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Dahlke S, Hunter KF. How nurses' use of language creates meaning about healthcare users and nursing practice. Nurs Inq 2020; 27:e12346. [PMID: 32064704 DOI: 10.1111/nin.12346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/27/2022]
Abstract
Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses' use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person-centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses' compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power-laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others.
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Affiliation(s)
- Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Dahlke SA, Hunter KF, Negrin K. Nursing practice with hospitalised older people: Safety and harm. Int J Older People Nurs 2019; 14:e12220. [PMID: 30628753 DOI: 10.1111/opn.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nursing teams work with hospitalised older people in institutions, which prioritise a biomedical model of care. This model does not fit the needs of older people because it emphasises efficacy and a narrow definition of patient safety, but does not prioritise functional needs. Nursing care is provided around the clock within the context of fiscal restraints as well as negative societal and nursing perspectives about ageing and old people. Yet, nursing perceptions of managing safety and potential harms to older patients within these hospital institutions are not well understood. METHODS An integrative review was conducted to examine nursing perspectives of safety and harm related to hospitalised older people. RESULTS The majority of included papers focused on restraint use. Findings reveal that nurses are using restraints and limiting mobility as strategies to manage their key priority of keeping older patients safe, reflecting a narrow conceptualisation of safety. Policy, administrative support and individual nurse characteristics influence restraint use. Safety policies that nurses interpret as preventing falls can encourage the use of restraints and limiting mobility, both of which result in functional losses to older people. CONCLUSIONS This complex issue requires attention from clinical nurses, leaders, policy makers and researchers to shift the focus of care to preservation and restoration of function for older people in hospital as a safety priority. IMPLICATIONS FOR PRACTICE Clinical leaders and nursing teams should engage in developing processes of care that incorporate maintaining and restoring older people's function.
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Affiliation(s)
- Sherry Ann Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Negrin
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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3
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Abstract
Although legislation has forced discretion in using physical restraints for institutionalized elders, considerable discussion continues about this matter. In particular, decision making around restraint use is not adequately understood. Awareness of the perceptions of nursing staff, who are usually involved in most decisions about restraint use, would be helpful to an understanding of the continued use of restraints. This study examined attitudes held by staff in long-term care settings and explored relationships of education and employment characteristics to physical restraint use. Licensed and unlicensed nursing personnel (N = 140) from 4 long-term care facilities were surveyed using a previously developed questionnaire. Results of stepwise regres sion showed that concerns about resident falls, resident disability, and staff harm explained a large portion of the variation in recommendations regarding restraint use Other findings suggest there is reason to believe improvements in perceptions about restraint use are occurring. Implications for staff education and areas for change in the work environment are provided
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Chien WT, Lee IY. Psychiatric nurses’ knowledge and attitudes toward the use of physical restraint on older patients in psychiatric wards. ACTA ACUST UNITED AC 2014. [DOI: 10.5172/mra.455.1.1.52] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Möhler R, Meyer G. Attitudes of nurses towards the use of physical restraints in geriatric care: a systematic review of qualitative and quantitative studies. Int J Nurs Stud 2013; 51:274-88. [PMID: 24176718 DOI: 10.1016/j.ijnurstu.2013.10.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine nurses' attitudes towards the use of physical restraints in geriatric care. DESIGN Systematic review and synthesis of qualitative and quantitative studies. DATA SOURCES The following databases were searched: Medline, CINAHL, EMBASE, Psyndex, PsychInfo, Social SciSearch, SciSearch, Forum Qualitative Social Research (1/1990 to 8/2013). We performed backward and forward citation tracking to all of the included studies. REVIEW METHODS We included in the present review all qualitative and quantitative studies in English and German that investigated nurses' attitudes towards the use of physical restraints in geriatric care. Two independent reviewers selected the studies for inclusion and assessed the study quality. We performed a thematic synthesis for the qualitative studies and a content analysis of the questionnaires' items as well as a narrative synthesis for the quantitative surveys. RESULTS We included 31 publications in the review: 20 quantitative surveys, 10 qualitative and 1 mixed-method study. In the qualitative studies, nurses' attitudes towards the use of physical restraints in geriatric care were predominately characterised by negative feelings towards the use of restraints; however, the nurses also described a perceived need for using restraints in clinical practice. This discrepancy led to moral conflicts, and nurses described several strategies for coping with these conflicts when restraints were used. When nurses were in doubt regarding the use of restraints, they decided predominantly in favour of using restraints. The results of the quantitative surveys were inconsistent regarding nurses' feelings towards the use of restraints in geriatric care. Prevention of falls was identified as a primary reason for using restraints. However, the items of the questionnaires focussed primarily on the reasons for the use of restraints rather than on the attitudes of nurses. CONCLUSIONS Despite the lack of evidence regarding the benefits of restraints and the evidence on the adverse effects, nurses often decided in favour of using restraints when in doubt and they used strategies to cope with negative feelings when they used restraints. A clear policy change in geriatric care institutions towards restraint-free care seems to be warranted to change clinical practice. The results of this review should also be considered in the development of interventions aimed at reducing the use of restraints.
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Affiliation(s)
- Ralph Möhler
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Gabriele Meyer
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany; Institute of Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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Goethals S, Dierckx de Casterlé B, Gastmans C. Nurses’ decision-making in cases of physical restraint: a synthesis of qualitative evidence. J Adv Nurs 2011; 68:1198-210. [DOI: 10.1111/j.1365-2648.2011.05909.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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8
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The effect of a restraint reduction program on physical restraint rates in rehabilitation settings in Hong Kong. Rehabil Res Pract 2011; 2011:284604. [PMID: 22110972 PMCID: PMC3195393 DOI: 10.1155/2011/284604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Revised: 07/04/2011] [Accepted: 07/05/2011] [Indexed: 11/18/2022] Open
Abstract
Background. In view of the adverse effects of using restraints, studies examining the use of restraint reduction programs (RRPs) are needed. Objectives. To investigate the effect of an RRP on the reduction of physical restraint rates in rehabilitation hospitals. Methods. A prospective quasi-experimental clinical trial was conducted. Demographic data, medical and health-related information on recruited patients from two rehabilitation hospitals, as well as facility data on restraint rates were collected. Results. The increase in the restraint rate in the control site was 4.3 times greater than that in the intervention site. Changes in the restraint mode, from continuous to intermittent, and the type of restraint used were found between the pre- and postintervention periods in both the control site and the intervention site. Discussion. Compared with that in the control site, the RRP in the intervention site helped arrest any increase in the restraint rate although it had no effect on physical restraint reduction. The shift of restraint mode from continuous to intermittent in the intervention site was one of the positive outcomes of the RRP.
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Lane C, Harrington A. The factors that influence nurses' use of physical restraint: A thematic literature review. Int J Nurs Pract 2011. [DOI: 10.1111/j.1440-172x.2011.01925.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Programme d'intervention visant à réduire l'utilisation des contentions physiques dans des unités de soins de longue durée — mise en oeuvre et effets sur le personnel soignant. Can J Aging 2010. [DOI: 10.1017/s0714980800002099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
ABSTRACTThis study aimed at (a) developing a restraint reduction program, (b) describing its implementation in long-term care units, and (c) examining its effects on care staff's perceptions of and knowledge about the use of restraints. The program was composed of three parts: consciousness-raising meetings, staff education, and clinical follow-up. The study was a randomized, controlled clinical trial with eight intervention care units (five nursing homes) and 11 controls (five additional nursing homes). Care staff was surveyed at two time intervals over a 7-month period (pre- and post-test intervention; intervention care units: N = 171 [T0] and N = 158 [T1]; controls: N = 181 [T0] and N = 166 [T1]). The implementation of the program was successful and results showed significant changes in care staff perceptions of and knowledge about the use of restraints.
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Gelkopf M, Roffe Z, Behrbalk P, Melamed Y, Werbloff N, Bleich A. Attitudes, opinions, behaviors, and emotions of the nursing staff toward patient restraint. Issues Ment Health Nurs 2009; 30:758-63. [PMID: 19916810 DOI: 10.3109/01612840903159777] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Physical restraints are used as a psychiatric intervention to protect psychiatric inpatients from self-harm or harm to others, by securing a safe environment for the patients and staff. We examined nurses' attitudes, environmental concerns, and emotional responses to physical restraint of psychiatric inpatients, using a questionnaire we constructed expressly for this study. Nurses reported that the main criteria for restraint were endangerment of the patient's self or surroundings. Bothersome actions and environmental conditions also significantly impacted nurses' decisions to physically restrain patients. Emotional reactions to restraining procedures as experienced by staff and as perceived for patients were generally negative. Nurses should be trained to deal with violent patients, establish limits, and recognize the therapeutic aspect of restraints in order to respond assertively.
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Affiliation(s)
- Marc Gelkopf
- Lev Hasharon Mental Health Center, P.O. Box 90000, Netanya 42100, Israel.
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12
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Hantikainen V. Nursing staff perceptions of the behaviour of older nursing home residents and decision making on restraint use: a qualitative and interpretative study. J Clin Nurs 2008. [DOI: 10.1111/j.1365-2702.2001.00468.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Chuang YH, Huang HT. Nurses' feelings and thoughts about using physical restraints on hospitalized older patients. J Clin Nurs 2007; 16:486-94. [PMID: 17335524 DOI: 10.1111/j.1365-2702.2006.01563.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To explore nurses' feelings and thoughts about physically restraining older hospitalized patients. BACKGROUND The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses' knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses' perceptions about the use of physical restraints, or on elderly patients' experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses' feelings and thoughts about the use of physical restraints in Taiwan. DESIGN AND METHODS A qualitative approach was used to understand this phenomenon. Semi-structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data. RESULTS Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings. CONCLUSIONS Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients' autonomy and the practice of care. However, other nurses said they had 'no feelings' or 'feeling of security' while using physical restraints. RELEVANCE TO CLINICAL PRACTICE The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in-service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical restraints.
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MESH Headings
- Adaptation, Psychological
- Adult
- Aged
- Attitude of Health Personnel
- Conflict, Psychological
- Education, Nursing, Continuing
- Emotions
- Female
- Geriatric Nursing/education
- Geriatric Nursing/ethics
- Geriatric Nursing/methods
- Grief
- Guilt
- Health Knowledge, Attitudes, Practice
- Health Services Needs and Demand
- Humans
- Inservice Training
- Negativism
- Nursing Methodology Research
- Nursing Staff, Hospital/education
- Nursing Staff, Hospital/ethics
- Nursing Staff, Hospital/organization & administration
- Nursing Staff, Hospital/psychology
- Patient Advocacy
- Qualitative Research
- Restraint, Physical/adverse effects
- Restraint, Physical/ethics
- Restraint, Physical/statistics & numerical data
- Surveys and Questionnaires
- Taiwan
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Affiliation(s)
- Yeu-Hui Chuang
- Lecturer, Department of Nursing, Chung Hwa College of Medical Technology, Tainan, Taiwan.
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Abstract
Traditional approaches to bioethics, that privilege impartiality and objectivity and that focus primarily on moral reasoning, are relatively silent on the moral habitability of healthcare environments. Nurses and others in "the trenches" of healthcare are increasingly voicing the need to address everyday ethical issues, interdisciplinary tensions, and systemic concerns, in addition to the ethics of high-profile medical cases. Attention to the institutional processes that shape and constrain ethical dialogue and practice is required. In this article, the call is made for a shift in thinking about ethics in healthcare.
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Affiliation(s)
- Wendy Austin
- Faculty of Nursing and the Dossetor Health Ethics Centre, University of Alberta, Edmonton, Canada.
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15
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Abstract
This descriptive study investigated the patterns of use of physical restraints in a Korean Intensive Care Unit (ICU) with the aim of identifying the factors that would best discriminate the times of application and removal of restraints in the same patients. The subjects of the study were 23 physically restrained patients out of 51 patients who were admitted to a medical ICU in a university hospital admitted during a 6-week period, and the 29 nurses who applied or removed the restraints. Ninety-four incidents of restraint application and removal on the 23 patients were analysed. Data were collected using a self-reporting questionnaire of attitudes towards restraint application for nurses, restraint document sheets, ICU flowsheets and patient chart reviews. Restraint-related patient data were collected on a restraint document sheet by the nurse in charge at each instance of application and removal of restraint. The most common type of restraint was the bilateral wrist restraint. The mean number of restraint applications per patient was 3.62 +/- 3.56 (mean +/- SD), and the mean restrained period per incident was 22.64 +/- 58 hours. There were no significant differences in the frequency of restraint use during the day, evening and night shifts. The most significant discriminators for restraint application and removal were the restless-behaviour score and the presence of a nasogastric tube - the classification accuracy by these two factors was 70.2%. More than 90% of the decisions to apply restraints were made by nurses. Nurses reported that preventing the patient from removing medical devices (48.6%) was the primary reason for application, and improvement of cognitive status (29.3%) was the primary reason for removal of restraint. In conclusion, as the most discriminating factor of application or removal of restraints was the patient's restless behaviour, providing nurses with tools for the accurate evaluation of patient restlessness will shorten restraint application periods in ICUs.
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Affiliation(s)
- Eunha Choi
- Seoul National University Hospital, Seoul, Korea
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16
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Bower FL, McCullough CS, Timmons ME. A synthesis of what we know about the use of physical restraints and seclusion with patients in psychiatric and acute care settings: 2003 update. Worldviews Evid Based Nurs 2003; 10:1. [PMID: 12800050 DOI: 10.1111/j.1524-475x.2003.00001.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This article is an update of the January 19, 2000, Volume 7, Number 2 article of the synthesis of research findings on the use of restraint and seclusion with patients in psychiatric and acute care settings. CONCLUSIONS The little that is known about restraint/seclusion use with these populations is inconsistent. Attitudes and perceptions of patients, family, and staff differ. However, all patients had very negative feelings about both, whether they were restrained/secluded or observed by others who were not restrained. The reasons for restraint/seclusion use vary with no accurate use rate for either. What precipitates the use of restraint/seclusion also varies, but professionals claim they are necessary to prevent/treat violent or unruly behavior. Some believe seclusion/restraint is effective, but there is no empirical evidence to support this belief. Many less restrictive alternatives have been tested with varying outcomes. Several educational programs to help staff learn about different ways to handle violent/confused patients have been successful. IMPLICATIONS Until more is known about restraint/seclusion use from prospective controlled research, the goal to use least restrictive methods must be pursued. More staff educational programs must be offered and the evaluation of alternatives to restraint/seclusion pursued. When seclusion/restraint is necessary, it should be used less arbitrarily, less frequently, and with less trauma. As the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Health Care Financing Administration (HCFA) have prescribed, "Seclusion and restraint must be a last resort, emergency response to a crisis situation that presents imminent risk of harm to the patient, staff, or others" (p. 25) [99A].
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Affiliation(s)
- Fay L Bower
- Department of Nursing at Holy Names College.
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Abstract
Rehabilitation nurses who work with geriatric patients are concerned about reliance on physical restraints, as are all nurses. Controversy exists as to the benefits and risks, as well as the ethical and legal consequences, of their use. Nurses are ambivalent about using restraints, believing that they affect patients' freedom, self-respect, and self-reliance; they also often believe that there are no appropriate alternatives. This pilot study explored the use of music as a potential alternative to using physical restraints with hospitalized patients. The research question was: Will patients have more positive behaviors, as measured by the Restraint Music Response Instrument (RMRI), while out of restraints and listening to preferred music compared with the patients not listening to music who are out of restraints while being observed? Forty medical-surgical patients participated in the study and were randomized into either the experimental group (music) or the control group (no music). The mean age of the 21 males and 19 females was 76.6 years (range 56-94). A t test for equality of means was used to determine if there were differences in the number of positive and negative behaviors in the preintervention, intervention, and postintervention phases between the two groups. There was a significant difference (p < .01) in behaviors during the intervention phase. Patients who listened to preferred music had more positive behaviors while out of restraints than patients who were out of restraints but not exposed to music.
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Affiliation(s)
- Linda M Janelli
- Department of Nursing, Nazareth College of Rochester, 4245 East Avenue, Rochester, NY 14618, USA
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Abstract
Since the Omnibus Budget Reconciliation Act (OBRA) of 1987, there has been a significant reduction in the use of physical restraints to prevent falls in older adults who are institutionalized because of the developing awareness of the physical and psychological problems associated with them. The purpose of this ex post facto descriptive study was to determine if there is a difference in falls when physical restraints are allowed or prohibited in one older adult population. Data from incident reports from a purposive sample of 97 older adults in one long-term care facility were analyzed before and after the implementation of a restraint-free policy. The results indicated no significant difference in the number of falls before and after the policy change. However, there was a significantly lower number of falls with injuries and a significantly higher number of falls without injuries. These findings suggest older adults will continue to fall with or without the use of physical restraints because of changes associated with the aging process and risk factors. Removing physical barriers from older adults and allowing freedom of movement may decrease the severity of injury sustained in a fall.
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Affiliation(s)
- K S Dunn
- Oakland University, School of Nursing, Rochester, MI 48309-4401, USA
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Werner P, Mendelsson G. Nursing staff members' intentions to use physical restraints with older people: testing the theory of reasoned action. J Adv Nurs 2001; 35:784-91. [PMID: 11529981 DOI: 10.1046/j.1365-2648.2001.01911.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM OF THE STUDY To examine nursing staff members' attitudes, subjective norms, moral obligations and intentions to use physical restraints, using the Theory of Reasoned Action (TRA). RATIONALE During the last two decades an extensive body of research has examined nurses' attitudes as one of the main factors affecting the decision to use or not to use physical restraints with older persons. However, no studies have examined empirically the antecedents to nurses' intentions to use physical restraints within a theoretically based framework. METHOD A correlational design was used with 303 nursing staff members from an 800-bed elder care hospital in central Israel. Participants completed a questionnaire including questions based on the TRA as well as socio-demographic and professional characteristics. RESULTS Regression analyses found attitudes, subjective norms and moral considerations to be significantly associated to intention to use physical restraints with older people. The TRA explained 48% of the variance in nurses' intentions. CONCLUSIONS The TRA proved to be a useful framework for examining nurses' intentions to use physical restraints. Nurses' attitudes, beliefs and expectations of significant others should be examined before implementing educational programmes regarding the use of physical restraints.
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Affiliation(s)
- P Werner
- Department of Gerontology, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.
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Terpstra TL, Terpstra TL, Pettee EJ, Hunter M. Nursing Staff's Attitudes Toward Seclusion & Restraint. J Psychosoc Nurs Ment Health Serv 2001; 39:20-8. [PMID: 11360868 DOI: 10.3928/0279-3695-20010501-10] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Staff preferred to treat patients as they themselves wanted to be treated. 2. More than one third of respondents did not view seclusion and restraint use as a time for a therapeutic intervention. 3. If staff are practicing from their belief patterns, they will choose interventions to avoid use of seclusion and restraint. 4. The majority of respondents preferred using medication to treat out-of-control behavior because they considered it less restrictive.
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Affiliation(s)
- T L Terpstra
- Battle Creek VA Medical Center, 5500 Armstrong Road, Battle Creek, MI 49015-1099, USA
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21
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Myers H, Nikoletti S, Hill A. Nurses' use of restraints and their attitudes toward restraint use and the elderly in an acute care setting. Nurs Health Sci 2001; 3:29-34. [PMID: 11882175 DOI: 10.1046/j.1442-2018.2001.00068.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A descriptive correlation study was conducted in an acute-care hospital to explore the relationship between nurses' use of restraints and their attitudes toward restraint use and the elderly. A total of 201 nurses returned a questionnaire that collected demographic information and included two research instruments: (i) Perceptions of Restraint Use Questionnaire and (ii) Attitudes toward the Aged Semantic Differential. Results showed slightly positive attitudes towards the elderly and toward the use of restraints, although there was no correlation between scores on the two scales. Furthermore, nurses' attitudes did not predict their self-reported use of restraints.
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Affiliation(s)
- H Myers
- Nursing Practice Research Network, Sir Charles Gairdner Hospital University Department of Nursing Research and Development, Perth, Western Australia.
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Hantikainen V. Nursing staff perceptions of the behaviour of older nursing home residents and decision making on restraint use: a qualitative and interpretative study. J Clin Nurs 2001; 10:246-56. [PMID: 11820346 DOI: 10.1046/j.1365-2702.2001.00468.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined staff perceptions of the behaviour of older nursing home residents and how these perceptions govern their decision making on restraint use. Data were collected in unstructured interviews with 20 trained and untrained nursing staff from two Swiss nursing homes. Data analysis was based on Colaizzi's phenomenological method. Two main themes were extracted from the data: (i) situations in which behaviour is perceived in terms of a problem that needs to be controlled and consequently leads to restraint use; and (ii) situations in which behaviour is perceived in terms of something one has to learn to live with and consequently leads to avoidance of restraint. Staff members' choices to perceive resident's behaviour from the angle they did were clearly associated with the rights and responsibilities of both nursing staff and older people. It is concluded that the primary source of change towards the avoidance of restraint use does not necessarily lie in external factors, but in staff members themselves.
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Affiliation(s)
- V Hantikainen
- University of Turku, Department of Nursing, Finland.
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23
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24
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Hantikainen V, Käppeli S. Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision-making. J Adv Nurs 2000; 32:1196-205. [PMID: 11115005 DOI: 10.1046/j.1365-2648.2000.01590.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The study reported in this paper applied a qualitative and interpretative approach to nursing staff perceptions of the use of restraint with elderly nursing home residents, and into nurses' decision-making on restraint use. The data were collected using unstructured interviews with a purposive sample of 20 trained and untrained nursing staff from two Swiss nursing homes. Data analysis was based on Colaizzi's phenomenological method. Three main themes were extracted from the data: (1) understanding the term restraint, (2) situations in which the decision to apply restraint is considered justified and (3) situations in which nursing staff are uncertain about the use of restraint. The underlying bases with respect to decision-making were: understanding restraint, the rights and responsibilities of both residents and staff, and the duties of staff. Staff members were ambiguous in their understanding of restraint and they showed positive as well as confused attitudes towards its use. Their behaviour was defensive and protective rather than challenging. Further research is required on what is meant by safety in care of the elderly nursing today. In nursing practice, as far as issues of restraint are concerned, greater attention should be devoted to the relationship between elderly residents' self-determination and responsibility for their actions.
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Affiliation(s)
- V Hantikainen
- Department of Nursing Science, University of Turku, Finland.
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25
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Karlsson S, Bucht G, Rasmussen BH, Sandman. Restraint use in elder care: decision making among registered nurses. J Clin Nurs 2000. [DOI: 10.1046/j.1365-2702.2000.00442.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bower FL, McCullough CS, Timmons ME. A Synthesis of What We Know About the Use of Physical Restraints and Seclusion with Patients in Psychiatric and Acute Care Settings. Worldviews Evid Based Nurs 2000. [DOI: 10.1111/j.1524-475x.2000.00022.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Abstract
1. When making decisions about the use of physical restraints, minimizing the physical risk of patients was determined to be the most important obligation. 2. Nurses' understanding and consideration of important factors that influence restraint use are essential to its reduction. 3. Nurses should be aware of their ethical responsibilities to older patients and their families. They must ensure the patient's right to be informed and respect their dignity.
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Affiliation(s)
- W T Chien
- Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
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28
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Abstract
The use of physical restraint has been a controversial intervention in the nursing management of hospitalized elderly patients in many countries. This ethnographic study was conducted in one psychogeriatric ward in Hong Kong in order to explore what determines psychiatric nurses' decisions to use restraints on their elderly patients. By comparing the findings of three data sources, comprising semistructured interviews, observations, and clinical records, five main themes were identified with regard to the nurses decision of restraint use. They included the rationale of physical restraint, consideration of alternative measures, consideration of adverse consequences, ethical considerations, and policy and documentation of restraint use. The findings of this study demonstrate that nurses must question the established practice myths about restraint use being the best way to maintain patient safety. Most importantly, nurses need cognitive and ethical preparation to face different situations in which physical restraint may be used.
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Affiliation(s)
- W T Chien
- Department of Nursing, Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
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29
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Abstract
The purpose of this pilot study is to validate the use of the Perceptions of Restraint Use Questionnaire (PRUQ) in assessing chemical restraint perceptions among nurses working in long-term care. The convenience sample includes 60 licensed nurses working in six long-term care facilities in Illinois. The reliability analysis for a modified version of the PRUQ, based on the research sample chosen, was found to have a Cronbach's coefficient alpha of .9450. Study findings reflect a moderately positive attitude toward chemical restraint use by nurses in long-term care.
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Affiliation(s)
- J A Thurmond
- School of Nursing, Northern Illinois University, DeKalb, USA
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30
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Abstract
Clinical judgment of psychiatric nurses was investigated using judgment analysis within the framework of social judgment theory. Nine nurses at a short-term psychiatric care facility made recommendations concerning restraint and seclusion for 80 patients described on paper in terms of 17 characteristics (cues). Nurses generally favored close observation of patients over seclusion and restraint, and information about current behavior and functioning had more impact on nurses' judgments than did patient history. Nurses had good insight into the nature of their own judgments. However, individual differences in cue utilization and inconsistency in strategy usage led to disagreement among nurses about specific recommendations for particular patients. No one patient received identical recommendations from all nurses, and nurses agreed with each other on specific recommendations only about a third of the time. The lack of agreement has implications for development of staff training programs and further research on the clinical judgment processes of nurses.
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Affiliation(s)
- R J Holzworth
- University of Connecticut, Department of Psychology, Storrs 06269-1020, USA
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31
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Fradkin M, Kidron D, Hendel T. Israeli student nurses' attitudes about physical restraints in acute care settings. Geriatr Nurs 1999; 20:101-5. [PMID: 10382427 DOI: 10.1053/gn.1999.v20.97018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A total of 147 nursing students from an academic school of nursing in Israel, affiliated with the Nursing Department at Tel Aviv University, were studied to determine their attitudes toward the use of physical restraints, their knowledge of patient restraint protocol, related reasons, alternatives, follow-up, and reporting. Data were analyzed according to the student's year of learning and experience in restraining. Significant results showed that most students displayed negative attitudes toward restraining. Most were quite knowledgeable of patient restraint protocol, but they acted according to accepted practice in the hospital wards. These findings suggest that nursing educators must play an important role in reinforcing knowledge and improving the practicum of nursing students in the clinical area concerning restraints. This goal will be achieved by various educational strategies.
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Affiliation(s)
- M Fradkin
- Dina Academic School of Nursing, Rabin Medical Center, Petach Tikva, Israel
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32
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Lee DT, Chan MC, Tam EP, Yeung WS. Use of physical restraints on elderly patients: an exploratory study of the perceptions of nurses in Hong Kong. J Adv Nurs 1999; 29:153-9. [PMID: 10064294 DOI: 10.1046/j.1365-2648.1999.00880.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A qualitative study was designed to explore nurses' perceptions of the use of physical restraints on elderly patients in Hong Kong. Content analysis of semi-structured interviews with 20 registered nurses working in medical and geriatric settings of two regional hospitals revealed that although nurses generally had mixed feelings about the use of physical restraints on elderly patients, they did not question this 'routine' practice and their knowledge about the consequences and alternatives to the use of restraint was limited. It was found that nurses had an overriding concern in ensuring elderly patients' physical safety and using restraints therefore provided them with a sense of security. The deleterious impact of restraint on the care received by elderly patients was largely unrecognized. Implications for practice and future studies are discussed in the light of these findings.
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Affiliation(s)
- D T Lee
- Department of Nursing, The Chinese University of Hong Kong, Shatin, NT
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33
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Abstract
To illuminate nurses' experience of using coercion against psychiatric patients, a phenomenological hermeneutic study was conducted with seven registered nurses and seven enrolled mental nurses. The findings revealed that these nurses desired to be seen by themselves, their co-workers and patients as doing good, being good and providing good care but they experienced the use of coercion as not good. This conflict made it difficult for these nurses to question the use of coercion and consider alternative solutions. The theory of change by Watzlawick et al. (1974) served as a theoretical framework for the interpretation of all interviews regarded as one text. In order to explore alternatives to the use of coercion in psychiatric care, nurses need assistance to step outside the traditional way of regarding coercion in psychiatric care and seek to create new solutions.
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Affiliation(s)
- B Olofsson
- Department of Nursing, Umeå University, Sweden
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34
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35
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36
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Sullivan-Marx EM, Strumpf NE. Restraint-free care for acutely ill patients in the hospital. AACN CLINICAL ISSUES 1996; 7:572-8. [PMID: 8970258 DOI: 10.1097/00044067-199611000-00012] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A growing body of empirical evidence documenting the negative effects and the limited effectiveness of physical restraints continues to shape policy and professional standards. In addition to occurrences of serious harm from restraint devices, ethical concerns about care with dignity have supported reevaluation of restraints in all settings for all patients. Lessons from considerable research conducted in nursing homes and clinical experience with restraint reduction in long-term care facilities are applicable to acute care settings, where restraint-free care can and should be embraced.
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37
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Mion LC. Establishing alternatives to physical restraints in the acute care setting: a conceptual framework to assist nurses' decision making. AACN CLINICAL ISSUES 1996; 7:592-602. [PMID: 8970261 DOI: 10.1097/00044067-199611000-00015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Critical care and acute care nurses must determine ways to deliver optimal patient care without the use of physical restraints. This article explores the application of the clinical decision analysis model to the challenge of finding nonrestraint approaches to care. Clinical decision analysis is a structured, quantified approach for choosing an optimal course of action in a situation that involves tradeoffs among risks and preferences and when outcomes are uncertain. Decision analysis provides a graphic representation of the decision situation that facilitates evaluation of factors relevant to the situation and evaluation of the potential events and outcomes following a chosen strategy. The decision analysis model can be useful for determining guidelines for clinical practices, facilitating discussions among health care providers and patients, and determining areas in need of additional research.
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38
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Karlsson S, Bucht G, Eriksson S, Sandman PO. Physical restraints in geriatric care in Sweden: prevalence and patient characteristics. J Am Geriatr Soc 1996; 44:1348-54. [PMID: 8909351 DOI: 10.1111/j.1532-5415.1996.tb01406.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Physical restraints are used frequently in geriatric care to promote the safety of frail older patients. This study investigated the prevalence of the use of physical restraints in geriatric care and the way in which patient characteristics are related to the use of physical restraints. DESIGN A point prevalence study of patients cared for in various types of geriatric settings. SETTING Eight nursing homes, 15 old people's homes, a somatic geriatric clinic, and a psychogeriatric clinic in a health care district in northern Sweden. PARTICIPANTS A total of 1325 patients, mean age 82 years, 64% of whom were women. MEASUREMENTS The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to measure motor function, vision, hearing, speech, ADLs, behavioral symptoms, psychiatric symptoms, use of psychoactive drugs, and the physical and psychological workload of the staff. In addition, questions concerning the use of physical restraints were added to the instrument. RESULTS Twenty-four percent of the patients were physically restrained. The highest prevalence was found in nursing homes and psychogeriatric care. Physical restraints were found to relate most strongly to cognitive impairment, impaired ADLs, and speech and walking ability. Ninety-four percent of the restrained patients were cognitively impaired. Other variables relating to the use of physical restraints were psychiatric symptoms and behavioral disturbances. CONCLUSIONS This study has shown that physical restraints are used frequently in geriatric care in Sweden and that cognitive and physical impairments relate very closely to the use of physical restraints.
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Affiliation(s)
- S Karlsson
- Department of Geriatric Medicine, Umeá University, Sweden
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39
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Abstract
Regulatory changes concerning the use of physical restraints in nursing homes have stimulated an examination of restraint use practices in other care settings. Caregivers are receiving mixed messages about appropriate restraint use in the hospital. Legal decisions are ambiguous in terms of the nurse's liability for restraint decisions, and the use of restraints may create a conflict between respecting patient autonomy and acting in the patient's best interest. Recent research does not support the belief that restraint use prevents patient injuries, but continues to document the untoward effects of restraints. Restraint reduction efforts have been successful in nursing homes, and many strategies can be adapted in acute care. As the movement to integrated systems of care places increased emphasis on continuity of services across settings and improved client outcomes, restraint practice is one area where interinstitutional collaboration and coordination must occur. The advanced practice nurse is in a key role to facilitate continuity of restraint reduction efforts.
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Affiliation(s)
- C A Quinn
- Scripps Gerontology Center, Miami University of Chio, USA
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40
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Abstract
Decisions by nurses to avoid physical restraint use in older adults is a complex process that requires individualized, comprehensive assessment and creative problem-solving. Institutional and social policy increasingly support a standard of restraint elimination influencing care decisions with frail older adults. It has become clear that the decision to avoid or use physical restraint is influenced as well by nurses' attitude or beliefs about the efficacy of restraint. To further understand how decisions are made to avoid physical restraint, it is important to also explore the degree to which nurses possess knowledge, autonomy, and accountability in this decision-making process. Understanding how decisions are influenced will advance the development of restraint-free care interventions for older adults.
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41
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Abstract
A phenomenological approach was used to examine nursing staff's experiences using physical restraints. A total of 12 nurses from a tertiary hospital participated in one of three focus groups. Exploring the attitudes of nurses can contribute to a better understanding of how decisions are made concerning restraints. An analysis of the focus group data resulted in a description of the lived experiences of nurses using restraints. Seven themes emerged from the data, one of which reflected that the nurses felt ambiguous about restraints, yet they made judgments and justified their decisions after assessing patient characteristics, environmental safety, and unit traditions. Nurse clinicians could use the focus group method to sensitize themselves to the staff's needs and to allow staff the opportunity to share ideas and to dispel misconceptions about restraints.
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42
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Abstract
1. Staff nurses continue to use physical restraints in well-intended efforts to protect patients from potential harm despite the overwhelming evidence of negative consequences from this practice. The use of physical restraints remains an unresolved clinical practice issue. 2. This stratified, random sample demonstrated that LPNs consistently attached greater importance to the use of restraints than either RNs or Managers, suggesting that the educational level of nurses may have an impact on the continued use of physical restraints. 3. The survey further demonstrates that nurses are aware of many alternatives to restraint use. The authors suggest that alternatives may not be widely used because the measures are often not considered practical.
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