Educational intervention on physical restraint use in long-term care facilities - Systematic review and meta-analysis

"Physical restraint" formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities.

DESIGN

A systematic review with meta-analysis and meta-regression. Eight databases, including Cochrane Library, ProQuest, PubMed, EMBASE, EBSCO, Web of Science, Ovid Medline and Physiotherapy Evidence Database (PEDro), were searched up to January 2017. Eligible studies were classified by intervention and accessed for quality using the Quality Assessment Tool for quantitative studies. Sixteen research articles were eligible in the final review; 10 randomize control trail studies were included in the analysis. The meta-analysis revealed that the use of physical restraint was significantly less often in the experimental (education) group (OR = 0.55, 95% CI: 0.39 to 0.78, p < 0.001) compared to the control group. Meta-regression revealed the period of post education would have decreased the effect of the restraint educational program (β: 0.08, p = 0.002); instead, the longer education period and more times of education would have a stronger effect of reducing the use of physical restraint (β: -0.07, p < 0.001; β: -0.04, p = 0.056). The educational program had an effect on the reduced use of physical restraint. The results of meta-regression suggest that long-term care facilities should provide a continuous education program of physical restraint for caregivers.

Measuring Empathetic Care

Purpose:

This study describes the development of a self-report survey measure of empathetic care. Empathetic care is defined as caregiving that supports clients’ socioemotional capabilities and addresses their emotional needs. It is distinct from instrumental care, which involves assisting with physical needs such as activities of daily living.

Design and Method:

Based on a literature review, structured interviews, and focus groups, we identify three dimensions of empathetic care: extra-role behavior, emotional support, and relational richness. We then developed a large pool of items that could tap into these dimensions and administered versions of the survey to nearly 300 health care paraprofessionals.

Results:

After performing exploratory factor analyses on a larger survey of 138 paraprofessionals, a 10-item, three-factor measure, the Empathetic Care Scale (ECS), was developed that predicts decisions on consequential allocation scenarios. A second sample of 125 paraprofessionals provided data for a confirmatory factor analysis; results suggested that the ECS has desirable psychometric properties and evidence of convergent and discriminant validity. Further samples demonstrated acceptable levels of test-retest reliability and no social desirability bias.

Implications:

This study provides a short self-report measure that can be used to gauge care workers’ individual levels of empathetic care. Future research can use this measure to explore relationships between ECS responses and previously proposed but untested outcomes such as patient well-being and employee burnout or turnover rates.

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

This 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.

A Longitudinal Evaluation of Restraint Reduction within a Multi-site, Multi-model Canadian Continuing Care Organization

Bien que la documentation américaine sur la réduction de l'usage des moyens de contention soit relativement importante, les travaux de recherche publiés sur cette même question sont moins nombreux sur les pensionnaires d'un établissement canadien de soins de longue durée. Les statistiques des plus importants établissements de ce type financés et exploités au Canada ont mis au jour des attitudes révélatrices envers les moyens mécaniques de contention. Durant les quatre années d'une étude comportant une campagne visant à réduire l'utilisation de moyens mécaniques de contention, la prévalence organisationnelle est passée de 24,68 % à 16,01 %. Il existait une variabilité substantielle en matière de contention parmi les 11 centres de l'organisation (échelle de 0 à 39,86 % des pensionnaires faisant l'objet de contention) et tous sauf un ont pu réduire la contention mécanique. Des facilitateurs particuliers à la réalisation et au maintien de la réduction de la contention sont indiqués, notamment les établissements de petite taille, la fourniture de soins spécialisés (par ex., maladie d'Alzheimer), et un «champion» résidant sur place. Des obstacles particuliers, comme la grande taille d'un établissement et un champion résidant à l'extérieur font aussi l'objet de discussion.