Preventing the use of physical restraints on residents newly admitted to psycho-geriatric nursing home wards: a cluster-randomized trial.

Department of Health Care Studies, Section of Nursing Science, Maastricht University, The Netherlands.
International journal of nursing studies (Impact Factor: 2.25). 06/2008; 46(4):459-69. DOI: 10.1016/j.ijnurstu.2008.03.005
Source: PubMed

ABSTRACT Although there is an urgent need for restraint-free care, the number of randomized clinical trials on preventing or reducing physical restraints has been limited.
To investigate the effectiveness of an educational intervention to prevent the use of physical restraints on residents newly admitted to psycho-geriatric nursing home wards.
Cluster-randomized trial.
Fourteen Dutch psycho-geriatric nursing home wards.
138 residents admitted to 14 psycho-geriatric nursing home wards after baseline measurement of the trial were selected, out of which 33 residents died or informed consent had not been obtained. A total of 105 residents were included in the analyses.
The nursing home wards were randomly assigned to either educational intervention or control status. The educational intervention consisted of an educational programme for nurses combined with a nurse specialist's consultation. The data were collected at 1, 4 and 8 months post-intervention. The use of physical restraints was measured by blinded, trained observers on four separate occasions over a 24-h period. The Minimum Data Set was used to determine residents' characteristics, such as their cognitive status.
During the study period, no statistically significant differences between the experimental group and the control group regarding restraint status, restraint intensity, multiple restraints and types of restraints were found. One month post-intervention, 38% of the residents newly admitted to the experimental wards were restrained. Bilateral bedrails were the most frequently used restraints at Post-test 1 (24%), Post-test 2 (23%) and Post-test 3 (28%), followed by the use of infrared systems at Post-tests 2 and 3.
An educational programme combined with the consultation of a nurse specialist does not prevent the use of physical restraints on residents newly admitted to psycho-geriatric nursing home wards. Although other studies have shown promising results with the effectiveness of these types of intervention on restraint reduction, the development of additional interventions to prevent restraint usage is recommended.

  • Source
    • "Comparisons of PR use between countries are hampered by differences in measurement of PR. Studies in the USA, Canada, Finland, Switzerland, Netherlands and Hong Kong count any type of restraint as PRs, excluding bedrails (Feng et al. 2009, Huizing et al. 2009a, Medicare gov 2009); Germany (Meyer et al. 2009) and Australia (Retsas 2008) only counted bedrails, belts and chairs with tables. This study defined PR as any restriction limiting an individual's normal mobility, including bedrails , seat belts, wheelchairs with lap trays, mitts, waist restraints, restraining belts on the feet and restraining belts on the bed. "
    [Show abstract] [Hide abstract]
    ABSTRACT: AimTo 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. DesignA 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. ResultsOf 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.
    Journal of Advanced Nursing 06/2013; 70(1). DOI:10.1111/jan.12176 · 1.69 Impact Factor
  • Source
    • "These American studies, as well as a number of studies conducted later in Europe and Asia in both hospitals and nursing homes, however, have not consistently resulted in clinically meaningful reductions of physical restraints (Capezuti et al., 2007; Huizing, Hamers, Gulpers, & Berger, 2006, 2009; Lai et al., 2007; Testad, Aasland, & Aarsland, 2005). Recent intervention studies in nursing homes in the Netherlands providing an education approach with nurse specialist consultation (Huizing et al., 2009) and in Norway providing an education approach with guidance (Testad et al.) also demonstrated inconsistent results. Thus, it might not be sufficient to focus on nurses' education alone to change practice conditions. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Attitudes of nursing home staff, residents, and their relatives determine the decision-making process about the use of physical restraints. Knowledge of staffs' attitudes toward physical restraints is sparse; even less is known about relatives' attitudes. Therefore, we surveyed relatives' attitudes and opinions toward physical restraints and compared the results to a survey of nursing home staff. Cross-sectional survey comparing 177 nursing home residents' relatives from 13 German facilities in 2008 to 258 nursing home nurses from 25 German facilities in 2007. The German version of the Maastricht Attitude Questionnaire was administered. Part I contains 22 items with three subscales (reasons, consequences, and appropriateness of restraints); Part II contains 16 items evaluating restrictiveness and discomfort of restraint measures, respectively. Descriptive and explorative inferential statistics were used for data analyses. Response rate in both samples was above 90%. Mean age was 62 years (SD 12.60; range 24-93) in relatives and 44 years (SD 11.40; range 19-65) in nurses; 72% and 82% were female, respectively. Relatives assess physical restraints a little more positively compared to nurses, with an average of 3.40 (SD 0.60) versus 3.07 (SD 0.48) on a 5-point scale (5=strongly positive attitude). Relatives assess physical restraints as slightly less restrictive, with 2.11 (SD 0.33), and as less discomforting, with 2.10 (SD 0.38) points, compared to nursing staff, who assess the restraints' restrictiveness with 2.19 (SD 0.29) points and its discomfort with 2.17 (SD 0.32) on a 3-point scale (3=very restrictive/discomforting). Both groups consider wrist and ankle belts as most restrictive and uncomfortable, while sensor mats, infrared systems, and unilateral bedrails were rated as the lowest for restrictiveness and discomfort. Attitudes of nursing home residents' relatives toward physical restraints are rather positive and generally comparable with nursing home staffs' attitudes. Interventions aimed to reduce physical restraints need to include education of both staff and relatives of nursing home residents.
    Journal of Nursing Scholarship 12/2010; 42(4):448-56. DOI:10.1111/j.1547-5069.2010.01341.x · 1.77 Impact Factor
  • Source
    • "Several studies suggest that comparable interventions on quality of care improvement are differently effective throughout European countries (Meesterberends et al., 2007; Tannen et al., 2006). This has been shown for approaches on restraint reduction too (Becker et al., 2007; Huizing et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the attitudes of nursing staff towards restraint measures and restraint use in nursing home residents, and to investigate if these attitudes are influenced by country of residence and individual characteristics of nursing staff. A questionnaire on attitudes regarding restraints (subscales: reasons, consequences, and appropriateness of restraint use) and opinions regarding the restrictiveness of restraint measures and discomfort in using them was distributed to a convenience sample of nursing staff in The Netherlands (n=166), Germany (n=258), and Switzerland (n=184). In general, nursing staff held rather neutral opinions regarding the use of physical restraints, but assessed the use of restraints as an appropriate measure in their clinical practice. Gender and age were not related to attitudes of nursing staff, but we did find some differences in attitudes between nursing staff from the different countries. Dutch nursing staff were most positive regarding the reasons of restraint use (p<0.01), but were less positive than German and Swiss nursing staff regarding the appropriateness of restraint use (p<0.01). Swiss nursing staff were less positive than German nursing staff regarding the appropriateness of restraint use (p<0.01). Nursing staff with longer clinical experience showed a more negative attitude towards restraint use than nursing staff with less experience (p<0.05) and charge nurses had the least positive attitude towards restraint use (p<0.05). Opinions regarding restraint measures differed between the three countries. The use of bilateral bedrails was considered as a moderate restrictive measure; the use of belts was rated as the most restrictive measure and nursing staff expressed pronounced discomfort on the use of these measures. Nursing staff from three European countries have different attitudes and opinions regarding the use of physical restraints. The results underline the importance of more tailored, culturally sensitive interventions to reduce physical restraints in nursing homes.
    International journal of nursing studies 02/2009; 46(2):248-55. DOI:10.1016/j.ijnurstu.2008.06.007 · 2.25 Impact Factor
Show more


Available from