1
|
Mion LC, Momeyer MA. Tying down patients: Our past, present and future. Geriatr Nurs 2020; 41:501-504. [PMID: 32636020 DOI: 10.1016/j.gerinurse.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
2
|
|
3
|
Berzlanovich AM, Schöpfer J, Keil W. Deaths due to physical restraint. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:27-32. [PMID: 22334818 DOI: 10.3238/arztebl.2012.0027] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/13/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Physical restraint is used primarily for patients at risk of falling, those with motor unrest and agitated behavior, and those who manifest an intention of doing harm to themselves or are at risk of suicide. The use of freedom-restraining measures (FRM), and, in particular, the use of physical restraints against the patient's will, can be a serious intrusion of basic human rights and, as such, an act of violence against the patient. The improper use of physical restraints can cause injuries of varying severity, which can sometimes be fatal. METHODS We analyzed all cases of death under physical restraint that were recorded in the autopsy reports of the Institute of Forensic Medicine in Munich from 1997 to 2010. RESULTS Among the 27 353 autopsies conducted over the period of the study, there were 26 cases of death while the individual was physically restrained. Three of these cases involved patients who died of natural causes while restrained, and one was a suicide. The remaining 22 deaths were caused solely by physical restraint; all of them occurred in patients under nursing care who were not continuously observed. The immediate cause of death was strangulation (11 cases), chest compression (8 cases), or dangling in the head-down position (3 cases). In 19 of these 22 patients, the restraints were incorrectly fastened, including two cases in which improvised non-standard restraints were used. One nursing-home patient died because of an abdominal restraint even though it had been correctly applied: She was mobile enough to slip through the restraint till it compressed her neck, and then unable to extricate herself from it, so that she died of strangulation. CONCLUSION To prevent such deaths, we recommend from a forensic medical standpoint that all possible alternatives to FRM should be used instead. If direct-contact restraints are truly necessary, they must be applied as recommended and the restrained person must be closely observed.
Collapse
Affiliation(s)
- Andrea M Berzlanovich
- Forensische Gerontologie, Department für Gerichtsmedizin Wien, Medizinische Universität Wien, Wien, Austria.
| | | | | |
Collapse
|
4
|
Luo H, Lin M, Castle N. Physical restraint use and falls in nursing homes: a comparison between residents with and without dementia. Am J Alzheimers Dis Other Demen 2011; 26:44-50. [PMID: 21282277 PMCID: PMC10845417 DOI: 10.1177/1533317510387585] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To estimate the use of different types of physical restraints and assess their associations to falls and injuries among residents with and without Alzheimer's disease (AD) or dementia in US nursing homes. METHODS Data were from the 2004 National Nursing Home Survey. AD or dementia was identified using International Classification of Diseases, Ninth Revision (ICD-9) codes. Analyses were conducted with the Surveyfreq and Surveylogistic procedures in SAS v.9.1. RESULTS Residents with either AD or dementia were more likely to be physically restrained (9.99% vs 3.91%, P < .001) and less likely to have bed rails (35.06% vs 38.43%, P < .001) than those residents without the disease. The use of trunk restraints was associated with higher risk for falls (adjusted odds ratio [AOR] = 1.66, P < .001) and fractures (AOR = 2.77, P < .01) among residents with the disease. The use of full bed rails was associated with lower risk for falls among residents with and without the disease (AOR = 0.67 and AOR = 0.72, Ps < .05, respectively). CONCLUSIONS The use of a trunk restraint is associated with a higher risk for falls and fractures among residents with either AD or dementia.
Collapse
Affiliation(s)
- Huabin Luo
- Department of Health Care Management, Mount Olive College, NC, USA.
| | | | | |
Collapse
|
5
|
Nelson RL, Furner SE. Risk factors for the development of fecal and urinary incontinence in Wisconsin nursing home residents. Maturitas 2005; 52:26-31. [PMID: 16143223 DOI: 10.1016/j.maturitas.2004.12.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Revised: 12/01/2004] [Accepted: 12/02/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine factors associated with the development of urinary and fecal incontinence in nursing homes. DESIGN AND METHODS Residents of Wisconsin skilled nursing facilities reported in the Wisconsin annual nursing home survey continent to both urine and stool in 1992 were re-assessed 1 year later for the development of urinary and/or fecal incontinence. Independent variables were elements of the HCFA minimum data set found to be significantly associated with incontinence in cross-sectional surveys of Wisconsin nursing home residents. RESULTS Dementia and advancing age were consistently associated with the development of incontinence, but the strongest associations were impairment of activities of daily living and the use of patient restraints. IMPLICATION Adjusting for the major reasons to apply patient restraint: dementia, blindness, arthritis and stroke, along with other risk factors for incontinence, the use of patient restraints is the most significant cause for the development of incontinence in nursing homes.
Collapse
Affiliation(s)
- Richard L Nelson
- Department of Surgery, University of Illinois at Chicago, Room 2204, Mail Code 957, 1740 West Taylor Street, Chicago, IL 60612, USA.
| | | |
Collapse
|
6
|
Bredthauer D, Becker C, Eichner B, Koczy P, Nikolaus T. Factors relating to the use of physical restraints in psychogeriatric care: A paradigm for elder abuse. Z Gerontol Geriatr 2005; 38:10-8. [PMID: 15756482 DOI: 10.1007/s00391-005-0285-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 01/10/2005] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to address one component of the complex topic "elder abuse". A prospective observational study in the psychogeriatric unit of an acute psychiatric hospital demonstrated that 30% (n=37) of all included patients (n=122) were physically restrained. The highest incidence (48%) was found in elderly patients with severe cognitive impairments (diagnosis of dementia and/or delirium) (n=60). The most commonly used devices of physical restraints were bed rails (100%), belts (trunk 93%, limbs 40%) and chair-tables ("gerichair") (41%). Most restraints occurred at the beginning of hospitalization (83%). Physical restraints were continued for many days and on average of many hours a day. Patients with low cognitive status and serious mobility impairments showed a very high risk of being restrained (p=0.015; OR 32.0 [95% CI:2.0-515.1]). Inability to perform ADL activities increased the frequency of restraint use (p=0.035; OR27.7 [95%CI: 1.3-604.1]). As possible co-factors repetitive disruptive behaviors were found. There was no significant difference between the frequency of falls in restrained or unrestrained patients during the observational period, but fall-related fractures (n=2) only occurred in restrained patients. It is possible that restraints increase the use of benzodiazepines and classical neuroleptics. These results confirm that physical restraints remain a common practice in psychogeriatric care. No evidence-based data support the value of restraints in regard to fall prevention and control of behavioral disturbances in elderly people with serious mental illness. In contrast, these devices can have serious adverse effects and mean one of the most severe interventions in fundamental human rights.
Collapse
Affiliation(s)
- D Bredthauer
- Bethesda Geriatrische Klinik der Universität Ulm, Zollernring 26-28, 89073 Ulm, Germany
| | | | | | | | | |
Collapse
|
7
|
Happ MB. Further Considerations Regarding the Effects of Physical Restraint in the Intensive Care Unit. Crit Care Med 2004; 32:1977; author reply 1977. [PMID: 15343038 DOI: 10.1097/01.ccm.0000128979.54213.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
8
|
Abstract
Although hospital nurses are skilled in meeting the acute health needs of the elderly, they may not have the expertise required to manage the behavioral disturbances typically seen in this population. Using the Progressively Lowered Stress Threshold Model (PLST), this article helps identify factors that may precipitate undesirable behaviors in the acute care setting and suggests strategies to help nurses prevent or control them.
Collapse
Affiliation(s)
- Rose M McCloskey
- Department of Nursing, University of New Brunswick Saint John, Canada
| |
Collapse
|
9
|
|
10
|
|
11
|
Nelson R, Furner S, Jesudason V. Urinary incontinence in Wisconsin skilled nursing facilities: prevalence and associations in common with fecal incontinence. J Aging Health 2001; 13:539-47. [PMID: 11813740 DOI: 10.1177/089826430101300406] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This article reports the characteristics associated with fecal incontinence (FI) in a nursing home population that are also associated with urinary incontinence (UI). METHOD A cross-sectional survey composed of data from the Wisconsin Center for Health Statistics' Annual Nursing Home Survey in 1992 and 1993. Demographic characteristics, functional status, and disease histories were correlated with UI. RESULTS Data were available for 18,170 and 17,117 residents respectively, 56% of who were to varying degrees incontinent of urine in each year. Significant positive associations with UI included, in order of adjusted odds ratios: FI, truncal restraints, dementia, female gender, impaired vision, stroke, and constipation. Inverse associations were age, body mass index, tube feedings, and pressure ulcers. Diabetes, heart disease, arthritis, fecal impaction, and race were not associated with UI. CONCLUSIONS UI frequently coexists with FI in nursing home residents. FI and UI differ in their association with age, body mass, and gender.
Collapse
Affiliation(s)
- R Nelson
- Departments of Surgery and Epidemiology and Biostatistics, University of Illinois at Chicago, USA.
| | | | | |
Collapse
|
12
|
Mion LC, Fogel J, Sandhu S, Palmer RM, Minnick AF, Cranston T, Bethoux F, Merkel C, Berkman CS, Leipzig R. Outcomes following physical restraint reduction programs in two acute care hospitals. THE JOINT COMMISSION JOURNAL ON QUALITY IMPROVEMENT 2001; 27:605-18. [PMID: 11708040 DOI: 10.1016/s1070-3241(01)27052-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Physical restraint rates can be reduced safely in long term care settings, but the strategies used to prevent wandering, falls, and patient aggression have not been tested for their effectiveness in preventing therapy disruption. A restraint reduction program (RRP) consisting of four core components (administrative, educational, consultative, and feedback) was implemented in 1998-1999 in 14 units at two acute care hospitals in geographically distant cities. METHODS The RRP was targeted at units with prevalence rates of > or = 4% for non-intensive care units (non-ICUs) and > or = 25% for ICUs, as well as two additional units. The RRP was implemented by an interdisciplinary team consisting of geriatricians and nurse specialists. RESULTS Of the 16,605 admissions to the RRP units, 2,772 cases received RRP consultations. Only six units (four of seven general units and two of six ICUs) demonstrated a relative reduction of > or = 20% in the physical restraint use rate. No increase in secondary outcomes of patient falls and therapy disruptions (patient-initiated discontinuation or dislodgment of therapeutic devices) occurred, injury rates were low, and no deaths occurred as a direct result of either a fall or therapy disruption event. DISCUSSION Given the minimal success in the ICU settings, further studies are needed to determine effective nonrestraint strategies for critical care patients. ICU clinicians need to be persuaded of the favorable risk-to-benefit ratio of alternatives to physical restraint before they will change their practice patterns. SUMMARY Efforts to identify more effective interventions that match patient needs and to identify non-clinician factors that affect physical restraint use are needed.
Collapse
Affiliation(s)
- L C Mion
- Geriatric Nursing Program, Division of Nursing, Cleveland Clinic Foundation, Cleveland, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
Restraint-free care has emerged as an indicator of quality care for older adults in all settings. The most difficult challenges to achieving this goal are care of hospitalized older adults who are functionally dependent and cognitively impaired. The purpose of this article is to report findings from a descriptive study of restrained hip fracture patients, and discuss approaches to achieving restraint-free care. Rate of restraint use was 33.2% among hospitalized hip fracture patients during an 11-year period in 20 metropolitan teaching hospitals. Restrained patients were older men who resided in nursing homes prior to hospitalization. Clinically, restrained patients had a diagnosis of dementia, were noted to be confused or disoriented by nursing staff, and were dependent in activities of daily living. An individualized approach to care is the best method to avoid use of physical restraints for patients with acute confusion and cognitive impairment.
Collapse
Affiliation(s)
- E M Sullivan-Marx
- University of Pennsylvania, School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104-6096, USA
| |
Collapse
|
14
|
Rader J, Jones D, Miller L. The importance of individualized wheelchair seating for frail older adults. J Gerontol Nurs 2000; 26:24-32; quiz 46-7. [PMID: 11883618 DOI: 10.3928/0098-9134-20001101-07] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Rader
- School of Nursing, Oregon Health Sciences University, Portland, USA
| | | | | |
Collapse
|
15
|
Kellogg FR, Brickner PW. Long-term home health care for the impoverished frail homebound aged: a twenty-seven-year experience. J Am Geriatr Soc 2000; 48:1002-11. [PMID: 10968309 DOI: 10.1111/j.1532-5415.2000.tb06902.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- F R Kellogg
- Dept of Community Medicine, Saint Vincents Hospital and Medical Center and New York Medical College, New York, New York 10011, USA
| | | |
Collapse
|
16
|
Happ MB. Using a best practice approach to prevent treatment interference in critical care. PROGRESS IN CARDIOVASCULAR NURSING 2000; 15:58-62. [PMID: 10804596 DOI: 10.1111/j.0889-7204.2000.080394.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Treatment interference, also known as therapy disruption, device disruption, or self extubation, is a common and especially difficult clinical problem in critical care. This paper presents creative and practical clinical innovations and relevant research findings as a "best practice approach" to prevent treatment interference in critical care settings. Key principles are presented to guide patient assessment and selection of nursing strategies. Nursing assessment parameters are described and a wide range of nonrestraint strategies are discussed.
Collapse
Affiliation(s)
- M B Happ
- Center for Advancing Care in Serious Illness, School of Nursing, University of Pennsylvania, Philadelphia 19104-6069, USA
| |
Collapse
|
17
|
Rader J, Jones D, Miller LL. Individualized Wheelchair Seating: Reducing Restraints and Improving Comfort and Function. TOPICS IN GERIATRIC REHABILITATION 1999. [DOI: 10.1097/00013614-199912000-00006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
18
|
Sullivan-Marx EM, Strumpf NE, Evans LK, Baumgarten M, Maislin G. Initiation of physical restraint in nursing home residents following restraint reduction efforts. Res Nurs Health 1999; 22:369-79. [PMID: 10520189 DOI: 10.1002/(sici)1098-240x(199910)22:5<369::aid-nur3>3.0.co;2-g] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this pilot study a one group pretest posttest design was employed to identify resident characteristics and environmental factors associated with initiation of physical restraint. Predictors of restraint initiation for older adults were examined using secondary analysis of an existing data set of nursing home residents who were subjected to a federal mandate and significant restraint reduction efforts. Lower cognitive status (OR = 1.5 [for every 7-point decrease in Mini-Mental State Examination], 95% CI = 1.0, 2.1) and a higher ratio of licensed nursing personnel (OR = 3.7, 95% CI = 1.2, 11.9) were predictive of restraint initiation. Key findings suggest that restraint initiation occurs, despite significant restraint reduction efforts, when a nursing home resident is cognitively impaired or when more licensed nursing personnel (predominantly licensed practical nurses) are available for resident care. Achievement of restraint-free care in nursing homes requires specific and individualized approaches for residents who are cognitively impaired, as well as greater attention to staff mix of registered nurses, licensed practical nurses, and nursing aides.
Collapse
Affiliation(s)
- E M Sullivan-Marx
- University of Pennsylvania, School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104-6096, USA
| | | | | | | | | |
Collapse
|
19
|
Ryden MB, Feldt KS, Oh HL, Brand K, Warne M, Weber E, Nelson J, Gross C. Relationships between aggressive behavior in cognitively impaired nursing home residents and use of restraints, psychoactive drugs, and secured units. Arch Psychiatr Nurs 1999; 13:170-8. [PMID: 10478495 DOI: 10.1016/s0883-9417(99)80003-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study examined relationships between aggressive behavior in cognitively impaired nursing home residents and physical restraints, psychoactive drugs, and placement on a secured unit. Data were obtained from 116 residents who were consistently aggressive as measured by the Ryden Aggression Scale 2. Subjects averaged 9.5 aggressive behaviors per day. Forty-seven percent of subjects were restrained, and 62% were regularly receiving psychoactive drugs. Use of restraints, antipsychotics, and placement on a secured unit were all significantly related to increased physical aggression scores. Four variables accounted for 23% of the variance in physical aggression scores: location on a secured unit, not receiving an antidepressant, being restrained, and number of psychotropic and/or anxiolytic medications administered. Significantly lower physical aggression scores were noted for subjects receiving antidepressants.
Collapse
Affiliation(s)
- M B Ryden
- University of Minnesota School of Nursing, USA
| | | | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Frengley JD, Mion LC. Physical Restraints in the Acute Care Setting: Issues and Future Direction. Clin Geriatr Med 1998. [DOI: 10.1016/s0749-0690(18)30088-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
22
|
|