1
|
Jacobsen FF, Mekki TE, Førland O, Folkestad B, Kirkevold Ø, Skår R, Tveit EM, Øye C. A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes. BMC Nurs 2017; 16:55. [PMID: 28936121 PMCID: PMC5604397 DOI: 10.1186/s12912-017-0244-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 09/01/2017] [Indexed: 11/15/2022] Open
Abstract
Background People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study. Methods We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention. Results Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness. Conclusions Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships. Trial registration The trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506. Electronic supplementary material The online version of this article (10.1186/s12912-017-0244-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Frode F Jacobsen
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway.,VID Specialized University, Bergen, Norway
| | - Tone Elin Mekki
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway
| | - Oddvar Førland
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway.,VID Specialized University, Bergen, Norway
| | - Bjarte Folkestad
- Center for Care Research, Western Norway, Bergen, Norway.,Uni Research Rokkan Centre, Bergen, Norway
| | - Øyvind Kirkevold
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ageing and Health, Oslo, Norway
| | - Randi Skår
- Western Norway University of Applied Sciences, Bergen, Norway
| | - Eva Marie Tveit
- Center for Care Research, Western Norway, Bergen, Norway.,Bergen Tourist Information, Bergen, Norway
| | - Christine Øye
- Center for Care Research, Western Norway, Bergen, Norway.,Western Norway University of Applied Sciences, P.O.Box 7030, N-5020 Bergen, Norway
| |
Collapse
|
2
|
Abstract
Introduction: To meet and take care of people with dementia implicate professional and moral challenges for caregivers. Using force happens daily. However, staff also encounter challenges with the management in the units. Managing the caretaking function is also significant in how caretakers experience working in dementia care. Purpose: The purpose of this study is to explore the caregiver’s experiences with ethical challenges in dementia care settings and the significance of professional leadership in this context. Method: The design is qualitative, and data appear through narrative interviews. A total of 23 caretakers participated in the study. The transcribed interviews were subjected to a phenomenological-hermeneutical interpretation. Ethical considerations: The respondents signed an informed consent for participation prior to the interviews. They were assured anonymity and confidentiality in the publication of the data. Ricoeur’s method for interpretation ensures anonymity as the researcher relates to the data as one collective text. The study is part of a larger research project in ethics, in its entirety approved in line with the Helsinki Convention. Results: The findings show that the caretakers experienced inadequacy. Some of them described a negative work atmosphere where they experienced that their leaders did not take them seriously. Because of this, informal negative sub-groups functioned as an exclusive debriefing arena. Some of the informants described the opposite experience where the leaders actively supported them. Discussion: The analyses of the findings are discussed in light of the concepts of trust and mistrust in leadership. Conclusion: There is a correlation between the leadership and the caregivers’ experience of being in difficult situations.
Collapse
|
3
|
Smebye KL, Kirkevold M, Engedal K. Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study. BMC Health Serv Res 2016; 16:21. [PMID: 26787190 PMCID: PMC4717656 DOI: 10.1186/s12913-015-1217-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home. METHODS This Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients' records were included in the study. An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework. RESULTS The analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer's and professional caregiver's need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer. CONCLUSIONS In order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.
Collapse
Affiliation(s)
| | - Marit Kirkevold
- Institute for Health and Society, Faculty of Medicine, University of Oslo, Blindern, P.B. 1130, 0318 Oslo, Norway
- Institute of Public Health, Aarhus University, Aarhus, Denmark
| | - Knut Engedal
- Norwegian Centre for Aging and Health, Vestfold Health Trust, 3130 Tønsberg, Norway
| |
Collapse
|
4
|
An interpretative phenomenological analysis (IPA) of coercion towards community dwelling older adults with dementia: findings from Mysore studies of natal effects on ageing and health (MYNAH). Soc Psychiatry Psychiatr Epidemiol 2016; 51:1659-1664. [PMID: 27689233 PMCID: PMC5131085 DOI: 10.1007/s00127-016-1286-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/10/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Limited availability of specialist services places a considerable burden on caregivers of Persons with Dementia (PwD) in Low- and Middle-Income Countries (LMICs). There are limited qualitative data on coercive behavior towards PwD in an LMIC setting. AIM The aim of this study was to find relevant themes of the lived experience of relatives as caregivers for PwD in view of their use of coercive measures in community setting in South India. METHOD Primary caregivers (n = 13) of PwDs from the Mysore study of Natal effects on Ageing and Health (MYNAH) in South India were interviewed to explore the nature and impact of coercion towards community dwelling older adults with dementia. The narrative data were coded using an Interpretative Phenomenological Analysis (IPA) approach for thematic analysis and theory formation. RESULTS Caregivers reported feeling physical and emotional burn-out, a lack of respite care, an absence of shared caregiving arrangements, limited knowledge of dementia, and a complete lack of community support services. They reported restrictions on their lives through not being able take employment, a poor social life, reduced income and job opportunities, and restricted movement that impacted on their physical and emotional well-being. Inappropriate use of sedatives, seclusion and environmental restraint, and restricted dietary intake, access to finances and participation in social events, was commonly reported methods of coercion used by caregivers towards PwD. Reasons given by caregivers for employing these coercive measures included safeguarding of the PwD and for the management of behavioral problems and physical health. CONCLUSION There is an urgent need for training health and social care professionals to better understand the use of coercive measures and their impact on persons with dementia in India. It is feasible to conduct qualitative research using IPA in South India.
Collapse
|
5
|
Brodtkorb K, Skisland AVS, Slettebø Å, Skaar R. Ethical challenges in care for older patients who resist help. Nurs Ethics 2014; 22:631-41. [DOI: 10.1177/0969733014542672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Situations where patients resist necessary help can be professionally and ethically challenging for health professionals, and the risk of paternalism, abuse and coercion are present. Research question: The purpose of this study was to examine ethical challenges in situations where the patient resists healthcare. Research design: The method used was clinical application research. Academic staff and clinical co-researchers collaborated in a hermeneutical process to shed light on situations and create a basis for new action. Participants and research context: Four research groups were established. Each group consisted of six to eight clinical co-researchers, all employees with different health profession backgrounds and from different parts of the municipal healthcare services, and two scientific researchers. Ethical considerations: The study was conducted in compliance with ethical guidelines and principles. Participants were informed that participation was voluntary and that confidentiality would be maintained. They signed a consent form. Findings: The findings showed that the situations where patients opposed help related to personal hygiene, detention in an institution and medication associated with dental treatment. The situations were perceived as demanding and emotionally stressful for the clinicians. Discussion: The situations can be described as everyday ethics and are more characterised by moral uncertainty and moral distress than by being classic ethical dilemmas. Conclusion: Norwegian legislation governing the use of force seems to provide decision guidance with the potential to reduce uncertainty and moral stress if the clinicians’ legal competence had been greater.
Collapse
|
6
|
Huang HC, Huang YT, Lin KC, Kuo YF. Risk factors associated with physical restraints in residential aged care facilities: a community-based epidemiological survey in Taiwan. J Adv Nurs 2013; 70:130-43. [PMID: 23734585 DOI: 10.1111/jan.12176] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2013] [Indexed: 11/30/2022]
Abstract
AIM To identify the rate and risk factors of physical restraint in residential aged care facilities in Taiwan. BACKGROUND In Taiwan, physical restraint is commonly used in aged care facilities to prevent accidents. Many are unaware of the associated risks. Restrained residents cannot move freely, increasing the risk of atrophy and leading to reduced physical functioning. DESIGN A community-based epidemiological survey. METHODS Data were collected from June-December 2007 across 178 residential aged care facilities with 5,173 residential beds in the target city of Taiwan. Twenty facilities were sampled using probability proportional to size by beds and accreditation ranking. In all, 256 primary caregivers (78 nurses and 178 care aides) and 847 residents completed the study questionnaires and tests. A multilevel analysis approach was used to identify individual- and facility-level risk factors for physical restraint and assess the variation in physical restraint at the individual- and facility-level. RESULTS Of 847 residents, 62% (527) were restrained during the study period. The main reasons for restraint use were fall prevention and prevention of tube removal. Resident level risk factors for physical restraint included lower Barthel Index scores (more dependent) and an agreement allowing the use of physical restraint to avoid injury signed by a family member or social worker. A facility-level risk factor for physical restraint was younger primary caregivers. CONCLUSION To reduce the incidence of physical restraint in residential aged care facilities in Taiwan, educational programmes should target primary caregivers and families in facilities.
Collapse
Affiliation(s)
- Hui Chi Huang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Yu Tai Huang
- Information Science and Applications Alumni Association, Asia University, Taichung, Taiwan
| | - Kuan Chia Lin
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taiwan
| | - Yong Fang Kuo
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| |
Collapse
|
7
|
Gjerberg E, Hem MH, Førde R, Pedersen R. How to avoid and prevent coercion in nursing homes. Nurs Ethics 2013; 20:632-44. [DOI: 10.1177/0969733012473012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In many Western countries, studies have demonstrated extensive use of coercion in nursing homes, especially towards patients suffering from dementia. This article examines what kinds of strategies or alternative interventions nursing staff in Norway used when patients resist care and treatment and what conditions the staff considered as necessary to succeed in avoiding the use of coercion. The data are based on interdisciplinary focus group interviews with nursing home staff. The study revealed that the nursing home staff usually spent a lot of time trying a wide range of approaches to avoid the use of coercion. The most common strategies were deflecting and persuasive strategies, limiting choices by conscious use of language, different kinds of flexibility and one-to-one care. According to the staff, their opportunities to use alternative strategies effectively are greatly affected by the nursing home’s resources, by the organization of care and by the staff’s competence.
Collapse
|
8
|
De Bellis A, Mosel K, Curren D, Prendergast J, Harrington A, Muir-Cochrane E. Education on physical restraint reduction in dementia care: a review of the literature. DEMENTIA 2011; 12:93-110. [PMID: 24336665 DOI: 10.1177/1471301211421858] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dementia is a priority area for all countries as populations age and dementia prevalence increases. The use of physical restraint is a possible clinical practice for persons with dementia across settings when behaviours indicate a perceived need. Indeed, this may be the first choice in practice, occurring in part because of lack of education, safety concerns, perceived costs and staffing issues. This article reviews the literature on the issues surrounding, and use of, physical restraint for people with dementia, highlighting the rationales for use and the benefits and barriers to physical restraint. Recommendations include the importance of education and policy to reduce or eliminate physical restraint of persons with dementia to overcome identified barriers at the individual, cultural and organizational levels. An educational programme from the literature review is proposed specific to the reduction or elimination of physical restraint.
Collapse
|
9
|
Jakobsen R, Sørlie V. Dignity of older people in a nursing home: narratives of care providers. Nurs Ethics 2010; 17:289-300. [PMID: 20444771 DOI: 10.1177/0969733009355375] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to illuminate the ethically difficult situations experienced by care providers working in a nursing home. Individual interviews using a narrative approach were conducted. A phenomenological-hermeneutic method developed for researching life experience was applied in the analysis. The findings showed that care providers experience ethical challenges in their everyday work. The informants in this study found the balance between the ideal, autonomy and dignity to be a daily problem. They defined the culture they work in as not supportive. They also thought they were not being seen and heard in situations where they disagree with the basic values of the organization. The results are discussed in terms of Habermas's understanding of modern society. Care settings for elderly people obviously present ethical challenges, particularly in the case of those suffering from dementia. The care provider participants in this study expressed frustration and feelings of powerlessness. It is possible to understand their experiences in terms of Habermas's theory of modern society and the concept of the system's colonization of the life world.
Collapse
Affiliation(s)
- Rita Jakobsen
- Lovisenberg Deaconal University College, Oslo, Norway.
| | | |
Collapse
|
10
|
Saarnio R, Isola A. Nursing staff perceptions of the use of physical restraint in institutional care of older people in Finland. J Clin Nurs 2010; 19:3197-207. [PMID: 20726929 DOI: 10.1111/j.1365-2702.2010.03232.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS AND OBJECTIVES To describe the perceptions of nursing staff on the use of physical restraints in institutional care of older people. BACKGROUND Physical restraint of older people is a common practice in institutional care in many countries, including Finland. As the nursing staff plays a major role in deciding on physically restraining older patient and in the care the patient receives, new research information is needed on the nursing staff's attitudes towards the use of physical restraints. DESIGN A qualitative study. METHOD The data consisted of focus group interviews with staff and supervisors. There were four focus groups: nurses, practical nurses, institutional assistants and care supervisors. RESULTS In addition to traditional methods of restraint, such as belts and locked doors, the nursing staff also used indirect restraint by removing the patient's mobility aid. Factors contributing to the use of restraints included requests by the patient's family members to use restraint to ensure the patient's safety and social reasons, in the form of lack of legislation on the use of restraint. The use of restraints caused feelings of guilt among the nursing staff, but on the other hand, it was seen as a way of making older patient feel more secure. CONCLUSIONS There is a need for official guidelines on the use of physical restraints in care of older people. This would require the entire nursing team to make a joint decision on the use of restraints and constant reassessment of the need of using restraints. RELEVANCE TO CLINICAL PRACTICE The results of the study provide nursing staff and supervisors a chance to ethically deliberate and evaluate their own work. Alternative practices for physical restraint can also be directly applied to practical care of older people.
Collapse
Affiliation(s)
- Reetta Saarnio
- Faculty of Medicine, Institute of Health Sciences, University of Oulu, Oulu, Finland.
| | | |
Collapse
|
11
|
Saarnio R, Isola A. Use of physical restraint in institutional elderly care in Finland: perspectives of patients and their family members. Res Gerontol Nurs 2009; 2:276-86. [PMID: 20077984 DOI: 10.3928/19404921-20090706-02] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 04/09/2009] [Indexed: 11/20/2022]
Abstract
The purpose of this qualitative study was to describe the use of physical restraint and the perspectives of elderly patients and their family members on the use of physical restraint in long-term institutional care. Data were collected in three elderly care units through participant observation and theme interviews. The results revealed that in addition to traditional means of restraint, such as restraint belts and raising the sides of the bed, the nursing staff used indirect methods of restraint as well. These included a mode of operation that promoted passivity, such as removing the patient's mobility aid and keeping the patient inadequately clothed. The results also revealed that the patients felt so unsafe in the nursing environment that they voluntarily locked themselves in their rooms. Another interesting finding was that patients' family members were active in restraint situations. The study findings provide information that can be applied in the development of long-term institutional care.
Collapse
|
12
|
Malmedal W, Hammervold R, Saveman BI. To report or not report? Attitudes held by Norwegian nursing home staff on reporting inadequate care carried out by colleagues. Scand J Public Health 2009; 37:744-50. [DOI: 10.1177/1403494809340485] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: The aims of this study are, first, to describe attitudes held by nursing home staff on reporting acts of inadequate care committed by their colleagues, and second, to investigate whether nursing staff have different attitudes depending on age, education, and length of experience of working in the healthcare services. Methods: A questionnaire survey was conducted among nursing staff in 16 nursing homes in the central part of Norway. The response rate was 79% (n=616). Results: A positive attitude towards reporting acts of inadequate care committed by their colleagues was held by the participants in this study. Compared with younger staff, the older staff seemed to be more reluctant to report colleagues, to feel less brave, to be more afraid of what would happen to them if they reported, and to agree that it is best to deal with such matters internally. Regarding education, it seemed that a higher educational level was related with a more positive attitude towards a willingness to report and less fear of negative sanctions. Conclusions: Staff who observe acts of inadequate care committed by colleagues agree that it is their intention to report such incidents. Institutions need to develop and implement mechanisms for understanding and evaluating acts of inadequate care, and staff must be encouraged to speak out on behalf of residents rather than be punished for doing so.
Collapse
Affiliation(s)
- Wenche Malmedal
- Faculty of Health Education and Social Work, Sør-Trøndelag University College, Trondheim, Norway,
| | - Randi Hammervold
- Sør-Trøndelag University College, Trondheim Business School, Trondheim, Norway
| | | |
Collapse
|
13
|
Mechanical restraint – A philosophy of man, a philosophy of care, or no philosophy at all? ACTA ACUST UNITED AC 2009. [DOI: 10.1017/s1742646409001411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
14
|
Saarnio R, Isola A, Laukkala H. The use of physical restraint in institutional care of older people in Finland: nurses’ individual, communal and alternative modes of action. J Clin Nurs 2009; 18:132-40. [DOI: 10.1111/j.1365-2702.2008.02383.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Edwards N, Danseco E, Heslin K, Ploeg J, Santos J, Stansfield M, Davies B. Development and Testing of Tools to Assess Physical Restraint Use. Worldviews Evid Based Nurs 2006; 3:73-85. [PMID: 17040512 DOI: 10.1111/j.1741-6787.2006.00056.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND To implement best practice in restraint use, healthcare providers and decision makers require current, accurate, and easily accessible information about restraint practices in their setting. There is a need for a reliable and valid instrument that is feasible for use in these settings to rapidly assess physical restraint use. METHOD Two instruments to assess physical restraint use were developed and tested: an observation tool and a chart audit. The instruments were tested in complex continuing care units and rehabilitation units at two healthcare organizations. The restraint use observation tool was administered by trained observers in a series of five observations over a 2-week period. Chart audits were conducted for a sample of residents. Inter-rater agreement of the observation tool and chart audit was assessed. Point prevalence estimates were obtained for each site. The time required to use the observation tool and complete chart audits as well as the comparability of findings from the two data sources were described. FINDINGS Restraint use observations were completed for 289 patients and chart audits were completed for 207 patients. Prevalence and patterns of restraint use varied between sites and across time periods. Observations took an average of 2.6 (Site A) and 0.6 (Site B) minutes per patient. There was excellent inter-rater agreement for most items on the observation tool with the exception of whether or not the patient was able to release or loosen the restraint. There was significant concordance but as expected, not complete agreement between paired estimates of prevalence using the observational tool and the chart audit. CONCLUSION The observation and chart audit tools are feasible to use and reliably assess physical restraint use in healthcare organizations. The patient's physical capacity to move independently, the patient's waking status, and the restraint's restriction of mobility are items that should be added to the observation tool. The tools are complementary and should be used in tandem to capture the multifaceted complexity of restraint use in health service organizations.
Collapse
Affiliation(s)
- Nancy Edwards
- School of Nursing, Department of Epidemiology and Community Medicine, University of Ottawa, Ontario, Canada.
| | | | | | | | | | | | | |
Collapse
|