Restraint Reduction Reduces Serious Injuries Among Nursing Home Residents

The Commonwealth National Restraint Minimization Project, New York, New York, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 11/1999; 47(10):1202-7. DOI: 10.1111/j.1532-5415.1999.tb05200.x
Source: PubMed


To describe how removing physical restraints affected injuries in nursing home settings.
A 2-year prospective study of an educational intervention for physical restraint reduction.
Sixteen diverse nursing homes with 2075 beds in California, Michigan, New York, and North Carolina.
Study A: 859 residents who were physically restrained at the onset of the intervention on October 1, 1991. Study B: all residents who occupied the 2075 beds in the 16 facilities 3 months before the intervention and 3 months after its completion.
Educational program for nursing home staff followed by quarterly site consultations to participating nursing homes.
Rate of physical restraint use and injuries.
Study A: Serious injuries declined significantly among the 859 residents restrained initially when restraint orders were discontinued (X2 = 6.2, P = .013). Study B: During the intervention period, physical restraint use among the 2075 residents decreased from 41% to 4%, a 90% reduction. The decrease in the percentage of injuries of moderate to serious severity was significant (i.e., 7.5% vs 4.4%, P2-tail = .0004) as was the rate of moderate and serious injuries combined (Rate Ratio = 1.580, P2-tail = .0033).
A substantial decrease in restraint use occurred without an increase in serious injuries. Although minor injuries and falls increased, restraint-free care is safe when a comprehensive assessment is done and restraint alternatives are used.

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    • "Restraining residents with dementia in a bed or a chair, for example, with a Swedish belt or chair belt, is thought to prevent them from falls and subsequent injury. However, there is evidence that the use of physical restraints does not reduce the incidence of injuries (Neufeld et al., 1999). Moreover, physical restraints may have adverse effects on the quality of life of the people being subjected to them (Castle, 2006; Castle & Engberg, 2009). "
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    ABSTRACT: As physical restraints should only be used in exceptional cases, there is an urgent need for alternatives to restraint use. Surveillance technology could be such an alternative. This study explored whether nursing-home residents with dementia subjected to surveillance technology had better quality of life scores for mood, behavioral and societal dimensions than residents with physical restraints. Quality of life was assessed longitudinally, with three measurements in six psychogeriatric nursing homes of residents with surveillance technology (n = 170) and residents with physical restraints (n = 22). QUALIDEM subscales were used to measure five dimensions of quality of life. Multilevel longitudinal univariate and multivariate regression techniques were used to analyze the data. Because physical restraints were almost exclusively used in residents with low activities of daily living (ADL) independency (18 of the 22), we restricted the regression analyses to residents with a Barthel Index score ≤ 5 (overall n = 53). Univariate results showed that highly ADL-dependent residents with surveillance technology had significantly more positive affect than highly ADL-dependent residents with physical restraints. However, this difference proved to be no longer significant after adjustment for the confounders: age, sex and stage of dementia. Quality of life of highly ADL-dependent nursing-home residents with dementia seems to be unrelated to the use of surveillance technology as opposed to physical restraints. Copyright
    Full-text · Article · Apr 2013 · International Journal of Geriatric Psychiatry
    • "The use of physical restraints in acute and residential healthcare facilities is a widespread practice in many countries (Karlsson et al. 1996, Hantikainen 1998, Minnick et al. 1998, Neufeld et al. 1999, Meyers et al. 2001, Evans & Fitzgerald 2002, Gallinagh et al. 2002, Choi & Song 2003, Capezuti 2004; Hamers et al. 2004, Demir 2007). However, the reported frequencies of physical restraint use vary widely, making it almost impossible to determine the true prevalence "
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    ABSTRACT:   This article is a report of a review that aimed to synthesize the available qualitative evidence on nurses' decision-making in cases of physical restraint.   The use of physical restraint in acute and residential healthcare facilities is a widespread practice in many countries. Decisions about the use of physical restraints are complex and ethically laden. The lack of evidence supporting the use of physical restraints, the negative consequences of restraint for patients, and the low availability of alternatives obviously complicate the decision-making.   Research papers published between January 1990 and January 2010 were identified in Cinahl, Embase, Medline, PsycInfo and Web of Science.   A systematic review was carried out to obtain a meta-synthesis of qualitative evidence. The process of meta-synthesis was supported by the Joanna Briggs Institute's guidelines.   The decision-making of nurses dealing with the use of physical restraints is a complex trajectory primarily focused on safety. However, thoughtful decision-making requires nurses to carefully balance different options and associated ethical values. The decision-making process of nurses is influenced by both nurse- and context-related factors.   This review provides a deeper understanding of nurses' decision-making process on the use of physical restraints. Context- and nurse-related factors can hinder nurses from making an ethical decision on the appropriate use of physical restraints. There is an urgent need to stimulate and educate nurses to arrive at an appropriate decision about the use of physical restraints.
    No preview · Article · Dec 2011 · Journal of Advanced Nursing
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    • "For example, monitoring devices can give nurses piece of mind about the safety of a resident. Also, it might be useful to educate care professionals and relatives about the negative consequences associated with restraint use (Neufeld et al., 1999; Mion et al., 2001 Evans et al., 2003; Engberg et al., 2008). Fourthly, regular evaluation of the restraints that are being used and discussion about alternatives to those restraints might also be helpful in eliminating the accusatory implications nurses feel when discussing restraint use. "
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    ABSTRACT: ABSTRACTIntroduction: Although in most developed countries the use of restraints is regulated and restricted by law, the concept of restraint in nursing home care remains ambiguous. This study aims to explore how care professionals and family members of nursing home residents with dementia in the Netherlands experience and define the concept of restraint.Methods: Individual interviews were held with relatives (n = 7) and key persons (n = 9) in seven nursing homes. We also conducted eight focus group discussions with nursing home staff. In addition, a structured questionnaire was administered to the nurses of participating nursing homes.Results: In the questionnaire, over 80% of the respondents indicated considering “fixation” (e.g. use of belts) as a restraint and 50 to 70% of the respondents regarded other physical interventions, such as geriatric chairs and bedrails, as restraints. The interviews and focus group discussions show that the residents' perception of the intervention, the staff's intention behind the intervention and concerns of privacy are the criteria used by the respondents in defining an intervention as a restraint.Conclusions: When trying to diminish restraint use, it is important to be aware of the “local logic” of care practice and to take into account the fact that, for staff and relatives, an intervention is only regarded as a restraint when it is bothering a resident or when an intervention is used for the sole purpose of restricting freedom and/or when interventions invade the privacy of a resident.
    Full-text · Article · Jun 2011 · International Psychogeriatrics
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