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: 2.9). 06/2008; 46(4):459-69. DOI: 10.1016/j.ijnurstu.2008.03.005
Source: PubMed


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.

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    • "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. "
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    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.
    Full-text · Article · Jun 2013 · Journal of Advanced Nursing
    • "Only one study (Huizing et al., 2009b) reported on the prevention of physical restraint use in newly admitted residents. In this study, an educational programme combined with consultation provided by a nursing specialist did not prevent the use of physical restraints in newly admitted residents to psychogeriatric nursing home wards (Huizing et al., 2009b). Most studies that aim to reduce restraint use also have mostly used education and consultation interventions . "
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    ABSTRACT: BACKGROUND: Physical restraints are commonly used in psychogeriatric nursing home residents despite reports of negative consequences. Most research has focused on restraint reduction without addressing methods to prevent initiation of restraints in nursing homes. EXBELT has been found to decrease belt restraint use but should also be evaluated for its use in preventing restraints. OBJECTIVE: To investigate the effectiveness of the EXBELT intervention to prevent the use of belt restraints on psychogeriatric residents newly admitted to nursing homes. DESIGN: Quasi-experimental study design. SETTING: Twenty-six nursing home wards from thirteen Dutch nursing homes. PARTICIPANTS: Newly admitted residents (n=104) during a four month period. INTERVENTIONS: Fifteen wards (intervention group) implemented the EXBELT intervention, which consisted of four components: a policy change, education, consultation and the availability of alternative interventions. METHODS: Data on the use of belt restraints, other types of physical restraints, falls and fall-related injuries and psychoactive drug use were collected at T2 (4 months) and T3 (8 months) after baseline (T1) for those resident who were newly admitted after baseline and before T2 (4 months). Physical restraint use data were collected by a trained, blinded observer four times during a 24-h period. RESULTS: A total of 104 residents were newly admitted after baseline (T1) and before T2. Of those, 82 were present on T2 and T3. Informed consent was obtained from legal representatives of 49 out of the 82 residents. In the control group (n=20), 15% and 20% used belts at T2 (4 months) and T3 (8 months), respectively. In the intervention group (n=29), these proportions were 3% and 0%, respectively (OR=0.08; 95% CI (0.01-0.76); p=0.03). There was no increase in the intervention group in the use of other physical restraints, falls and fall-related injuries or psychoactive drug use. CONCLUSION: The EXBELT intervention effectively seems to prevent the use of belt restraints in newly admitted residents in psychogeriatric nursing homes.
    No preview · Article · Aug 2012 · International journal of nursing studies
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    • "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. "
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    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.
    Full-text · Article · Dec 2010 · Journal of Nursing Scholarship
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