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Guenna Holmgren A, von Vogelsang AC, Lindblad A, Juth N. Restraint in somatic healthcare: how should it be regulated? JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109240. [PMID: 37852743 DOI: 10.1136/jme-2023-109240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
Restraint is regularly used in somatic healthcare settings, and countries have chosen different paths to regulate restraint in somatic healthcare. One overarching problem when regulating restraint is to ensure that patients with reduced decision-making capacity receive the care they need and at the same time ensure that patients with a sufficient degree of decision-making capacity are not forced into care that they do not want. Here, arguments of justice, trust in the healthcare system, minimising harm and respecting autonomy are contrasted with different national regulations. We conclude that a regulation that incorporates an assessment of patients' decision-making capacity and considers the patient's best interests is preferable, in contrast to regulations based on psychiatric diagnoses or regulations where there are no legal possibilities to exercise restraint at all in somatic care.
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Affiliation(s)
- Amina Guenna Holmgren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Niklas Juth
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Gupta I, Nelson-Greenberg I, Wright SM, Harris CM. Physical Restraint Usage in Hospitals Across the United States: 2011-2019. Mayo Clin Proc Innov Qual Outcomes 2024; 8:37-44. [PMID: 38259804 PMCID: PMC10801224 DOI: 10.1016/j.mayocpiqo.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Objective To determine the change in rates of physical restraint (PR) use and associated outcomes among hospitalized adults. Patients and Methods Using national inpatient sample databases, we analyzed years 2011-2014 and 2016-2019 to determine trends of PR usage. We also compared the years 2011-2012 and 2018-2019 to investigate rates of PR use, in-hospital mortality, length of stay, and total hospital charges. Results There were 242,994,110 hospitalizations during the study period. 1,538,791 (0.63%) had coding to signify PRs, compared with 241,455,319 (99.3%), which did not. From 2011 to 2014, there was a significant increase in PR use (p-trend<.01) and a nonsignificant increase in PR rates from 2016-2019 (p-trend=.07). Over time, PR use increased (2011-2012: 0.52% vs 2018-2019: 0.73%; p<.01). Patients with PRs reported a higher adjusted odds for in-hospital mortality in 2011-2012 (adjusted odds ratio [aOR], 3.9; 95% CI, 3.7-4.2; p<.01) and 2018-2019 (aOR, 3.5; 95% CI, 3.4-3.7; p<.01). Length of stay was prolonged for patients with PRs in 2011-2012 (adjusted mean difference [aMD], 4.3 days; 95% CI, 4.1-4.5; p<.01) and even longer in 2018-2019 (aMD, 5.8 days; 95% CI, 5.6-6.0; p<.01). Total hospital charges were higher for patients with PRs in 2011-2012 (aMD, +$55,003; 95% CI, $49,309-$60,679; p<.01). Following adjustment for inflation, total charges remained higher for patients with PRs compared with those without PRs in 2018-2019 (aMD, +$70,018; 95% CI, $65,355-$74,680; p<.01). Conclusion Overall, PR rates did not decrease across the study period, suggesting that messaging and promulgating best practice guidelines have yet to translate into a substantive change in practice patterns.
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Affiliation(s)
- Ishaan Gupta
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Ilana Nelson-Greenberg
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Scott Mitchell Wright
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Ché Matthew Harris
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
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Siegrist‐Dreier S, Thomann S, Barbezat I, Richter D, Schmitt K, Hahn S. Experience of patients with restraints in acute care hospitals and the view of their relatives: A qualitative study. Nurs Open 2023; 10:7224-7232. [PMID: 37612841 PMCID: PMC10563431 DOI: 10.1002/nop2.1975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/08/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023] Open
Abstract
AIM To describe the experiences of patients and relatives with any form of restraints in somatic acute care hospitals. DESIGN Qualitative explorative design. METHODS Qualitative research methods were used. Participants were recruited through clinical nursing specialists in participating departments of a university hospital between June and August 2020. Individual interviews were conducted and analysed using content analysis. RESULTS Four interviews with patients and five interviews with relatives were conducted with a mean duration of 25 min. The following three topics emerged in the analysis as important: What was perceived as restraints, Assessing the experiences of restraint use on a continuum, and Lack of information about restrictive measures. Patients and relatives defined restraint very broadly and assessed the experiences of restraint on a continuum from positive to negative, with a more critical view from patients. Relatives clearly seemed to approve of the use of restraints in acute care hospitals because it provided them with a sense of security. In general, there seemed to be a lack of information about the use of restraint and its effects on patients and relatives alike. CONCLUSION The involvement of patients and relatives in the decision-making process about restraint use seems to be low. Healthcare professionals need to be better educated to be able to pass on adequate information and to involve patients and their relatives adequately in all processes of restraint use. However, when relatives are involved in decision-making as proxies for patients, it is important to consider that patients' and relatives' opinions on restraints may differ. PATIENT OR PUBLIC CONTRIBUTION Patients and relatives agreed to participate in the study and shared their experiences with us.
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Affiliation(s)
- Sandra Siegrist‐Dreier
- Bern University of Applied Sciences, School of Health Professions, Applied Research & Development in NursingBernSwitzerland
| | - Silvia Thomann
- Bern University of Applied Sciences, School of Health Professions, Applied Research & Development in NursingBernSwitzerland
| | - Isabelle Barbezat
- Department of Nursing, Academic‐Practice‐PartnershipBern University HospitalBernSwitzerland
| | - Dirk Richter
- Bern University of Applied Sciences, School of Health Professions, Applied Research & Development in NursingBernSwitzerland
| | - Kai‐Uwe Schmitt
- Bern University of Applied Sciences, School of Health Professions, Applied Research & Development in NursingBernSwitzerland
- Department of Nursing, Academic‐Practice‐PartnershipBern University HospitalBernSwitzerland
| | - Sabine Hahn
- Bern University of Applied Sciences, School of Health Professions, Applied Research & Development in NursingBernSwitzerland
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Abraham J, Möhler R. [Development and evaluation of complex interventions in nursing : Application of the medical research council's framework using the example of interventions to prevent physical restraints]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:523-529. [PMID: 37074448 PMCID: PMC10163081 DOI: 10.1007/s00103-023-03689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
Many nursing interventions are complex. They comprise different intervention elements (components) and aim to change processes or behaviours of individuals or groups. A framework of the British Medical Research Council comprises methodological recommendations for the development and evaluation of complex interventions. This narrative review describes the framework's methodological recommendations using an example of interventions to reduce physical restraints in hospital and long-term care settings, such as bedrails or belts in chairs and beds. In addition to the characteristics of the complex interventions, the development and theoretical foundation of the interventions as well as the feasibility test and evaluation is described.
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Affiliation(s)
- Jens Abraham
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland
| | - Ralph Möhler
- Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät und Universitätsklinik Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Thomas A, Burkholder I, Renaud D. [Physical restraints in acute hospitals: A quantitative observational study as a starting point for the further development of quality management]. Pflege 2023; 36:115-124. [PMID: 35549711 DOI: 10.1024/1012-5302/a000888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Physical restraints in acute hospitals: A quantitative observational study as a starting point for the further development of quality management Abstract: Background: Despite the known associated risks and adverse events, physical restraints are mostly observed in daily care practice of long-term care. Comparatively few studies are available for normal wards. Research question/aim: The explorative cross-sectional study investigated prevalences, types and reasons of physical restraints in nine selected normal wards of a maximum care hospital. Methods: The prevalences and types of physical restraints were collected in the early and late shift in summer 2020 via direct observation using standardised observation forms. The reasons for the use were recorded via a standardised survey of the nursing staff. Results: In the early shift, 15 out of 167 patients had physical restraints (9%), in the late shift 23 out of 191 (12%). People over 80 years were most affected (n = 8; 23.5% and n = 14, 25.9%). The highest prevalence was found in the clinic for neurogeriatrics with 21.4% (n = 3) and 37.5% (n = 6). Bedside restraints were used particularly frequently (n = 14; 93.3% and n = 22, 95.7%, resp.). The physical restraints were predominantly justified with the protection against fall injuries (n = 8, 53.3% and n = 15, 65.2%). Conclusions: Raising awareness among nursing staff through training and other accompanying measures are starting points for reducing physical restraints. In order to achieve sustainable changes, the management level should initiate appropriate measures and consistently accompany their implementation.
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Affiliation(s)
- Annika Thomas
- Department Gesundheit und Pflege, htw saar, Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken, Deutschland
| | - Iris Burkholder
- Department Gesundheit und Pflege, htw saar, Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken, Deutschland
| | - Dagmar Renaud
- Department Gesundheit und Pflege, htw saar, Hochschule für Technik und Wirtschaft des Saarlandes, Saarbrücken, Deutschland
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Ertuğrul B, Özden D. Physical Restraint Experiences of Family Caregivers of Patients With Stroke in Turkey: A Qualitative Study. Clin Nurs Res 2023; 32:499-509. [PMID: 36028990 DOI: 10.1177/10547738221115229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to explore the experiences and needs of family caregivers of stroke patients who require physical restraints. The themes and sub-themes that emerged included "the reason for the use of PR" (disruptive behaviors of the patient and personal reasons of caregivers), "the turmoil of having to use PR" (inevitableness, comparing benefits and harms, the emotional effect of PR, and physical effects), and "unmet needs and suggestions" (unmeet needs and suggestions). Nurses should take the experiences of patient relatives into account in the process of PR application, organize training programs, and determine application standards for PR.
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Tresfon J, Langeveld K, Brunsveld-Reinders AH, Hamming J. Coming to Grips-How Nurses Deal With Restlessness, Confusion, and Physical Restraints on a Neurological/Neurosurgical Ward. Glob Qual Nurs Res 2023; 10:23333936221148816. [PMID: 36712230 PMCID: PMC9880574 DOI: 10.1177/23333936221148816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/06/2022] [Accepted: 12/16/2022] [Indexed: 01/26/2023] Open
Abstract
Physical restraints are viewed as potentially dangerous objects for patient safety. Contemporary efforts mainly focus on preventing bad outcomes in restraint use, while little attention is paid under what circumstances physical restraints are applied harmlessly. The aim of this research was to understand how physical restraints are used by neurology/neurosurgery ward nurses in relation to the protocol. In ethnographic action research, the Functional Resonance Analysis Method (FRAM) was used to map and compare physical restraints as part of daily ward care against the protocol of physical restraints. Comparison between protocol and actual practice revealed that dealing with restlessness and confusion is a collective nursing skill vital in dealing with physical restraints, while the protocol failed to account for these aspects. Supporting and maintaining this skillset throughout this and similar nursing teams can prevent future misguided application physical restraints, offering valuable starting point in managing patient safety for these potentially dangerous objects.
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Affiliation(s)
- Jaco Tresfon
- Leiden University Medical Centre,
Zuid-Holland, The Netherlands,Jaco Tresfon, Department of Quality and
Safety, Leiden University Medical Centre, PO box 9600 Post Zone C1-R, Leiden,
Zuid-Holland 2300 RC, The Netherlands
| | | | | | - Jaap Hamming
- Leiden University Medical Centre,
Zuid-Holland, The Netherlands
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Prevalence, Risk Factors and Outcomes Associated with Physical Restraint in Acute Medical Inpatients over 4 Years-A Retrospective Cohort Study. Geriatrics (Basel) 2023; 8:geriatrics8010015. [PMID: 36826357 PMCID: PMC9957493 DOI: 10.3390/geriatrics8010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/27/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Physical restraints are frequently used in acute care hospitals. Their application is associated with negative outcomes, while their intended preventive effect is debated. OBJECTIVES To determine the prevalence of physical restraints and associated outcomes on medical wards in a tertiary care hospital. METHODS Retrospective cohort study (January 2018 to December 2021). We included all adult medical in-patients and excluded patients with admission to the intensive care unit, short stays (length of stay (LOS) < 48 h), and patients declining informed consent. RESULTS Of 11,979 admissions, the prevalence of patients with at least one restraint was 6.4% (n = 772). Sensor mats were used most frequently (73.0%, n = 666), followed by blanket restrictions (14.5%, n = 132), bedrails (8.8%, n = 80) and belts (3.7%, n = 34). On average, restraints were applied 19 h (standard deviation (SD) ± 161) before a fall. Average restraint duration was 42 h (SD ± 57). Patients with a restraint had longer LOS 8 days (IQR 5-14) vs. 5 days (IQR 3-9). Median nurses' time expenditure was 309 h (IQR 242-402) vs. 182 h (IQR 136-243) for non-restrained patients. Patients with restraints fell more often (22.5% vs. 2.7%) and were more likely to die (13.3% vs. 5.1%). These differences persisted after adjusting a regression model for important clinical confounders. We saw a decline in the duration of restraints over the years, but no variation between wards. CONCLUSION Approximately 6% of medical patients, mostly older and severely ill, were affected by restraint use. For the first time, we report data over 4 years up to ward-level granularity.
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Gottschalk S, Meyer G, Haastert B, Abraham J. Prevention of physical restraints in the acute care setting (PROTECT): study protocol for a cluster-randomised controlled pilot study. BMJ Open 2023; 13:e066291. [PMID: 36592997 PMCID: PMC9809259 DOI: 10.1136/bmjopen-2022-066291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Physical restraints (PR) are regularly used in acute care settings, although evidence for their effectiveness and safety (eg, for prevention of falls) is lacking. Their use is associated with adverse events, such as decreased mobility and injuries for patients. We developed a complex intervention to prevent PR in acute care settings according to the UK Medical Research Council Framework, and investigated the feasibility. The intervention comprised the qualification of key nurses as multipliers and a short interprofessional information session. The intervention has proven to be feasible. It also became apparent that further development of the intervention and the study procedures is necessary. Therefore, this study aims to refine and pilot the complex intervention. Furthermore, the objective of this pilot study is to improve study procedures. METHODS AND ANALYSIS In a preparatory phase, we will conduct focus groups and individual interviews with the target groups to explore the possibilities for adaption of the intervention and implementation strategies. Subsequently, a cluster-randomised controlled trial with a 6-month follow-up period will be conducted. It is planned to recruit eight general hospitals in Germany (area of Halle (Saale) and Leipzig) with 28 wards and 924 patients per observation period (2772 overall). Primary outcome is the proportion of patients with at least one PR after 6 months. Data will be collected by direct observation over a period of seven consecutive days and three times a day. Secondary outcomes are falls, interruptions in therapy and prescription of psychotropic medication. A comprehensive process evaluation will accompany the study. ETHICS AND DISSEMINATION The Ethics committee of the Medical Faculty of the University of Halle (Saale) approved the study protocol. Results will be published in a peer-reviewed journal and presented at conferences. Study information and additional material will be freely available on an already existing website. TRIAL REGISTRATION NUMBER DRKS00027989.
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Affiliation(s)
- Susan Gottschalk
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
| | | | - Jens Abraham
- Institute of Health and Nursing Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Saxony-Anhalt, Germany
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García Andreu MDM, Díez-Manglano J. Restraint measures in the agitated patient, safety or danger? Med Clin (Barc) 2022; 159:541-542. [PMID: 36064505 DOI: 10.1016/j.medcli.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/03/2023]
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Abraham J, Hirt J, Richter C, Köpke S, Meyer G, Möhler R. Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings. Cochrane Database Syst Rev 2022; 8:CD012476. [PMID: 36004796 PMCID: PMC9404383 DOI: 10.1002/14651858.cd012476.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Physical restraints, such as bedrails, belts in chairs or beds, and fixed tables, are commonly used for older people in general hospital settings. Reasons given for using physical restraints are to prevent falls and fall-related injuries, to control challenging behavior (such as agitation or wandering), and to ensure the delivery of medical treatments. Clear evidence of their effectiveness is lacking, and potential harms are recognised, including injuries associated with the use of physical restraints and a negative impact on people's well-being. There are widespread recommendations that their use should be reduced or eliminated. OBJECTIVES To assess the best evidence for the effects and safety of interventions aimed at preventing and reducing the use of physical restraint of older people in general hospital settings. To describe the content, components and processes of these interventions. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register the International Clinical Trials Registry Portal on 20 April 2022. SELECTION CRITERIA We included randomised controlled trials and controlled clinical trials that investigated the effects of interventions that aimed to prevent or reduce the use of physical restraints in general hospital settings. Eligible settings were acute care and rehabilitation wards. We excluded emergency departments, intensive care and psychiatric units, as well as the use of restrictive measures for penal reasons (e.g. prisoners in general medical wards). We included studies with a mean age of study participants of at least 65 years. Control groups received usual care or active control interventions that were ineligible for inclusion as experimental interventions. DATA COLLECTION AND ANALYSIS Two review authors independently selected the articles for inclusion, extracted data, and assessed the risk of bias of all included studies. Data were unsuitable for meta-analysis, and we reported results narratively. We used GRADE methods to describe our certainty in the results. MAIN RESULTS We included four studies: two randomised controlled trials (one individually-randomised, parallel-group trial and one clustered, stepped-wedge trial) and two controlled clinical trials (both with a clustered design). One study was conducted in general medical wards in Canada and three studies were conducted in rehabilitation hospitals in Hong Kong. A total of 1709 participants were included in three studies; in the fourth study the number of participants was not reported. The mean age ranged from 67 years to 84 years. The duration of follow-up covered the period of patients' hospitalisation in one study (21 days average length of stay) and ranged from 4 to 11 months in the other studies. The definition of physical restraints differed slightly, and one study did not include bedrails. Three studies investigated organisational interventions aimed at implementing a least-restraint policy to reduce physical restraints. The theoretical approach of the interventions and the content of the educational components was comparable across studies. The fourth study investigated the use of pressure sensors for participants with an increased falls risk, which gave an alarm if the participant left the bed or chair. Control groups in all studies received usual care. Three studies were at high risk of selection bias and risk of detection bias was unclear in all studies. Because of very low-certainty evidence, we are uncertain about the effect of organisational interventions aimed at implementing a least-restraint policy on our primary efficacy outcome: the use of physical restraints in general hospital settings. One study found an increase in the number of participants with at least one physical restraint in the intervention and control groups, one study found a small reduction in both groups, and in the third study (the stepped-wedge study), the number of participants with at least one physical restraint decreased in all clusters after implementation of the intervention but no detailed information was reported. For the use of bed or chair pressure sensor alarms for people with an increased fall risk, we found moderate-certainty evidence of little to no effect of the intervention on the number of participants with at least one physical restraint compared with usual care. None of the studies systematically assessed adverse events related to use of physical restraint use, e.g. direct injuries, or reported such events. We are uncertain about the effect of organisational interventions aimed at implementing a least-restraint policy on the number of participants with at least one fall (very low-certainty evidence), and there was no evidence that organisational interventions or the use of bed or chair pressure sensor alarms for people with an increased fall risk reduce the number of falls (low-certainty evidence from one study each). None of the studies reported fall-related injuries. We found low-certainty evidence that organisational interventions may result in little to no difference in functioning (including mobility), and moderate-certainty evidence that the use of bed or chair pressure sensor alarms has little to no effect on mobility. We are uncertain about the effect of organisational interventions on the use of psychotropic medication; one study found no difference in the prescription of psychotropic medication. We are uncertain about the effect of organisational interventions on nurses' attitudes and knowledge about the use of physical restraints (very low-certainty evidence). AUTHORS' CONCLUSIONS We are uncertain whether organisational interventions aimed at implementing a least-restraint policy can reduce physical restraints in general hospital settings. The use of pressure sensor alarms in beds or chairs for people with an increased fall risk has probably little to no effect on the use of physical restraints. Because of the small number of studies and the study limitations, the results should be interpreted with caution. Further research on effective strategies to implement a least-restraint policy and to overcome barriers to physical restraint reduction in general hospital settings is needed.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute of Applied Nursing Science, Eastern Switzerland University of Applied Sciences (formerly FHS St. Gallen), St. Gallen, Switzerland
| | - Christin Richter
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
- School of Public Health, Bielefeld University, Bielefeld, Germany
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Hu FW, Yeh CY, Huang CC, Cheng HC, Lin CH, Chang CM. A novel intervention to reduce noninfectious and infectious complications associated with indwelling urethral catheters in hospitalized older patients: a quasi-experimental study. BMC Geriatr 2022; 22:426. [PMID: 35578174 PMCID: PMC9109338 DOI: 10.1186/s12877-022-03113-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indwelling urethral catheters are widely used in clinical settings. Catheter-associated urinary tract infection has been recognized as a common adverse event in older patients. However, noninfectious complications are almost 5 times as common as infectious complications, and insufficient attention has been given to noninfectious complications. Given this importance, a novel intervention related to removing unnecessary catheters in a timely manner to promote, after removal, the recovery of self-voiding function is herein developed to reduce infectious and noninfectious complications associated with indwelling urethral catheters in hospitalized older patients. METHODS A quasi-experimental study design was adopted. Patients aged 65 and older who had a urinary catheter placed within 24 h of hospital admission were included. All patients were allocated into either an intervention group, in which the novel intervention developed in the study was implemented, or a control group, who received care as usual. The outcomes of this study were to evaluate whether the novel intervention reduced the incidence of the following: catheter-associated urinary tract infections, catheter-associated noninfectious complications, decline in activities of daily living, and new nursing home admissions. RESULTS Of 106 hospitalized older patients who consented to participate, 92 completed follow-up until discharge, including 49 in the control group and 43 in the intervention group. The patients in the intervention group were significantly older than those in the control group [83.72 ± 9.18 vs. 80.26 ± 7.66, p = 0.038], and no differences were found between the groups in other demographics or present health conditions. Multivariable logistic regression analysis showed that the control group was more likely to develop noninfectious complications [adjusted odds ratio: 3.01, 95% confidence interval: 1.32-6.81] and a decline in ADLs [adjusted odds ratio: 11.20, 95% confidence interval: 3.68-34.00]. CONCLUSIONS A novel intervention can be effective as a means of reducing noninfectious complications associated with indwelling urethral catheters in hospitalized older patients. This approach will help to standardize urethral catheter care, and it highlights the fact that health care professionals can play a crucial role in preventing harm from urethral catheters.
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Affiliation(s)
- Fang-Wen Hu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan
| | - Chun-Yin Yeh
- Department of Computer Science and Information Engineering, National Cheng Kung University, No. 1, University Road, Tainan City, 70101, Taiwan
| | - Chi-Chang Huang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan
| | - Hsiu-Chi Cheng
- Department of Internal Medicine, and Institute of Clinical Medicine and Molecular Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan.,Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, 125 Jhongshan Rd, West Central Dist, 70043, Tainan City, Taiwan
| | - Cheng-Han Lin
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan
| | - Chia-Ming Chang
- Division of Geriatrics and Gerontology, Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan City, 70403, Taiwan.
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Abstract
Restraint has been used within health care settings for many centuries. Initially physical restraint (PR) was the method of choice, in present times. Within critical care units PR and chemical restraint are used, frequently in tandem. Restraint is not a benign intervention and PR specifically is associated with physical and psychological trauma towards those receiving it. Healthcare staff also suffer psychological consequences. This paper has reviewed the literature (using the terms 'physical restraint'; 'hospital'; 'care home critical care'; 'intensive care' 'attitudes'; 'knowledge' 'use of'; 'healthcare') to investigate the reasons for the use of restraints, its consequences and the attitudes of healthcare professionals' attitudes towards physical restraint currently present in critical care. Restraint use remains common practice in Critical Care Units (for 'patient safety'), initiated outside of institutional protocols, despite evidence questioning its effectiveness and the resulting harm to patients and staff.
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Affiliation(s)
- David Smithard
- Geriatric Medicine, Lewisham and Greenwich NHS Trust, London, UK
| | - Rhea Randhawa
- Medical School, King's College London School of Medical Education, London, UK
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14
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Nomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med 2022; 26:192-198. [PMID: 35712746 PMCID: PMC8857706 DOI: 10.5005/jp-journals-10071-24103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background/aim Patients in the intensive care units (ICUs) are at high risk of developing delirium and agitation. Physical restraint (PR) has increased to control these patients which accompanies by adverse consequences. The aim was to determine the PR use and associated factors in patients hospitalized at the ICUs in the North of Iran. Materials and methods In this cross-sectional study, a total of 272 patients in 3 ICUs of 5 Azar referral hospital affiliated to Golestan University of Medical Sciences (Gorgan, Iran) in 2018 were included. Confusion assessment method for the ICU (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), acute physiology and chronic health evaluation II (APACHE II), and Glasgow Coma Scale (GCS) were used to evaluate delirium, sedation level, disease severity, and level of consciousness, respectively. Analysis was done by STATA version 14.2 (StataCorp LP, College Station, Texas), univariate and multiple analyses. Results Data from 272 patients were analyzed (mean age of 45.8 ± 21.3 years). PR was used for 74.5% of patients. Restrained patients had more severe disease [mean of APACHE II score, 20.20 (7.5) vs 11.6 (7.1)], longer length of stay [mean of 10 (5.5) vs 5.5 (4.6) days], and lower level of consciousness [mean of GCS score, 8.7 (3.5) vs 13.5 (3.3)] than patients without it. CAM-ICU was positive in majority of patients (79.5 vs 10.4%) and agitation level of RASS score was higher in restrained patients (31.7 vs 3.0%). Associated factors in multiple analysis were use of sedative and psychoactive drugs [odds ratio (OR), 2.85; 95% confidence interval (CI): 1.04–7.82], presence of delirium (OR, 15.13; 95% CI: 4.61–49.65), deep sedation (OR, 0.04; 95% CI: 0.00–0.45), and GCS score (OR, 0.69; 95% CI: 0.53–0.9). Conclusion This study revealed the high use of PR in the ICUs, and use of sedative and psychoactive drugs, presence of delirium, deep sedation, and GCS score were such associated factors. How to cite this article Nomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med 2022;26(2):192–198.
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Affiliation(s)
- Mahin Nomali
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Student Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Yadegari
- Bandar-e gaz Shohada Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdis Nomali
- Alejalil Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahnaz Modanloo
- Nursing Research Center, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
- Mahnaz Modanloo, Nursing Research Center, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran, Phone: +01732456900; +989112739242, e-mail:
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15
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Siegrist-Dreier S, Barbezat I, Thomann S, Richter D, Hahn S, Schmitt KU. Restraining patients in acute care hospitals-A qualitative study on the experiences of healthcare staff. Nurs Open 2022; 9:1311-1321. [PMID: 35088948 PMCID: PMC8859077 DOI: 10.1002/nop2.1175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022] Open
Abstract
Aim The focus was to explore the perceptions and experiences of healthcare workers with respect to the use of restraints in acute care hospitals. Design The study followed a qualitative design. Methods Three topic‐based focus group interviews were conducted, involving 19 participants from the fields of nursing, physical therapy and medicine. For data collection and analysis, the method of mapping techniques for rapid qualitative data analysis was used. After discussing and validating the individual mind maps, all data were condensed to identify the key findings. Results Participants described restraints as safety measures for the patients. The implementation of most restraints was led by nurses. The use of restraints differed significantly, even in the interprofessional team. Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision‐making process.
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Affiliation(s)
- Sandra Siegrist-Dreier
- Department of Health Professions, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Isabelle Barbezat
- Academic-Practice-Partnership, University Hospital of Bern, Bern, Switzerland
| | - Silvia Thomann
- Department of Health Professions, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Dirk Richter
- Department of Health Professions, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Sabine Hahn
- Department of Health Professions, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland
| | - Kai-Uwe Schmitt
- Department of Health Professions, Division of Nursing, Bern University of Applied Sciences, Bern, Switzerland.,Academic-Practice-Partnership, University Hospital of Bern, Bern, Switzerland
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16
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Kawai Y, Hamamoto M, Miura A, Yamaguchi M, Masuda Y, Iwata M, Kanbe M, Ikematsu Y. Prevalence of and factors associated with physical restraint use in the intensive care unit: a multicenter prospective observational study in Japan. Intern Emerg Med 2022; 17:37-42. [PMID: 33852145 DOI: 10.1007/s11739-021-02737-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
Physical restraint is widely used in the intensive care unit (ICU) to ensure patient safety despite its ethical implications. We performed a prospective observational study in six ICUs in Japan to determine the prevalence of and factors associated with physical restraint use in the ICU, a phenomenon that has not yet been reported on in Japan. Data were collected on 10 random days between November 2018 and February 2019. We evaluated physical restraint use in ICU patients aged ≥ 20 years during the data collection days. Among the 787 observations, the prevalence of physical restraint use was 32.9%; however, it was 41.5% in patients receiving invasive mechanical ventilation (IMV). The average age of patients was 68.5 years, and the average Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score was 19.4. Among the included patients, 52.1% received IMV, and 17.2% were diagnosed with delirium. Logistic regression analysis revealed that the independent factors [odds ratio (95% confidence interval)] associated with physical restraint use were age [1.02 (1.00-1.05)], APACHE II score [1.05 (1.01-1.09)], IMV [2.15 (1.16-4.01)], central venous catheter indwelling [2.66 (1.46-4.85)], sedative medication [2.98 (1.72-5.17)], agitation [7.83 (2.96-20.8)], and delirium [4.16 (2.37-7.29)]. Approximately one-third of the ICU patients required physical restraint in Japan. In addition, physical restraint use was influenced by disease severity, mental condition, and the medical apparatus used. Based on these findings, further investigations are imperative to develop strategies to reduce physical restraint use.
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Affiliation(s)
- Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Miya Hamamoto
- Department of Nursing, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Atsuko Miura
- Intensive Care Unit, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-cho, Toyohashi, Aichi, 441-8570, Japan
| | - Mayumi Yamaguchi
- Intensive Care Unit, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yukari Masuda
- National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Maiko Iwata
- Department of Nursing, Nagoya City University Hospital, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan
| | - Miki Kanbe
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yuko Ikematsu
- Department of Nursing, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
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17
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Abraham J, Neef R, Meyer G, Möhler R. [Development and feasibility of an intervention to reduce physical restraints in hospitals: A mixed methods study]. Pflege 2021; 35:155-163. [PMID: 34939434 DOI: 10.1024/1012-5302/a000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Development and feasibility of an intervention to reduce physical restraints in hospitals: A mixed methods study Abstract. Background: Physical restraints (PR) are regularly used in people with dementia or delirium in general hospital settings. There is no clear evidence for the effectiveness of PR, but their use is associated with an increased risk for harm. Therefore, a restraint-free care is recommended. Aim: Development and feasibility test of an intervention to reduce PR in general hospital settings. Methods: Systematic literature reviews and theory-guided modelling of an intervention involving relevant clinical stakeholders and mixed methods study in two wards of a university hospital (geriatric traumatology and neurology). Results: The complex intervention comprises the following components: qualification of multipliers, interprofessional education about PR reduction, regular audit and feedback meetings, and the support regarding the aim of the intervention from nursing and medical leaders. The results of the feasibility test indicate that the intervention is feasible and helpful, but the interprofessional approach was not implemented as planned. An important barrier hampering PR reduction was the high workload. The results on the prevalence of PR could not be interpreted due to a very low number of measures applied. Conclusion: The complex intervention with a multiplier approach for preventing PR use was judged as feasible, but there is a need for further development to strengthen interprofessional cooperation. The feasibility of the intervention should also be tested in other departments.
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Affiliation(s)
- Jens Abraham
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Rüdiger Neef
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Abteilung für Alterstraumatologie, Universitätsklinikum Halle (Saale)
| | - Gabriele Meyer
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
| | - Ralph Möhler
- Institut für Gesundheits- und Pflegewissenschaft, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg.,Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät und Universitätsklinik Düsseldorf, Heinrich-Heine-Universität Düsseldorf
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18
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Okuno T, Itoshima H, Shin JH, Morishita T, Kunisawa S, Imanaka Y. Physical restraint of dementia patients in acute care hospitals during the COVID-19 pandemic: A cohort analysis in Japan. PLoS One 2021; 16:e0260446. [PMID: 34807945 PMCID: PMC8608313 DOI: 10.1371/journal.pone.0260446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 11/09/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals. Methods In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint. Results In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government’s announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic. Conclusion Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.
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Affiliation(s)
- Takuya Okuno
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Hisashi Itoshima
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Jung-ho Shin
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Tetsuji Morishita
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto City, Kyoto, Japan
- * E-mail:
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19
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Canzan F, Mezzalira E, Solato G, Mortari L, Brugnolli A, Saiani L, Debiasi M, Ambrosi E. Nurses' Views on the Use of Physical Restraints in Intensive Care: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189646. [PMID: 34574571 PMCID: PMC8464991 DOI: 10.3390/ijerph18189646] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/03/2022]
Abstract
Despite the worldwide promotion of a “restraint-free” model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses’ feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient’s bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person.
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Affiliation(s)
- Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
- Correspondence: ; Tel.: +39-045-8027288
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
| | - Giorgio Solato
- Cardiac Surgery Unit, San Bortolo Hospital, Viale Ferdinando Rodolfi, 37, 36100 Vicenza, Italy;
| | - Luigina Mortari
- Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy;
| | - Anna Brugnolli
- Centre of Higher Education for Health Sciences, Azienda Provinciale per i Servizi Sanitari, Via Briamasco 2, 38121 Trento, Italy; (A.B.); (M.D.)
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
| | - Martina Debiasi
- Centre of Higher Education for Health Sciences, Azienda Provinciale per i Servizi Sanitari, Via Briamasco 2, 38121 Trento, Italy; (A.B.); (M.D.)
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
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20
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Guenna Holmgren A, Juth N, Lindblad A, von Vogelsang AC. Nurses' experiences of using restraint in neurosurgical care - A qualitative interview study. J Clin Nurs 2021; 31:2259-2270. [PMID: 34514650 DOI: 10.1111/jocn.16044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To describe nurses' experiences of using restraint in neurosurgical care. BACKGROUND Despite reports of negative consequences, and conflicts with key values in healthcare, restraint measures are still practised in somatic healthcare worldwide. When using restraint, basic principles of nursing collide, creating dilemmas known to be perceived as difficult for many nurses. Patients in neurosurgical care are at high risk of being subjected to restraint, but research on nurses' experiences of using restraint in neurosurgical care are scarce. DESIGN A qualitative, descriptive design guided by a naturalistic inquiry was used. METHODS Semi-structured interviews with 15 nurses working in three neurosurgical departments in Sweden were analysed with inductive qualitative content analysis. COREQ reporting guidelines were used as reporting checklist. RESULTS The analysis resulted in one overarching theme, The struggling professional, and two categories. The category Internal struggle describes nurses' conflicting emotions and internal struggle when engaging in restraint. The category The struggle in clinical practice, describes how nurses struggle with handling restraint in clinical practice, and how the use of restraint is based on individual assessment rather than guidelines. CONCLUSION Nurses' experience restraint in neurosurgical care as a multi-layered struggle, ranging from inner doubts to practical issues. In order to enhance patient safety, there is a need for policies and guidelines regarding the use of restraint, as well as structured discussions and reflections for nurses engaged in the practice. RELEVANCE TO CLINICAL PRACTICE The results highlight the importance of clear guidelines, openness, support and teamwork for nurses working with patients at risk to be subjected to restraint, in order to create a safer care for patients as well as healthcare personnel. When developing guidelines and policies concerning restraint in somatic care, both practical issues such as the decision-making process, and the emotional effect on nurses should be considered.
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Affiliation(s)
- Amina Guenna Holmgren
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Department of Neurosurgery, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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21
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Physical Restraints in Critically Ill Children: A Multicenter Longitudinal Point Prevalence Study. Crit Care Med 2021; 49:1955-1962. [PMID: 34166295 DOI: 10.1097/ccm.0000000000005111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We elucidate to investigate the prevalence of and factors associated with the use of physical restraints among critically ill or injured children in PICUs. DESIGN This was a multicenter, longitudinal point prevalence study. SETTING We included 26 PICUs in Japan. PATIENTS Included children were 1 month to 10 years old. We screened all admitted patients in the PICUs on three study dates (in March, June, and September 2019). INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We collected prevalence and demographic characteristics of critically ill or injured children with physical restraints, as well as details of physical restraints, including indications and treatments provided. A total of 398 children were screened in the participating PICUs on the three data collection dates. The prevalence of children with physical restraints was 53% (211/398). Wrist restraint bands were the most frequently used means (55%, 117/211) for potential contingent events. The adjusted odds of using physical restraint in patients 1-2 years old was 2.3 (95% CI, 1.3-4.0) compared with children less than 1 year old. When looking at the individual hospital effect, units without a prespecified practice policy for physical restraints management or those with more than 10 beds were more likely to use physical restraints. CONCLUSIONS The prevalence of physical restraints in critically ill or injured children was high, and significant variation was observed among PICUs. Our study findings suggested that patient age, unit size, and practice policy of physical restraint could be associated with more frequent use of physical restraints.
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22
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Kısacık ÖG, Sönmez M, Coşğun T. Use of Physical Restraints in Critical Care Units: Nurses' Knowledge, Attitudes, and Practices. Crit Care Nurse 2021; 40:37-47. [PMID: 32476027 DOI: 10.4037/ccn2020856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Various factors affect the use of physical restraints in the intensive care unit, with nurses' knowledge and attitudes being the strongest determinants. OBJECTIVE To determine Turkish intensive care unit nurses' knowledge, attitudes, and practices regarding physical restraints and factors influencing them. METHODS This cross-sectional, correlational study was conducted in the intensive care units of state and university hospitals. A total of 191 nurses provided information on their sociodemographic and professional characteristics and completed a questionnaire on their knowledge, attitudes, and practices regarding physical restraints. RESULTS Statistically significant differences were found between average knowledge scores according to type of intensive care unit, weekly working hours, work shift, and frequency of using physical restraints, with the highest scores found in nurses who worked in the surgical unit, worked 40 hours a week, worked only during the day, and used physical restraints every day. Significant differences were found between average attitude scores according to type of intensive care unit, with the highest scores found in nurses who worked in the cardiology unit. Significant differences were found between average practice scores according to level of education and use of physical restraints without a physician's order, with the highest scores found in nurses with undergraduate and postgraduate degrees and those who did not use physical restraints without a physician's order. CONCLUSIONS This study revealed inadequate knowledge about physical restraints and some unsafe practices among participants. Evidence-based guidelines and laws regarding physical restraints are needed, as well as regular training programs for involved personnel.
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Affiliation(s)
- Öznur Gürlek Kısacık
- Öznur Gürlek Kısacık is an assistant professor, Nursing Department, Faculty of Health Science, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Münevver Sönmez
- Münevver Sönmez is an assistant professor, Nursing Department, Faculty of Health Science, Bülent Ecevit Health Sciences University, Zonguldak, Turkey
| | - Tuğba Coşğun
- Tuğba Coşğun is a clinical nurse, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
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23
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Thomann S, Hahn S, Bauer S, Richter D, Zwakhalen S. Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria. BMC Health Serv Res 2021; 21:367. [PMID: 33879134 PMCID: PMC8056521 DOI: 10.1186/s12913-021-06362-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). METHODS A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016-2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. RESULTS The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. CONCLUSIONS The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible.
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Affiliation(s)
- Silvia Thomann
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Sabine Hahn
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland
| | - Silvia Bauer
- Department of Nursing Science, Medical University of Graz, Universitätsplatz 4, 8010 Graz, Austria
| | - Dirk Richter
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland
- Center for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Murtenstrasse 46, 3008 Bern, Switzerland
- University Hospital for Psychiatry and Psychotherapy, University of Bern, Bolligenstrasse 111, 3060 Bern, Switzerland
| | - Sandra Zwakhalen
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, PO BOX 616, 6200 MD Maastricht, The Netherlands
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[Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain]. Salud Colect 2021; 17:e3045. [PMID: 33822542 DOI: 10.18294/sc.2021.3045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.
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Jöbges S, Biller-Andorno N. [Use of coercive measures in the intensive care unit]. Med Klin Intensivmed Notfmed 2021; 116:205-209. [PMID: 33660019 PMCID: PMC8016755 DOI: 10.1007/s00063-021-00800-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/07/2021] [Indexed: 11/17/2022]
Abstract
Zwangsbehandlungen in der Medizin umfassen Maßnahmen, die gegen eine aktuelle oder frühere Willensäußerung der betroffenen Person durchgeführt werden. Hierunter fällt auch die Überwindung manifestierter Widerstände z. B. bei nicht einwilligungsfähigen Patienten. Zwang gibt es nicht nur in der Psychiatrie, sondern kann auch auf der Intensivstation ausgeübt werden. Im Spannungsfeld zwischen intensivmedizinischer Behandlung, Fürsorge und Patientenwille besteht ein hohes Risiko für Zwangsbehandlungen sowie freiheitseinschränkende Maßnahmen. Häufig ist dem Team dieses moralische Spannungsfeld nur zum Teil bewusst. Vom Patienten wird Zwang als Kontrollverlust beschrieben und kann als traumatisierend, entwürdigend und stressauslösend wahrgenommen werden. Die Herausforderung für das Team einer hochspezialisierten Intensivstation besteht darin, den Patienten in seiner Individualität zu sehen und so weit wie möglich einzubinden. Um Zwang auf Intensivstation zu vermeiden und dem individuellen Patienten gerecht zu werden, muss die Problematik zuallererst wahrgenommen werden. Hilfreich zur Vermeidung von Zwang auf einer Intensivstation können Ausbildungskonzepte, eine ethische Reflexion im Team (Teamkultur), Supervision und psychologische Begleitung für Patienten und das Team sowie klinikinternen Standards sein. Diese Arbeit beschreibt Ursachen, verschiedene Formen und Häufigkeiten von Zwangsbehandlungen auf der Intensivstation sowie juristische Vorgaben. Es wird eine Annäherung versucht, welche intensivmedizinischen Maßnahmen mit der Ausübung von Zwang einhergehen können und wie Zwang von Patienten und dem Team wahrgenommen wird.
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Affiliation(s)
- S Jöbges
- Institut für Biomedizinische Ethik und Medizingeschichte (IBME), Universität Zürich, Winterthurerstrasse 30, 8006, Zürich, Schweiz.
| | - N Biller-Andorno
- Institut für Biomedizinische Ethik und Medizingeschichte (IBME), Universität Zürich, Winterthurerstrasse 30, 8006, Zürich, Schweiz
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Font R, Quintana S, Monistrol O. [Impact of family restrictions during COVID-19 pandemic on the use of physical restraint in an acute hospital: An observational study]. J Healthc Qual Res 2021; 36:263-268. [PMID: 34147410 PMCID: PMC8130495 DOI: 10.1016/j.jhqr.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/31/2021] [Accepted: 04/28/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION During the worldwide pandemic of COVID-19 caused by coronavirus SARS-CoV-2, hospitals developed contingency plans that transformed and reorganized the hospital activity. One of the measures was to restrict access to family members of hospitalized patients. The presence of the patient's family is considered an alternative to physical restraint. The aim of this study is to compare the use of physical restraint in hospitalized patients in an acute care hospital during the previous period of the pandemic of COVID-19 with the post-confinement period with hospitals being still closed to family. MATERIAL AND METHODS We made an observational study that compares the prevalence of physical restraint in an acute care hospital during the previous period to the alarm state (February 2020) with the second period, when visits where restricted (May 2020). From the clinical history of the patients with physical restraint we collected the following variables: sex, diagnostic, hospital admission unit, reason for using physical restraint, localization, length, type of material, registration in the medical record, information given to the family, alternatives to the physical restraint and injuries related to the physical restraint. RESULTS We evaluated 690 patients: 388 during the previous period and 320 during the second period. From all patients, 29 needed physical restraint. The use of physical restraint went from 8 (2%) to 21 (7%) (p=0.003). In the second period, a not statistically significant increase in continuous physical restraint was identified compared to the first period. CONCLUSIONS The physical restraint prevalence has been superior during the second period in which families were not present with the hospitalized patients.
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Affiliation(s)
- R. Font
- Área de Desarrollo de Enfermería, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España,Autor para correspondencia
| | - S. Quintana
- Unidad de Críticos y Semicríticos, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
| | - O. Monistrol
- Área de Desarrollo de Enfermería, Hospital Universitari Mútua Terrassa, Terrassa, Barcelona, España
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Soeno S, Takada T, Takeshima T, Kaneyama M, Sagawa M, Hayashi M, Miyashita J, Azuma T, Fukuma S, Fukuhara S. Association between the use of physical restraint and functional decline among older inpatients admitted with pneumonia in an acute care hospital: A retrospective cohort study. Arch Gerontol Geriatr 2020; 94:104330. [PMID: 33493952 DOI: 10.1016/j.archger.2020.104330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
AIM This study was conducted to investigate the association between the use of physical restraint and functional decline in older inpatients admitted with pneumonia in an acute care setting. Although several adverse effects related to restraint use have been reported, few researchers have examined this subject in acute care settings. METHODS This retrospective cohort study was conducted at a 471-bed, acute care hospital in Japan. Patients 65 years old and older who were admitted with pneumonia between April 2015 and September 2017 were included. The use of restraints (belts and/or mittens) was recorded for every 8-hour shift. The number of shifts during which each patient was restrained was used as an explanatory variable. The primary outcome was the Katz ADL score at discharge. We used multiple linear regression analysis to adjust for confounding factors. RESULTS Of 403 patients, 94 required physical restraints. The mean age was 84.5 years (standard deviation [SD] 8.2); 44.4% were women. The mean Katz score on admission was 2.7 (SD 2.4). For multiple linear regression analysis, the coefficient of the number of restraints used was -0.024 (95% confidence interval: -0.044, -0.003, p = .022). Consequently, the restraint use for 13.9 days was associated with the decrease in the Katz score by 1.0. CONCLUSIONS Results suggest that physical restraint use is associated with functional decline among older inpatients admitted with pneumonia in acute care settings.
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Affiliation(s)
- Shoko Soeno
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan.
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Taro Takeshima
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan
| | - Mirei Kaneyama
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Manami Sagawa
- Nursing Service Department, Shirakawa Kosei General Hospital, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Michio Hayashi
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Teruhisa Azuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan
| | - Shingo Fukuma
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Human Health Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, 2-1 Toyochi Kamiyajiro, Shirakawa, Fukushima 961-0005, Japan; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Center for Innovative Research for Communities and Clinical Excellence (CIRC(2)LE), Fukushima Medical University, 1 Hikarigaoka, Fukushima 960-1295, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, 54 Syogoinkawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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Yu TK, Suen LKP, Liu YB, Wong ALY, Lai CKY. Patient safety and bedrail use as a global phenomenon: A prevalence study. Contemp Nurse 2020; 56:204-214. [PMID: 33121361 DOI: 10.1080/10376178.2020.1844576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Although bedrail use may increase the risk of accidents among patients, bedrails are still extensively used in healthcare facilities. Therefore, the field calls for a review of bedrail use in practice. Objective: This report examined the prevalence and implications of bedrail use in rehabilitation facilities in Hong Kong. The findings are compared with the current state of bedrail use worldwide. Design and methods: This work is a cross-sectional, observational study. A secondary analysis was conducted on the database of a prospective trial. Bilateral bedrail use was observed in two Hong Kong rehabilitation hospitals. Logistic regression was performed to examine the factors associated with bedrail use. Results: A total of 3,384 restraint observations were made. The bedrail rate was 31.34%, which revealed that bedrail use was the second most commonly used physical restraint. The fall history (OR: 2.84), cognitive impairment (OR: 0.91) and functional dependency (OR: 0.79) of patients were significant predictors of bedrail use, p < .05. Conclusion: This study examines bedrail prevalence through direct observation, which is the preferred method for examining bedrail use in practice. We found that actual bedrail use is higher than the numbers reported in previous studies in Hong Kong. In addition, our research reveals that bedrails are commonly used for vulnerable patients. This finding highlights the need to change nurses' beliefs on bedrail use through education. The management of these health facilities should also aim to create an institutional environment that promotes the reduction of bedrail use. Implementation strategies on restraint reduction should also fit the culture of the organisation and local nursing practices, as well as the staff's values. Impact Statement: This study provides preliminary information about the widespread use of bedrails in Hong Kong and other countries. The research also introduces effective ways to achieve the reduction of bedrail use.
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Affiliation(s)
- Tsz Kiu Yu
- Department of Social Work, The Chinese University of Hong Kong, Room 101, T.C. Cheng Building, Shatin, New Territories, HKSAR, Hong Kong
| | - Lorna Kwai-Ping Suen
- School of Nursing, The Hong Kong Polytechnic University, GH520, School of Nursing, Hung Hom, Kowloon, HKSAR, Hong Kong
| | - Yong-Bing Liu
- Department of Nursing, Yangzhou University, No. 88, South Road, Yangzhou, Jiangsu 225009, People's Republic of China
| | - Adrienne Lei Yung Wong
- Department of Social Work, The Chinese University of Hong Kong, Room 101, T.C. Cheng Building, Shatin, New Territories, HKSAR, Hong Kong
| | - Claudia Kam Yuk Lai
- School of Nursing, The Hong Kong Polytechnic University, GH520, School of Nursing, Hung Hom, Kowloon, HKSAR, Hong Kong
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Thomann S, Zwakhalen S, Richter D, Bauer S, Hahn S. Restraint use in the acute-care hospital setting: A cross-sectional multi-centre study. Int J Nurs Stud 2020; 114:103807. [PMID: 33217663 DOI: 10.1016/j.ijnurstu.2020.103807] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/07/2020] [Accepted: 10/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Restraints are likely to negatively affect patients' health and therefore a reduction in their usage is recommended for all health-care settings. To date, research on restrictive practices has concentrated on mental health and long-term care settings. In the acute-care hospital setting few studies have been published and these studies mainly focus on physical/mechanical restraints in specific subpopulations and/or on intensive care units. However, to ensure restraints are used as little as possible in the acute-care hospital setting, it seems important to investigate more comprehensively the use of restraints, to include all types of restraints irrespective of ward type or subpopulations and to identify factors associated with restraint use. OBJECTIVE The aim of this study was to investigate restraint use regardless of ward type in the acute-care hospital setting, including restraint type, reasons for restraint use, process indicators when using restraints and restraint use-associated patient characteristics. METHODS Using a cross-sectional multi-centre design, data were collected by means of an annual international prevalence measurement in acute-care hospitals in Switzerland and Austria. All hospitalised patients aged 18+ who gave informed consent were included. Data were collected at three measurement points between 2016 and 2018. Descriptive and multivariate logistic regression analyses were performed. RESULTS A total of 29,477 patients hospitalised in 140 hospitals were included in this study. The prevalence rate for the use of at least one restraint over a 30-day period was 8.7% (n = 2577), with mechanical restraints representing the highest proportion of restraint type used (55.0%, n = 1417). The main reason for restraint use was fall prevention (43.8%, n = 1129), followed by confusion or delirious behaviour (20.4%, n = 525). In 64.3% of the cases (n = 1657), restraint use was documented in the patient file. Regular evaluation occurred in 42.9% of the cases (n = 1105). Care dependency had the strongest association with restraint use (odds ratio [OR] 25.00, 95% confidence interval [CI] 21.01-29.78 for completely dependant patients in comparison to completely independent patients), followed by mental and behavioural disorders (OR 2.36, 95% CI 2.15-2.59). CONCLUSIONS Restraints are often utilised in hospitals in complex care situations such as with patients at risk of falling or with delirium. When using restraints the consideration of processes like documentation and evaluation shows great potential for improvement. Standardisation of these processes and education of the interprofessional team could be beneficial for raising awareness and for the sustainable reduction of restraint use. Tweetable abstract: In hospitals restraints are often used in complex care situations. However, their use seems to be insufficiently documented and evaluated.
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Affiliation(s)
- Silvia Thomann
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland,.
| | - Sandra Zwakhalen
- Department of Health Services Research, Maastricht University, Care and Public Health Research Institute, PO BOX 616, 6200 MD, Maastricht, the Netherlands.
| | - Dirk Richter
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland,; Center for Psychiatric Rehabilitation, Bern University Hospital for Mental Health, Murtenstrasse 46, 3008 Bern, Switzerland; University of Bern, University Hospital for Psychiatry and Psychotherapy, Bolligenstrasse 111, 3060 Bern, Switzerland.
| | - Silvia Bauer
- Medical University of Graz, Department of Nursing Science, Universitätsplatz 4, 8010 Graz, Austria.
| | - Sabine Hahn
- Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008 Bern, Switzerland,.
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Lei R, Jiang X, Liu Q, He H. Nurse education to reduce physical restraints use in ICU: A scoping review. Nurs Crit Care 2020; 27:824-837. [PMID: 32969127 DOI: 10.1111/nicc.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physical restraints are defined as a manual approach to reduce a patient's physical movement and has been regarded as a protective nursing measure in the intensive care unit (ICU) to avoid unplanned extubation, falls, and other unexpected events. However, the limitations and changes associated with physical restraints have been verified by several studies. Restraint minimization has been advocated by studies worldwide; however, the most effective interventions are still being explored. AIM To identify and map nurse education strategies that reduce the use of physical restraints in the ICU. DESIGN AND METHODS A systematic literature search that followed the steps of a scoping review was performed in the Cochrane, PubMed, Embase, CINAHL, CNKI, Wan Fang Data, and VIP databases. We included studies that focused on nurse education aiming to reduce the use of physical restraints and/or use physical restraints reasonably. RESULTS The included studies (n = 12) described a variety of education strategies. Two delivery modes, eight common course durations, 14 main topics, two types of teaching methods with various materials, and two kinds of outcome measurements were identified and compared. CONCLUSION There are a variety of nurse education activities that could effectively improve ICU nurses' knowledge, attitudes, and behaviours towards physical restraints. However, the strategies of nurse education, such as delivery mode, teaching methods, and outcome measurements, require further study. RELEVANCE TO CLINICAL PRACTICE Nurse education on physical restraints should be carried out in ICUs. Online courses, practical sessions, and simulated scenarios should be a part of future nurse education. In addition to nurses' knowledge and attitude changes, frequency of physical restraints and other patient-related outcomes should also be considered for outcome evaluation.
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Affiliation(s)
- Ruobing Lei
- Nursing Department; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Xiaoping Jiang
- Nursing Department; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Qin Liu
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, P.R. China
| | - Hui He
- Nursing Department; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
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Factors influencing critical care nurses’ intentions to use physical restraints adopting the theory of planned behaviour: A cross-sectional multicentre study. Aust Crit Care 2020; 33:426-435. [DOI: 10.1016/j.aucc.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023] Open
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Abraham J, Hirt J, Kamm F, Möhler R. Interventions to reduce physical restraints in general hospital settings: A scoping review of components and characteristics. J Clin Nurs 2020; 29:3183-3200. [PMID: 32558091 DOI: 10.1111/jocn.15381] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/26/2020] [Accepted: 06/05/2020] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To describe the characteristics of interventions for reducing physical restraints in general hospital settings. BACKGROUND Physical restraints, such as bedrails and belts in beds and chairs, are commonly used in general hospital settings. However, there is no clear evidence on their effectiveness but some evidence on potential risks for harm. DESIGN Scoping review. METHODS We conducted a systematic database search (MEDLINE via PubMed, CINAHL, Cochrane Library; March 2020) and snowballing techniques. We included both interventional studies and quality improvement projects conducted in general hospital settings and published in English or German language. Two reviewers independently performed the study selection and data extraction. The Scoping Reviews (PRISMA-ScR) Checklist was used. RESULTS We included 31 articles (published between 1989 and 2018), 15 quality improvement projects and 16 intervention studies. Only five studies used a controlled design. Most studies and quality improvement projects investigated multicomponent interventions including education (predominantly for nursing staff) and additional components (e.g. case conferences). Three studies examined simple educational programmes without additional components. CONCLUSIONS A large number of multicomponent interventions for preventing and reducing physical restraints in general hospital settings have been developed. The interventions differed widely regarding the components, contents and settings. Well-designed evaluation studies investigating the effects of such interventions are lacking. RELEVANCE TO CLINICAL PRACTICE Multicomponent educational interventions might be one approach to change clinical practice, but only insufficient information is available about potential effects of these approaches.
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Affiliation(s)
- Jens Abraham
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Julian Hirt
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of Health, Center for Dementia Care, Institute of Applied Nursing Sciences, FHS St. Gallen, St. Gallen, Switzerland
| | - Friederike Kamm
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,School of Public Health, Bielefeld University, Bielefeld, Germany
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Sharifi A, Arsalani N, Fallahi-Khoshknab M, Mohammadi-Shahbolaghi F, Ebadi A. Iranian nurses' perceptions about using physical restraint for hospitalized elderly people: a cross-sectional descriptive-correlational study. BMC Geriatr 2020; 20:233. [PMID: 32631236 PMCID: PMC7339549 DOI: 10.1186/s12877-020-01636-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/01/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Using physical restraint (PR) for hospitalized elderly people is a major nursing challenge. It is associated with different physical and mental complications and ethical dilemmas, though many nurses still use it to ensure patient safety. Nurses' perceptions are one of the most important factors affecting PR use. This study aimed to evaluate Iranian nurses' perceptions about PR use for hospitalized elderly people. METHODS This cross-sectional descriptive-correlational study was conducted from July to December 2019. Participants were 270 hospital nurses who were purposively recruited from intensive care units and medical and surgical wards of three teaching hospitals in Kermanshah, Iran. Data were collected using a demographic questionnaire and the Perceptions of Restraint Use Questionnaire (PRUQ). The SPSS software (v. 23.0) was used for data analysis through the independent-sample t test, the one-way analysis of variance, and the multiple regression analysis. RESULTS The total mean score of PRUQ was 4.08 ± 0.12 in the possible range of 1-5. The most important reasons for PR use were to prevent patients from falling out of bed and to prevent them from pulling out catheters. The total mean score of PRUQ had significant relationship with participants' age, work experience, and history of receiving PR-related educations (P < 0.05), but had no significant relationship with their gender, educational degree, and affiliated hospital ward (P > 0.05). CONCLUSION This study suggests that nurses attach high importance to PR use for hospitalized elderly people. Healthcare policy-makers at national and hospital levels are recommended to provide nurses with PR-related educations in order to reduce the rate of PR-related complications.
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Affiliation(s)
- Azam Sharifi
- Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Arsalani
- Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | | | | | - Abbas Ebadi
- Nursing School, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Shen X, Hu B, Pang X, Lin J, Yin X, Jiang Y, Zhao Y, Liu Q, Zhu X. Nurses' behaviours towards physical restraint use in the ICU: A descriptive qualitative study. Int J Nurs Pract 2020; 27:e12868. [PMID: 32608564 DOI: 10.1111/ijn.12868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022]
Abstract
AIMS AND OBJECTIVES The study aims to explore and describe nurses' behaviours towards physical restraint (PR) use in intensive care units (ICUs) and identify key characteristics of these experiences. BACKGROUND Patients within the ICU are always vulnerable, which requires a thoughtful deliberation when employing PR in ethically laden situations. Considering that the qualitative study on nurses' behaviours towards PR use in ICUs is limited, a deep understanding of how nurses reason and restrict patients is necessary before developing a minimizing programme in hospitals. METHODS A descriptive qualitative study was conducted in this paper. Data were collected by 24 semistructured, in-depth and individual interviews about PR, where 24 nurses were drawn from six ICUs of four hospital settings from a comprehensive tertiary care hospital in Qingdao. The QSR NVivo 11.0 software program was used to manage the interview data, and data analysis was guided by the Qualitative Analysis Guide of Leuven. The checklist of Consolidated Criteria for Reporting Qualitative Studies was followed as a guideline in reporting the study. RESULTS Regarding PR, nurses' behaviours start with a hazard perception, followed by hesitation about whether to restrict the patient. They would usually decide to apply PR when they think that no other choice to control the situation is available. Then, they would reflect on and rationalize their behaviours. Nurses, intensivists, patients and their families participate in and affect this process directly or indirectly. CONCLUSIONS Nurses' behaviours towards PR use comprise a series of complex processes centred on safety. Nurses' decision making should be performed with the participation of intensivists, patients and family caregivers.
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Affiliation(s)
- Xiufang Shen
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Bo Hu
- Department of Thoracic surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xufeng Pang
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Lin
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaomeng Yin
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Yuanyuan Jiang
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Yaling Zhao
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Qingwei Liu
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Xiuli Zhu
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
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Lawson TN, Tan A, Thrane SE, Happ MB, Mion LC, Tate J, Balas MC. Predictors of New-Onset Physical Restraint Use in Critically Ill Adults. Am J Crit Care 2020; 29:92-102. [PMID: 32114609 DOI: 10.4037/ajcc2020361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Physical restraints are frequently used for intensive care patients and are associated with substantial morbidity. The effects of common evidence-based critical care interventions on use of physical restraints remain unclear. OBJECTIVE To identify independent predictors of new-onset use of physical restraints in critically ill adults. METHODS Secondary analysis of a prospective cohort study involving 5 adult intensive care units in a tertiary care medical center in the United States. Use of physical restraints was determined via daily in-person assessments and medical record review. Mixed-effects logistic regression analysis was used to examine factors associated with new-onset use of physical restraints, adjusting for covariates and within-subject correlation among intensive care unit days. RESULTS Of 145 patients who were free of physical restraints within 48 hours of intensive care unit admission, 24 (16.6%) had restraints newly applied during their stay. In adjusted models, delirium (odds ratio [OR], 5.09; 95% CI, 1.83-14.14), endotracheal tube presence (OR, 3.47; 95% CI, 1.22-9.86), and benzodiazepine administration (OR, 3.17; 95% CI, 1.28-7.81) significantly increased the odds of next-day use of physical restraints. Tracheostomy was associated with significantly lowered odds of next-day restraint use (OR, 0.13; 95% CI, 0.02-0.73). Compared with patients with a target sedation level, patients who were in a coma (OR, 2.56; 95% CI, 0.80-8.18) or deeply sedated (OR, 2.53; 95% CI, 0.91-7.08) had higher odds of next-day use of physical restraints, and agitated patients (OR, 0.08; 95% CI, 0.00-2.07) were less likely to experience restraint use. CONCLUSION Several potentially modifiable risk factors are associated with next-day use of physical restraints.
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Affiliation(s)
- Thomas N Lawson
- Thomas N. Lawson is a doctoral student at The Ohio State University College of Nursing and an acute care nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alai Tan
- Alai Tan is a research associate professor, The Ohio State University College of Nursing
| | - Susan E Thrane
- Susan E. Thrane is an assistant professor, The Ohio State University College of Nursing
| | - Mary Beth Happ
- Mary Beth Happ is a professor and Associate Dean for Research and Innovation, The Ohio State University College of Nursing
| | - Lorraine C Mion
- Lorraine C. Mion is a professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center
| | - Judith Tate
- Judith Tate is an assistant professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center
| | - Michele C Balas
- Thomas N. Lawson is a doctoral student at The Ohio State University College of Nursing and an acute care nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio. Alai Tan is a research associate professor, Susan E. Thrane is an assistant professor, Mary Beth Happ is a professor and Associate Dean for Research and Innovation, and Michele C. Balas is an associate professor, The Ohio State University College of Nursing. Lorraine C. Mion is a professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center. Judith Tate is an assistant professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center
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de Bruijn W, Daams JG, van Hunnik FJG, Arends AJ, Boelens AM, Bosnak EM, Meerveld J, Roelands B, van Munster BC, Verwey B, Figee M, de Rooij SE, Mocking RJT. Physical and Pharmacological Restraints in Hospital Care: Protocol for a Systematic Review. Front Psychiatry 2020; 10:921. [PMID: 32184738 PMCID: PMC7058582 DOI: 10.3389/fpsyt.2019.00921] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 11/19/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Physical and pharmacological restraints, defined as all measures limiting a person in his or her freedom, are extensively used to handle unsafe or problematic behavior in hospital care. There are increasing concerns as to the extent with which these restraints are being used in hospitals, and whether their benefits outweigh their potential harm. There is currently no comprehensive literature overview on the beneficial and/or adverse effects of the use of physical and pharmacological restraints in the hospital setting. METHODS A systematic review of the existing literature will be performed on the beneficial and/or adverse effects of physical and pharmacological restraints in the hospital setting. Relevant databases will be systematically searched. A dedicated search strategy was composed. A visualization of similarities (VOS) analysis was used to further specify the search. Observational studies, and if available, randomized controlled trials reporting on beneficial and/or adverse effects of physical and/or pharmacological restraints in the general hospital setting will be included. Data from included articles will be extracted and analyzed. If the data is suitable for quantitative analysis, meta-analysis will be applied. DISCUSSION This review will provide data on the beneficial and/or adverse effects of the use of physical and pharmacological restraints in hospital care. With this review we aim to guide health professionals by providing a critique of the available evidence regarding their choice to either apply or withhold from using restraints. A limitation of the current review will be that we will not specifically address ethical aspects of restraint use. Nevertheless, the outcomes of our systematic review can be used in the composition of a multidisciplinary guideline. Furthermore, our systematic review might determine knowledge gaps in the evidence, and recommendations on how to target these gaps with future research. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42019116186.
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Affiliation(s)
- Wendy de Bruijn
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joost G. Daams
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - A. M. Boelens
- Department of Geriatrics, UMCG, Groningen, Netherlands
| | - Ellen M. Bosnak
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Barbara C. van Munster
- Department of Internal Medicine/Geriatrics, Gelre Hospitals and UMCG, Groningen, Netherlands
| | - Bas Verwey
- Department of Hospital Psychiatry, NVvP, Utrecht, Netherlands
| | - Martijn Figee
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Psychiatry, Icahn Medical School at Mount Sinai, New York, NY, United States
| | | | - Roel J. T. Mocking
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Salehi Z, Joolaee S, Hajibabaee F, Ghezeljeh TN. The challenges of using physical restraint in intensive care units in Iran: A qualitative study. J Intensive Care Soc 2020; 22:34-40. [PMID: 33643430 DOI: 10.1177/1751143719892785] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018-2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.
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Affiliation(s)
- Zahra Salehi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soodabeh Joolaee
- Nursing Care Research Centre, Iran University of Medical Sciences, Isfahan, Tehran, Iran.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada
| | - Fatemeh Hajibabaee
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Centre, Iran University of Medical Sciences, Isfahan, Tehran, Iran
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Ritzi S, Kruse A. [Dignity, freedom, embodiment : Ethical categories concerning the use of freedom-depriving measures in people with dementia in acute care settings]. Z Gerontol Geriatr 2019; 52:243-248. [PMID: 31602507 DOI: 10.1007/s00391-019-01622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
The use of freedom-depriving measures (physical and medicinal restraints) in people with cognitive impairment or dementia in clinical care settings is of ongoing importance. At the same time, these coercive measures are not only heavily debated but also in most cases ethically questionable from the perspective of the ethics of human dignity. Usually, the ethical evaluation of freedom-depriving measures follows classical paradigms of medical ethics, such as the Principles of Biomedical Ethics by Beauchamp and Childress. To enrich the debate at this point, the ethical category of embodiment ("Leiblichkeit" ) is introduced and discussed after a short summary of the ethical problem at hand. The phenomenon of the living body that has received increasingly more attention in several sciences since the proclaimed "corporeal turn" enables new perspectives towards human dignity, freedom and deprivation of freedom: freedom-depriving measures do not take place in an invisible realm of ideas but are directly applied to the psychophysical unity that is the living body of a person. Thus, freedom-depriving measures are an intervention into the bodily autonomy of the human being and the personal freedom that is manifested in the living body. The concept of the living body ("Leib") that is applied here, signifies more than just a physical object and is especially apt to capture the (inter)subjective dimension that has to be taken into account here. Finally, it will have to be investigated whether the use of medicinal restraints represents an especially serious interference into the sphere of human embodiment. Once introduced into the debate on freedom-depriving measures in clinical care, the category of embodiment can warrant decisive new emphases.
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Affiliation(s)
- S Ritzi
- Institut für Gerontologie, Universität Heidelberg, Heidelberg, Deutschland. .,Institut für Gerontologie, Netzwerk Alternsforschung (NAR), Bergheimer Straße 20, 69115, Heidelberg, Deutschland.
| | - A Kruse
- Institut für Gerontologie, Universität Heidelberg, Heidelberg, Deutschland
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Moore C, Damari N, Liles EA, Bramson B. Who You Gonna Call? Outcomes of a Team-Based Approach to Respond to Disruptive Behavioral Issues in Hospitalized Patients. Jt Comm J Qual Patient Saf 2019; 45:781-785. [PMID: 31582223 DOI: 10.1016/j.jcjq.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The behavioral response system (BRS) at one institution is designed to bring immediate resources to bear when hospitalized patients experience acute episodes of disruptive behavior. The goal of this study was to describe the patient population, inciting events, and outcomes of the BRS. METHODS The researchers identified all patients admitted to the institution from July 2016 to June 2017 for whom the BRS was activated. Descriptive statistics were calculated, and logistic regression was used to evaluate associations between demographic and clinical characteristics and use of physical and/or chemical restraints. RESULTS There were 271 BRS calls (range: 0-9 per day). One injury every month occurred for patients and hospital staff. Men, African Americans, and older patients were significantly overrepresented in BRS calls when compared to the overall hospital population. Either chemical or physical restraints were used in 68.7% of cases: 53.9% of patients (or visitors) received chemical restraints, 28.8% were placed in physical restraints, and 17.7% were placed in manual holds. In multivariate analyses, use of physical and chemical restraints were correlated with age ≥ 65 years. Having a dementia/delirium diagnosis was the only significant predictor of chemical restraints, and threatening harm to staff or self was a significant predictor of the use of physical restraints. CONCLUSION Our study adds to the growing body of knowledge describing how BRSs interact with patients and hospital staff at large academic medical centers. Future studies should focus on investigating if implicit bias influences provider activation of the BRS and reducing the need for patient restraints.
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Kavak F, Yılmaz E, Okanlı A, Aslanoğlu E. The effect of psychoeducation given to psychiatry nurses on level of knowledge, attitudes, and practices regarding physical restraint: A randomized controlled study. Perspect Psychiatr Care 2019; 55:743-751. [PMID: 31390072 DOI: 10.1111/ppc.12429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/20/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aims to determine the effect of psychoeducation, given to nurses working in a psychiatry clinic, on level of knowledge, attitudes, and practices regarding physical restraint. DESIGN AND METHODS This study was conducted with a randomized-controlled-study design. A total of 111 nurses were recruited and randomly assigned to experimental (n = 53) and control (n = 58) groups. The experimental group received psychoeducation, while no intervention was applied to the control group. This study was conducted in a psychiatric hospital located in the Eastern Anatolia of Turkey. A Descriptive Form and the Levels of Knowledge, Attitudes, and Practices of Nurses Regarding Physical Restraints Questionnaire were used to collect data. FINDINGS Statistically significant differences were found between the pretest and posttest total mean scores on the level of knowledge (P = .000), attitudes (P = .000), and practices (P = .000) of the nurses in the control group and the study group. PRACTICE IMPLICATIONS An increase in the level of knowledge and positive improvement in attitudes and practices were observed in the nurses who received psychoeducation. Providing nurses with psychoeducation on physical restraint can positively contribute to improving their level of knowledge and to eliminating their negative attitudes and practices on this subject.
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Affiliation(s)
- Funda Kavak
- Department of Psychiatric Nursing, Inonu Unıversıty, Malatya, Turkey
| | - Emine Yılmaz
- Department of Psychiatric Nursing, Bıngol Unıversıty, Bingöl, Turkey
| | - Ayşe Okanlı
- Department of Psychiatric Nursing, Istanbul Medeniyet Unıversıty, Istanbul, Turkey
| | - Eren Aslanoğlu
- Elazığ Mental Health and Illness Hospital, Elazığ, Turkey
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Guenna Holmgren A, Juth N, Lindblad A, von Vogelsang AC. Restraint in a Neurosurgical Setting: A Mixed-Methods Study. World Neurosurg 2019; 133:104-111. [PMID: 31568917 DOI: 10.1016/j.wneu.2019.09.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the extent to which restraint is used in neurosurgical care, under what circumstances, and how it is documented. METHODS A cross-sectional study with a mixed-methods approach was used to identify neurosurgical inpatients subjected to restraint. The data were collected in 2 phases: (1) a study-specific questionnaire was distributed to nurses in which they identified if restraints had occurred during their shifts, and if so, which restraint and to which patient; and (2) scrutinizing of electronic medical records of patients identified by the questionnaires. Numeric data were analyzed using descriptive and analytic statistical methods, and textual data were analyzed using qualitative content analysis. The findings from the different data sources were compared and merged. RESULTS Of the 517 patients admitted to the studied department during the study period, 58 (11%) were reported to have been subjected to restraint and most of the restraining events occurred in the neurointensive care unit. Most restraint measures were not documented in the electronic medical records. The identified patients were predominantly diagnosed with traumatic brain injury or subarachnoid hemorrhage. The qualitative content analysis showed the circumstances when restraints were used: when patients were considered a danger to self or others (theme) and which symptoms and behaviors (categories) were observed in relation to the use of restraint. CONCLUSIONS Restraint in neurosurgical care is mostly used to prevent patients from harming themselves or others. Because of the lack of documentation, restraint measures cannot be openly assessed, thus putting patients' safety at risk.
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Affiliation(s)
- Amina Guenna Holmgren
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
| | - Niklas Juth
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2019; 46:e825-e873. [PMID: 30113379 DOI: 10.1097/ccm.0000000000003299] [Citation(s) in RCA: 1715] [Impact Index Per Article: 343.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. METHODS Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. RESULTS The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. CONCLUSIONS We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.
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Lüdecke D, Poppele G, Klein J, Kofahl C. Quality of life of patients with dementia in acute hospitals in Germany: a non-randomised, case-control study comparing a regular ward with a special care ward with dementia care concept. BMJ Open 2019; 9:e030743. [PMID: 31494617 PMCID: PMC6731932 DOI: 10.1136/bmjopen-2019-030743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To identify factors that predict the quality of life (QoL) of patients with dementia in acute hospitals and to analyse if a special care concept can increase patients' QoL. DESIGN A non-randomised, case-control study including two internal medicine wards from hospitals in Hamburg, Germany. SETTING AND PARTICIPANTS In all, 526 patients with dementia from two hospitals were included in the study (intervention: n=333; control: n=193). The inclusion criterion was an at least mild cognitive impairment or dementia. The intervention group was a hospital with a special care ward for internal medicine focusing on patients with dementia. The control group was from a hospital with a regular care ward without special dementia care concept. OUTCOME MEASURES Our main outcome was the QoL (range 0-100) from patients with dementia in two different hospitals. A Bayesian multilevel analysis was conducted to identify predictors such as age, dementia, agitation, physical and chemical restraints, or functional limitations that affect QoL. RESULTS QoL differs significantly between the control (40.7) and the intervention (51.2) group (p<0.001). Regression analysis suggests that physical restraint (estimated effect: -4.9), psychotropic drug use (-4.4) and agitation (-2.9) are negatively associated with QoL. After controlling for confounders, the positive effect of the special care concept remained (5.7). CONCLUSIONS A special care ward will improve the quality of care and has a positive impact on the QoL of patients with dementia. Health policies should consider the benefits of special care concepts and develop incentives for hospitals to improve the QoL and quality of care for these patients.
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Affiliation(s)
- Daniel Lüdecke
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Poppele
- Station DAVID, Evangelisches Krankenhaus Alsterdorf, Hamburg, Germany
| | - Jens Klein
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christopher Kofahl
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Souza LMDS, Santana RF, Souza MVD, Rembold SM, Menezes AK. Pressure injury associated with mechanical restraint: a cross-sectional study. ESTIMA 2019. [DOI: 10.30886/estima.v17.703_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To verify the association of the practice of mechanical restraint with pressure injury (PI) in hospitalized patients. Method: A cross-sectional study of 111 patients from medical, surgical and intensive care units at a public hospital in the state of Rio de Janeiro, Brazil. To analyze the association between variables, the [odds ratio (OR)] was adopted. Results: It were found 57 patients in mechanical restraint (51.4%). In the group of patients contained, the occurrence of PI was estimated in 43.9% and in the group of patients not contained in 5.6%. The chance of the contained patient to present PI was 13 times higher than in patients not contained. The location of the injury was more frequently in the sacral region, classified as stage 2 (21.1%) and stage 3 (12.3%), followed by trochanter (15.8%) and calcaneus (10.5%). Conclusion: It is recommended the adoption of nursing practices of suppression or reduction of the time in the use of mechanical restraint, adopting educational measures and prevention of PI.
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Souza LMDS, Santana RF, Souza MVD, Rembold SM, Menezes AK. Lesão por pressão associada à contenção mecânica: estudo transversal. ESTIMA 2019. [DOI: 10.30886/estima.v17.703_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo: Verificar associação da prática de contenção mecânica com lesão por pressão (LP) em pacientes hospitalizados. Método: Estudo transversal realizado com 111 pacientes de unidades de clínica médica, cirúrgica e de terapia intensiva em um hospital público do estado do Rio de Janeiro, Brasil. Para analisar a associação entre as variáveis, adotou-se a razão de chances [odds ratio (OR)]. Resultados: Encontraram-se 57 pacientes em contenção mecânica (51,4%). No grupo de pacientes contidos, a ocorrência de LP foi estimada em 43,9% e, no grupo de não contidos, em 5,6%. A chance de o paciente contido apresentar LP foi 13 vezes maior do que em pacientes não contidos. A localização da lesão foi mais frequentemente na região sacra, classificada em estágio 2 (21,1%) e estágio 3 (12,3%), seguida de trocânter (15,8%) e calcâneo (10,5%). Conclusão: Recomenda-se a adoção de práticas de enfermagem de supressão ou redução do tempo no uso da contenção mecânica, adotando medidas educativas e de prevenção da LP.
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Souza LMDS, Santana RF, Capeletto CDSG, Menezes AK, Delvalle R. Factors associated with mechanical restraint in the hospital environment: a cross-sectional study. Rev Esc Enferm USP 2019; 53:e03473. [PMID: 31215614 DOI: 10.1590/s1980-220x2018007303473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 12/13/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of mechanical restraint in the hospital environment and the factors associated with its performance. METHOD A cross-sectional, observational study with patients from a public hospital from the medical clinic, surgical clinic and intensive care unit evaluated by descriptive, univariate and multivariate analyses. RESULTS One hundred eleven (111) patients participated in the study. The prevalence of mechanical restraint was 51.4%; bilateral rails on the bed were used in 100% of the restraints, and bilateral wrist restraints were also observed in 29.8%. The most common justifications were the risk of falls (100.0%) and the risk of non-scheduled removal of invasive devices (57.9%). The restrained patients differ significantly from those not restrained by the following associated factors: male gender; age; stroke diagnosis; the hospitalization unit; ambulation capacity; the use of sedative medication; and the use of invasive devices. CONCLUSION This study estimated a high mechanical restraint prevalence in the hospital environment and determined factors associated with the risk of a patient being restrained. A medical restraint evaluation team is recommended for an in-depth analysis of indication and therapy.
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Affiliation(s)
| | | | | | | | - Romulo Delvalle
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Niterói, RJ, Brazil
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Ahmadi M, Bagheri-Saweh MI, Nouri B, Mohamadamini O, Valiee S. Effect of Interventional Educational Programs on Intensive Care Nurses' Perception, Knowledge, Attitude, and Practice About Physical Restraints: A Pre-/Postclinical Trial. Crit Care Nurs Q 2019; 42:106-116. [PMID: 30507671 DOI: 10.1097/cnq.0000000000000244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The article reports results of an educational program designed to modify negative attitudes of intensive care nurses regarding the use of physical restraints. Findings revealed that increased knowledge about appropriate utilization of various types of restraints positively impacted perceptions, attitudes, and patient care practices. Authors also explore restraint use in several countries and identify variations in use of restraining methods.
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Affiliation(s)
- Mohamad Ahmadi
- Student Research Committee (Mr Ahmadi), Clinical Care Research Center (Mr Bagheri-Saweh and Dr Valiee), Social Determinants of Health Research Center, Research Institute for Health Development (Dr Nouri), and Salahuddin Ayyubi Hospital (Mr Mohamadamini), Kurdistan University of Medical Sciences, Sanandaj, Iran
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Xyrichis A, Hext G, Clark LL. Beyond restraint: Raising awareness of restrictive practices in acute care settings. Int J Nurs Stud 2018; 86:A1-A2. [DOI: 10.1016/j.ijnurstu.2018.06.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Scheepmans K, Milisen K, Vanbrabant K, Paquay L, Van Gansbeke H, Dierckx de Casterlé B. Factors associated with use of restraints on older adults with home care: A secondary analysis of a cross-sectional survey study. Int J Nurs Stud 2018; 89:39-45. [PMID: 30339954 DOI: 10.1016/j.ijnurstu.2018.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 07/22/2018] [Accepted: 07/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although there is evidence that use of restraints in home care is increasing, research into the factors associated with restraints in this setting is scarce. OBJECTIVE To gain insight into the factors associated with restraints in older adults receiving home care. DESIGN A secondary analysis of a cross-sectional survey about restraint use in home care. SETTINGS Older adults receiving home care in Belgium. PARTICIPANTS 8000 subjects were randomly selected from a total of 45,700 older adults. The mean age of the sample (n = 6397) was 80.6 years, 66.8% were women and 46.4% lived alone. METHODS A cross-sectional survey of restraint use on older adults receiving home care from a nursing organisation in Belgium was completed by the patients' primary care nurses. A binary logistic regression model with generalised estimating equations was used to evaluate factors associated with restraint use. Additional analyses focused on the subgroups with and without an informal caregiver and living alone / with others. Data from 6397 participants were analysed in detail. RESULTS Multivariate logistic regression indicated that restraint use was associated with supervision [OR = 2.433, 95% CI = 1.948-3.038]; dependency in activities of daily living (i.e. eating [OR = 2.181, 95% CI = 1.212-3.925], transfer [OR = 2.131, 95% CI = 1.191-3.812] and continence [OR = 1.436, 95% CI = 0.925-2.231]; perceived risk of falling in the nurses' clinical judgement [OR = 1.994, 95% CI = 1.710-2.324], daily behavioural problems [OR = 1.935, 95% CI = 1.316-2.846] and less than daily behavioural problems [OR = 1.446, 95% CI = 1.048-1.995]; decreased well-being of the informal caregiver [OR = 1.472, 95% CI = 1.126-1.925], the informal caregiver's dissatisfaction with family support [OR = 1.339, 95% CI = 1.003-1.788]; patient's cognitive impairment [OR = 1.398, 95% CI = 1.290-1.515]; and polypharmacy [OR = 1.415, 95% CI = 1.219-1.641]. The nurses' perception of risk of falling, cognitive impairment (observed with the Cognitive Performance Scale) and supervision are the only variables consistently associated with restraint use across all the analyses. CONCLUSION The study results provide insight into new and context-specific factors associated with restraint use in home care (e.g. supervision, informal caregiver's decreased well-being and dissatisfaction with family support). These insights could support the development of interventions to reduce restraint use in home care.
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Affiliation(s)
- Kristien Scheepmans
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium; Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium; Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Leuven, Belgium
| | - Koen Vanbrabant
- KU Leuven - University of Leuven & Universiteit Hasselt, Interuniversity Institute for Biostatistics and Statistical Bioinformatics, B-3000 Leuven, Belgium
| | - Louis Paquay
- Wit-Gele Kruis van Vlaanderen, Nursing Department, Brussels, Belgium
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