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Ertuğrul B, Özden D. Physical Restraint Experiences of Family Caregivers of Patients With Stroke in Turkey: A Qualitative Study. Clin Nurs Res 2023; 32:499-509. [PMID: 36028990 DOI: 10.1177/10547738221115229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to explore the experiences and needs of family caregivers of stroke patients who require physical restraints. The themes and sub-themes that emerged included "the reason for the use of PR" (disruptive behaviors of the patient and personal reasons of caregivers), "the turmoil of having to use PR" (inevitableness, comparing benefits and harms, the emotional effect of PR, and physical effects), and "unmet needs and suggestions" (unmeet needs and suggestions). Nurses should take the experiences of patient relatives into account in the process of PR application, organize training programs, and determine application standards for PR.
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2
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Moermans VRA, Bleijlevens MHC, Verbeek H, Passos VL, Milisen K, Hamers JPH. District nurses' attitudes towards involuntary treatment in dementia care at home: A cross-sectional study. Geriatr Nurs 2022; 47:107-115. [PMID: 35905633 DOI: 10.1016/j.gerinurse.2022.07.009] [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: 05/06/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022]
Abstract
One in two persons living with dementia (PLWD) at home receive care which they resist to and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in the use of involuntary treatment. However, little is known how their attitudes and opinions influence the use of involuntary treatment. This cross-sectional study aims to investigate the attitudes of district nurses towards the use of involuntary treatment in dementia care at home, determinants and their opinion about its restrictiveness and discomfort. Results show that district nurses perceive involuntary treatment as regular part of nursing care, having neither positive nor negative attitude towards its appropriateness. They consider involuntary treatment usage as moderately restrictive to PLWD and feel moderately uncomfortable when using it. These findings underscore the need to increase the awareness of district nurses regarding the negative consequences of involuntary treatment use to PLWD at home.
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Affiliation(s)
- Vincent R A Moermans
- PhD - Student, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht 6229 GT, The Netherlands; Regional Manager and Nurse Specialist, Department of Nursing, White and Yellow Cross Limburg, Genk, Belgium; Voluntary Scientific Assistant, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.
| | - Michel H C Bleijlevens
- Assistant Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Hilde Verbeek
- Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Valéria Lima Passos
- Associate Professor, Department Methodology and Statistics, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Koen Milisen
- Professor, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Jan P H Hamers
- Professor, Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Kuppili PP, Vengadavaradan A, Bharadwaj B. A Cross-Sectional Study to Assess the Frequency of Restraint, and Knowledge and Attitudes of the Caregivers of Patients Toward Restraint in a General Hospital Psychiatry Setting from South India. Indian J Psychol Med 2022; 44:359-365. [PMID: 35949638 PMCID: PMC9301748 DOI: 10.1177/02537176211061304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is limited Indian data on the epidemiology of hospital-based restraint practices and the knowledge and attitude of caregivers toward restraint. Therefore, this study aimed to report the frequency and pattern of restraints in a general hospital psychiatry setting and assess the knowledge and attitude about restraint practices among caregivers of patients. METHODS We calculated the frequency of restraints (physical and chemical) over one year. The knowledge and attitude toward restraint were assessed in 75 caregivers each of patients from inpatient and outpatient settings, using a questionnaire designed by the authors and pretested in a pilot study. RESULTS The frequency of any form of restraint was 19%. The frequency of chemical and physical restraints was 19% and 0.5%, respectively. Less than 20% of caregivers in both groups reported that restraint was either stigmatizing (5.33% inpatient caregivers vs. 12% outpatient caregivers), cruel (8% inpatient caregivers vs. 15.33% outpatient caregivers), or a measure of punishment (9% inpatient caregivers vs. 16% outpatient caregivers). No significant difference was found between knowledge and attitude about restraint between caregivers of outpatients and inpatients, except for a significantly greater number of caregivers of outpatients reporting that the restraint practices in the hospital were similar to those adopted by faith healers or religious/spiritual centers. CONCLUSION The frequency of either physical or chemical restraint was less compared to the existing international and Indian data. In addition, most caregivers of patients of both outpatients and inpatients did not report a negative attitude toward restraints.
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Affiliation(s)
| | - Ashvini Vengadavaradan
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvanthri Nagar, Puducherry, India
| | - Balaji Bharadwaj
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvanthri Nagar, Puducherry, India
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Özdemir ÖF, Keçeci A. Evaluation of patient relatives’ opinions on physical restraint. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221102437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Most of the research on physical restraint is focused on determining patients’ experiences of restraint, the consequences of restraint, and healthcare professionals’ perceptions and attitudes. The aim of this study was to determine the opinions of the relatives of patients, who are a critical component of care, about physical restraint. The study used the mixed methods research approach, which combines quantitative and qualitative data collection methods. Method The study population consisted of 984 relatives of patients hospitalized in units where physical restraint was commonly applied between January 2018 and December 2018, and the sample consisted of 277 relatives of patients. The qualitative sample of the study consisted of 22 patient's relatives who were interviewed using the maximum diversity sampling method, a purposive sampling method. The quantitative data were analyzed using frequency, percentage, Chi Square (X2-Chi Square) test, and the qualitative data were analyzed using content analysis. Results The results showed that consent for physical restraint was generally obtained from spouses, physical restraint was applied to prevent self-harm, but relatives of the patients were insufficiently informed and worried about complications. It was also found that the most frequent reasons for physical restraint were self-harm and facilitation of treatment and care for the male patients and the feeling of helplessness for the female patients. Conclusion It was determined that the relatives of patients regarded physical restraint for treatment positively, but they were worried about complications, and they were mostly insufficiently informed before the intervention.
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Affiliation(s)
| | - Ayla Keçeci
- Düzce University Faculty of Health Sciences, Department of Nursing, Düzce, Turkey
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Carrero-Planells A, Urrutia-Beaskoa A, Moreno-Mulet C. The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147509. [PMID: 34299959 PMCID: PMC8306247 DOI: 10.3390/ijerph18147509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 11/16/2022]
Abstract
The use of physical restraints is a common practice in the care of hospitalised and institutionalised elderly people. This use is determined by factors related to the patients, their families, the healthcare professionals, the institution, and prevailing social values. Today, however, this practice is often questioned because of its physical, psychological, moral, ethical, and legal repercussions. The present study explores attitudes among healthcare professionals towards the physical restraint of geriatric patients in intermediate care hospitals in Majorca. This study is based on a qualitative design, combining an ethnomethodological approach with critical discourse analysis. The theoretical framework is drawn from Foucault’s work in this field and from Haslam’s theory of mechanisation. Individual interviews will be conducted with physicians, nurses, and nursing assistants at intermediate care hospitals in Majorca. The analysis will focus on these professionals’ knowledge, attitudes, and practices regarding the use of such measures, seeking to identify the factors, especially institutional factors, that determine the use of restraints. It is essential to determine the prevailing culture among healthcare professionals regarding the use of physical restraints on geriatric patients in order to design and propose a more dignified health care model in which such restraints are eliminated.
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Affiliation(s)
- Alba Carrero-Planells
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Spain;
- Care, Chronicity, and Health Evidences Research Group, University of the Balearic Islands, 07122 Palma, Spain
- Correspondence: ; Tel.: +34-971-259-854
| | | | - Cristina Moreno-Mulet
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma, Spain;
- Care, Chronicity, and Health Evidences Research Group, Health Research Institute of the Balearic Islands (IdISBa), 07010 Palma, Spain
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Wang J, Liu W, Zhao Q, Xiao M, Peng D. An Application of the Theory of Planned Behavior to Predict the Intention and Practice of Nursing Staff Toward Physical Restraint Use in Long-Term Care Facilities: Structural Equation Modeling. Psychol Res Behav Manag 2021; 14:275-287. [PMID: 33688280 PMCID: PMC7936668 DOI: 10.2147/prbm.s293759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/11/2021] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Understanding the factors that affect nursing staffs' intention and practice of physical restraint (PR) on older adults help develop restraint-reduction programs. This study aimed to identify the relationship between the Theory of Planned Behavior (TPB) constructs and nursing staffs' practice to use PR in long-term care (LTC) facilities. PATIENTS AND METHODS A cross-sectional survey was conducted via convenience sampling among 316 nursing staff in six Chinese LTC facilities. PR-TPB questionnaire and the practice subscale of the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR were used to collect the data. Structural equation modeling (SEM) was used to examine the relationship between variables. RESULTS The SEM fit well with the data (χ2/df =1.639, RMSEA = 0.045, CFI= 0.955, GFI=0.945). Attitude (β=0.536, P<0.001) and perceived behavioral control (PBC) (β=0.139, P<0.05) predicted intention (R2 =0.359). PBC was a significant predictor of practice, with R2 accounting for 0.151. CONCLUSION TPB provided useful insight into better understanding nursing staffs' PR practices, although it did not support all the TPB principles significantly. Prospective studies may be conducted to design and implement multi-component interventions based on TPB and explore the effectiveness of PR reduction in LTC facilities in-depth.
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Affiliation(s)
- Jun Wang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Daomei Peng
- The First Social Welfare Home of Chongqing, Chongqing, People’s Republic of China
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Vandervelde S, Scheepmans K, Milisen K, van Achterberg T, Vlaeyen E, Flamaing J, Dierckx de Casterlé B. Reducing the use of physical restraints in home care: development and feasibility testing of a multicomponent program to support the implementation of a guideline. BMC Geriatr 2021; 21:77. [PMID: 33494710 PMCID: PMC7831193 DOI: 10.1186/s12877-020-01946-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A validated evidence-based guideline was developed to reduce physical restraint use in home care. However, the implementation of guidelines in home care is challenging. Therefore, this study aims to systematically develop and evaluate a multicomponent program for the implementation of the guideline for reducing the use of physical restraints in home care. METHODS Intervention Mapping was used to develop a multicomponent program. This method contains six steps. Each step comprises several tasks towards the design, implementation and evaluation of an intervention; which is theory and evidence informed, as well as practical. To ensure that the multicomponent program would support the implementation of the guideline in home care, a feasibility study of 8 months was organized in one primary care district in Flanders, Belgium. A concurrent triangulation mixed methods design was used to evaluate the multicomponent program consisting of a knowledge test, focus groups and an online survey. RESULTS The Social Cognitive Theory and the Theory of Planned Behavior are the foundations of the multicomponent program. Based on modeling, active learning, guided practice, belief selection and resistance to social pressure, eight practical applications were developed to operationalize these methods. The key components of the program are: the ambassadors for restraint-free home care (n = 15), the tutorials, the physical restraint checklist and the flyer. The results of the feasibility study show the necessity to select uniform terminology and definition for physical restraints, to involve all stakeholders from the beginning of the process, to take time for the implementation process, to select competent ambassadors and to collaborate with other home care providers. CONCLUSIONS The multicomponent program shows promising results. Prior to future use, further research needs to focus on the last two steps of Intervention Mapping (program implementation plan and developing an evaluation plan), to guide implementation on a larger scale and to formally evaluate the effectiveness of the multicomponent program.
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Affiliation(s)
- Sara Vandervelde
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35 blok d bus 7001, 3000, Leuven, Belgium
| | - Kristien Scheepmans
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35 blok d bus 7001, 3000, Leuven, Belgium.,Wit-Gele Kruis van Vlaanderen, Nursing Department, Frontispiesstraat 8, bus 1.2, 1000, Brussels, Belgium
| | - Koen Milisen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35 blok d bus 7001, 3000, Leuven, Belgium.,University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49, 3000, Leuven, Belgium
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35 blok d bus 7001, 3000, Leuven, Belgium
| | - Ellen Vlaeyen
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35 blok d bus 7001, 3000, Leuven, Belgium
| | - Johan Flamaing
- University Hospital Leuven, Department of Geriatric Medicine, Herestraat 49, 3000, Leuven, Belgium.,KU Leuven, Department of Public Health and Primary Care, Division of Gerontology and Geriatrics, Kapucijnenvoer 35 blok d bus 7001, 3000, Leuven, Belgium
| | - Bernadette Dierckx de Casterlé
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Kapucijnenvoer 35 blok d bus 7001, 3000, Leuven, Belgium.
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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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Yu TK, Suen LKP, Liu YB, Wong ALY, Lai CKY. Patient safety and bedrail use as a global phenomenon: A prevalence study. Contemp Nurse 2020; 56:204-214. [PMID: 33121361 DOI: 10.1080/10376178.2020.1844576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Although bedrail use may increase the risk of accidents among patients, bedrails are still extensively used in healthcare facilities. Therefore, the field calls for a review of bedrail use in practice. Objective: This report examined the prevalence and implications of bedrail use in rehabilitation facilities in Hong Kong. The findings are compared with the current state of bedrail use worldwide. Design and methods: This work is a cross-sectional, observational study. A secondary analysis was conducted on the database of a prospective trial. Bilateral bedrail use was observed in two Hong Kong rehabilitation hospitals. Logistic regression was performed to examine the factors associated with bedrail use. Results: A total of 3,384 restraint observations were made. The bedrail rate was 31.34%, which revealed that bedrail use was the second most commonly used physical restraint. The fall history (OR: 2.84), cognitive impairment (OR: 0.91) and functional dependency (OR: 0.79) of patients were significant predictors of bedrail use, p < .05. Conclusion: This study examines bedrail prevalence through direct observation, which is the preferred method for examining bedrail use in practice. We found that actual bedrail use is higher than the numbers reported in previous studies in Hong Kong. In addition, our research reveals that bedrails are commonly used for vulnerable patients. This finding highlights the need to change nurses' beliefs on bedrail use through education. The management of these health facilities should also aim to create an institutional environment that promotes the reduction of bedrail use. Implementation strategies on restraint reduction should also fit the culture of the organisation and local nursing practices, as well as the staff's values. Impact Statement: This study provides preliminary information about the widespread use of bedrails in Hong Kong and other countries. The research also introduces effective ways to achieve the reduction of bedrail use.
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Affiliation(s)
- Tsz Kiu Yu
- Department of Social Work, The Chinese University of Hong Kong, Room 101, T.C. Cheng Building, Shatin, New Territories, HKSAR, Hong Kong
| | - Lorna Kwai-Ping Suen
- School of Nursing, The Hong Kong Polytechnic University, GH520, School of Nursing, Hung Hom, Kowloon, HKSAR, Hong Kong
| | - Yong-Bing Liu
- Department of Nursing, Yangzhou University, No. 88, South Road, Yangzhou, Jiangsu 225009, People's Republic of China
| | - Adrienne Lei Yung Wong
- Department of Social Work, The Chinese University of Hong Kong, Room 101, T.C. Cheng Building, Shatin, New Territories, HKSAR, Hong Kong
| | - Claudia Kam Yuk Lai
- School of Nursing, The Hong Kong Polytechnic University, GH520, School of Nursing, Hung Hom, Kowloon, HKSAR, Hong Kong
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Watson K, Hatcher D. Factors influencing management of agitation in aged care facilities: A qualitative study of staff perceptions. J Clin Nurs 2020; 30:136-144. [PMID: 33090623 DOI: 10.1111/jocn.15530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Agitation in older people is commonly associated with cognitive decline, complex medical diagnoses and polypharmacy. Impaired communication and comprehension within a dementia trajectory adds complexity to assessment and management. Despite high prevalence, agitated behaviours remain challenging to manage in residential aged care settings. AIM To explore staff perceptions of agitation in residents of aged care facilities, including the influence of dementia, when selecting management strategies to reduce agitated behaviour. DESIGN Qualitative descriptive. METHODS Semi-structured interviews with 11 aged care staff were conducted at two aged care sites. Transcripts were examined using content analysis to identify common issues and categories. The study complied with COREQ guidelines (see. Appendix S1). RESULTS Participants reported managing resident agitation at least once per shift; most frequently manifesting as wandering, restlessness or aggression. Management strategies included distraction, providing space, knowing the resident, identifying causative factors, spending individual time and if necessary medication administration. Agitation management was more challenging for residents with dementia due to impaired communication or comprehension of instruction. CONCLUSIONS While participants strived to deliver individualized person-centred care, this was difficult given time and resource constraints. Contemporary management of agitation therefore remains variable in everyday practice, with resident preference used when causative factors were known. Conversely, for residents with impaired communication and/or comprehension, distraction and chemical restraint were commonly used. Nuanced education for assessment and management is recommended to better address this unmet need for some residents. RELEVANCE TO CLINICAL PRACTICE For optimal care, appropriate allocation of time and resources is necessary to identify causative and contextual factors for individual residents. Recommendations are for additional staff training in communication and attitude, and collaborating with frontline staff to develop a practical guide for management of agitation in aged care. These simple initiatives may help to improve consistency of care delivery and resident outcomes.
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Affiliation(s)
- Karen Watson
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Deborah Hatcher
- School of Nursing and Midwifery, Western Sydney University, Penrith South, NSW, Australia
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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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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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13
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Mengelers AMHJ, Bleijlevens MHC, Verbeek H, Capezuti E, Tan FES, Hamers JPH. Professional and family caregivers' attitudes towards involuntary treatment in community-dwelling people with dementia. J Adv Nurs 2018; 75:96-107. [PMID: 30168165 PMCID: PMC7379622 DOI: 10.1111/jan.13839] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/28/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Abstract
Aims The aim of this study was to gain insight into professional and family caregivers’ attitudes towards involuntary treatment in community‐dwelling people with dementia (PwD). Background The number of PwD with complex care needs living at home is increasing rapidly. In some situations, caregivers provide care against the will of PwD, referred to as involuntary treatment, which includes non‐consensual care, psychotropic medication and physical restraints. Design A cross‐sectional study. Methods A total of 228 professional (nursing staff, general practitioners (GPs) and other healthcare professionals such as physical therapists and psychologists) and 77 family caregivers of PwD completed the Maastricht Attitude Questionnaire—Home Care. This questionnaire measures attitudes towards involuntary treatment and perceived restrictiveness of and experienced discomfort in using involuntary treatment. Data were collected in the Netherlands between June and November 2016. Results Family caregivers and GPs had more positive attitudes towards involuntary treatment than nursing staff and other healthcare professionals, indicating that they are more accepting of involuntary treatment. A more positive attitude was associated with higher perceived caregiver burden and being a family caregiver. Family caregivers and GPs found the use of involuntary treatment less restrictive and indicated feeling more comfortable when using these measures. Conclusion It is important to account for the differences in attitudes and foster dialogue among professional and family caregivers to find common ground about alternatives to involuntary treatment. These results will inform the development of an intervention that aims to prevent involuntary treatment in home care.
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Affiliation(s)
- Angela M H J Mengelers
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Michel H C Bleijlevens
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Hilde Verbeek
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Elizabeth Capezuti
- Hunter College and the Graduate Center of City, University of New York, New York, United States
| | - Frans E S Tan
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Jan P H Hamers
- Faculty of Health, Medicine and Lifesciences, CAPHRI, Maastricht University, Maastricht, The Netherlands
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14
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Iaboni A, Van Ooteghem K, Marcil MN, Cockburn A, Flint AJ, Grossman D, Keren R. A Palliative Approach to Falls in Advanced Dementia. Am J Geriatr Psychiatry 2018; 26:407-415. [PMID: 29336907 DOI: 10.1016/j.jagp.2017.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/10/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
Abstract
Falls are viewed as a preventable cause of injury, functional loss, and death in older adults with dementia, and have been used as a marker of quality of care in long-term care facilities. Despite intensive intervention around fall prevention in these settings, falls and injury remain frequent, particularly among residents in the advanced stages of dementia. In this clinical review, we consider the common challenges and pitfalls in both the management of falls and the provision of palliative care in advanced dementia. We then describe a palliative approach to falls in advanced dementia that involves identifying individuals who would benefit from this care approach, framing falls and loss of mobility as a quality of life issue, and devising an individualized symptom assessment and management plan. A palliative approach can lead to recognition and acceptance that recurrent falls are often symptomatic of advanced dementia, and that not all falls are preventable. We conclude that falls in the advanced stage of dementia can be sentinel events indicating the need for a palliative approach to care. Rather than replace falls prevention activities, a palliative approach to falls prompts us to select dementia stage-appropriate interventions with a focus on symptom management, comfort, and dignity.
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Affiliation(s)
- Andrea Iaboni
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada; Departments of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Karen Van Ooteghem
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Meghan N Marcil
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Amy Cockburn
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Alastair J Flint
- Centre for Mental Health, University Health Network, Toronto, ON, Canada; Departments of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphna Grossman
- Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Freeman Centre for the Advancement of Palliative Care, North York General Hospital, Toronto, ON, Canada
| | - Ron Keren
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Centre for Mental Health, University Health Network, Toronto, ON, Canada; Departments of Psychiatry, University of Toronto, Toronto, ON, Canada
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15
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Shrestha Y. Knowledge and Attitude of Family Member of Mentally Ill Patient Regarding Restraint, 2016. Arch Psychiatr Nurs 2018; 32:297-299. [PMID: 29579527 DOI: 10.1016/j.apnu.2017.11.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/18/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND People who have observed or are aware that a consumer has been restrained may experience distress, confusion, concern, anger or fear and perceive as punishment. However, studies that examine the perspective of patient's family are limited. This study has explored the knowledge and attitude of family member of mentally ill patient. METHOD A descriptive cross-sectional study was carried out among family member of mentally ill patient at Punarjeevan Hospital, Balkumari, Lalitpur to assess the knowledge and attitude of family member of mentally ill patient regarding restraint. Interview schedule was used to collect data related to knowledge and attitude regarding restraint along with demographic features. RESULT The average score of knowledge regarding physical restraint was 30.66 (72.99%) and average attitude score was 4.17 (83.31%). In the study 40% relationship was found between knowledge and attitude. Regarding the association between knowledge and selected socio-demographic variables, knowledge was found to be associated with age, educational level and relation with patient of respondents. In terms of association between attitude and selected socio-demographic variables, attitude was found to be associated with relation with patient of respondents. CONCLUSION This study concludes that family member has relevant knowledge regarding physical restraint but the knowledge regarding risk and consequences of physical restraint was lacking. In terms of attitudes about physical restraint over all attitude was found to be positive among family members but attitude regarding feeling of patient towards physical restraint was contrast.
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Affiliation(s)
- Yashu Shrestha
- JF Institute of Health Sciences, Hattiban, Lalitpur, Nepal.
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16
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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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17
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Eltaliawi AG, El-Shinawi M, Comer A, Hamazah S, Hirshon JM. Restraint use among selected hospitalized elderly patients in Cairo, Egypt. BMC Res Notes 2017; 10:633. [PMID: 29183388 PMCID: PMC5704368 DOI: 10.1186/s13104-017-2978-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
Objective This study’s primary objective was to investigate the prevalence of physical and chemical restraint use in selected elderly hospitalized patients. Results This study was conducted in April 2014 in four major acute care hospitals. Trained data collectors assessed the use of physical and chemical restraint among all admitted elderly patients. There were 287 elderly patients (median age 64 years, 46% women). 32 patients were restrained. The overall prevalence of restraints was 11.1%, with physical restraint use alone at 3.2% and chemical restraints use alone at 7.3%. Restraint use varied by hospital type, with the highest at the private hospital (22.9%) and the lowest at the two university hospitals (< 6%). In conclusion the prevalence of physical and chemical restraint use among admitted elderly patients in Egypt is comparable to that seen in developed countries. However, the use appears to vary widely by hospital type. The use of restraints in the elderly remains an important question considering the increasing number of elderly. Electronic supplementary material The online version of this article (10.1186/s13104-017-2978-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Angela Comer
- Charles McC. Mathias Jr., National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sarah Hamazah
- Department of Geriatrics, Ain Shams University, Cairo, Egypt
| | - Jon Mark Hirshon
- Charles McC. Mathias Jr., National Study Center for Trauma and Emergency Medical Systems, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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18
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Kong EH, Song E, Evans LK. Effects of a Multicomponent Restraint Reduction Program for Korean Nursing Home Staff. J Nurs Scholarsh 2017; 49:325-335. [PMID: 28384390 DOI: 10.1111/jnu.12296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE Physical restraints are used frequently in Korea, suggesting a growing need for access to programs focused on reduction. The aim of this study was to evaluate the effects of a multicomponent restraint reduction program (MRRP) for nursing staff in Korean nursing homes. DESIGN A cluster-randomized, single-blind, controlled pretest-posttest design was used. A total of 122 nursing staff (nurses and geriatric care assistants) in two Korean nursing homes participated in this study: 62 in the experimental group (EG) and 60 in the control group (CG). METHODS Nursing staff in the EG home received the MRRP comprising three educational sessions (two classroom-based and one web-based) and two unit-based consultations. Three instruments were used to measure nursing staff's knowledge, perceptions, and attitudes regarding physical restraints. Data were collected immediately before and after the intervention, and again 1 and 3 months later. FINDINGS Repeated measures analysis of variance showed significant differences between groups in knowledge (p < .001), perceptions (p < .001), and attitudes (p = .011) over time. These significant improvements in the MRRP group (EG) were sustained over the 3-month period. CONCLUSIONS The MRRP effectively improved the knowledge, perceptions, and attitudes of nursing home staff about restraint use with older adults. Additional studies are recommended to evaluate effects of its components while using larger samples and rigorous research methods and measurements, and the inclusion of boosters or other supports to sustain change. CLINICAL RELEVANCE These results provide valuable knowledge regarding a multicomponent intervention for changing nursing home staff attributes that likely influence clinical practice. Elements of the educational content and methods found useful for nursing home staff may also be effective in vocational and continuing education as well as for families of older nursing home residents.
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Affiliation(s)
- Eun-Hi Kong
- Xi, Associate Professor, Gachon University, College of Nursing, Gyeonggi-do, Korea (ROK)
| | - Eunjin Song
- Doctoral student, Kyung Hee University, College of Nursing Science, Seoul, Korea (ROK)
| | - Lois K Evans
- Xi, Professor Emerita of Nursing, University of Pennsylvania, School of Nursing, Philadelphia, PA, USA
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19
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Van Gansbeke H, Milisen K. Restraint Use in Older Adults Receiving Home Care. J Am Geriatr Soc 2017; 65:1769-1776. [PMID: 28369736 DOI: 10.1111/jgs.14880] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application. DESIGN Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses. SETTING Homes of older adults receiving care from a home nursing organization in Belgium. PARTICIPANTS Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female). MEASUREMENTS For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions. RESULTS Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated. CONCLUSION Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings.
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Affiliation(s)
- Kristien Scheepmans
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | | | - Louis Paquay
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, 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
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20
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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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21
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Gjerberg E, Lillemoen L, Pedersen R, Førde R. Coercion in nursing homes: Perspectives of patients and relatives. Nurs Ethics 2015; 23:253-64. [PMID: 25566815 DOI: 10.1177/0969733014564907] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives. OBJECTIVES The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under which circumstances? METHODS The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives. ETHICAL CONSIDERATIONS Participation was based on written informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. RESULTS More than half of the patients and the majority of the relatives accepted the use of coercion, trusting the staff to act in the patient's best interest. However, the acceptance of coercion is strongly related to the patients' lack of understanding, to prevent health risks and to preserve the patient's dignity. CONCLUSION The majority of nursing home patients and relatives accepted the use of coercion in specific situations, while at the same time they emphasised the need to try alternative strategies first. There is still a need for good qualitative research on the use of coercion in nursing homes, especially with a closer focus on the perspectives and experiences of nursing home patients.
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Abstract
BACKGROUND There is controversy concerning the use of physical restraint. Despite this controversy, some nurses still consider the application of physical restraint unavoidable for some of their clients. AIM Identify the perceptions and practice of physical restraint in China. RESEARCH DESIGN This was a descriptive study that combined qualitative interviews with a quantitative cross-sectional survey. PARTICIPANTS A total of 18 nurses were interviewed and 330 nurses were surveyed. ETHICAL CONSIDERATIONS Approval of the study was obtained from the hospital ethics committee. Permission to conduct the study was obtained from the director of nursing. Participants were assured that their participation is voluntary. RESULTS Physical restraint was commonly used to protect patients' safety. Naturally, intensive care unit nurses used physical restraint much more frequently than general medical/surgical ward nurses (p < 0.01). In addition, night shift nurses tended to use physical restraint more frequently. CONCLUSION Nursing managers should be aware of the role nurses play in the use of physical restraint. In-service training regarding the proper use of physical restraint should be strengthened and nurse staffing levels should be improved in order to minimize the use of physical restraint in China.
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Affiliation(s)
- Hui Jiang
- Tongji University School of Medicine, China
| | | | - Yan Gu
- Tongji University School of Medicine, China
| | - Yanan He
- Tongji University School of Medicine, China
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23
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Bretschneider W. Die neue Schweizer Gesetzgebung zu bewegungseinschränkenden Maßnahmen auf dem medizinethischen Prüfstand. Ethik Med 2014. [DOI: 10.1007/s00481-014-0317-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kurata S, Ojima T. Knowledge, perceptions, and experiences of family caregivers and home care providers of physical restraint use with home-dwelling elders: a cross-sectional study in Japan. BMC Geriatr 2014; 14:39. [PMID: 24674081 PMCID: PMC3986818 DOI: 10.1186/1471-2318-14-39] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 03/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of physical restraints by family caregivers with home-dwelling elders has not been extensively studied but it might be widespread. Furthermore, it is also not clear how home care providers who support family caregivers perceive the use of physical restraint in elders' homes. This study assessed family caregivers' and home care providers' knowledge and perceptions of physical restraint used with elders living at home in Japan, a country with the highest proportion of elders in the world and where family caregiving is common. METHODS We undertook a cross-sectional study of 494 family caregivers, 201 home helpers, 78 visiting nurses, 131 visiting physicians, and 158 care managers of home-dwelling frail elders needing some care and medical support in Japan, using questionnaires on knowledge of 11 physical restraint procedures prohibited in institutions and 10 harmful effects of physical restraints, perceptions of 17 reasons for requiring physical restraints, and experiences involving physical restraint use. RESULTS Family caregivers were aware of significantly fewer recognized prohibited physical restraint procedures and recognized harmful effects of physical restraint than home care providers, and differences among home care providers were significant. The average importance rating from 1 (least) to 5 (most) of the 17 reasons for requiring physical restraints was significantly higher among family caregivers than home care providers, and significantly different among the home care providers. Moreover, these differences depended in part on participation in physical restraint education classes. While 20.1% of family caregivers had wavered over using physical restraints, 40.5% of home care providers had seen physical restraints used in elders' homes and 16.7% had advised physical restraint use or used physical restraints themselves. CONCLUSIONS Knowledge and perceptions of physical restraints differed between family caregivers and home care providers and were also diverse among home care providers. Because both groups might be involved in physical restraint use with home-dwelling elders, home care providers should acquire standardized and appropriate knowledge and perceptions of physical restraints to help family caregivers minimize abusive physical restraint use.
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Affiliation(s)
- Sadami Kurata
- Gerontological Nursing, Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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25
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Van Gansbeke H, Boonen S, Milisen K. Restraint use in home care: a qualitative study from a nursing perspective. BMC Geriatr 2014; 14:17. [PMID: 24498859 PMCID: PMC3946146 DOI: 10.1186/1471-2318-14-17] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 02/04/2014] [Indexed: 11/26/2022] Open
Abstract
Background Despite the growing demand for home care and preliminary evidence suggesting that the use of restraint is common practice in home care, research about restraint use in this setting is scarce. Methods To gain insight into the use of restraints in home care from the perspective of nurses, we conducted a qualitative explorative study. We conducted semi-structured face-to-face interviews of 14 nurses from Wit-Gele Kruis, a home-care organization in Flanders, Belgium. Interview transcripts were analyzed using the Qualitative Analysis Guide of Leuven. Results Our findings revealed a lack of clarity among nurses about the concept of restraint in home care. Nurses reported that cognitively impaired older persons, who sometimes lived alone, were restrained or locked up without continuous follow-up. The interviews indicated that the patient’s family played a dominant role in the decision to use restraints. Reasons for using restraints included “providing relief to the family” and “keeping the patient at home as long as possible to avoid admission to a nursing home.” The nurses stated that general practitioners had no clear role in deciding whether to use restraints. Conclusions These findings suggest that the issue of restraint use in home care is even more complex than in long-term residential care settings and acute hospital settings. They raise questions about the ethical and legal responsibilities of home-care providers, nurses, and general practitioners. There is an urgent need for further research to carefully document the use of restraints in home care and to better understand it so that appropriate guidance can be provided to healthcare workers.
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Affiliation(s)
| | | | | | | | | | - Koen Milisen
- Department of Public Health and Primary Care, Centre for Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35, 4th Floor, 3000 Leuven, Belgium.
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26
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Barton-Gooden A, Dawkins PE, Bennett J. Physical Restraint Usage at a Teaching Hospital. Clin Nurs Res 2013; 24:73-90. [PMID: 23814174 DOI: 10.1177/1054773813493112] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed method study examines the prevalence of restraint usage; perception of nurses and doctors about the practice and whether they were trained to apply physical restraints. The physical restraint prevalence tools were used to observe 172 adult patients and conduct 47 chart audits in the medical-surgical wards and a psychiatric unit in November 2011. Focus group discussions with nurses and doctors were conducted. Quantitative data were analyzed using the SPSS and focus group discussions thematically analyzed. The prevalence of physical restraints between the medical-surgical wards was 75%. Nurses and medical doctors were not formally trained to apply restraint, and had learnt from peer observation. They expressed sadness, guilt, and fear when restraints are used and identified that inadequate institutional support existed. Restraint usage was high, and nurses and doctors experienced moral dilemma when they perceived that lack of formal training and inadequate institutional support may contribute to patient injury.
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Affiliation(s)
| | | | - Joanna Bennett
- Head of Department, Senior Lecturer at the UWI School of Nursing, University of the West Indies, Kingston 7, Jamaica, West Indies
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27
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Huang HC, Huang YT, Lin KC, Kuo YF. Risk factors associated with physical restraints in residential aged care facilities: a community-based epidemiological survey in Taiwan. J Adv Nurs 2013; 70:130-43. [PMID: 23734585 DOI: 10.1111/jan.12176] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2013] [Indexed: 11/30/2022]
Abstract
AIM To identify the rate and risk factors of physical restraint in residential aged care facilities in Taiwan. BACKGROUND In Taiwan, physical restraint is commonly used in aged care facilities to prevent accidents. Many are unaware of the associated risks. Restrained residents cannot move freely, increasing the risk of atrophy and leading to reduced physical functioning. DESIGN A community-based epidemiological survey. METHODS Data were collected from June-December 2007 across 178 residential aged care facilities with 5,173 residential beds in the target city of Taiwan. Twenty facilities were sampled using probability proportional to size by beds and accreditation ranking. In all, 256 primary caregivers (78 nurses and 178 care aides) and 847 residents completed the study questionnaires and tests. A multilevel analysis approach was used to identify individual- and facility-level risk factors for physical restraint and assess the variation in physical restraint at the individual- and facility-level. RESULTS Of 847 residents, 62% (527) were restrained during the study period. The main reasons for restraint use were fall prevention and prevention of tube removal. Resident level risk factors for physical restraint included lower Barthel Index scores (more dependent) and an agreement allowing the use of physical restraint to avoid injury signed by a family member or social worker. A facility-level risk factor for physical restraint was younger primary caregivers. CONCLUSION To reduce the incidence of physical restraint in residential aged care facilities in Taiwan, educational programmes should target primary caregivers and families in facilities.
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Affiliation(s)
- Hui Chi Huang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu Tai Huang
- Information Science and Applications Alumni Association, Asia University, Taichung, Taiwan
| | - Kuan Chia Lin
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Yong Fang Kuo
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Kang J, Lee EN, Park EY, Lee Y, Lee MM. Emotional Response of ICU Patients Family toward Physical Restraints. ACTA ACUST UNITED AC 2013. [DOI: 10.7475/kjan.2013.25.2.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jiyeon Kang
- Department of Nursing, Dong-A University, Busan, Korea
| | - Eun-Nam Lee
- Department of Nursing, Dong-A University, Busan, Korea
| | | | - Youngock Lee
- SICU, Kosin University Gaspel Hospital, Busan, Korea
| | - Mi Mi Lee
- SICU, Seoul National University Hospital, Seoul, Korea
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[Development, appraisal and synthesis of complex interventions - a methodological challenge]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2011; 105:751-61. [PMID: 22176984 DOI: 10.1016/j.zefq.2011.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 11/02/2011] [Accepted: 11/04/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Many medical interventions are of a complex nature. They comprise interdependent components differently interacting within various complex settings, e.g., stroke units. Appraising the efficacy, benefit and harm of complex interventions is far more difficult than appraising single interventions like specific drug treatments. Detailed methodological procedures for the development, appraisal and synthesis of complex interventions are increasingly discussed internationally. METHODS Systematic inventory of methodological guidance for the development and evaluation of complex interventions through searching scientific literature databases and web resources of international institutes. Review of the current state of discussion and suggestions for the development, appraisal and synthesis of complex interventions. RESULTS Five methodological guidance papers have been identified. In particular, the UK Medical Research Council's guidance offers a structured introduction to the development and evaluation of complex interventions in health care and medicine. Synthesis of complex interventions using customary methods of systematic reviews is not satisfying. Other approaches to synthesis like realist evaluation as well as statistical procedures exploring the active components of complex interventions have been discussed. However, post hoc analytical procedures could never adequately replace careful prospective development and exploration of complex interventions and interdependencies with contextual factors. CONCLUSION Complex interventions require multi-stage development, use of different methods, reporting on all developing phases and new approaches for synthesis. Presentation of the complete evidence on a specific complex intervention might be more useful than synthesis of a variety of different complex interventions by customarily applied methods of (meta-analytical) systematic review.
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