely to use physical restraint. However, there is concern regarding perception of healthcare assistants on use of restraint. IMPLICATIONS FOR NURSING AND HEALTH POLICY Results from this study compare favourably with those in countries that have no policy on physical restraint use. Educational programmes alone are insufficient to address use of physical restraint. Attention to skill mix with adequate support for healthcare assistants in long-term care settings is recommended.
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Affiliation(s)
- P Leahy-Warren
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - V Varghese
- Health Services Executive South, Cork, Ireland
| | - M R Day
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - M Curtin
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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Lühnen J, Mühlhauser I, Richter T. Informed decision-making with and for people with dementia: Developing and pilot testing an education program for legal representatives (PRODECIDE). DEMENTIA 2017; 18:2303-2321. [PMID: 29271251 DOI: 10.1177/1471301217746751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background People living with dementia are often appointed a legal representative, to support and protect their ethical and legal rights to informed healthcare decisions. However, legal representatives usually have no qualifications in healthcare. Objective The aim of this study was to explore decision-making processes with participation of legal representatives and, resulting from this, to develop and pilot test an education program for legal representatives in Germany. Methods We conducted interviews with legal representatives and senior citizens about decision-making processes in healthcare, with special focus on percutaneous endoscopic gastrostomy, physical restraints, and prescription of antipsychotics for people with dementia. We generated a curriculum based on systematic literature searches and the results of these interviews. We tested the education program for comprehensibility, feasibility, usability, and acceptance. Results Personal interviews with voluntary ( n = 12) and professional ( n = 12) representatives, and senior citizens ( n = 14) were conducted. Preferences, attitudes, and wishes regarding percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics, and the process of decision-making, were heterogeneous. A structural approach is lacking. The education program proxy-decison-making (PRODECIDE) comprises four modules: (A) decision-making processes and methods; (B–D) evidence-based knowledge about percutaneous endoscopic gastrostomy, physical restraints, and antipsychotics. We conducted eight trainings with 47 legal representatives. PRODECIDE was well accepted. Comprehensibility of contents and materials was rated high. The program seems feasible for implementation. Conclusion PRODECIDE seems suitable to improve the decision-making processes of legal representatives in Germany. Implementation will be appropriate if efficacy is proven; a randomized controlled trial is currently underway.
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Lühnen J, Haastert B, Mühlhauser I, Richter T. Informed decision-making with and for people with dementia - efficacy of the PRODECIDE education program for legal representatives: protocol of a randomized controlled trial (PRODECIDE-RCT). BMC Geriatr 2017; 17:217. [PMID: 28915861 PMCID: PMC5603024 DOI: 10.1186/s12877-017-0616-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In Germany, the guardianship system provides adults who are no longer able to handle their own affairs a court-appointed legal representative, for support without restriction of legal capacity. Although these representatives only rarely are qualified in healthcare, they nevertheless play decisive roles in the decision-making processes for people with dementia. Previously, we developed an education program (PRODECIDE) to address this shortcoming and tested it for feasibility. Typical, autonomy-restricting decisions in the care of people with dementia-namely, using percutaneous endoscopic gastrostomy (PEG) or physical restrains (PR), or the prescription of antipsychotic drugs (AP)-were the subject areas trained. The training course aims to enhance the competency of legal representatives in informed decision-making. In this study, we will evaluate the efficacy of the PRODECIDE education program. METHODS A randomized controlled trial with a six-month follow-up will be conducted to compare the PRODECIDE education program with standard care, enrolling legal representatives (N = 216). The education program lasts 10 h and comprises four modules: A, decision-making processes and methods; and B, C and D, evidence-based knowledge about PEG, PR and AP, respectively. The primary outcome measure is knowledge, which is operationalized as the understanding of decision-making processes in healthcare affairs and in setting realistic expectations about benefits and harms of PEG, PR and AP in people with dementia. Secondary outcomes are sufficient and sustainable knowledge and percentage of persons concerned affected by PEG, FEM or AP. A qualitative process evaluation will be performed. Additionally, to support implementation, a concept for translating the educational contents into e-learning modules will be developed. DISCUSSION The study results will show whether the efficacy of the education program could justify its implementation into the regular training curricula for legal representatives. Additionally, it will determine whether an e-learning course provides a valuable backup or even alternative learning strategy. TRIAL REGISTRATION TRN: ISRCTN17960111 , Date: 01/06/2017.
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Affiliation(s)
- Julia Lühnen
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences (MIN), University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany.
| | | | - Ingrid Mühlhauser
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences (MIN), University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany
| | - Tanja Richter
- Unit of Health Sciences and Education, Faculty of Mathematics, Informatics and Natural Sciences (MIN), University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany
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Antipsychotic drug use in nursing home residents with and without dementia: keep an eye on the pro re nata medication. Int Clin Psychopharmacol 2017; 32:213-218. [PMID: 28346296 DOI: 10.1097/yic.0000000000000173] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Behavioral and psychological symptoms of dementia often lead to the prescription of antipsychotics, especially in nursing homes, but their use remains controversial. This study aimed to assess antipsychotic drug use in residents with dementia compared with those without dementia. Data were obtained through the cross-sectional 'inappropriate medication in patients with renal insufficiency in nursing homes' (IMREN) study including data from 21 nursing homes. Descriptive statistics were used and factors associated with the prescription of antipsychotics were identified by logistic regression. Overall, 57.5% of the 837 residents had a diagnosis of dementia and 47.0% of residents with dementia and 19.5% of those without dementia received antipsychotics. 35.9% of all antipsychotics in residents with dementia were prescribed as pro re nata (PRN) compared with 23.0% for residents without dementia. Typical antipsychotics were prescribed more commonly than atypical ones. The adjusted logistic regression showed a significant association between the prescription of antipsychotics and dementia (odds ratio: 3.58, 95% confidence interval: 2.45-5.25) as well as severe care dependency (odds ratio: 1.68, 95% confidence interval: 1.10-2.55). Despite safety warnings, antipsychotics are still frequently prescribed to residents with dementia. Almost half received antipsychotics and about a third of the antipsychotics are prescribed as PRN. Further studies should assess the use of PRN antipsychotics and guidelines for PRN prescriptions are clearly needed.
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O'Keeffe ST. Physical restraints and nursing home residents: dying to be safe? Age Ageing 2017; 46:536-537. [PMID: 28200010 DOI: 10.1093/ageing/afx014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/12/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shaun T O'Keeffe
- Department of Geriatric Medicine, Galway University Hospitals, Galway, Ireland
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["Because we feel, we have to do something" - Barriers in the prevention of violence and key areas requiring action : A qualitative interview study with professional nurses and managers in the field of elderly care]. Z Gerontol Geriatr 2017; 51:329-334. [PMID: 28432418 DOI: 10.1007/s00391-017-1228-0] [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: 06/10/2015] [Revised: 03/08/2017] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In recent years, politics and society have shown an increasing interest in the prevention of violence. Despite the scientific studies and prevention programs that have been conducted over the past few years, there is no indication that the prevalence of violence in elderly care is falling. A high number of unreported cases may still be assumed. OBJECTIVE The present study examined the barriers in transferring research knowledge into practice. Furthermore, it dealt with the requirements of an interventional approach which is practical and which effectively addresses the barriers. MATERIAL AND METHODS The data were collected in qualitative interviews (n = 20) and analyzed by using qualitative content analysis. RESULTS The study revealed uncertainties in dealing with violence. The institutions lacked a clear definition of violence and the respondents did not have a clear concept of when and where violence starts. A high proportion of the respondents stated that violence occurred in various forms in daily nursing care but that there were no specific strategies for action. Only very few cases were documented at all. Moreover, a lack of practical further training was reported. The visibility of these barriers opens up new approaches to developing preventive measures which work in practice. CONCLUSION A common definition of violence, clear and binding standards, regular training and education measures are central to the prevention of violence in care.
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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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Øye C, Jacobsen FF, Mekki TE. Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway. J Clin Nurs 2017; 26:1906-1916. [PMID: 27504978 DOI: 10.1111/jocn.13504] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2016] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate (1) what kind of restraint is used in three nursing homes in Norway and (2) how staff use restraint under what organisational conditions. BACKGROUND Restraint use in residents living with dementia in nursing homes is controversial, and at odds with fundamental human rights. Restraint is a matter of hindering residents' free movement and will by applying either interactional, physical, medical, surveillance or environmental restraint. Previous research has identified use of restraint related to individual resident characteristics such as agitation, aggressiveness and wandering. DESIGN This model is embedded in an overall mixed-method education intervention design study called Modelling and evaluating evidence-based continuing education program in dementia care (MEDCED), applying ethnography postintervention to examine the use of restraint in 24 nursing homes in Norway. METHOD Based on restraint diversity measured in the trial, ethnographic investigation was carried out in three different nursing homes in Norway over a 10-month period to examine restraint use in relation to organisational constraints. RESULTS Several forms of restraint were observed; among them, interactional restraint was used most frequently. We identified that use of restraint relates to the characteristics of individual residents, such as agitation, aggressiveness and wandering. However, restraint use should also be explained in relation to organisational conditions such as resident mix, staff culture and available human resources. CONCLUSION A fluctuating and dynamic interplay between different individual and contextual factors determines whether restraint is used - or not in particular situations with residents living with dementia. RELEVANCE TO CLINICAL PRACTICE Educational initiatives targeting staff to reduce restraint must be sensitive towards fluctuating organisational constraints.
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Affiliation(s)
- Christine Øye
- Stord/Haugesund University College, Stord, Norway.,Centre of Care Research West, Bergen University College, Bergen, Norway
| | - Frode Fadnes Jacobsen
- Centre of Care Research West, Bergen University College, Bergen, Norway.,VID Specialized University, Bergen, Norway
| | - Tone Elin Mekki
- Centre of Care Research West, Bergen University College, Bergen, Norway
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Estévez-Guerra GJ, Fariña-López E, Núñez-González E, Gandoy-Crego M, Calvo-Francés F, Capezuti EA. The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study. BMC Geriatr 2017; 17:29. [PMID: 28109267 PMCID: PMC5251344 DOI: 10.1186/s12877-017-0421-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily. METHODS We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated. RESULTS The prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7-88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1-87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents. CONCLUSIONS The prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.
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Affiliation(s)
- Gabriel J Estévez-Guerra
- Nursing Department, University of Las Palmas de Gran Canaria, Tahiche, Spain. .,Unidad Docente de Enfermería de Lanzarote. Facultad de Ciencias de la Salud. ULPGC, C/Rafael Alberti 50, Tahiche, 35507, Spain.
| | - Emilio Fariña-López
- Nursing Department, University of Las Palmas de Gran Canaria, Tahiche, Spain
| | | | - Manuel Gandoy-Crego
- Nursing Department, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Fernando Calvo-Francés
- Nursing Department, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Elizabeth A Capezuti
- William Randolph Hearst Foundation Chair in Gerontology, Hunter College of the City University of New York, New York, NY, USA
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Hoffmann F, Boeschen D, Dörks M, Herget-Rosenthal S, Petersen J, Schmiemann G. Renal Insufficiency and Medication in Nursing Home Residents. A Cross-Sectional Study (IMREN). DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:92-8. [PMID: 26931625 DOI: 10.3238/arztebl.2016.0092] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nursing home residents often suffer from a multiplicity of medical conditions and take many different drugs. Many drugs are eliminated via the kidneys and thus require dose adjustment in patients with renal insufficiency. This is the first study to address the prevalence of renal insufficiency among nursing home residents in Germany, and the extent to which such persons take drugs that are contraindicated or incorrectly dosed because of renal insufficiency. METHODS We carried out a cross-sectional study in nursing homes in the German regions of Bremen and Lower Saxony. Data were collected by nursing staff and given to us anonymously. Whenever the nursing home data did not include a current creatinine value, the patient's general practitioner was asked to supply this value. The estimated creatinine clearance (eCCr) was calculated with the Cockcroft-Gault formula. RESULTS 852 residents of 21 nursing homes were included in the study; eCCr values were obtainable for 685 (80.4%) of them (average age, 83.3 years; 75.2% female). 48.2% of these patients (95% confidence interval [CI] 41.8-54.5) had moderate renal insufficiency (eCCr 59-30 mL/min), and 15.5% (95% CI 12.4-18.6) had severe renal insufficiency (eCCr <30 mL/min). 19.7% were regularly taking at least one medication that was contraindicated or incorrectly dosed in the light of renal insufficiency. Predictors for such inappropriate drug use were advanced age, female sex, arterial hypertension, and polypharmacy. The drugs that were most often inappropriately used were metformin, ramipril, and potassium chloride. CONCLUSION Nursing home residents often suffer from renal insufficiency and should therefore have their creatinine levels measured regularly. A knowledge of the creatinine level is a prerequisite for the proper adjustment of drug doses (if necessary). A practical and compact summary of dose-adjustment recommendations for patients with renal insufficiency would be desirable but is not yet available.
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Affiliation(s)
- Falk Hoffmann
- Department of Health Services Research, Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Medical Clinic, Rotes-Kreuz-Krankenhaus, Bremen, Department of Health, Nursing and Age Studies, SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Department for Health Services Research, Institute for Public Health and Nursing Research, University of Bremen and Health Sciences Bremen
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Bleijlevens MHC, Wagner LM, Capezuti E, Hamers JPH. Physical Restraints: Consensus of a Research Definition Using a Modified Delphi Technique. J Am Geriatr Soc 2016; 64:2307-2310. [PMID: 27640335 DOI: 10.1111/jgs.14435] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To develop an internationally accepted research definition of physical restraint. DESIGN Comprehensive literature search followed by a web-based, three-round, modified Delphi technique comprising reviews and feedback. SETTING Clinical care settings. PARTICIPANTS An international group of 48 experts consisting of researchers and clinicians from 14 countries who have made sustained contribution to research and clinical application in the field of physical restraint in clinical care. MEASUREMENTS Data were collected using an online survey program and one in-person meeting. Results of the online survey and the in-person meeting were used for distribution in subsequent rounds until consensus on a definition was reached. Consensus was defined as 90% of the participating experts agreeing with the proposed definition of physical restraint. RESULTS Thirty-four different definitions were identified during the literature search and served as a starting point for the modified Delphi technique. After three rounds, 45 (95.7%) of 47 remaining experts agreed with the newly proposed definition: "Physical restraint is defined as any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person's body that he/she cannot control or remove easily." CONCLUSION A multidisciplinary, internationally representative panel of experts reached consensus on a research definition for physical restraints in older persons. This is a necessary step toward improved comparisons of the prevalence of physical restraint use across studies and countries. This definition can further guide research interventions aimed at reducing use of physical restraints.
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Affiliation(s)
- Michel H C Bleijlevens
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Laura M Wagner
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California
| | | | - Jan P H Hamers
- Department of Health Services Research, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Hoben M, Estabrooks CA, Squires JE, Behrens J. Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care. Front Psychol 2016; 7:1339. [PMID: 27656156 PMCID: PMC5013130 DOI: 10.3389/fpsyg.2016.01339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90-0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group.
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Affiliation(s)
- Matthias Hoben
- Knowledge Utilization Studies Program, Faculty of Nursing, University of AlbertaEdmonton, AB, Canada; Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-WittenbergHalle, Germany; Network Aging Research, Heidelberg UniversityHeidelberg, Germany
| | - Carole A Estabrooks
- Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta Edmonton, AB, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of OttawaOttawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa HospitalOttawa, ON, Canada
| | - Johann Behrens
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg Halle, Germany
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Dörks M, Herget-Rosenthal S, Schmiemann G, Hoffmann F. Polypharmacy and Renal Failure in Nursing Home Residents: Results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study. Drugs Aging 2016; 33:45-51. [PMID: 26659732 DOI: 10.1007/s40266-015-0333-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Polypharmacy has become an emerging public health issue in recent years, since use of multiple medications or polypharmacy is beneficial for many conditions, but may also have negative effects like adverse drug reactions. The risk further increases in patients with chronic renal failure, a comorbidity very frequent in nursing home residents. Since more than 50% of all drugs were renally excreted, dose adjustments in patients with renal failure are required. OBJECTIVE To assess polypharmacy in German nursing homes, in particular in residents with renal failure. METHODS Multi-center cross-sectional study in 21 nursing homes in Bremen and Lower Saxony/Germany. Baseline data were analysed using descriptive statistics. Multivariable logistic regression model and 95% confidence intervals were used to study the association of renal failure and polypharmacy. RESULTS Of all 852 residents, the analysis comprised those 685 with at least one serum creatinine value so that the estimated creatinine clearance could be calculated. Of those, 436 (63.6%) had a severe or moderate renal failure, defined as estimated creatinine clearance <60 mL/min. Polypharmacy (5-9 drugs) was found in 365 (53.3%) and excessive polypharmacy (≥10 drugs) in 112 (16.4%) residents. Diuretics and psycholeptics were the most commonly used drug classes. Severe renal failure (estimated creatinine clearance <30 mL/min) was associated with polypharmacy (OR: 2.8, 95% CI 1.4-5.7). CONCLUSION Both, polypharmacy and renal failure are common in German nursing home residents and an association of both could be found. Further studies are needed to assess the appropriateness of polypharmacy in these patients.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany.
| | | | - Guido Schmiemann
- Department of Health Services Research, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany
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Lämås K, Karlsson S, Nolén A, Lövheim H, Sandman PO. Prevalence of constipation among persons living in institutional geriatric-care settings - a cross-sectional study. Scand J Caring Sci 2016; 31:157-163. [PMID: 27327073 DOI: 10.1111/scs.12345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 02/22/2016] [Indexed: 01/08/2023]
Abstract
RATIONAL The current state of knowledge about the prevalence of constipation among persons living in institutional geriatric-care settings is limited. AIM The aim was to investigate the prevalence of constipation among institutional geriatric-care residents and identify resident characteristics related to constipation. METHODOLOGICAL DESIGN In a cross-sectional study of all the institutional geriatric-care settings in a county in northern Sweden, 2970 residents were assessed. The member of staff who knew each resident best used the Multi-Dimensional Dementia Assessment Scale and the resident's records of prescribed medication to monitor cognitive function, activities in daily life, behavioural and psychological symptoms, physical restraints, speech ability, nutrition and pharmacologic agents. The study was approved by the Regional Ethical Review Board. RESULT The prevalence of constipation was 67%. The mean age was higher among those with constipation. A significantly higher proportion of the constipated had cognitive and/or physical impairments, physical restraints, impaired speech, problems with nutrition, and higher numbers of drugs for regular use. Of those with constipation, 68% were prescribed laxatives for regular use. Twenty-three per cent of the constipated residents were prescribed opioid analgesics (n = 465), and 29% (n = 134) of these were not prescribed any laxatives. STUDY LIMITATION Due to the cross-sectional design, the results should be interpreted with caution in terms of causal reasoning, generalisation and conclusions about risk factors. Another limitation is the use of proxy assessments of constipation. CONCLUSION The results show that constipation is common among residents in institutional geriatric-care settings in Sweden, which is in line with previous studies from other Western countries. Despite being constipated when having prescribed opioid analgesics, a large number did not have prescribed laxatives. The results indicate the urgency of finding strategies and implementing suitable interventions to improve bowel management in residents in institutional geriatric-care settings.
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Affiliation(s)
| | - Stig Karlsson
- Department of Nursing, Umea University, Umea, Sweden
| | - Anna Nolén
- Department of Nursing, Umea University, Umea, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umea University, Umea, Sweden
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Is an unhealthy work environment in nursing home care for people with dementia associated with the prescription of psychotropic drugs and physical restraints? Int Psychogeriatr 2016; 28:983-94. [PMID: 26830698 DOI: 10.1017/s1041610216000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Research showed that long-term care facilities differ widely in the use of psychotropic drugs and physical restraints. The aim of this study is to investigate whether characteristics of an unhealthy work environment in facilities for people with dementia are associated with more prescription of psychotropic drugs and physical restraints. METHODS Data were derived from the first wave (2008-2009) of a national monitoring study in the Netherlands. This paper used data on prescription of psychotropic drugs and physical restraints from 111 long-term care facilities, residing 4,796 residents. Survey data of a sample of 996 staff and 1,138 residents were considered. The number of residents with prescribed benzodiazepines and anti-psychotic drugs, and physical restraints were registered. Work environment was assessed using the Leiden Quality of Work Questionnaire (LQWQ). RESULTS Logistic regression analyses showed that more supervisor support was associated with less prescription of benzodiazepines. Coworker support was found to be related to less prescription of deep chairs. Job demands and decision authority were not found to be predictors of psychotropic drugs and physical restraints. CONCLUSIONS Staff's job characteristics were scarcely related to the prescription of psychotropic drugs and physical restraints. This finding indicates that in facilities with an unhealthy work environment for nursing staff, one is not more likely to prescribe drugs or restraints. Further longitudinal research is needed with special attention for multidisciplinary decision making - especially role of physician, staff's knowledge, philosophy of care and institutional policy to gain further insight into factors influencing the use of psychotropic drugs and restraints.
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Dörks M, Schmiemann G, Hoffmann F. Pro re nata (as needed) medication in nursing homes: the longer you stay, the more you get? Eur J Clin Pharmacol 2016; 72:995-1001. [PMID: 27075194 DOI: 10.1007/s00228-016-2059-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/03/2016] [Indexed: 01/01/2023]
Abstract
PURPOSE Injudicious pro re nata (PRN) or as needed prescribing can lead to polypharmacy, potentially harmful drug interactions and total drug doses exceeding the maximum recommended. Despite the known risks and the widespread administration, there is a paucity of current research examining the use of PRN drugs in nursing homes. Therefore, we examined characteristics of PRN drug use and potential predictors in nursing homes. METHODS The multicentre cross-sectional study included a heterogeneous sample of 21 nursing homes in Northwestern Germany comprising 852 residents. Descriptive statistics and multivariable regression models were used to analyse and present the collected data. RESULTS Nearly three quarters (74.9 %) of all residents were treated with at least one PRN medication. On average, each resident was prescribed 2.5 ± 2.3 PRN drugs. On average, residents with no PRN prescriptions stayed since 2.4 ± 2.9 years in the nursing home. Residents with five and more PRN prescriptions were on average since 4.8 ± 4.3 years in the nursing home. In a multivariable analysis, length of stay above the median of 2.1 years (OR 2.4; 95 % CI 1.8, 3.2) and polypharmacy with five or more long-term drugs (OR 2.1; 95 % CI 1.5, 2.9) were associated with a higher number of PRN prescriptions. Most commonly used PRN drug was acetaminophen, which was prescribed to 289 (33.9 %) residents. CONCLUSIONS The high prevalence of PRN medication should be taken into account when considering polypharmacy and inappropriate drug prescribing or using screening tools like the STOPP/START (screening tool of older persons' potentially inappropriate prescriptions/screening tool to alert doctors to right) criteria in nursing homes. Physicians should regularly reconsider the need of each PRN drug on the medication schedule. Moreover, the high prevalence of PRN medication and the association with length of stay highlights the importance of an accurate documentation.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany.
| | - Guido Schmiemann
- Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany
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Möhler R, Meyer G. Development methods of guidelines and documents with recommendations on physical restraint reduction in nursing homes: a systematic review. BMC Geriatr 2015; 15:152. [PMID: 26589496 PMCID: PMC4654891 DOI: 10.1186/s12877-015-0150-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical restraint, e.g. bedrails or belts in beds or chairs, are commonly used in nursing homes. However, there have been reports of pronounced differences in the prevalence between different facilities. Guidelines or other documents with recommendations for clinical practice are one approach to overcome centre variation and improve the quality of care. Rigorous development methods are deemed to ensure the validity, clarity and clinical applicability of practice recommendations. This study aims at describing the development methods of documents offering recommendations on physical restraint reduction in geriatric long-term care. METHODS We performed a systematic search (February 2014) in electronic databases (PubMed, CINAHL, Gerolit, Carelit), the World Wide Web (via google.de) and on the homepages of 34 international scientific or healthcare organisations, using various terms related to documents offering guidance for clinical practice and physical restraints. All German and English language documents with recommendations for clinical practice aimed at reducing physical restraints' in nursing homes were included. Documents targeting mental health or acute care settings were excluded. Two reviewers independently selected the documents and extracted data, using a self-developed and piloted data extraction form. RESULTS We identified 28 documents from Germany, USA, Australia, Switzerland, Canada and UK, published between 2002 and 2014. The documents were developed or published by governmental organisations, nursing or healthcare organisations, non-profit organisation, research institutions and private organisations. Two documents were developed mono-disciplinary (nursing) and eight documents interdisciplinary (including different healthcare professionals, lawyers or other stakeholders). In 18 documents the composition of the development group was not described. Two documents described the methods used for developing the recommendations. In both documents, the recommendations were based on a systematic literature search, critical appraisal of the evidence and developed in a consensus process. Materials or tools supporting the implementation were mentioned in 18 documents. CONCLUSIONS This review shows that most of the identified documents with recommendations to reduce physical restraints in nursing homes did not adhere to rigorous scientific development methods. Only two documents comprised a systematic literature search and critical appraisal. Guidance aimed to inform clinical practice should rely on transparent and evidence-based methodologically with sound developed recommendations.
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Affiliation(s)
- Ralph Möhler
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Straße 12, D-58453, Witten, Germany. .,Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany.
| | - Gabriele Meyer
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Straße 12, D-58453, Witten, Germany. .,Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany.
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Hofmann H, Schorro E, Haastert B, Meyer G. Use of physical restraints in nursing homes: a multicentre cross-sectional study. BMC Geriatr 2015; 15:129. [PMID: 26489664 PMCID: PMC4617908 DOI: 10.1186/s12877-015-0125-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/12/2015] [Indexed: 11/24/2022] Open
Abstract
Background Although many countries have implemented strict legal rules, the prevalence of physical restraints in nursing homes seems to remain high. In Switzerland, data related to the frequency of physical restraints are scarce and little is known about associations with resident and nursing home characteristics. The aim of this study was to investigate the prevalence and types of physical restraints in nursing homes in two Swiss cantons and to explore whether resident-related and organisational factors are associated with the use of physical restraints. Methods We conducted a multicentre cross-sectional study. Twenty nursing homes with 1362 residents from two culturally different cantons were included. Data on physical restraints and residents’ characteristics were extracted from residents’ records (11/2013 to 2/2014). Organisational data were collected by questionnaires addressing nursing home directors or nursing managers. Sample size calculation and outcome analysis took cluster-adjustment into account. Descriptive statistics and multiple logistic regression analysis with nursing homes as random effect were used for investigation. Results The prevalence of residents with at least one physical restraint was 26.8 % (95 % confidence interval [CI] 19.8–33.8). Centre prevalence ranged from 2.6 to 61.2 %. Bilateral bedrails were most frequently used (20.3 %, 95 % CI 13.5–27.1). Length of residence, degrees of care dependency and mobility limitation were significantly positively associated with the use of physical restraint, but none of the organisational characteristics was significantly associated. Conclusion Approximately a quarter of the nursing home residents included in our study experienced physical restraints. Since variation between nursing homes was pronounced, it seems to be worthwhile to explore nursing homes with particularly low and high use of physical restraints in future research, especially by using qualitative methods. There is a need for effective interventions aiming at restraint-free nursing care. Development of interventional approaches should consider specific residents’ characteristics associated with restraint use.
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Affiliation(s)
- Hedi Hofmann
- Department of Health, University of Applied Sciences, Rosenbergstrasse 59, P.O. Box, CH-9001, St.Gallen, Switzerland. .,Department of Nursing Science, Witten/Herdecke University, Witten, Germany.
| | - Ewald Schorro
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,School of Health, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland.
| | | | - Gabriele Meyer
- Department of Nursing Science, Witten/Herdecke University, Witten, Germany. .,Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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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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Abraham J, Möhler R, Henkel A, Kupfer R, Icks A, Dintsios CM, Haastert B, Meyer G, Köpke S. Implementation of a Multicomponent intervention to Prevent Physical Restraints In Nursing home residenTs (IMPRINT): study protocol for a cluster-randomised controlled trial. BMC Geriatr 2015. [PMID: 26195247 PMCID: PMC4509466 DOI: 10.1186/s12877-015-0086-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical restraints such as bedrails and belts are regularly applied in German nursing homes despite clear evidence showing their lack of effectiveness and safety. In a cluster-randomised controlled trial, the efficacy and safety of a guideline-based multicomponent intervention programme has been proven. The present study aims to evaluate the effectiveness of two different versions of the original intervention in nursing home residents in four different regions throughout Germany. METHODS/DESIGN The study is a pragmatic cluster-randomised controlled trial comparing two intervention groups, i.e. (1) the updated original multicomponent intervention programme and (2) the concise version of the updated programme, with a control group receiving optimised usual care. The first intervention group receives an educational programme for all nurses, additional training and structured support for nominated key nurses, printed study material and other supportive material. In the second intervention group, nurses do not receive education as part of the intervention, but may be trained by nominated key nurses who have received a short train-the-trainer module. All other components are similar to the first intervention group. The control group receives the printed study material only. Overall, 120 nursing homes including approximately 10,800 residents will be recruited and randomly assigned to one of the three groups. The primary outcome is defined as the proportion of residents with at least one physical restraint after 12 months follow-up. The use of physical restraints will be assessed by direct observation. Secondary outcomes are the residents' quality of life and safety parameters, e.g. falls and fall-related fractures. In addition, comprehensive process and economic evaluations will be performed. CONCLUSIONS We expect a clinically relevant reduction in the proportion of residents with physical restraints. It is also expected that the process outcomes of this trial will enrich the knowledge about facilitators and barriers for the implementation of the multicomponent intervention programme. TRIAL REGISTRATION ClinicalTrials.gov: NCT02341898.
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Affiliation(s)
- Jens Abraham
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Science, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Ralph Möhler
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Science, Magdeburger Str. 8, 06112, Halle (Saale), Germany. .,Witten/Herdecke University, Faculty of Health, School of Nursing Science, Stockumer Str. 12, 58453, Witten, Germany.
| | - Adrienne Henkel
- University of Lübeck, Institute of Social Medicine, Nursing Research Unit, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Ramona Kupfer
- University of Lübeck, Institute of Social Medicine, Nursing Research Unit, Ratzeburger Allee 160, 23538, Lübeck, Germany. .,University of Hamburg, MIN Faculty, Health Sciences, Martin-Luther-King-Platz 6, 20146, Hamburg, Germany.
| | - Andrea Icks
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Public Health, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Charalabos-Markos Dintsios
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department of Public Health, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | | | - Gabriele Meyer
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Science, Magdeburger Str. 8, 06112, Halle (Saale), Germany.
| | - Sascha Köpke
- University of Lübeck, Institute of Social Medicine, Nursing Research Unit, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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48
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Richter C, Berg A, Fleischer S, Köpke S, Balzer K, Fick EM, Sönnichsen A, Löscher S, Vollmar HC, Haastert B, Icks A, Dintsios CM, Mann E, Wolf U, Meyer G. Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): study protocol for a cluster-randomised controlled trial. Implement Sci 2015; 10:82. [PMID: 26037324 PMCID: PMC4464611 DOI: 10.1186/s13012-015-0268-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/15/2015] [Indexed: 12/02/2022] Open
Abstract
Background The majority of nursing home residents with dementia experience behavioural and psychological symptoms like apathy, agitation, and anxiety. According to analyses of prescription prevalence in Germany, antipsychotic drugs are regularly prescribed as first-line treatment of neuropsychiatric symptoms in persons with dementia, although guidelines clearly prioritise non-pharmacological interventions. Frequently, antipsychotic drugs are prescribed for inappropriate reasons and for too long without regular reviewing. The use of antipsychotics is associated with adverse events like increased risk of falling, stroke, and mortality. The aim of the study is to investigate whether a person-centred care approach, successfully evaluated in nursing homes in the United Kingdom, can be implemented in German nursing homes and, in comparison with a control group, can result in a clinically relevant reduction of the proportion of residents with antipsychotic prescriptions. Methods/design The study is a cluster-randomised controlled trial comparing an intervention group (two-day initial training on person-centred care and ongoing training and support programme) with a control group. Both study groups will receive, as optimised usual care, a medication review by an experienced psychiatrist/geriatrician providing feedback to the prescribing physician. Overall, 36 nursing homes in East, North, and West Germany will be randomised. The primary outcome is the proportion of residents receiving at least one antipsychotic prescription (long-term medication) after 12 months of follow-up. Secondary outcomes are residents’ quality of life, agitated behaviour, as well as safety parameters like falls and fall-related medical attention. A health economic evaluation and a process evaluation will be performed alongside the study. Discussion To improve care, a reduction of the current high prescription rate of antipsychotics in nursing homes by the intervention programme is expected. Trial registration ClinicalTrials.gov: NCT02295462 Electronic supplementary material The online version of this article (doi:10.1186/s13012-015-0268-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christin Richter
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Almuth Berg
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Steffen Fleischer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Sascha Köpke
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Katrin Balzer
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Eva-Maria Fick
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
| | - Andreas Sönnichsen
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Susanne Löscher
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany. .,Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | | | - Andrea Icks
- Department of Public Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Charalabos-Markos Dintsios
- Department of Public Health, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
| | - Eva Mann
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria.
| | - Ursula Wolf
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany. .,University Hospital of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
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Kvale E, Dionne-Odom JN, Redden DT, Bailey FA, Bakitas M, Goode PS, Williams BR, Haddock KS, Burgio KL. Predictors of Physical Restraint Use in Hospitalized Veterans at End of Life: An Analysis of Data from the BEACON Trial. J Palliat Med 2015; 18:520-6. [PMID: 25927909 PMCID: PMC4441001 DOI: 10.1089/jpm.2014.0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of physical restraints in dying patients may be a source of suffering and loss of dignity. Little is known about the prevalence or predictors for restraint use at end of life in the hospital setting. OBJECTIVE The objective was to determine the prevalence and predictors of physical restraint use at the time of death in hospitalized adults. METHODS Secondary analysis was performed on data from the "Best Practices for End-of-Life Care for Our Nation's Veterans" (BEACON) trial conducted between 2005 and 2011. Medical record data were abstracted from six Veterans Administration Medical Centers (VAMCs). Data on processes of care in the last seven days of life were abstracted from the medical records of 5476 who died in the six VAMCs. We prospectively identified potential risk factors for restraint use at the time of death from among the variables measured in the parent trial, including location of death, medications administered, nasogastric tube, intravenous (IV) fluids, family presence, and receipt of a palliative care consultation. RESULTS Physical restraint use at time of death was documented in 890 decedents (16.3%). Restraint use varied by location of death, with patients in intensive settings being at higher risk. Restraint use was significantly more likely in patients with a nasogastric tube and those receiving IV fluids, benzodiazepines, or antipsychotics. CONCLUSIONS This is the first study to document that one in six hospitalized veterans were restrained at the time of death and to identify predictors of restraint use. Further research is needed to identify intervention opportunities.
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Affiliation(s)
- Elizabeth Kvale
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - David T. Redden
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - F. Amos Bailey
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marie Bakitas
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama
| | - Patricia S. Goode
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Beverly R. Williams
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Kathryn L. Burgio
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
- Center for Palliative and Supportive Care, University of Alabama at Birmingham, Birmingham, Alabama
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50
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Olsson A, Engström M, Åsenlöf P, Skovdahl K, Lampic C. Effects of tracking technology on daily life of persons with dementia: three experimental single-case studies. Am J Alzheimers Dis Other Demen 2015; 30:29-40. [PMID: 24771764 PMCID: PMC10852717 DOI: 10.1177/1533317514531441] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To investigate the effects of using tracking technology on independent outdoor activities and psychological well-being in 3 persons with dementia (PwDs) and their spouses. METHODS Three experimental single-case studies with an A1B1A2B2 design. The intervention entailed access to a passive positioning alarm and technical support. Continual daily measures of independent outdoor activities among PwDs' and spouses' worries about these activities were made during all phases. RESULTS Access to a tracking technology consistently increased the independent outdoor activities of 2 PwDs. One of the spouses consistently reported decreased worry during B phases, another's worry decreased only in B2, and the third showed little variability in worrying across all phases. CONCLUSION Tracking technology may support PwDs to engage in independent outdoor activities and decrease spouses' worries; however, randomized controlled group studies are needed to investigate whether these results can be replicated on a group level.
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Affiliation(s)
- Annakarin Olsson
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Maria Engström
- Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Kirsti Skovdahl
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden Faculty of Health Sciences, Buskerud University College, Drammen, Norway
| | - Claudia Lampic
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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