Barriers to reducing the use of restraints in residential elder care facilities

AIM

This paper is a report of a study to compare perspectives of staff in residential elder care facilities with those of residents and family members from the same facilities about barriers to reducing the use of physical, chemical and environmental restraints.

BACKGROUND

There is growing research evidence of the potential risk of physical and emotional harm of restraining residents in residential elder care facilities. Despite the potential harms, restraints continue to be a common practice in facilities across Australia. Little research has been undertaken to explore the barriers to reducing the use of restraints.

METHOD

Eighteen individual interviews were conducted with staff, general practitioners and a pharmacist and three focus groups were conducted with a total of 12 residents and 17 family members associated with three residential elder care facilities in Melbourne, Australia in 2004.

FINDINGS

The three participating facilities were committed to reducing the use of restraints, although physical, chemical and environmental restraints were used in all three facilities. Barriers to reducing restraint use included fear of resident injury, staff and resource limitations, lack of education and information about alternatives to restraints, environmental constraints, policy and management issues, beliefs and expectations (of staff, family and residents), inadequate review practices and communication barriers.

CONCLUSION

Further education and support for staff and family members in evidence-based practice in relation to resident care and restraint use is needed in at least some residential elder care facilities.

Overcoming Restraint Use: EXAMINING BARRIERS IN AUSTRALIAN AGED CARE FACILITIES

The purpose of this article is to discuss the outcomes of a project that sought to identify alternatives to restraint use in aged care facilities. (In Australia, the term aged care facility refers to those facilities previously known as hostels and nursing homes.) A literature review was conducted and discussion forums and individual interviews were held with interested stakeholders in Australian capital cities, as well as in a rural city in each state. Site visits were conducted at 16 aged care facilities. Participants identified legal concerns, existing organizational culture, and lack of alternatives as barriers to implementing restraint-minimization practices. Recommendations to facilitate minimal restraint are implementing national policy guidelines, adopting a best practice philosophy in relation to restraint minimization, continuing staff education related to alternatives, and maintaining constant communication with families.