Physical restraint initiation in nursing homes and subsequent resident health.
ABSTRACT It is widely believed that physical restraint use causes mental and physical health decline in nursing home residents. Yet few studies exist showing an association between restraint initiation and health decline. In this research, we examined whether physical restraint initiation is associated with subsequent lower physical or mental health.
We used all nursing homes (N = 740) in Pennsylvania in 2001, with 12,820 residents. We used the Minimum Data Set data; Online Survey, Certification and Reporting data; and the Area Resource File as data sources. We restricted our sample to newly admitted nursing home residents who were not restrained in the first two quarters of their residency. We examined which facility and individual characteristics during those first two quarters were associated with restraint initiation during the third quarter. We then examined the association of third-quarter restraint initiation with fourth-quarter health outcomes, using regressions that controlled for first- and second-quarter health status as well as other resident, facility, and market characteristics. The physical health outcomes examined consisted of falls, walking dependence, activities of daily living (ADLs), pressure ulcers, and contractures. Mental health outcomes examined consisted of cognitive performance, depression, and behavior problems.
The initiation of restraint use was associated with a previous fall (p <.01), psychoactive medication use (p <.05), low cognition (p <.01), ADL scores (p <.01), and the absence of pressure ulcers (p <.10), as well as a variety of facility characteristics. Subsequent to restraint initiation, we found an association with lower cognitive performance (p <.01), lower ADL performance (p <.01), and higher walking dependence (p <.01).
We found that an association between restraint initiation and subsequent adverse health consequences exists and is substantial. Moreover, these results would appear to have practical as well as statistical significance.
SourceAvailable from: Eimear Muir-Cochrane[Show abstract] [Hide abstract]
ABSTRACT: Accessible summaryWhile the decision to use restraint and seclusion was not taken lightly, nurse participants felt that there were no effective alternatives to the use of these measures.Adverse interpersonal, physical and practice environments contributed to the onset of aggression in old age psychiatry inpatient settings.Policies to reduce or eliminate the use of restraint and seclusion need to take account of wide-ranging strategies to deal with aggression, including the provision of appropriate education and support and addressing ethical and workplace cultural issues associated with these practices.AbstractRestraint and seclusion are often ineffective and can affect patients adversely. In this study, we explored nurses' experiences of restraint and seclusion in short-stay acute old age psychiatry inpatient units and how these experiences underpin resistance to eliminating these practices. Qualitative interviews were conducted with nurses in three old age psychiatry units in Melbourne, Australia. The results provide one overarching theme, lack of accessible alternatives to restraint and seclusion, indicating that nurses believe there are no effective, accessible alternatives to these practices. Three related themes contribute to this perception. First, an adverse interpersonal environment contributes to restraint and seclusion, which relates to undesirable consequences of poor staff-to-patient relationships. Second, an unfavourable physical environment contributes to aggression and restraint and seclusion use. Third, the practice environment influences the adoption of restraint and seclusion. The findings contribute to the limited evidence about nurses' experiences of these practices in short-stay old age psychiatry, and how account needs to be taken of these experiences and contextual influences when introducing measures to address these practices. Policies addressing these measures need to be accompanied by wide-ranging initiatives to deal with aggression, including providing appropriate education and support and addressing ethical and workplace cultural issues surrounding these practices.Journal of Psychiatric and Mental Health Nursing 03/2015; 22(2). DOI:10.1111/jpm.12189 · 0.98 Impact Factor
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ABSTRACT: Studies have demonstrated the extensive use of coercion in Norwegian nursing homes, which represents ethical, professional as well as legal challenges to the staff. We have, however, limited knowledge of the experiences and views of nursing home patients and their relatives. The aim of this study is to explore the perspectives of nursing home patients and next of kin on the use of coercion; are there situations where the use of coercion can be defended, and if so, under which circumstances? The data are based on individual interviews with 35 patients living in six nursing homes and seven focus group interviews with 60 relatives. Participation was based on written informed consent, and the study was approved by the Regional Committees for Medical and Health Research Ethics. More than half of the patients and the majority of the relatives accepted the use of coercion, trusting the staff to act in the patient's best interest. However, the acceptance of coercion is strongly related to the patients' lack of understanding, to prevent health risks and to preserve the patient's dignity. The majority of nursing home patients and relatives accepted the use of coercion in specific situations, while at the same time they emphasised the need to try alternative strategies first. There is still a need for good qualitative research on the use of coercion in nursing homes, especially with a closer focus on the perspectives and experiences of nursing home patients. © The Author(s) 2015.Nursing Ethics 01/2015; DOI:10.1177/0969733014564907 · 1.09 Impact Factor
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ABSTRACT: Caring for people with dementia in dementia special care units is a demanding job. Challenging behaviour is one of the factors influencing the job satisfaction and burnout of care staff. A care programme for the challenging behaviour of nursing home residents with dementia might, next to diminishing the challenging behaviour of residents, improve job satisfaction and reduce the care staff's feelings of burnout.International Journal of Nursing Studies 10/2014; 52(1). DOI:10.1016/j.ijnurstu.2014.10.003 · 2.25 Impact Factor