1
|
Liu M, Wang Y, Zeng Q, Li J, Yang L, Zeng Y. Prevalence of involuntary treatment among community-living older persons with dementia: A systematic review. Arch Gerontol Geriatr 2024; 127:105574. [PMID: 39059035 DOI: 10.1016/j.archger.2024.105574] [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: 02/07/2024] [Revised: 06/25/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to ascertain the prevalence of involuntary treatment among community-living older persons with dementia and explore associated factors. METHODS We comprehensively searched seven electronic databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, and Scopus) from their inception to October 17, 2023, with an update conducted on April 1, 2024. Meta-analysis synthesized prevalence estimates of involuntary treatment and its three subcategories, with 95% confidence intervals. RESULTS This study included 11 research papers involving 12,136 community-dwelling individuals with cognitive impairment and dementia from 19 countries. The pooled prevalence of involuntary treatment among community-dwelling older persons with dementia was 45.2% (95% CI: 33.7-60.5%). Subcategories included physical restraints (9.8%, 95% CI: 5.1-18.8%), psychotropic medication (19.1%, 95% CI: 13.6-26.9%), and non-consensual care (34.3%, 27.6-42.7%). Factors influencing involuntary treatment were categorized as caregiver-related and care recipient-related. CONCLUSION This study underscores the prevalent use of involuntary treatment among community-dwelling older persons with dementia, emphasizing its association with specific caregiver and care recipient factors. Addressing these findings underscores the importance of proactive measures and targeted interventions to improve the quality of care for this vulnerable population.
Collapse
Affiliation(s)
- Minyan Liu
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuqiang Wang
- Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Qinglin Zeng
- Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Jia Li
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Liping Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yanli Zeng
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
| |
Collapse
|
2
|
Werny R. Cared for masculinities in nursing homes - A material perspective on the intersectionality of institutional, spacial, gendered and corporal materiality. J Aging Stud 2024; 68:101206. [PMID: 38458725 DOI: 10.1016/j.jaging.2024.101206] [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: 12/08/2022] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 03/10/2024]
Abstract
This paper takes the co-construction of age and gender over the course of a life as a starting point and expands this perspective by looking at the intersectional interplay of institutional, spatial, and bodily materiality in the setting of a nursing home. Nursing homes are often perceived as a female space, both socially and physically. Moreover, they are institutional spaces that are primarily oriented towards the deficits of aging and bodies in need of care so that age and aging are reproduced in a narrative of decline, and gender hardly has space to be constructed. This interweaving of institutional spaces, bodies in need of care, and gender poses the question: How are age and gender produced through the space(s) of the nursing home and its materiality, and vice versa? On this basis, the influence on the construction of masculinities in the context of materialism is discussed. This paper draws on two case studies, Walter Probst (age 93) and Günther Schiffke (age 78), based on biographical interviews, to focus on the perspective of very old men in need of care and work out the interplay between the material nature of the institutional space and the body in need of care. It will be shown how closely the performance of age, gender, and masculinities is determined by spatial materiality in the nursing home and the increasing dependence of bodies in need of care, as well as how these bodies produce the spaces in turn. On the basis of the case studies, three aspects of materiality of care home spaces are highlighted. The first aspect of this materiality shows how the body can be increasingly perceived and treated as a material object. The second aspect is defined by the body situated in space, and its relationship to objects and aids. As a third aspect, the possibilities of interacting in communal and private spaces of the nursing home are explored. The article thus contributes to linking the (re-) construction of biographic narratives more strongly to spatial materiality and to embedding the construction and performance of age and gender in spatial and institutional structures, thus demonstrating that spaces and environments shape age, gender, and masculinities in a reciprocal way.
Collapse
Affiliation(s)
- Rafaela Werny
- Institute of Interdisciplinary Ageing Research, Goethe University Frankfurt, Germany.
| |
Collapse
|
3
|
Liu J, Luo Y, Chai X, Zeng S, Liu Y, Zhao L. Rasch analysis of Morse Fall Scale among the older adults with cognitive impairment in nursing homes. Geriatr Nurs 2024; 56:94-99. [PMID: 38340434 DOI: 10.1016/j.gerinurse.2024.02.004] [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: 11/26/2023] [Revised: 01/12/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024]
Abstract
This is a cross-sectional study to investigate the efficacy of Morse Fall Scale (MFS) in nursing homes for older adults with cognitive impairment. According to Rasch analysis, the person separation index was 0.95 (person reliability 0.48), and the item separation index was 9.23 (item reliability 0.99). Wright map showed all items can be considered appropriately directed to the older adults, but the items mainly located at both ends with the center missing. Each item was accepted with good infit and outfit statistics with positive PTMEA CORR. values from 0.49 to 0.68. Two items could be significant differential item functioning (DIF) between the two groups of different fall experience in the past year (item 1 and item 3). In conclusion, nursing assistant could adopt MFS to evaluate fall risk of older adults with cognitive impairment, but the risk grades are still not precise enough. In the future, MFS should be explored and refined further.
Collapse
Affiliation(s)
- Jin Liu
- Hunan Normal University, Hunan Guangxiu hospital, Changsha, 410000, China.
| | - Yuan Luo
- Capital Medical University, School of Nursing, Beijing, 100069, China; Central South University, Xiangya Nursing School, Changsha, 410013, China.
| | - Xiaoni Chai
- Sun Yet-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, 510120, China
| | - Siqian Zeng
- The First Hospital of Changsha, Changsha, 410000, China
| | - Yan Liu
- Shaoyang University, School of Medical Technology, Shaoyang, 422000, China
| | - Liping Zhao
- Central South University, Xiangya Nursing School, Changsha, 410013, China; Central South University, The Second Xiangya Hospital, Changsha, 410011, China
| |
Collapse
|
4
|
Guenna Holmgren A, von Vogelsang AC, Lindblad A, Juth N. Restraint in somatic healthcare: how should it be regulated? JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109240. [PMID: 37852743 DOI: 10.1136/jme-2023-109240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
Restraint is regularly used in somatic healthcare settings, and countries have chosen different paths to regulate restraint in somatic healthcare. One overarching problem when regulating restraint is to ensure that patients with reduced decision-making capacity receive the care they need and at the same time ensure that patients with a sufficient degree of decision-making capacity are not forced into care that they do not want. Here, arguments of justice, trust in the healthcare system, minimising harm and respecting autonomy are contrasted with different national regulations. We conclude that a regulation that incorporates an assessment of patients' decision-making capacity and considers the patient's best interests is preferable, in contrast to regulations based on psychiatric diagnoses or regulations where there are no legal possibilities to exercise restraint at all in somatic care.
Collapse
Affiliation(s)
- Amina Guenna Holmgren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Niklas Juth
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
5
|
Chong Y, Wang C, Min H, Zhang L, Zhi T, Wu X, Wang Y. Physical Restraint Experience of Patients with Mental Disorders in Mainland China: A Qualitative Study. J Multidiscip Healthc 2024; 17:431-444. [PMID: 38314012 PMCID: PMC10838508 DOI: 10.2147/jmdh.s438269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction The use of physical restraint (PR) is considered a controversial practice and research in Western countries has demonstrated negative physical and psychological consequences for patients, as well as staff, family members/carers, organisations and society as a whole. However, there are few research reports on restraint experiences of patients with mental disorders in non-Western countries, especially in mainland China. Aim This study aims to explore the subjective experiences and perceptions of patients with psychiatric disorders who have experienced PR in mainland China. Methods Semi-structured interviews were conducted with 8 inpatients with mental disorders in convalescence at a specialized mental health hospital in Shanghai. Interviews were recorded on audiotape and transcribed verbatim. Transcripts were analyzed using thematic analysis. Results Five themes emerged: "perception and understanding of PR", "response to PR", "negative physical and psychological experiences", "unmet care needs during PR" and "changes after PR", which together characterize patients' perceptions, experiences, feelings, and needs in PR. Conclusion The use of PR involves ethical issues and brings negative experiences to patients with mental disorders that cannot be ignored and should be used as a last resort. Different patients have different attitudes and reactions to PR. During PR, patients' physical and psychological needs are not adequately met. Medical staff should give more attention to patients in PR, meet their physical and psychological needs, and actively seek PR alternatives and reduction options based on evidence-based resources on restraint reduction available in the West and the national context and culture of China.
Collapse
Affiliation(s)
- Yue Chong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Can Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Haiying Min
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Lei Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Tingting Zhi
- Shanghai Baoshan Mental Health Center, Shanghai, 201900, People's Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| |
Collapse
|
6
|
Ha SM. [Nursing Students' Experiences of Observing the Use of Physical Restraints: A Qualitative Study]. J Korean Acad Nurs 2023; 53:610-621. [PMID: 38204345 DOI: 10.4040/jkan.23032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/03/2023] [Accepted: 11/10/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE The purpose of this study was to understand the experiences of final-year undergraduate nursing students in observing the use of physical restraints on patients in the course of clinical practice. METHODS Three focus group interviews were conducted with 12 Korean nursing students who could provide sufficient information about their observation of physical restraints. The collected data was analyzed through conventional content analysis. RESULTS The data were classified into four theme clusters, and nine themes. The four theme clusters included 'recognized as an unavoidable means,' 'experienced problems with the use of physical restraints,' 'realized the importance of the nurse's role and efforts,' and 'aspire to learn about correct use of physical restraints.' While nursing students recognized the necessities and problems of using physical restraints in clinical practice, and the importance of nurses' role and effort, the results found that education related to the use of physical restraints should be more systematic within the nursing curriculum. CONCLUSION This study highlights the necessity of educating nursing students to ensure they acquire accurate knowledge and awareness regarding the use of physical restraints, and suggests the inclusion of systematic guidelines through simulation or extracurricular activities.
Collapse
Affiliation(s)
- Sun Mi Ha
- Department of Nursing, Gimcheon University, Gimcheon, Korea.
| |
Collapse
|
7
|
Chong Y, Wang C, Zhi T, Fang S, Min H, Zhang L, Wu X, Wang Y. Psychiatric Nurses' Knowledge, Attitudes, and Practice Regarding Physical Restraint in China: A Multicentre Cross-Sectional Study. J Multidiscip Healthc 2023; 16:1475-1489. [PMID: 37274425 PMCID: PMC10237330 DOI: 10.2147/jmdh.s412485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
Background Physical restraint is widely used in mental health services to address safety concerns. However, studies have shown that improper physical restraint can result in adverse effects. Nurses are the main practitioners of physical restraint and play a crucial role in physical restraint decisions and nursing. In China, there is a lack of large-scale investigations into the current status of psychiatric physical restraint use. Aim This study aims to explore the situation and influencing factors of the psychiatric nurses' knowledge, attitudes and practices regarding physical restraint in China. Methods A cross-sectional multicenter descriptive study was conducted from December 2022 to February 2023, consecutively. A convenience sampling method was used to recruit 345 staff from three psychiatric hospitals in Shanghai. A psychiatric nurses' physical restraint use status questionnaire was administered to examine their knowledge, attitude, and practice regarding physical restraint. The data were analyzed using the Mann-Whitney U-test and the Kruskal-Wallis test. Multivariate linear stepwise regression analysis was used for multi-factor analysis. Results Overall, nurses had a good level of knowledge with positive attitudes and adequate practices. However, they had some misunderstandings and undesirable practices. Multiple linear regression analysis revealed that educational background, position and training experience were the main factors influencing physical restraint knowledge, attitudes and practice among psychiatric nurses (p<0.05). Conclusion This study highlights some important misconceptions and improper practices of psychiatric nurses about using physical restraint. It is necessary to strengthen education and training on physical restraint for nursing staff to reduce unnecessary physical restraint use.
Collapse
Affiliation(s)
- Yue Chong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Can Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Tingting Zhi
- Shanghai Psychological Consultation Center, Shanghai Baoshan Mental Health Center, Shanghai, 201900, People’s Republic of China
| | - Shihan Fang
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People’s Hospital, Hangzhou, 310005, People’s Republic of China
| | - Haiying Min
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Lei Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| |
Collapse
|
8
|
Wang J, Chen H, Wang H, Liu W, Peng D, Zhao Q, Xiao M. A Risk Prediction Model for Physical Restraints Among Older Chinese Adults in Long-term Care Facilities: Machine Learning Study. J Med Internet Res 2023; 25:e43815. [PMID: 37023416 PMCID: PMC10131772 DOI: 10.2196/43815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/07/2023] [Accepted: 03/12/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Numerous studies have identified risk factors for physical restraint (PR) use in older adults in long-term care facilities. Nevertheless, there is a lack of predictive tools to identify high-risk individuals. OBJECTIVE We aimed to develop machine learning (ML)-based models to predict the risk of PR in older adults. METHODS This study conducted a cross-sectional secondary data analysis based on 1026 older adults from 6 long-term care facilities in Chongqing, China, from July 2019 to November 2019. The primary outcome was the use of PR (yes or no), identified by 2 collectors' direct observation. A total of 15 candidate predictors (older adults' demographic and clinical factors) that could be commonly and easily collected from clinical practice were used to build 9 independent ML models: Gaussian Naïve Bayesian (GNB), k-nearest neighbor (KNN), decision tree (DT), logistic regression (LR), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and light gradient boosting machine (Lightgbm), as well as stacking ensemble ML. Performance was evaluated using accuracy, precision, recall, an F score, a comprehensive evaluation indicator (CEI) weighed by the above indicators, and the area under the receiver operating characteristic curve (AUC). A net benefit approach using the decision curve analysis (DCA) was performed to evaluate the clinical utility of the best model. Models were tested via 10-fold cross-validation. Feature importance was interpreted using Shapley Additive Explanations (SHAP). RESULTS A total of 1026 older adults (mean 83.5, SD 7.6 years; n=586, 57.1% male older adults) and 265 restrained older adults were included in the study. All ML models performed well, with an AUC above 0.905 and an F score above 0.900. The 2 best independent models are RF (AUC 0.938, 95% CI 0.914-0.947) and SVM (AUC 0.949, 95% CI 0.911-0.953). The DCA demonstrated that the RF model displayed better clinical utility than other models. The stacking model combined with SVM, RF, and MLP performed best with AUC (0.950) and CEI (0.943) values, as well as the DCA curve indicated the best clinical utility. The SHAP plots demonstrated that the significant contributors to model performance were related to cognitive impairment, care dependency, mobility decline, physical agitation, and an indwelling tube. CONCLUSIONS The RF and stacking models had high performance and clinical utility. ML prediction models for predicting the probability of PR in older adults could offer clinical screening and decision support, which could help medical staff in the early identification and PR management of older adults.
Collapse
Affiliation(s)
- Jun Wang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hongmei Chen
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Houwei Wang
- College of Mathematics and Physics, Chongqing University of Science and Technology, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daomei Peng
- Aged Care Unit, The First Social Welfare Home of Chongqing, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
9
|
Luo Y, Ran H, Deng Y, Li H, Zhang M, Zhao L. Paid caregivers' experiences of falls prevention and care in China's senior care facilities: A phenomenological study. Front Public Health 2023; 11:973827. [PMID: 36875422 PMCID: PMC9978790 DOI: 10.3389/fpubh.2023.973827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Background In China, as population aging accelerates, senior care facilities have gradually become a mainstream option. According to the World Health Organization (WHO), the annual rate of falls has increased from 30 to 50% in senior care facilities. A study found that older adults who live in senior care facilities are three times more likely to fall than those who live in the community. The quality of care is highly related to the occurrence of falls. Therefore, exploring paid caregivers' experiences is very important to prevent falls in senior care facilities. Objective The aim of this study was to explore paid caregivers' experiences of fall prevention and care in China's senior care facilities. Furthermore, we discussed the situation and provided suggestions. Design This is a phenomenological study using face-to-face, in-depth, semi-structured interviews. Setting The study was conducted at four senior care facilities in Changsha, Hunan, China. Participants Fourteen paid caregivers in four senior care facilities, including nursing assistants and senior nurses, participated in this study. Methods A purposive sample method was used to select 14 nursing assistants and senior nurses from four different senior care facilities in Changsha from March to April 2022. Every participant individually completed a face-to-face, in-depth, semi-structured interview. Based on the phenomenological research methodology, the thematic analysis method and the Colaizzi analysis method were used for data analysis and theme extraction. Results Based on interview data, a total of seven themes were distilled: (1) paid caregivers' professional requirements; (2) paid caregivers' attitude toward falls; (3) paid caregivers' fall training and education; (4) paid caregivers' knowledge about falls; (5) paid caregivers' fall risk assessment; (6) paid caregivers' fall prevention; and (7) paid caregivers' fall treatment. Conclusion In China's senior care facilities, paid caregivers to need to be responsible and pay appropriate attention to older adults. First, senior nurses and nursing assistants need to enhance communication and cooperation. Second, they must learn about deficiencies in fall risk assessment and try their best to improve their capability. Third, they must adopt appropriate education methods to improve fall prevention capability. Finally, the protection of privacy should be taken seriously.
Collapse
Affiliation(s)
- Yuan Luo
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Haiye Ran
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Yuqian Deng
- Xiang Ya Nursing School, Central South University, Changsha, Hunan, China
| | - Huan Li
- Xiang Ya Second Hospital of Central South University, Changsha, Hunan, China
| | - Mengxi Zhang
- Xiang Ya Second Hospital of Central South University, Changsha, Hunan, China
| | - Liping Zhao
- Xiang Ya Second Hospital of Central South University, Changsha, Hunan, China
| |
Collapse
|
10
|
Kuhnow J, Hoben M, Weeks LE, Barber B, Estabrooks CA. Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study. Can Geriatr J 2022; 25:328-335. [PMID: 36505912 PMCID: PMC9684024 DOI: 10.5770/cgj.25.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
Collapse
Affiliation(s)
- Jason Kuhnow
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Matthias Hoben
- School of Health Policy & Management, York University, Toronto, ON
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Halifax, NS
| | | | | |
Collapse
|
11
|
Mazzetti G, Sciolino L, Guglielmi D, Mongardi M, Nielsen K, Dawson J. Organizational citizenship behaviour as a protective factor against the occurrence of adverse nursing-sensitive outcomes: A multilevel investigation. J Nurs Manag 2022; 30:4294-4303. [PMID: 36190738 PMCID: PMC10092892 DOI: 10.1111/jonm.13827] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 12/30/2022]
Abstract
AIMS This study aimed to investigate the association between organizational citizenship behaviour enacted by nurses and the occurrence of adverse nursing-sensitive patient outcomes. BACKGROUND Managing psychosocial factors (i.e., aspects concerning the work environment) is key to ensure patient safety, to prevent exacerbation of case complexity and to cope with critical shortages in human and financial resources. METHODS Self-report measures of nurses' organizational citizenship behaviour were combined with objective data on the incidence of adverse nursing-sensitive outcomes (i.e., pressure ulcers and restraint use) collected through patients' medical records. Participants were 11,345 patients and 1346 nurses across 52 teams working in 14 Italian hospitals. Data were analysed using multilevel binary logistic regression models. RESULTS A negative relationship between nurses' organizational citizenship behaviour and restraint use was identified, with an odds ratio of 0.11. Thus, for a one-unit higher organizational citizenship behaviour score, the odds of using restraints shrink to about one eighth of the previous level. CONCLUSIONS Intervention strategies to foster the implementation of organizational citizenship behaviour among nurses may inhibit the occurrence of critical outcomes affecting patients' health and well-being (i.e., using restraint devices). IMPLICATIONS FOR NURSING MANAGEMENT In health care organizations, shaping a psychosocial environment encouraging organizational citizenship behaviour can mitigate the occurrence of adverse nursing-sensitive outcomes such as restraint use on patients.
Collapse
Affiliation(s)
- Greta Mazzetti
- Department of Education StudiesUniversity of BolognaBolognaItaly
| | - Lorenzo Sciolino
- Hospital Care Service, General Direction for People Care, Health and WelfareEmilia‐Romagna RegionBolognaItaly
| | - Dina Guglielmi
- Department of Education StudiesUniversity of BolognaBolognaItaly
| | - Maria Mongardi
- Infectious Diseases Division, Diagnostics and Public Health DepartmentUniversity of VeronaVeronaItaly
| | - Karina Nielsen
- Sheffield University Management SchoolThe University of SheffieldSheffieldUK
| | - Jeremy Dawson
- Sheffield University Management SchoolThe University of SheffieldSheffieldUK
- School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUK
| |
Collapse
|
12
|
Wang J, Liu W, Li X, Li L, Tong J, Zhao Q, Xiao M. Effects and implementation of a minimized physical restraint program for older adults in nursing homes: A pilot study. Front Public Health 2022; 10:959016. [PMID: 36148339 PMCID: PMC9486015 DOI: 10.3389/fpubh.2022.959016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose Physical restraint (PR) reduction interventions are currently exploring in developed regions with well-established welfare systems, whereas developing countries with fast population aging have not attracted enough attention. This China's pilot study evaluated the effects of a minimized PR program on restraint reduction and nursing assistants' knowledge, attitudes, intention, and practice toward PR and explored nursing assistants' experience of the program. Patients and methods This was a one-group, pretest, and posttest pilot trial with a nested qualitative descriptive study. A minimized PR program was obtained by summarizing the best evidence and was implemented in one Chinese nursing home with 102 older adults from December 18, 2020, to March 21, 2021. An educational program including three theoretical lectures and one operation training was first conducted for nursing assistants one-month period. The primary outcome was PR rate at 3 months. The secondary outcomes contained duration of restraints, types of restraints, the rate of correct PR use, the incidence of falls and/or fall-related injuries, and antipsychotics use at 3 months. Data on PR use and older adults' characteristics were collected through physical restraints observation forms and older adults' medical records. Nursing assistants' knowledge, attitude, intention, and practice toward PR were measured using the Staff Knowledge, Attitudes, and Practices Questionnaire regarding PR at 1 month. A semi-structured interview for two administrative staff and a focus group discussion with 13 nursing assistants were analyzed using content analysis to explore perspectives of intervention implementation at 3 months. Results There were a significant increase in knowledge, attitude, and practice and a decrease in intention of nursing assistants after 1-month educational intervention (P < 0.001). Furthermore, only the rate of correct PR increased and the duration of restraint in the daytime decreased significantly at 3 months (P < 0.05). There were no significant effects on PR rate and other secondary outcomes at follow-up. Qualitatively, nursing assistants demonstrated overtly supportive perspectives and that assistance from the program enhanced their knowledge and practice. They noted several challenges that impeded implementation. Conclusion The intervention has acknowledged some benefits and was valued by nursing assistants. Implementation barriers should be addressed before delivering in larger trials.
Collapse
Affiliation(s)
- Jun Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Luyong Li
- Chongqing Shanxing Nursing Home, Chongqing, China
| | - Jinyan Tong
- Chongqing Shanxing Nursing Home, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Qinghua Zhao
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Mingzhao Xiao
| |
Collapse
|
13
|
Favez L, Simon M, Bleijlevens MH, Serdaly C, Zúñiga F. Association of surveillance technology and staff opinions with physical restraint use in nursing homes: Cross‐sectional study. J Am Geriatr Soc 2022; 70:2298-2309. [PMID: 35435250 PMCID: PMC9544699 DOI: 10.1111/jgs.17798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lauriane Favez
- Nursing Science, Department Public Health, Faculty of Medicine University of Basel Basel Switzerland
| | - Michael Simon
- Nursing Science, Department Public Health, Faculty of Medicine University of Basel Basel Switzerland
| | - Michel H.C. Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute Maastricht University Maastricht The Netherlands
- Living Lab in Ageing and Long‐Term Care Maastricht University Maastricht The Netherlands
| | | | - Franziska Zúñiga
- Nursing Science, Department Public Health, Faculty of Medicine University of Basel Basel Switzerland
| |
Collapse
|
14
|
Palese A, Longhini J, Businarolo A, Piccin T, Pitacco G, Bicego L. Between Restrictive and Supportive Devices in the Context of Physical Restraints: Findings from a Large Mixed-Method Study Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312764. [PMID: 34886489 PMCID: PMC8657237 DOI: 10.3390/ijerph182312764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives'/patients' requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories 'Restrictive' and 'Supportive' devices aimed at 'Preventing risks' and at 'Promoting support', respectively, have emerged. Reasons triggering 'restrictive devices' involved patients' risks, the health professionals' and/or the relatives' concerns. In contrast, the 'supportive' ones were triggered by patients' problems/needs. 'Restrictive' and 'Supportive' devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with 'restrictive devices' (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings.
Collapse
Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
- Correspondence: ; Tel.: +39(0)-432-590926
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Angela Businarolo
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Tiziana Piccin
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Giuliana Pitacco
- Ethics Management for Clinical Practice Area, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy;
| | | |
Collapse
|
15
|
Thunborg C, Salzman-Erikson M, Olsson A. The Swedish translation of Perceptions of Restraint Use Questionnaire (PRUQ): A test-retest reliability study in two dementia nursing homes. BMC Geriatr 2021; 21:589. [PMID: 34686135 PMCID: PMC8539803 DOI: 10.1186/s12877-021-02486-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Perceptions of Restraint Use Questionnaire measures perception of restraint in a 17-item questionnaire. The aim of this study was to assess the test-retest reliability of the PRUQ as a measure of staff attitudes to restraint in elderly older persons care for people with dementia from two different nursing homes, and its ability to produce reliable results. METHODS Twenty-six staff members from two different nursing homes completed the 17-item PRUQ twice with 14-21 days between time points. As the questionnaire has already been translated in another study, the current study evaluated total item scores, mean, internal consistency, and intraclass correlation for reliability purposes. RESULTS The internal consistency Cronbach's Alpha were ˃ ≥0.726. The Intraclass correlation (ICC) between test and retest was moderate to good for the three subscales, with ICC (A,1) and ICC (C,1) values approximately equal and in the range 0.480-0.962. A Bland-Altman plot of the PRUQ total mean scores illustrates no systematic change in the mean. CONCLUSIONS The Swedish version of the PRUQ shows mainly good reliability. Therefore, we suggest that researchers continue to develop the PRUQ to be an even higher reliable questionnaire of health care professionals' perceptions of measure for restraint use in nursing homes for persons with dementia.
Collapse
Affiliation(s)
- Charlotta Thunborg
- Karolinska Institutet Department of Neurobiology, Care Sciences and Society, Clinical Geriatrics, Stockholm, Sweden. .,School of Health, Care and Social Welfare, Division of Physiotherapy, Mälardalen University, Västerås, Sweden. .,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.
| | - Martin Salzman-Erikson
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Annakarin Olsson
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
| |
Collapse
|
16
|
|
17
|
Guzman-Parra J, Aguilera-Serrano C, Huizing E, Bono Del Trigo A, Villagrán JM, García-Sánchez JA, Mayoral-Cleries F. A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards. J Psychiatr Ment Health Nurs 2021; 28:197-207. [PMID: 32667113 DOI: 10.1111/jpm.12669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A relevant number of restraint prevention programmes have been developed internationally. In Spain, there is no harmonized policy to prevent the use of restraint. More studies are necessary to establish which programmes and components are necessary to prevent restraint. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention. There was no significant decreasing trend in the number of mechanical restraint episodes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context. All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. ABSTRACT: Introduction Mechanical restraint (MR) is used in many countries, including Spain, where non-harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (-1.79%, p < .001), but not in the number of restraint episodes (-0.45%; p = .149). Discussion The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice Interventions at a regional level aimed at preventing MR are feasible in the Spanish context.
Collapse
Affiliation(s)
- Jose Guzman-Parra
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Carlos Aguilera-Serrano
- Community Mental Health Unit of Motril, South Health Management Area of Granada, Motril, Spain
| | | | | | - José María Villagrán
- Mental Health Hospitalization Unit, Jerez de la Frontera Hospital, Jerez de la Frontera, Spain
| | - Juan Antonio García-Sánchez
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
De La Cuesta-Benjumea C, Lidón-Cerezuela B, Abad-Corpa E, Meseguer-Liza C, Arredondo-González CP. Managing and keeping control: A qualitative synthesis of nursing and care staff strategies to prevent older people from falling. J Adv Nurs 2021; 77:3008-3019. [PMID: 33608944 DOI: 10.1111/jan.14794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/14/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
AIM To better understand formal care providers' role in fall prevention. DESIGN Qualitative synthesis as part of an integrative review. DATA SOURCES Fifteen electronic databases were consulted with the time limit being December 2017. Studies included were qualitative primary studies on formal care providers and fall prevention of people over 65 years of age in health care facilities. 17 studies were included. REVIEW METHODS Qualitative researchers carried out a critical appraisal and abstraction of the studies retained. Primary studies were imported into Nvivo 12 software; grounded theory procedures of constant comparison, microanalysis, coding, development of memos and diagrams were completed concurrently in a continuous growing process of data conceptualization. Analysis was iterative; it started with open coding and ended with the development of an integrative memo. FINDINGS Primary studies were synthesized with the emerging core category of "Managing and keeping control" and described by the emerging strategies of risk management, risk control and articulation work. These three categories account for the formal care providers' role in fall prevention in health care facilities. CONCLUSION Fall prevention is not given by a series of means and instruments; it is rather built in the interactions between formal care providers and the material and social world. The interactive character of prevention implies that outcomes cannot always be anticipated. IMPACT Although falls are one of the most researched clinical problems in nursing, the role played by nursing and care staff is dispersed and scantily documented. Formal care providers alternate risk management with risk control strategies to prevent older people from falling in health care facilities, they also resort to the articulation of the health care team as a complementary strategy. This review shows the dynamic character of fall prevention, which is something that has tended to go unnoticed in the literature and in policy.
Collapse
Affiliation(s)
| | | | - Eva Abad-Corpa
- University of Murcia-Murcia Health Service (IMIB-Arrixaca), Murcia, Spain.,Nursing and Healthcare Research Unit (Investén-isciii), Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Madrid, Spain
| | | | | |
Collapse
|
20
|
Ferrão SADS, Bleijlevens MHC, Nogueira PJ, Henriques MAP. A cross-sectional study on nurses' attitudes towards physical restraints use in nursing homes in Portugal. Nurs Open 2021; 8:1571-1577. [PMID: 33438841 PMCID: PMC8186690 DOI: 10.1002/nop2.769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/18/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
Aim To explore nurses' opinions regarding restraint measures and attitudes towards physical restraints use in nursing homes. Design Cross‐sectional study. Methods Nursing staff of 33 Portuguese nursing homes was asked to complete the Portuguese version of the Maastricht Attitude Questionnaire (MAQ), an instrument on attitudes regarding physical restraints (reasons, consequences and appropriateness of restraint use) and opinions about restraint measures (restrictiveness and discomfort). Descriptive statistics and bivariate analysis were performed. Results Data from 186 nurses were included in the analysis. Overall, nurses expressed neutral to moderately positive attitudes towards physical restraints usage. Nurses with longer professional experience reported a more positive attitude regarding the appropriateness of restraint use in their clinical practice. Wrist and ankle restraints were the measures that nurses reported feeling most uncomfortable using, and the most restrictive. Bilateral bedrails were globally assessed as a slightly restrictive measure and nurses reported not feeling uncomfortable using them.
Collapse
Affiliation(s)
- Sónia Alexandra da Silva Ferrão
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Paulo Jorge Nogueira
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratório de Biomatemática, Faculdade de Medicina, Instituto de Medicina Preventiva e Saúde Pública, Universidade de Lisboa, Lisbon, Portugal
| | - Maria Adriana Pereira Henriques
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
21
|
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.
Collapse
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
| |
Collapse
|
22
|
Heusinger von Waldegg G. Freiheitsentziehende Maßnahmen in der Geriatrie. GERIATRIE-REPORT 2020. [PMCID: PMC7659901 DOI: 10.1007/s42090-020-0631-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
23
|
Brugnolli A, Canzan F, Mortari L, Saiani L, Ambrosi E, Debiasi M. The Effectiveness of Educational Training or Multicomponent Programs to Prevent the Use of Physical Restraints in Nursing Home Settings: A Systematic Review and Meta-Analysis of Experimental Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186738. [PMID: 32947851 PMCID: PMC7558973 DOI: 10.3390/ijerph17186738] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 01/07/2023]
Abstract
This review assesses the effectiveness of interventions to reduce physical restraint (PR) use in older people living in nursing homes or residential care facilities. A systematic search of studies published in four electronic databases (MEDLINE, CINHAL, PsycINFO, Cochrane Central Register of Controlled Trials). The review included individual and cluster randomized controlled trials that compared educational training and multicomponent programs to avoid PR use. Risk bias of randomized controlled trials (RCTs) was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. This review includes 16 studies in a qualitative synthesis that met the inclusion criteria, nine of them offered a multicomponent program and seven offered only educational training. The results of the 12 studies included in the meta-analysis showed a significant trend in favor of intervention over time and intensity of PR use tends to decrease. The review indicates that educational programs and other supplementary interventions should be effective, but the heterogeneous operative definition of physical restraints can make difficult data generalization.
Collapse
Affiliation(s)
- Anna Brugnolli
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Luigina Mortari
- Department of Human Sciences, University of Verona, 37134 Verona, Italy;
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Martina Debiasi
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
- Correspondence:
| |
Collapse
|
24
|
Wang J, Liu W, Peng D, Xiao M, Zhao Q. The use of physical restraints in Chinese long-term care facilities and its risk factors: An observational and cross-sectional study. J Adv Nurs 2020; 76:2597-2609. [PMID: 33463735 DOI: 10.1111/jan.14486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/28/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022]
Abstract
AIM To investigate the use of physical restraints among Chinese long-term care facilities older adults and to identify its risk factors. DESIGN Observational and cross-sectional study. METHODS A total of 1,026 older adults from six long-term care facilities in Chongqing were recruited by cluster sampling method from July - November 2019. Data on physical restraint use and older adults' characteristics were collected using physical restraints observation forms and older adults' records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi-square test and binary logistic regression. RESULTS The study found that the prevalence of physical restraints in six long-term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. CONCLUSION The use of physical restraints among Chinese long-term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. IMPACT This study will provide an effective reference for nursing staff in long-term care facilities to assess high-risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.
Collapse
Affiliation(s)
- Jun Wang
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daomei Peng
- The First Social Welfare Home of Chongqing, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
25
|
Shen X, Hu B, Pang X, Lin J, Yin X, Jiang Y, Zhao Y, Liu Q, Zhu X. Nurses' behaviours towards physical restraint use in the ICU: A descriptive qualitative study. Int J Nurs Pract 2020; 27:e12868. [PMID: 32608564 DOI: 10.1111/ijn.12868] [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: 09/28/2019] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022]
Abstract
AIMS AND OBJECTIVES The study aims to explore and describe nurses' behaviours towards physical restraint (PR) use in intensive care units (ICUs) and identify key characteristics of these experiences. BACKGROUND Patients within the ICU are always vulnerable, which requires a thoughtful deliberation when employing PR in ethically laden situations. Considering that the qualitative study on nurses' behaviours towards PR use in ICUs is limited, a deep understanding of how nurses reason and restrict patients is necessary before developing a minimizing programme in hospitals. METHODS A descriptive qualitative study was conducted in this paper. Data were collected by 24 semistructured, in-depth and individual interviews about PR, where 24 nurses were drawn from six ICUs of four hospital settings from a comprehensive tertiary care hospital in Qingdao. The QSR NVivo 11.0 software program was used to manage the interview data, and data analysis was guided by the Qualitative Analysis Guide of Leuven. The checklist of Consolidated Criteria for Reporting Qualitative Studies was followed as a guideline in reporting the study. RESULTS Regarding PR, nurses' behaviours start with a hazard perception, followed by hesitation about whether to restrict the patient. They would usually decide to apply PR when they think that no other choice to control the situation is available. Then, they would reflect on and rationalize their behaviours. Nurses, intensivists, patients and their families participate in and affect this process directly or indirectly. CONCLUSIONS Nurses' behaviours towards PR use comprise a series of complex processes centred on safety. Nurses' decision making should be performed with the participation of intensivists, patients and family caregivers.
Collapse
Affiliation(s)
- Xiufang Shen
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Bo Hu
- Department of Thoracic surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xufeng Pang
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Lin
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaomeng Yin
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Yuanyuan Jiang
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Yaling Zhao
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Qingwei Liu
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Xiuli Zhu
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| |
Collapse
|
26
|
de Bruijn W, Daams JG, van Hunnik FJG, Arends AJ, Boelens AM, Bosnak EM, Meerveld J, Roelands B, van Munster BC, Verwey B, Figee M, de Rooij SE, Mocking RJT. Physical and Pharmacological Restraints in Hospital Care: Protocol for a Systematic Review. Front Psychiatry 2020; 10:921. [PMID: 32184738 PMCID: PMC7058582 DOI: 10.3389/fpsyt.2019.00921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Physical and pharmacological restraints, defined as all measures limiting a person in his or her freedom, are extensively used to handle unsafe or problematic behavior in hospital care. There are increasing concerns as to the extent with which these restraints are being used in hospitals, and whether their benefits outweigh their potential harm. There is currently no comprehensive literature overview on the beneficial and/or adverse effects of the use of physical and pharmacological restraints in the hospital setting. METHODS A systematic review of the existing literature will be performed on the beneficial and/or adverse effects of physical and pharmacological restraints in the hospital setting. Relevant databases will be systematically searched. A dedicated search strategy was composed. A visualization of similarities (VOS) analysis was used to further specify the search. Observational studies, and if available, randomized controlled trials reporting on beneficial and/or adverse effects of physical and/or pharmacological restraints in the general hospital setting will be included. Data from included articles will be extracted and analyzed. If the data is suitable for quantitative analysis, meta-analysis will be applied. DISCUSSION This review will provide data on the beneficial and/or adverse effects of the use of physical and pharmacological restraints in hospital care. With this review we aim to guide health professionals by providing a critique of the available evidence regarding their choice to either apply or withhold from using restraints. A limitation of the current review will be that we will not specifically address ethical aspects of restraint use. Nevertheless, the outcomes of our systematic review can be used in the composition of a multidisciplinary guideline. Furthermore, our systematic review might determine knowledge gaps in the evidence, and recommendations on how to target these gaps with future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42019116186.
Collapse
Affiliation(s)
- Wendy de Bruijn
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joost G. Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - A. M. Boelens
- Department of Geriatrics, UMCG, Groningen, Netherlands
| | - Ellen M. Bosnak
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Barbara C. van Munster
- Department of Internal Medicine/Geriatrics, Gelre Hospitals and UMCG, Groningen, Netherlands
| | - Bas Verwey
- Department of Hospital Psychiatry, NVvP, Utrecht, Netherlands
| | - Martijn Figee
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, United States
| | | | - Roel J. T. Mocking
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
27
|
Physical restraining of nursing home residents in the last week of life: An epidemiological study in six European countries. Int J Nurs Stud 2019; 104:103511. [PMID: 32004777 DOI: 10.1016/j.ijnurstu.2019.103511] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND End-of-life care in nursing homes holds several risk factors for the use of physical restraints on residents, a practice shown to be neither safe nor effective. OBJECTIVES To determine the frequency of physical limb and/or trunk restraint use in the last week of life of nursing home residents in six European countries and its association with country, resident and nursing home characteristics. DESIGN Epidemiological survey study. SETTING Proportionally stratified random sample of nursing homes in Belgium (BE), England (ENG), Finland (FI), Italy (IT), the Netherlands (NL), and Poland (PL). PARTICIPANTS Nursing home staff (nurses or care assistants). METHODS In all participating nursing homes, we identified all residents who died during the three months prior to measurements. The staff member most involved in each resident's care indicated in a structured questionnaire whether trunk and/or limb restraints were used on that resident during the last week of life 'daily', 'less frequently than daily' or 'not used'. RESULTS In 322 nursing homes, staff returned questionnaires regarding 1384 deceased residents (response rate 81%). Limb and/or trunk restraints were used "daily" in the last week of life in 8% (BE), 1% (ENG), 4% (FI), 12% (IT), 0% (NL), and 0.4% (PL) of residents; and "less frequently than daily" in 4% (BE), 0% (ENG), 0.4% (FI), 6% (IT), 0% (NL), and 3.5% (PL) of residents. Restraint use was associated with country (p = 0.020) and inversely associated with residents' age (p = 0.017; odds ratio 0.96, 95% confidence interval 0.93 to 0.99). Restraint use was not significantly associated with resident's gender, dementia, functional status, staffing level, or the level of dependency of residents within the nursing home. CONCLUSIONS In all but one of the six countries studied, staff reported that nursing home residents were restrained through limb and/or trunk restraints in the last week of life. The proportion of restrained residents was highest in Italy and Belgium. Organizational and resident characteristics may not be relevant predictors of restraint use at the end of life in this setting. National policy that explicitly discourages physical restraints in nursing home care and suggests alternative practices may be an important component of strategies to prevent their use.
Collapse
|
28
|
Eastwood K, Bugeja L, Zail J, Cartwright A, Hopkins A, Ibrahim JE. Deaths of young people living in residential aged care: a national population-based descriptive epidemiological analysis of cases notified to Australian coroners. Disabil Rehabil 2019; 43:2213-2218. [PMID: 31774709 DOI: 10.1080/09638288.2019.1696417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM This study provides a descriptive epidemiological analysis stratified by age of deaths reported to Australian Coroners of residential aged care facility residents aged under 65 years. METHOD A national population-based retrospective analysis was conducted of deaths of Australian residential aged care facility residents reported to Australian Coroners between 2000 and 2013. Descriptive statistics compared adult residents categorised using age by factors relating to the individual, incident and death investigation. RESULTS Of the 21,736 deaths of residential aged care facilities residents aged over 20 years reported to Australian Coroners, 782 (3.6%) were of residents aged 20-64 years. Natural cause deaths occurred at similar rates irrespective of age. Intentional external cause deaths were higher in residents aged 20-64 years (5.3% vs. 16.0%; OR 3.43, 95% CI 2.0-5.9; p < 0.001), with suicide rates three times that of the over 65 years group (13.2% vs. 4.1%; OR 0.28, 95% CI 0.16-0.51; p < 0.001). External cause deaths from choking and falls were most common in the younger and older groups respectively. CONCLUSIONS More is required to prevent external cause deaths in young residential care facility residents.IMPLICATIONS FOR REHABILITATIONOne in seven (14.1%) deaths of people aged 20-64 years in residential aged care facilities are premature and potentially avoidable. The more common external causes of death include suicide, choking and falls.The prevalence and causes of preventable deaths in this study provide a basis for prompting and developing more specific prevention policies and practices to reduce harm for young people in residential aged care. Specifically, addressing loneliness would improve social inclusion, mental health and suicide risk. Better management of progressive neurological conditions with multidisciplinary team and re-ablement programs would reduce risk of choking and falls.Improving outcomes for young people in residential aged care requires a co-ordinated, multisector approach comprising relevant government departments, aged care providers, researchers and clinicians.Effective planning requires more information about the cause and nature of deaths, and due to the small event counts, this would ideally involve an international collaboration.
Collapse
Affiliation(s)
- Kathryn Eastwood
- Victorian Institute of Forensic Medicine, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lyndal Bugeja
- Department of Forensic Medicine, Monash University, Melbourne, Australia.,Monash Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Joshua Zail
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Anna Cartwright
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Alexandra Hopkins
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
29
|
Abraham J, Kupfer R, Behncke A, Berger-Höger B, Icks A, Haastert B, Meyer G, Köpke S, Möhler R. Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A pragmatic cluster randomized controlled trial. Int J Nurs Stud 2019; 96:27-34. [PMID: 31014546 DOI: 10.1016/j.ijnurstu.2019.03.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/20/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite clear evidence for the lack of effectiveness and safety, physical restraints are frequently applied in nursing homes. Multicomponent interventions addressing nurses' attitudes and organizational culture have been effective in reducing physical restraints. OBJECTIVE To evaluate the effectiveness of two versions of a guideline and theory-based multicomponent intervention to reduce physical restraints in nursing homes. DESIGN Pragmatic cluster randomized controlled trial. SETTING The study was conducted in 120 nursing homes in four regions in Germany. PARTICIPANTS All residents living in the participating nursing home during follow-up, newly admitted residents were also included. A total of 12,245 residents included in the primary analysis (4126 and 3547 residents in intervention group 1 and 2 and 4572 residents in the control group). METHODS Intervention group 1 received an updated version of a successfully tested guideline-based multicomponent intervention (comprising brief education for the nursing staff, intensive training of nominated key nurses in each cluster, introduction of a least-restraint policy and supportive material), intervention group 2 received a concise version of the original program and the control group received optimized usual care (i.e. supportive materials only). Primary outcome was physical restraint prevalence at twelve months, assessed through direct observation by blinded investigators. Intervention and control groups were compared using baseline-adjusted linear regression on cluster level, Bonferroni-adjusted for double testing. Secondary outcomes included falls, fall-related fractures, and quality of life. We also described intervention costs and performed a comprehensive process analysis. RESULTS At baseline, mean physical restraint prevalence was 17.4% and 19.6% in intervention groups 1 and 2, and 18.8% in the control group. After twelve months, mean prevalence was 14.6%, 15.7%, and 17.6%. Baseline-adjusted differences between mean prevalences were 2.0% (97.5% CI, -5.8 to 1.9) lower in intervention group 1 and 2.5% (97.5% CI, -6.4 to 1.4) lower in intervention group 2 compared to controls. Physical restraint prevalence showed a pronounced variation between the different clusters in all study groups. We found no significant differences in the secondary outcomes. According to the process evaluation, the intervention was mainly implemented as planned, but the expected change towards a least restraint culture of care was not achieved in all clusters. CONCLUSIONS Neither intervention showed a clear advantage compared to control. The pronounced center variation in physical restraint prevalence indicates that other approaches like governmental policies are needed to sustainably change physical restraint practice and reduce center variations in nursing homes. TRIAL REGISTRATION ClinicalTrials.gov : NCT02341898.
Collapse
Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Ramona Kupfer
- Health Sciences, MIN Faculty, University of Hamburg, Martin-Luther-King-Platz 6, 20146 Hamburg, Germany.
| | - Anja Behncke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Birte Berger-Höger
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Andrea Icks
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
| | | | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | - Ralph Möhler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany; School of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Str. 12, 58453 Witten, Germany.
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Bellenger EN, Ibrahim JE, Kennedy B, Bugeja L. Prevention of physical restraint use among nursing home residents in Australia: The top three recommendations from experts and stakeholders. Int J Older People Nurs 2019; 14:e12218. [DOI: 10.1111/opn.12218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/08/2018] [Accepted: 11/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Emma N. Bellenger
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
| | - Joseph E. Ibrahim
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
| | - Briohny Kennedy
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
| | - Lyndal Bugeja
- Health Law and Ageing Research Unit Department of Forensic Medicine, Victorian Institute of Forensic Medicine; Monash University; Southbank Vic. Australia
| |
Collapse
|
32
|
Berry SD, Rothbaum RR, Kiel DP, Lee Y, Mitchell SL. Association of Clinical Outcomes With Surgical Repair of Hip Fracture vs Nonsurgical Management in Nursing Home Residents With Advanced Dementia. JAMA Intern Med 2018; 178:774-780. [PMID: 29801122 PMCID: PMC5997966 DOI: 10.1001/jamainternmed.2018.0743] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE The decision whether to surgically repair a hip fracture in nursing home (NH) residents with advanced dementia can be challenging. OBJECTIVE To compare outcomes, including survival, among NH residents with advanced dementia and hip fracture according to whether they underwent surgical hip fracture repair. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective cohort study of 3083 NH residents with advanced dementia and hip fracture, but not enrolled in hospice care, using nationwide Medicare claims data linked with Minimum Data Set (MDS) assessments from January 1, 2008, through December 31, 2013. METHODS Residents with advanced dementia were identified using the MDS. Medicare claims were used to identify hip fracture and to determine whether the fracture was managed surgically. Survival between surgical and nonsurgical residents was compared using multivariable Cox proportional hazards with inverse probability of treatment weighting (IPTW). All analyses took place between November 2015 and January 2018. Among 6-month survivors, documented pain, antipsychotic drug use, physical restraint use, pressure ulcers, and ambulatory status were compared between surgical and nonsurgical groups. RESULTS Among 3083 residents with advanced dementia and hip fracture (mean age, 84.2 years; 79.2% female [n = 2441], 28.5% ambulatory [n = 879]), 2615 (84.8%) underwent surgical repair. By 6-month follow-up, 31.5% (n = 824) and 53.8% (n = 252) of surgically and nonsurgically managed residents died, respectively. After IPTW modeling, surgically managed residents were less likely to die than residents without surgery (adjusted hazard ratio [aHR], 0.88; 95% CI, 0.79-0.98). Among 2007 residents who survived 6 months, residents with surgical vs nonsurgical management had less docmented pain (29.0% [n = 465] vs 30.9% [n = 59]) and fewer pressure ulcers (11.2% [n = 200] vs 19.0% [n = 41]). In IPTW models, surgically managed residents reported less pain (aHR, 0.78; 95% CI, 0.61-0.99) and pressure ulcers (aHR, 0.64; 95% CI, 0.47-0.86). There was no difference between antipsychotic drug use and physical restraint use between the groups. Few survivors remained ambulatory (10.7% [n = 55] of surgically managed vs 4.8% [n = 1] without surgery). CONCLUSIONS AND RELEVANCE Surgical repair of a hip fracture was associated with lower mortality among NH residents with advanced dementia and should be considered together with the residents' goals of care in management decisions. Pain and other adverse outcomes were common regardless of surgical management, suggesting the need for broad improvements in the quality of care provided to NH residents with advanced dementia and hip fracture.
Collapse
Affiliation(s)
- Sarah D Berry
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts
| | - Randi R Rothbaum
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Division of Geriatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts
| | - Yoojin Lee
- Department of Health Services, Policy, and Practice & Center for Gerontology, Brown University School of Public Health, Providence, Rhode Island
| | - Susan L Mitchell
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.,Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts
| |
Collapse
|