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Min D, Park S, Kim S, Park HO. Patient Safety in Nursing Homes From an Ecological Perspective: An Integrated Review. J Patient Saf 2024; 20:77-84. [PMID: 38126786 DOI: 10.1097/pts.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVES The aims of the study were to identify the systemic factors affecting the characteristics and safety of older adults living in nursing homes and the resulting resident outcomes and to explore the relationship between them through an integrated literature review. METHODS A literature search was conducted from April 22 to May 6, 2021, in the PubMed, Embase, Cochrane CENTRAL, CIHNAL, RISS, NDL, and KoreaMed databases. The following key words and MeSH terms were used for the search: "nursing home," "skilled nursing facility," "long-term care facility," and "patient safety" or "safety." RESULTS Forty-seven qualifying articles were finally selected. Three domains were derived as personal factors, 12 as facility factors, and one as a policy factor. The interrelationships between them could result in positive or negative resident outcomes. The relationship between them was also reconstructed from an ecological perspective. CONCLUSIONS The results demonstrated that the safety and quality of life of older adults living in nursing homes were affected by both individual and institutional factors.
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Affiliation(s)
- Deulle Min
- From the Department of Nursing, College of Medicine, Wonkwang University, Iksan
| | - Seungmi Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju
| | - Suhee Kim
- School of Nursing and Research Institute of Nursing Science, Hallym University
| | - Hye Ok Park
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
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Jang SG, Lee W, Ha J, Choi S. Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments. BMC Nurs 2024; 23:94. [PMID: 38311777 PMCID: PMC10838439 DOI: 10.1186/s12912-024-01781-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/31/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Physical restraint (PR) is used to ensure the safety of care recipients. However, this causes an ethical dilemma between the autonomy and dignity of the recipients and the provision of effective treatment by health workers. This study aimed to analyze legal and ethical situations related to the use of PR using written judgments. METHODS This study uses a qualitative retrospective design. Qualitative content analysis was performed on South Korean written judgments. A total of 38 cases from 2015 to 2021 were categorized. The types of court decisions and ethical dilemma situations were examined according to the four principles of bioethics, and the courts' judgments were compared. RESULTS Written judgments related to PR were classified into three types according to the appropriateness of PR use, the presence or absence of duty of care, and legal negligence. Ethical dilemmas were categorized into three situations depending on whether the four principles of bioethics were followed. The courts' decisions regarding the ethical dilemmas differed depending on the situational factors before and after the use of PR and the conflicting conditions of the ethical principles. CONCLUSIONS Health workers should consider legal and ethical requirements when determining whether to use PR to provide the care recipient with the necessary treatment.
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Affiliation(s)
| | - Won Lee
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Jeongmin Ha
- Department of Nursing, Dong-A University, Busan, Republic of Korea
| | - Sungkyoung Choi
- Department of Nursing, Catholic Kwandong University, 24, Beomil-ro 579, 25601, Gangneung, Gangwon-do, Republic of Korea.
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Dichter MN, Dörner J, Wilfling D, Berg A, Klatt T, Möhler R, Haastert B, Meyer G, Halek M, Köpke S. Intervention for sleep problems in nursing home residents with dementia: a cluster-randomized study. Int Psychogeriatr 2024:1-14. [PMID: 38186227 DOI: 10.1017/s1041610223004489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To reduce sleep problems in people living with dementia using a multi-component intervention. DESIGN Cluster-randomized controlled study with two parallel groups and a follow-up of 16 weeks. SETTING Using external concealed randomization, 24 nursing homes (NH) were allocated either to the intervention group (IG, 12 clusters, 126 participants) or the control group (12 clusters, 116 participants). PARTICIPANTS Participants were eligible if they had dementia or severe cognitive impairment, at least two sleep problems, and residence of at least two weeks in a NH. INTERVENTION The 16-week intervention consists of six components: (1) assessment of sleep-promoting activities and environmental factors in NHs, (2) implementation of two "sleep nurses," (3) basic education, (4) advanced education for staff, (5) workshops to develop sleep-promoting concepts, and (6) written information and education materials. The control group (CG) received standard care. MEASUREMENTS Primary outcome was ≥ two sleep problems after 16 weeks assessed with the Sleep Disorders Inventory (SDI). RESULTS Twenty-two clusters (IG = 10, CG = 12) with 191 participants completed the study. At baseline, 90% of people living with dementia in the IG and 93% in the CG had at least two sleep problems. After 16 weeks, rates were 59.3% (IG) vs 83.8% (CG), respectively, a difference of -24.5% (95% CI, -46.3% - -2.7%; cluster-adjusted odds ratio 0.281; 95% CI 0.087-0.909). Secondary outcomes showed a significant difference only for SDI scores after eight and 16 weeks. CONCLUSIONS The MoNoPol-Sleep intervention reduced sleep problems of people living with dementia in NH compared to standard care.
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Affiliation(s)
- Martin Nikolaus Dichter
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jonas Dörner
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Lübeck, Germany
| | - Almuth Berg
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
| | - Thomas Klatt
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Medical Faculty, 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, Düsseldorf, Germany
| | | | - Gabriele Meyer
- Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Medical Faculty, Halle (Saale), Germany
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Steinert T, Baumgardt J, Bechdolf A, Bühling-Schindowski F, Cole C, Flammer E, Jaeger S, Junghanss J, Kampmann M, Mahler L, Muche R, Sauter D, Vandamme A, Hirsch S. Implementation of guidelines on prevention of coercion and violence (PreVCo) in psychiatry: a multicentre randomised controlled trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 35:100770. [PMID: 38058297 PMCID: PMC10696231 DOI: 10.1016/j.lanepe.2023.100770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023]
Abstract
Background Interventions to prevent the use of coercion in psychiatric hospitals have been summarized in the 2018 German Association for Psychiatry, Psychotherapy, and Psychosomatic's comprehensive guidelines. Twelve recommendations for implementation of these guideline on psychiatric wards have been deducted and their feasibility has been tested in a pilot study, using external implementation consultants as facilitators. The objective of the PreVCo study was to test their effect in a randomised clinical trial. Methods Fifty-four psychiatric wards in Germany treating voluntary and involuntary patients were randomly allocated to either an intervention or to a waiting list condition. The intervention consisted of the implementation of three out of 12 suggested recommendations as selected by the ward teams, supported by external study workers. As the primary outcome measure, the number of coercive measures used per bed and month in the final 3 months of the intervention period was determined. Secondary outcomes were the cumulative duration of coercive measures used per bed and months and assaults per bed and month. Achieved guideline adherence was measured by a fidelity scale developed for this purpose during a pilot study for the PreVCo Rating Tool. After a 3-month baseline collection period under routine conditions, randomisation was done after matching wards pairwise according to frequency of coercive measures used and scores on the PreVCo Rating Tool at baseline. The duration of the intervention period was 12 months; control wards received only an initial workshop presentation of the study and completed their PreVCo ratings. We used the Wilcoxon signed rank test and the paired t-test and conducted sensitivity analyses for different periods of observation. Findings Neither the number of coercive measures used per month and bed nor their cumulative duration nor the number of assaults per bed and months differed significantly between the 27 intervention wards and the 27 control wards in the final 3 months of the intervention period. The median number of coercive measures used decreased by 45% (median 0.96 (IQR 1.34)-0.53 (IQR 0.59) from baseline until the end of the intervention period on the intervention wards and by 28% (median 0.98 (IQR 1.71)-0.71 (IQR 1.08) on waiting list wards. The PreVCo Rating Tool showed a significant improvement in intervention wards compared to control wards, indicating a successful implementation. Interpretation The study demonstrated that guideline adherence could be significantly improved by the intervention. However, there was no evidence for an effect on the frequency or duration of coercive measures used. Spill-over effects and the impact of the COVID-19 pandemic on in-patient care might have limited the effect of the intervention. Further research from robust randomised controlled trials are necessary to identify effective interventions to reduce the use of coercion in psychiatric hospitals. Funding The study was funded by the German Innovationsfonds beim Gemeinsamen Bundesausschuss (project no. 01VSF19037). The funder had no role in study design or data collection.
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Affiliation(s)
- Tilman Steinert
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | | | | | | | | | - Erich Flammer
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | - Susanne Jaeger
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | | | - Marie Kampmann
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
| | | | - Rainer Muche
- Ulm University, Institute of Epidemiology and Medical Biometry, Germany
| | | | | | - Sophie Hirsch
- Ulm University, Germany
- Centres for Psychiatry Suedwuerttemberg, Germany
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Nguyen N, Thalhammer R, Meyer G, Le L, Mansmann U, Vomhof M, Skudlik S, Beutner K, Müller M. Effectiveness of an individually tailored complex intervention to improve activities and participation in nursing home residents with joint contractures (JointConEval): a multicentre pragmatic cluster-randomised controlled trial. BMJ Open 2023; 13:e073363. [PMID: 37899149 PMCID: PMC10619003 DOI: 10.1136/bmjopen-2023-073363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 10/01/2023] [Indexed: 10/31/2023] Open
Abstract
OBJECTIVE This study aims to examine the effects of the individually tailored complex intervention Participation Enabling Care in Nursing (PECAN) on activities and participation of residents with joint contractures. DESIGN Multicentre pragmatic cluster-randomised controlled trial. SETTING 35 nursing homes in Germany (August 2018-February 2020). PARTICIPANTS 562 nursing home residents aged ≥65 years with ≥1 major joint contracture (303 intervention group, 259 control group). INTERVENTIONS Nursing homes were randomised to PECAN (18 clusters) or optimised standard care (17 clusters) with researcher-concealed cluster allocation by facsimile. The intervention targeted impairments in activities and participation. Implementation included training and support for selected staff. Control group clusters received brief information. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint PaArticular Scales combined residents' activities and participation at 12 months. The secondary outcome comprised quality of life. Safety measures were falls, fall-related consequences and physical restraints. Residents, staff and researchers were unblinded. Data collection, data entry and statistical analysis were blinded. Primary analyses were intention-to-treat at cluster level and individual level using a generalised mixed-effect regression model and imputation of missing data. RESULTS Primary outcome analyses included 301 intervention group residents and 259 control group residents. The mean change on the Activities Scale was -1.47 points (SD 12.2) in the intervention group and 0.196 points (SD 12.5) in the control group and -3.87 points (SD 19.7) vs -3.18 points (SD 20.8) on the Participation Scale. The mean differences of changes between the groups were not statistically significant: Activities Scale: -1.72 (97.5% CI -6.05 to 2.61); Participation Scale: -1.24 (97.5% CI -7.02 to 4.45). We found no significant difference in the secondary outcome and no effects on safety measures. CONCLUSION The complex intervention did not improve the activities and participation of nursing home residents on the PaArticular Scales at 12 months. Current nursing conditions in Germany may hamper implementation. TRIAL REGISTRATION NUMBER DRKS00015185.
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Affiliation(s)
- Natalie Nguyen
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Regina Thalhammer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Gabriele Meyer
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Lien Le
- Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
| | - Ulrich Mansmann
- Faculty of Medicine, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig Maximilians University Munich, Munich, Germany
| | - Markus Vomhof
- Faculty of Medicine, Centre for Health and Society, Institute for Health Services Research and Health Economics, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefanie Skudlik
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Katrin Beutner
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
- Medical Faculty Heidelberg, Department for Primary Care and Health Services Research, Nursing Science and Interprofessional Care, Heidelberg University, Heidelberg, Germany
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Hakverdioğlu Yönt G, Kisa S, Princeton DM. Physical Restraint Use in Nursing Homes-Regional Variances and Ethical Considerations: A Scoping Review of Empirical Studies. Healthcare (Basel) 2023; 11:2204. [PMID: 37570444 PMCID: PMC10419255 DOI: 10.3390/healthcare11152204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Physical restraints are known to violate human rights, yet their use persists in long-term care facilities. This study aimed to explore the prevalence, methods, and interventions related to physical restraint use among the elderly in nursing homes. METHODS The method described by Joanna Briggs was followed to conduct a scoping review without a quality assessment of the selected studies. An electronic search was conducted to find eligible empirical articles using MEDLINE, PsycINFO, EMBASE, Web of Science, Scopus, Google Scholar, CINAHL, and grey literature. The database search was performed using EndNote software (version X9, Clarivate Analytics), and the data were imported into Excel for analysis. RESULTS The prevalence of physical restraint use was found to be highest in Spain (84.9%) and lowest in the USA (1.9%). The most common device reported was bed rails, with the highest prevalence in Singapore (98%) and the lowest (4.7%) in Germany, followed by chair restraint (57%). The largest number of studies reported the prevention and/or risk of falls to be the main reason for using physical restraints, followed by behavioral problems such as wandering, verbal or physical agitation, and cognitive impairment. Most studies reported guideline- and/or theory-based multicomponent interventions consisting of the training and education of nursing home staff. CONCLUSIONS This review provides valuable insights into the use of physical restraints among elderly residents in nursing homes. Despite efforts to minimize their use, physical restraints continue to be employed, particularly with elderly individuals who have cognitive impairments. Patient-related factors such as wandering, agitation, and cognitive impairment were identified as the second most common reasons for using physical restraints in this population. To address this issue, it is crucial to enhance the skills of nursing home staff, especially nurses, in providing safe and ethical care for elderly residents with cognitive and functional impairments, aggressive behaviors, and fall risks.
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Affiliation(s)
| | - Sezer Kisa
- Department of Nursing and Health Promotion, Faculty of Nursing, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
| | - Daisy Michelle Princeton
- Department of Nursing and Health Promotion, Faculty of Nursing, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
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Möhler R, Richter T, Köpke S, Meyer G. Interventions for preventing and reducing the use of physical restraints for older people in all long-term care settings. Cochrane Database Syst Rev 2023; 7:CD007546. [PMID: 37500094 PMCID: PMC10374410 DOI: 10.1002/14651858.cd007546.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
BACKGROUND Physical restraints (PR), such as bedrails and belts in chairs or beds, are commonly used for older people receiving long-term care, despite clear evidence for the lack of effectiveness and safety, and widespread recommendations that their use should be avoided. This systematic review of the efficacy and safety of interventions to prevent and reduce the use of physical restraints outside hospital settings, i.e. in care homes and the community, updates our previous review published in 2011. OBJECTIVES To evaluate the effects of interventions to prevent and reduce the use of physical restraints for older people who require long-term care (either at home or in residential care facilities) SEARCH METHODS: We searched ALOIS, 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 (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov and the World Health Organization's meta-register, the International Clinical Trials Registry Portal, on 3 August 2022. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that investigated the effects of interventions intended to prevent or reduce the use of physical restraints in older people who require long-term care. Studies conducted in residential care institutions or in the community, including patients' homes, were eligible for inclusion. We assigned all included interventions to categories based on their mechanisms and components. DATA COLLECTION AND ANALYSIS Two review authors independently selected the publications for inclusion, extracted study data, and assessed the risk of bias of all included studies. Primary outcomes were the number or proportion of people with at least one physical restraint, and serious adverse events related to PR use, such as death or serious injuries. We performed meta-analyses if necessary data were available. If meta-analyses were not feasible, we reported results narratively. We used GRADE methods to describe the certainty of the evidence. MAIN RESULTS We identified six new studies and included 11 studies with 19,003 participants in this review update. All studies were conducted in long-term residential care facilities. Ten studies were RCTs and one study a CCT. All studies included people with dementia. The mean age of the participants was approximately 85 years. Four studies investigated organisational interventions aiming to implement a least-restraint policy; six studies investigated simple educational interventions; and one study tested an intervention that provided staff with information about residents' fall risk. The control groups received usual care only in most studies although, in two studies, additional information materials about physical restraint reduction were provided. We judged the risk of selection bias to be high or unclear in eight studies. Risk of reporting bias was high in one study and unclear in eight studies. The organisational interventions intended to promote a least-restraint policy included a variety of components, such as education of staff, training of 'champions' of low-restraint practice, and components which aimed to facilitate a change in institutional policies and culture of care. We found moderate-certainty evidence that organisational interventions aimed at implementation of a least-restraint policy probably lead to a reduction in the number of residents with at least one use of PR (RR 0.86, 95% CI 0.78 to 0.94; 3849 participants, 4 studies) and a large reduction in the number of residents with at least one use of a belt for restraint (RR 0.54, 95% CI 0.40 to 0.73; 2711 participants, 3 studies). No adverse events occurred in the one study which reported this outcome. There was evidence from one study that organisational interventions probably reduce the duration of physical restraint use. We found that the interventions may have little or no effect on the number of falls or fall-related injuries (low-certainty evidence) and probably have little or no effect on the number of prescribed psychotropic medications (moderate-certainty evidence). One study found that organisational interventions result in little or no difference in quality of life (high-certainty evidence) and another study found that they may make little or no difference to agitation (low-certainty evidence). The simple educational interventions were intended to increase knowledge and change staff attitudes towards PR. As well as providing education, some interventions included further components to support change, such as ward-based guidance. We found pronounced between-group baseline imbalances in PR prevalence in some of the studies, which might have occurred because of the small number of clusters in the intervention and control groups. One study did not assess bedrails, which is the most commonly used method of restraint in nursing homes. Regarding the number of residents with at least one restraint, the results were inconsistent. We found very-low certainty evidence and we are uncertain about the effects of simple educational interventions on the number of residents with PR. None of the studies assessed or reported any serious adverse events. We found moderate-certainty evidence that simple educational interventions probably result in little or no difference in restraint intensity and may have little or no effect on falls, fall-related injuries, or agitation (low-certainty evidence each). Based on very low-certainty evidence we are uncertain about the effects of simple educational interventions on the number of participants with a prescription of at least one psychotropic medication. One study investigated an intervention that provided information about residents' fall risk to the nursing staff. We found low-certainty evidence that providing information about residents' fall risk may result in little or no difference in the mean number of PR or the number of falls. The study did not assess overall adverse events. AUTHORS' CONCLUSIONS Organisational interventions aimed to implement a least-restraint policy probably reduce the number of residents with at least one PR and probably largely reduce the number of residents with at least one belt. We are uncertain whether simple educational interventions reduce the use of physical restraints, and interventions providing information about residents' fall risk may result in little to no difference in the use of physical restraints. These results apply to long-term care institutions; we found no studies from community settings.
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Affiliation(s)
- 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
| | - Tanja Richter
- Unit of Health Sciences and Education, University of Hamburg, Hamburg, 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
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Downe S, Nowland R, Clegg A, Akooji N, Harris C, Farrier A, Gondo LT, Finlayson K, Thomson G, Kingdon C, Mehrtash H, McCrimmon R, Tunçalp Ö. Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001594. [PMID: 37093790 PMCID: PMC10124898 DOI: 10.1371/journal.pgph.0001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for 'othered' groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against 'othered' groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.
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Affiliation(s)
- Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebecca Nowland
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Naseerah Akooji
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Cath Harris
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Alan Farrier
- Healthy and Sustainable Settings Unit, University of Central Lancashire, Preston, United Kingdom
| | | | - Kenny Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Carol Kingdon
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rebekah McCrimmon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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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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Meyer G, Köpke S. [Health promotion and prevention in nursing homes in the context of the German Prevention Act]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:562-568. [PMID: 37074449 DOI: 10.1007/s00103-023-03690-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
The German Prevention Act obliges the nursing care insurance funds to provide health-promoting interventions and preventive offers in nursing homes. These interventions should clearly differ from activating nursing care and be of proven effectiveness and cost-effectiveness.The present opinion article critically appraises the evidence base of the interventions belonging to the pre-defined preventive areas "nutrition," "physical activity," "cognitive resources," "psychosocial health," and "prevention of elder abuse." The interventions' underlying evidence is weak or even missing. It is unclear whether the interventions contribute to the intended strengthening of the health-promoting potential of care facilities and meet the goal of improving the health situation and resources of the care-dependent people. On the other hand, there are areas of prevention, which are not covered, but have great potential for improving the life situation of those in need of care, for example, in the context of person-centered care and a caring nursing culture.
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Affiliation(s)
- Gabriele Meyer
- Medizinische Fakultät, Institut für Gesundheits- und Pflegewissenschaft, Martin-Luther-Universität Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Deutschland.
| | - Sascha Köpke
- Medizinische Fakultät & Uniklinik Köln, Institut für Pflegewissenschaft, Universität zu Köln, Köln, Deutschland
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11
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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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Hung L, Mann J, Upreti M. Using the Consolidated Framework for Implementation Research to Foster the Adoption of a New Dementia Education Game During the COVID-19 Pandemic. THE GERONTOLOGIST 2023; 63:467-477. [PMID: 36044753 PMCID: PMC9452118 DOI: 10.1093/geront/gnac138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The pandemic of coronavirus disease 2019 challenged educators to move staff education online and explore innovative ways to motivate learning to support dementia care for patients in geriatric settings. This article presents how the Consolidated Framework for Implementation Research (CFIR) was used to support the adoption of an online dementia education game in Canadian hospitals and long-term care homes (LTC). The dementia education was codeveloped with local staff and patient partners to teach practical person-centered care communication techniques. RESEARCH DESIGN AND METHODS CFIR guided our strategy development for overcoming barriers to implementation. Research meetings were conducted with practice leaders, frontline health care workers, and a patient partner. Our analysis examined 4 interactive domains: intervention, inner context, outer settings, and individuals involved and implementation process. RESULTS Our analysis identified 5 effective strategies: Easy access, Give extrinsic and intrinsic rewards, Apply implementation science theory, Multiple tools, and Engagement of champion. The CFIR provided a systematic process, a comprehensive understanding of barriers, and possible enabling strategies to implement gamified dementia education. Interdisciplinary staff (n = 3,025) in 10 hospitals and 10 LTC played online games. The evaluation showed positive outcomes in knowledge improvement in person-centered dementia care. DISCUSSION AND IMPLICATIONS Gamified education in dementia care offers a social experience and a component of fun to promote adoption. In addition, CFIR is useful for engaging stakeholders to conduct project planning and team reflection for implementation. The real-time discussion and adjustment helped overcome challenges and timely meet the needs of multiple organizations.
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Affiliation(s)
- Lillian Hung
- Corresponding Author: Dr. Lillian Hung, University of British Columbia, School of Nursing, T201 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5. E-mail:
| | - Jim Mann
- Person living with dementia, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mona Upreti
- Masters in Health Leadership and Policy in Senior Care Program, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
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Liang SH, Huang TT. The optimal intervention for preventing physical restraints among older adults living in the nursing home: A systematic review. Nurs Open 2023; 10:3533-3546. [PMID: 36826390 PMCID: PMC10170910 DOI: 10.1002/nop2.1632] [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: 02/21/2022] [Revised: 06/19/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023] Open
Abstract
AIM This study aimed to evaluate the effectiveness of restraint reduction programs for nursing home care providers in enforcing physical restraint on residents and identify the best strategies for such programs. DESIGN Systematic Review. METHODS We searched for randomized controlled trials published until February 2021 for systematic review. The systematic review captured multifactorial interventions, education and consultation measures, including nursing home residents' and care providers' results. Study quality was assessed using the Cochrane Collaboration criteria. RESULTS In all seven trials, the interventions were led by a nurse specialist or unit leader and targeted at care providers. Five of the restraint reduction programs effectively reduced the rate of physical restraint use; two increased knowledge of restraint reduction for care providers; and one each promoted positive attitudes and behaviours. Duration of at least 6 weeks significantly improved the knowledge of care providers.
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Affiliation(s)
- Su-Hua Liang
- Graduate Institute of Clinical Medical Sciences, Nursing, Chang Gung University, Tao-Yuan, Taiwan.,Department of Nursing, Jen-Teh Junior College of Medicine, Nursing & Management, Miaoli, Taiwan
| | - Tzu-Ting Huang
- Institute of Community Health Care, School of Nursing, National Yang-Ming University, Taipei, Taiwan
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Wallner M, Mayer H, Adlbrecht L, Hoffmann AL, Fahsold A, Holle B, Zeller A, Palm R. Theory-based evaluation and programme theories in nursing: A discussion on the occasion of the updated Medical Research Council (MRC) Framework. Int J Nurs Stud 2023; 140:104451. [PMID: 36812849 DOI: 10.1016/j.ijnurstu.2023.104451] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
Developing and evaluating health interventions for the benefit of patients is notoriously difficult. This also applies to the discipline of nursing, owing to the complexity of nursing interventions. Following significant revision, the updated guidance of the Medical Research Council (MRC) adopts a pluralistic view to intervention development and evaluation, including a theory-based perspective. This perspective promotes the use of program theory, aiming to understand how and under what circumstances interventions lead to change. In this discussion paper, we reflect the recommended use of program theory in the context of evaluation studies addressing complex nursing interventions. First, we review the literature by investigating the question whether and how evaluation studies targeting complex interventions used theory and to what extent program theories may contribute to enhance the theoretical foundations of intervention studies in nursing. Second, we illustrate the nature of theory-based evaluation and program theories. Third, we argue how this may impact theory building in nursing in general. We finish by discussing which resources, skills and competencies are necessary to fulfill the demanding task of undertaking theory-based evaluations. We caution against an oversimplified interpretation of the updated MRC guidance regarding the theory-based perspective, e.g. by using simple linear logic models, rather than articulating program theories. Instead, we encourage researchers to embrace the corresponding methodology, i.e. theory-based evaluation. With the prevailing perspective of knowledge production in crisis, we might be on the verge of a paradigm shift in health intervention research. Viewed through this lens, the updated MRC guidance could lead to a renewed understanding of what constitutes useful knowledge in nursing. This may facilitate knowledge production and, thereby, contribute to improve nursing practice for the benefit of the patient.
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Affiliation(s)
- Martin Wallner
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria; University of Vienna, Vienna Doctoral School of Social Sciences, Department of Nursing Science, Vienna, Austria.
| | - Hanna Mayer
- Karl Landsteiner University of Health Sciences, Division of Nursing Science with focus on Person-Centred Care Research, Krems, Austria
| | - Laura Adlbrecht
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Anna Louisa Hoffmann
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Anne Fahsold
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Bernhard Holle
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany; Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), site Witten, Witten, Germany
| | - Adelheid Zeller
- OST Eastern Switzerland University of Applied Sciences, Department of Health, Competence Center Dementia Care, St. Gallen, Switzerland
| | - Rebecca Palm
- Witten/Herdecke University, Faculty of Health, School of Nursing Science, Witten, Germany
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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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Möhler R, Calo S. Entwicklung und Evaluation komplexer Interventionen – was bringt das aktualisierte MRC-Modell? Pflege 2022; 35:312-313. [DOI: 10.1024/1012-5302/a000909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Ralph Möhler
- Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät und Universitätsklinik Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Deutschland
| | - Stella Calo
- Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät und Universitätsklinik Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Deutschland
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Wang J, Liu W, Li X, Li L, Tong J, Zhao Q, Xiao M. Effects and implementation of a minimized physical restraint program for older adults in nursing homes: A pilot study. Front Public Health 2022; 10:959016. [PMID: 36148339 PMCID: PMC9486015 DOI: 10.3389/fpubh.2022.959016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/08/2022] [Indexed: 01/24/2023] Open
Abstract
Purpose Physical restraint (PR) reduction interventions are currently exploring in developed regions with well-established welfare systems, whereas developing countries with fast population aging have not attracted enough attention. This China's pilot study evaluated the effects of a minimized PR program on restraint reduction and nursing assistants' knowledge, attitudes, intention, and practice toward PR and explored nursing assistants' experience of the program. Patients and methods This was a one-group, pretest, and posttest pilot trial with a nested qualitative descriptive study. A minimized PR program was obtained by summarizing the best evidence and was implemented in one Chinese nursing home with 102 older adults from December 18, 2020, to March 21, 2021. An educational program including three theoretical lectures and one operation training was first conducted for nursing assistants one-month period. The primary outcome was PR rate at 3 months. The secondary outcomes contained duration of restraints, types of restraints, the rate of correct PR use, the incidence of falls and/or fall-related injuries, and antipsychotics use at 3 months. Data on PR use and older adults' characteristics were collected through physical restraints observation forms and older adults' medical records. Nursing assistants' knowledge, attitude, intention, and practice toward PR were measured using the Staff Knowledge, Attitudes, and Practices Questionnaire regarding PR at 1 month. A semi-structured interview for two administrative staff and a focus group discussion with 13 nursing assistants were analyzed using content analysis to explore perspectives of intervention implementation at 3 months. Results There were a significant increase in knowledge, attitude, and practice and a decrease in intention of nursing assistants after 1-month educational intervention (P < 0.001). Furthermore, only the rate of correct PR increased and the duration of restraint in the daytime decreased significantly at 3 months (P < 0.05). There were no significant effects on PR rate and other secondary outcomes at follow-up. Qualitatively, nursing assistants demonstrated overtly supportive perspectives and that assistance from the program enhanced their knowledge and practice. They noted several challenges that impeded implementation. Conclusion The intervention has acknowledged some benefits and was valued by nursing assistants. Implementation barriers should be addressed before delivering in larger trials.
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Affiliation(s)
- Jun Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuelian Li
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Luyong Li
- Chongqing Shanxing Nursing Home, Chongqing, China
| | - Jinyan Tong
- Chongqing Shanxing Nursing Home, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,*Correspondence: Qinghua Zhao
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China,Mingzhao Xiao
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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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Chan HYL, Ho FKY, Chui KCM, Wong BPS, Chui MYP, Zhao Y, Yang C, Kwok TCY. Evaluation of a multicomponent restraint reduction intervention in care homes. Collegian 2022. [DOI: 10.1016/j.colegn.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127144. [PMID: 35742411 PMCID: PMC9222665 DOI: 10.3390/ijerph19127144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 02/03/2023]
Abstract
The attitude of nursing staff towards restraint use can be decisive for whether restraints are used. So far, nursing staff’s attitudes have been studied primarily in long-term and mental health care settings, while findings from somatic acute care hospital settings are largely lacking. Therefore, we aimed to investigate (a) the attitudes of hospital nursing staff towards restraint use, and (b) the construct validity and reliability of a measurement instrument for use in hospital settings that was developed and validated in long-term care settings (Maastricht Attitude Questionnaire (MAQ)). Using a cross-sectional design, the attitudes of 180 nursing staff towards restraint use were assessed. The data were analysed descriptively and by means of regression analysis and factor analysis. We found that nursing staff in hospitals have a neutral attitude towards restraint use and that the MAQ, with minor adaptations, can be used in hospital settings, although further testing is recommended. Neutral attitudes of nursing staff have also been observed in long-term and mental health care settings, where changing attitudes were found to be challenging. Interventions at the national level (e.g., legal regulations) and management level (e.g., providing alternatives and changing institutional culture) are suggested.
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Med Dir Assoc 2022; 23:323-327. [DOI: 10.1016/j.jamda.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/27/2022]
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22
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Li C, Shi C. Adverse Events and Risk Management in Residential Aged Care Facilities: A Cross-Sectional Study in Hunan, China. Risk Manag Healthc Policy 2022; 15:529-542. [PMID: 35378829 PMCID: PMC8976485 DOI: 10.2147/rmhp.s351821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/14/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Adverse events threaten residents’ safety. Risk management is important to provide proper care and maintain quality in residential aged care facilities (RACFs). However, there is little data on adverse events, risk management, and risk early warning in RACFs in the Chinese mainland. This study aimed to fill this gap by investigating the prevalence of the aforementioned aspects and related factors in China. Participants and Methods Using a cross-sectional design, a field survey of 272 RACFs in Hunan Province was conducted from January 25 to June 1, 2020. Data were collected using four main tools on prevalence of nursing adverse events, risk management, risk early warning, and general information. Descriptive statistics were described by frequency (percentage) and median (interquartile range). Mann–Whitney U-test and Kruskal–Wallis H-test, and Spearman coefficient were used for statistical analysis. Results RACFs experienced an average of five (15) adverse events in 2019, with falls and pressure ulcers being the most common. The total average score of risk management in RACFs was 4.72 (0.98) out of 5, with the environment and personnel management dimensions scoring the highest with 4.75 (1) and the service management dimension scoring the lowest with 4.60 (1). Only 72.79% had trained their staff on ethical and legal knowledge and 84.56% had utilized pre-hospital first aid. Further, 30% to 40% were unprepared for contingency plans of suicide, electric shock, gas poisoning, and drowning. There were significant risk management differences among the following variables: facilities’ locations, accreditation with the Practice Certificate of Social Welfare Facilities, bed-size, nursing hours per resident day, requirement for nursing staff with certificates, and payment for nursing staff (p < 0.05). Conclusion RACFs are facing safety challenges with a high prevalence of nursing adverse events. These facilities need to improve risk early warning and management to ensure residents’ safety.
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Affiliation(s)
- Chunyan Li
- School of Nursing, Hunan University of Chinese Medicine, Changsha, People’s Republic of China
| | - Chunhong Shi
- School of Nursing, Xiangnan University, Chenzhou, People’s Republic of China
- Correspondence: Chunhong Shi, Tel +86 15907354840, Fax +86 735 2325007, Email
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Geriatr Soc 2022; 70:688-694. [PMID: 35195278 PMCID: PMC8915540 DOI: 10.1111/jgs.17697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Address correspondence to Sheryl Zimmerman, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Campus Box 7590, Chapel Hill, NC 27599-7590, USA. (S. Zimmerman)
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Cari Levy
- Department of Veterans Affairs, Rocky Mountain Regional VA Medical Center, and University of Colorado, Aurora, CO, USA
| | - Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vincent Mor
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Peryer G, Kelly S, Blake J, Burton JK, Irvine L, Cowan A, Akdur G, Killett A, Brand SL, Musa MK, Meyer J, Gordon AL, Goodman C. Contextual factors influencing complex intervention research processes in care homes: a systematic review and framework synthesis. Age Ageing 2022; 51:6540144. [PMID: 35231097 PMCID: PMC8887840 DOI: 10.1093/ageing/afac014] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Indexed: 12/20/2022] Open
Abstract
Background Care homes are complex settings to undertake intervention research. Barriers to research implementation processes can threaten studies’ validity, reducing the value to residents, staff, researchers and funders. We aimed to (i) identify and categorise contextual factors that may mediate outcomes of complex intervention studies in care homes and (ii) provide recommendations to minimise the risk of expensive research implementation failures. Methods We conducted a systematic review using a framework synthesis approach viewed through a complex adaptive systems lens. We searched: MEDLINE, Embase, CINAHL, ASSIA databases and grey literature. We sought process evaluations of care home complex interventions published in English. Narrative data were indexed under 28 context domains. We performed an inductive thematic analysis across the context domains. Results We included 33 process evaluations conducted in high-income countries, published between 2005 and 2019. Framework synthesis identified barriers to implementation that were more common at the task and organisational level. Inductive thematic analysis identified (i) avoiding procedural drift and (ii) participatory action and learning as key priorities for research teams. Research team recommendations include advice for protocol design and care home engagement. Care home team recommendations focus on internal resources and team dynamics. Collaborative recommendations apply to care homes’ individual context and the importance of maintaining positive working relationships. Discussion Researchers planning and undertaking research with care homes need a sensitive appreciation of the complex care home context. Study implementation is most effective where an intervention is co-produced, with agreed purpose and adequate resources to incorporate within existing routines and care practices.
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Affiliation(s)
- Guy Peryer
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, England, UK
| | - Sarah Kelly
- Cambridge Public Health, University of Cambridge, East Forvie Site, Cambridge CB2 0SZ, UK
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge Biomedical Campus, Cambridge CB2 0AH, UK
| | - Jessica Blake
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Jennifer K Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, New Lister Building, Glasgow Royal Infirmary, Glasgow G31 2ER, UK
| | - Lisa Irvine
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Andy Cowan
- Cambridge Public Health, University of Cambridge, East Forvie Site, Cambridge CB2 0SZ, UK
| | - Gizdem Akdur
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Anne Killett
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
- NIHR Applied Research Collaboration, East of England, England, UK
| | - Sarah L Brand
- St Luke's Campus, Heavitree Road, University of Exeter, Exeter EX1 2LU, UK
- NIHR Applied Research Collaboration, South West Peninsula, England, UK
| | - Massirfufulay Kpehe Musa
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Julienne Meyer
- National Care Forum/Care for Older People, School of Health Sciences, Division of Nursing, City, University of London, London, UK
| | - Adam L Gordon
- School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Claire Goodman
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- NIHR Applied Research Collaboration, East of England, England, UK
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic trials and improving long-term care: Recommendations from a national institutes of health conference. Geriatr Nurs 2022; 44:288-292. [DOI: 10.1016/j.gerinurse.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Wang J, Liu W, Wang H, Zhao Q, Xiao M. Difference of Physical Restraint Knowledge, Attitudes and Practice Between Nurses and Nursing Assistants in Long-Term Care Facilities: A Cross-Sectional Study. Healthc Policy 2022; 15:243-255. [PMID: 35210886 PMCID: PMC8859256 DOI: 10.2147/rmhp.s349545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/27/2022] [Indexed: 11/23/2022] Open
Abstract
Background Purpose Methods Results Conclusion
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Affiliation(s)
- Jun Wang
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Weichu Liu
- Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Houwei Wang
- School of Mathematics & Physics and Big Data, Chongqing University of Science and Technology, Chongqing, People’s Republic of China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
- Correspondence: Qinghua Zhao; Mingzhao Xiao, Email ;
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
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Palese A, Longhini J, Businarolo A, Piccin T, Pitacco G, Bicego L. Between Restrictive and Supportive Devices in the Context of Physical Restraints: Findings from a Large Mixed-Method Study Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312764. [PMID: 34886489 PMCID: PMC8657237 DOI: 10.3390/ijerph182312764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/28/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives'/patients' requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories 'Restrictive' and 'Supportive' devices aimed at 'Preventing risks' and at 'Promoting support', respectively, have emerged. Reasons triggering 'restrictive devices' involved patients' risks, the health professionals' and/or the relatives' concerns. In contrast, the 'supportive' ones were triggered by patients' problems/needs. 'Restrictive' and 'Supportive' devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with 'restrictive devices' (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings.
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Affiliation(s)
- Alvisa Palese
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
- Correspondence: ; Tel.: +39(0)-432-590926
| | - Jessica Longhini
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Angela Businarolo
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Tiziana Piccin
- Department of Medical Sciences, University of Udine, 33100 Udine, Italy; (J.L.); (A.B.); (T.P.)
| | - Giuliana Pitacco
- Ethics Management for Clinical Practice Area, Azienda Sanitaria Universitaria Giuliano Isontina, 34149 Trieste, Italy;
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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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Implementation science in the nursing home. Int Psychogeriatr 2021; 33:865-866. [PMID: 34607620 DOI: 10.1017/s104161022000383x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bai Y, McArthur C, Ioannidis G, Giangregorio L, Straus S, Papaioannou A. Strategies for the implementation of an electronic fracture risk assessment tool in long term care: a qualitative study. BMC Geriatr 2021; 21:467. [PMID: 34418976 PMCID: PMC8379826 DOI: 10.1186/s12877-021-02388-3] [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] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/12/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Older adults in long-term care (LTC) homes experience high rates of fractures, which are detrimental to their quality of life. The purpose of this study is to identify and make recommendations on strategies to implementing an evidence-based Fracture Risk Clinical Assessment Protocol (CAP) in LTC. METHODS Following the Behaviour Change Wheel framework, we conducted six focus group interviews with a total of 32 LTC stakeholders (e.g. LTC physicians) to identify barriers and facilitators, suggest implementation strategies, and discuss whether the identified strategies were affordable, practicable, effective, acceptable, safe, and if they promote equity (APEASE). The interviews were transcribed verbatim and analyzed using thematic content analysis. RESULTS Themes of implementation strategies that met the APEASE criteria were minimizing any increase in workload, training on CAP usage, education for residents and families, and persuasion through stories. Other strategy themes identified were culture change, resident-centred care, physical restructuring, software features, modeling in training, education for staff, social rewards, material rewards, public benchmarking, and regulations. CONCLUSIONS To implement the Fracture Risk CAP in LTC, we recommend using implementation strategies centred around minimizing any increase in workload, training on CAP usage, providing education for residents and families, and persuading through stories. Through improving implementation of the fracture risk CAP, results from this work will improve identification and management of LTC residents at high fracture risk and could inform the implementation of guidelines for other conditions in LTC homes.
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Affiliation(s)
- Yuxin Bai
- McMaster University, 1280 Main Street West, L8S 4L8 Hamilton, Ontario Canada
- GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9 Hamilton, Ontario Canada
| | - Caitlin McArthur
- Dalhousie University, PO Box 15000, 6299 South St, NS B3H 4R2 Halifax, Canada
| | - George Ioannidis
- McMaster University, 1280 Main Street West, L8S 4L8 Hamilton, Ontario Canada
- GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9 Hamilton, Ontario Canada
| | - Lora Giangregorio
- University of Waterloo, 200 University Avenue West, N2L 3G1 Waterloo, Ontario Canada
- Schlegel-UW Research Institute for Aging, 150 Laurelwood Drive, N2J 0E2 Waterloo, Ontario Canada
| | - Sharon Straus
- University of Toronto, 27 King’s College Circle, M5S 1A4 Toronto, Ontario Canada
| | - Alexandra Papaioannou
- McMaster University, 1280 Main Street West, L8S 4L8 Hamilton, Ontario Canada
- GERAS Centre for Aging Research, 88 Maplewood Avenue, L8M 1W9 Hamilton, Ontario Canada
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McArthur C, Bai Y, Hewston P, Giangregorio L, Straus S, Papaioannou A. Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis. Implement Sci 2021; 16:70. [PMID: 34243789 PMCID: PMC8267230 DOI: 10.1186/s13012-021-01140-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/24/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The long-term care setting poses unique challenges and opportunities for effective knowledge translation. The objectives of this review are to (1) synthesize barriers and facilitators to implementing evidence-based guidelines in long-term care, as defined as a home where residents require 24-h nursing care, and 50% of the population is over the age of 65 years; and (2) map barriers and facilitators to the Behaviour Change Wheel framework to inform theory-guided knowledge translation strategies. METHODS Following the guidance of the Cochrane Qualitative and Implementation Methods Group Guidance Series and the ENTREQ reporting guidelines, we systematically reviewed the reported experiences of long-term care staff on implementing evidence-based guidelines into practice. MEDLINE Pubmed, EMBASE Ovid, and CINAHL were searched from the earliest date available until May 2021. Two independent reviewers selected primary studies for inclusion if they were conducted in long-term care and reported the perspective or experiences of long-term care staff with implementing an evidence-based practice guideline about health conditions. Appraisal of the included studies was conducted using the Critical Appraisal Skills Programme Checklist and confidence in the findings with the GRADE-CERQual approach. FINDINGS After screening 2680 abstracts, we retrieved 115 full-text articles; 33 of these articles met the inclusion criteria. Barriers included time constraints and inadequate staffing, cost and lack of resources, and lack of teamwork and organizational support. Facilitators included leadership and champions, well-designed strategies, protocols, and resources, and adequate services, resources, and time. The most frequent Behaviour Change Wheel components were physical and social opportunity and psychological capability. We concluded moderate or high confidence in all but one of our review findings. CONCLUSIONS Future knowledge translation strategies to implement guidelines in long-term care should target physical and social opportunity and psychological capability, and include interventions such as environmental restructuring, training, and education.
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Affiliation(s)
- Caitlin McArthur
- Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada. .,GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.
| | - Yuxin Bai
- GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Master University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Patricia Hewston
- GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Master University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Lora Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.,Schlegel-UW Research Institute for Aging, 150 Laurelwood Drive, Waterloo, Ontario, N2J 0E2, Canada
| | - Sharon Straus
- University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A4, Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Master University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
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Effects of a Web-Based Educational Program Regarding Physical Restraint Reduction in Long-Term Care Settings on Nursing Students: A Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136698. [PMID: 34206292 PMCID: PMC8297122 DOI: 10.3390/ijerph18136698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/29/2022]
Abstract
Physical restraint is still frequently used in many countries. However, a lack of education hinders physical restraint reduction in long-term care facilities. No study has yet to examine the effects of physical restraint reduction education on nursing students. This study aimed to evaluate the effects of a web-based educational program of physical restraint reduction on nursing students’ knowledge and perceptions. A cluster randomized controlled and single-blind design was used. This study was conducted at four nursing schools in South Korea. A total of 169 undergraduate nursing students completed this study. Using random allocation, two nursing schools (85 students) were allocated as the experimental group and the other two schools (84 students) as the control group. The experimental group received the web-based educational program, and the control group did not receive the educational program. Data were collected immediately before and after the web-based educational program. The experimental group’s knowledge and perceptions significantly improved between pre-test and post-test. The analysis of covariance showed statistically significant differences between groups in knowledge (p < 0.001) and perceptions (p < 0.001) over time, revealing positive effects of the web-based educational program. The web-based educational program regarding physical restraint reduction positively affected nursing students’ knowledge and perceptions. Future studies are required to examine the educational program’s longitudinal effects with more rigorous measurements and research methods.
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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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Definition and Measurement of Physical and Chemical Restraint in Long-Term Care: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073639. [PMID: 33807413 PMCID: PMC8037562 DOI: 10.3390/ijerph18073639] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/30/2022]
Abstract
This systematic review aimed to identify thematic elements within definitions of physical and chemical restraint, compare explicit and implicit definitions, and synthesize reliability and validity of studies examining physical and/or chemical restraint use in long-term care. Studies were included that measured prevalence of physical and/or chemical restraint use, or evaluated an intervention to reduce restraint use in long-term care. 86 papers were included in this review, all discussed physical restraint use and 20 also discussed chemical restraint use. Seven themes were generated from definitions including: restraint method, setting resident is restrained in, stated intent, resident capacity to remove/control, caveats and exclusions, duration, frequency or number, and consent and resistance. None of the studies reported validity of measurement approaches. Inter-rater reliability was reported in 27 studies examining physical restraint use, and only one study of chemical restraint. Results were compared to an existing consensus definition of physical restraint, which was found to encompass many of the thematic domains found within explicit definitions. However, studies rarely applied measurement approaches that reflected all of the identified themes of definitions. It is necessary for a consensus definition of chemical restraint to be established and for measurement approaches to reflect the elements of definitions.
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Ferrão SADS, Bleijlevens MHC, Nogueira PJ, Henriques MAP. A cross-sectional study on nurses' attitudes towards physical restraints use in nursing homes in Portugal. Nurs Open 2021; 8:1571-1577. [PMID: 33438841 PMCID: PMC8186690 DOI: 10.1002/nop2.769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/18/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022] Open
Abstract
Aim To explore nurses' opinions regarding restraint measures and attitudes towards physical restraints use in nursing homes. Design Cross‐sectional study. Methods Nursing staff of 33 Portuguese nursing homes was asked to complete the Portuguese version of the Maastricht Attitude Questionnaire (MAQ), an instrument on attitudes regarding physical restraints (reasons, consequences and appropriateness of restraint use) and opinions about restraint measures (restrictiveness and discomfort). Descriptive statistics and bivariate analysis were performed. Results Data from 186 nurses were included in the analysis. Overall, nurses expressed neutral to moderately positive attitudes towards physical restraints usage. Nurses with longer professional experience reported a more positive attitude regarding the appropriateness of restraint use in their clinical practice. Wrist and ankle restraints were the measures that nurses reported feeling most uncomfortable using, and the most restrictive. Bilateral bedrails were globally assessed as a slightly restrictive measure and nurses reported not feeling uncomfortable using them.
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Affiliation(s)
- Sónia Alexandra da Silva Ferrão
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Michel H C Bleijlevens
- Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Paulo Jorge Nogueira
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Laboratório de Biomatemática, Faculdade de Medicina, Instituto de Medicina Preventiva e Saúde Pública, Universidade de Lisboa, Lisbon, Portugal
| | - Maria Adriana Pereira Henriques
- Escola Superior de Enfermagem de Lisboa (ESEL), Lisbon, Portugal.,Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Dichter MN, Berg A, Hylla J, Eggers D, Wilfling D, Möhler R, Haastert B, Meyer G, Halek M, Köpke S. Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial. BMC Geriatr 2021; 21:40. [PMID: 33430785 PMCID: PMC7802225 DOI: 10.1186/s12877-020-01997-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sleep problems are highly prevalent in people with dementia. Nevertheless, there is no "gold standard" intervention to prevent or reduce sleep problems in people with dementia. Existing interventions are characterized by a pronounced heterogeneity as well as insufficient knowledge about the possibilities and challenges of implementation. The aim of this study is to pilot and evaluate the effectiveness of a newly developed complex intervention to prevent and reduce sleep problems in people with dementia living in nursing homes. METHODS This study is a parallel group cluster-randomized controlled trial. The intervention consists of six components: (1) the assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes, (2) the implementation of two "sleep nurses" as change agents per nursing home, (3) a basic education course for nursing staff: "Sleep problems in dementia", (4) an advanced education course for nursing staff: "Tailored problem-solving" (two workshops), (5) workshops: "Development of an institutional sleep-promoting concept" (two workshops with nursing management and sleep nurses) and (6) written information and education material (e.g. brochure and "One Minute Wonder" poster). The intervention will be performed over a period of 16 weeks and compared with usual care in the control group. Overall, 24 nursing homes in North, East and West Germany will be included and randomized in a 1:1 ratio. The primary outcome is the prevalence of sleep problems in people with dementia living in nursing homes. Secondary outcomes are quality of life, quality of sleep, daytime sleepiness and agitated behavior of people with dementia, as well as safety parameters like psychotropic medication, falls and physical restraints. The outcomes will be assessed using a mix of instruments based on self- and proxy-rating. A cost analysis and a process evaluation will be performed in conjunction with the study. CONCLUSIONS It is expected that the intervention will reduce the prevalence of sleep problems in people with dementia, thus not only improving the quality of life for people with dementia, but also relieving the burden on nursing staff caused by sleep problems. TRIAL REGISTRATION Current controlled trials: ISRCTN36015309 . Date of registration: 06/11/2020.
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Affiliation(s)
- Martin N Dichter
- Institute of Nursing Science, University Hospital of Cologne, Gleuler Straße 176-178, D-50935, Cologne, Germany.
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany.
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany.
| | - Almuth Berg
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Jonas Hylla
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
| | - Daniela Eggers
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Denise Wilfling
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
- School of Public health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | | | - Gabriele Meyer
- Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, 06112, Halle (Saale), Germany
| | - Margareta Halek
- Neurodegenerative Diseases (DZNE), Witten, Stockumer Straße 12, 58453, Witten, Germany
- School of Nursing Science, Witten/Herdecke University, Stockumer Straße 12, 58453, Witten, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University Hospital of Cologne, Gleuler Straße 176-178, D-50935, Cologne, Germany
- Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
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Lee DCA, Robins LM, Bell JS, Srikanth V, Möhler R, Hill KD, Griffiths D, Haines TP. Prevalence and variability in use of physical and chemical restraints in residential aged care facilities: A systematic review and meta-analysis. Int J Nurs Stud 2020; 117:103856. [PMID: 33601305 DOI: 10.1016/j.ijnurstu.2020.103856] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Use of physical and chemical restraints are common in residential aged care facilities worldwide. Restraint use can pose harm to residents even causing deaths. OBJECTIVE To synthesize the prevalence and variability in physical and chemical restraint use, and examine factors that may contribute to this variability of prevalence rates. METHODS Six health science databases were searched from inception up to 21st January 2020. Quantitative studies investigating restraint use in residential aged care facilities that reported data from year 2000 onwards were included. Meta-analyses of binomial data using a random effect model were performed to pool proportions of physical or chemical restraints with 95% confidence intervals. Univariable meta-regression analyses were used to assess factors that may contribute to the variability in physical and chemical restraint prevalence. Multiple meta-regression analyses were performed where possible to construct models of factors contributing to these variations. RESULTS Eighty-five papers were included. The pooled proportion of physical and chemical restraint use in residential aged care facilities were 33% and 32% respectively. Bedrails (44%) and benzodiazepines (42%) were the most prevalent forms of physical and chemical restraint respectively. Studies from North America (lower prevalence) [coefficient (95% CI): -0.15 (-0.27, -0.03)], measurement approaches using direct observation (higher prevalence) [0.17 (0.02, 0.33)] and a combination of multiple measurement approaches (higher prevalence) [0.17 (0.05, 0.29)] explained 25.5% of variability in the prevalence of physical restraint. Multiple meta-regression analyses were not performed to identify factors that may explain the observed variability in chemical restraint prevalence due to the small number of studies with data available. CONCLUSION Variability in prevalence of physical restraint could be explained partly by different measurement approaches and geographical regions. Valid and reliable measurement approaches across different regions is required to understand cultural differences due to geographical region effects on the prevalence of physical restraint use.
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Affiliation(s)
- Den-Ching A Lee
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia.
| | - Lauren M Robins
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Royal Parade, Parkville, VIC 3052, Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston Hospital, Frankston, VIC 3199, Australia
| | - Ralph Möhler
- Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Keith D Hill
- School of Primary and Allied Health Care, Rehabilitation, Ageing and Independent Living (RAIL) research centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - Debra Griffiths
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - Terry P Haines
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
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Abraham J, Bake M, Berger-Höger B, Köpke S, Kupfer R, Meyer G, Möhler R. Process evaluation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A mixed methods study. J Adv Nurs 2020; 77:1465-1477. [PMID: 33270930 DOI: 10.1111/jan.14694] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/15/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
AIMS To describe the implementation process and fidelity of two versions of a guideline-based, multicomponent intervention to reduce physical restraints in nursing homes and to identify factors that might explain the heterogeneity of effects between different clusters. DESIGN Mixed methods evaluation of the implementation process (dose delivered, dose received, response, and adaption) alongside a pragmatic three-arm cluster randomized controlled trial. METHODS Quantitative and qualitative process data were collected during the study period (February 2015-February 2017). Quantitative data from questionnaires and short surveys were analysed by descriptive statistics. Qualitative data from focus groups and semi-structured interviews were analysed using content analysis. An in-depth analysis was conducted by contrasting responding and non-responding clusters regarding the intervention goal and primary outcome. RESULTS Both interventions were implemented as planned in all clusters: we found no deviations from the protocol regarding the dose delivered to and received by the clusters. Satisfaction of staff targeted by the interventions was high. The in-depth analysis did not reveal any pronounced variation in the degree of implementation or adoption in clusters with a good or nearly no response to the interventions or factors explaining different study effects. CONCLUSION Although both versions of a guideline-based multicomponent intervention to prevent physical restraints in nursing homes were implemented as planned and the response was generally acceptable, the interventions' goal to change nursing practice towards a least-restraint policy was not achieved by the entire nursing staff in all of the clusters. No factors could be identified that might explain the different effects of the interventions. IMPACT For some nursing homes, different approaches than addressing nurses' attitudes and institutional policies might be needed to sustainably reduce the use of physical restraints; however, the process evaluation did not reveal characteristics that might have hampered or facilitated the effectiveness of the intervention.
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Affiliation(s)
- Jens Abraham
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mareike Bake
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Birte Berger-Höger
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Lübeck, Germany.,Institute of Nursing Science, Medical Faculty, University of Cologne, Cologne, Germany
| | - Ramona Kupfer
- Nursing Research Unit, Institute of Social Medicine & Epidemiology, University of Lübeck, Lübeck, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ralph Möhler
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,School of Nursing, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Institute for Health Services Research and Health Economics, Center for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Müller C, Hesjedal-Streller B, Fleischmann N, Tetzlaff B, Mallon T, Scherer M, Köpke S, Balzer K, Gärtner L, Maurer I, Friede T, König HH, Hummers E. Effects of strategies to improve general practitioner-nurse collaboration and communication in regard to hospital admissions of nursing home residents (interprof ACT): study protocol for a cluster randomised controlled trial. Trials 2020; 21:913. [PMID: 33153484 PMCID: PMC7643262 DOI: 10.1186/s13063-020-04736-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention. METHODS This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs' home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed. DISCUSSION This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers. TRIAL REGISTRATION ClinicalTrials.gov NCT03426475 . Initially registered on 7 February 2018.
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Affiliation(s)
- Christiane Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073, Göttingen, Germany.
| | - Berit Hesjedal-Streller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073, Göttingen, Germany
| | - Nina Fleischmann
- Nursing Science, Fulda University of Applied Sciences, Building 31, Room 122, Leipziger Straße 123, D-36037, Fulda, Germany
| | - Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Tina Mallon
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University Clinic Cologne, Gleueler Straße 176-178, D-50935, Köln, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Ratzeburger Allee 160, Haus 50, D-23538, Lübeck, Germany
| | - Linda Gärtner
- Institute for Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Ratzeburger Allee 160, Haus 50, D-23538, Lübeck, Germany
| | - Indre Maurer
- Chair of Organization and Corporate Development, Georg-August-University Göttingen, Platz der Göttinger Sieben 3, D-37073, Göttingen, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073, Göttingen, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246, Hamburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073, Göttingen, Germany
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Hertrampf K, Schlattmann P, Meyer G, Gassmann G, Abraham J, Hammen V, Schwendicke F. Oral health improvement for nursing home residents through delegated remotivation and reinstruction (MundZaRR Study): study protocol of a cluster-randomised controlled trial. BMJ Open 2020; 10:e035999. [PMID: 32978183 PMCID: PMC7520860 DOI: 10.1136/bmjopen-2019-035999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Oral health and oral health-related quality of life (OHrQL) of residents in German long-term residential care (LRC) are poor. We will develop an evidence-based catalogue of interventions ('Oral Health Toolbox') and provide care-accompanying reinstruction and remotivation of nursing staff by dental assistants (DA). We hypothesise that such intervention will significantly improve OHrQL, daily oral hygiene/care behaviour and is cost-effective. METHODS AND ANALYSIS A scoping review will be used to identify possible intervention components. Mixed methods will be used to identify barriers and enablers of oral hygiene and care in German LRC. The result will be the 'Oral Health Toolbox', a two-phased instrument supporting both initial intervention allocation to improve oral health/hygiene and reinstruction/remotivation. A two-arm clustered, randomised controlled trial (ratio of 1:1 via block randomisation) will be performed in LRC in Rhineland-Palatinate, Germany. Each nursing home represents a cluster. Based on a feasibility study, considering clustering and possible attrition, we aim at recruiting 618 residents in 18 clusters. In the intervention group, dentists will assign one or more intervention component from the box (phase 1). During follow-up, nursing staff will be reinstructed and remotivated by DA, who use the box to decide how to maintain the intervention (phase 2). In the control group residents will receive care as usual. The primary outcome, OHrQL, will be measured using the General Oral Health Assessment Index. Secondary outcomes include pain condition, general health-related quality of life, caries increment, oral/prosthetic hygiene and gingival status, incidence of dental emergencies and hospitalisations, and cost-utility/effectiveness. The endpoints will be measured at baseline and after 12 months. For our primary outcome, a mixed-linear model will be used within an intention-to-treat analysis. A process evaluation using mixed methods will be conducted alongside the trial. ETHICS AND DISSEMINATION Ethical approval by the University of Kiel was granted (D480/18). TRIAL REGISTRATION NUMBER NCT04140929.
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Affiliation(s)
- Katrin Hertrampf
- Clinic of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Schlattmann
- Medical Statistics, Computer and DataSciences, Friedrich-Schiller-Universitat Jena, Jena, Germany
| | - Gabriele Meyer
- Institute for Health Care and Nursing Studies, University Halle, Halle/Saale, Germany
| | - Georg Gassmann
- praxisHochschule pHfG Trägergesellschaft, praxisHochschule University of Applied Sciences, Cologne, Germany
| | - Jens Abraham
- Institute for Health Care and Nursing Studies, University Halle, Halle/Saale, Germany
| | - Volker Hammen
- praxisHochschule University of Applied Sciences, praxisHochschule University of Applied Sciences, Cologne, Germany
| | - Falk Schwendicke
- Zahnerhaltung, Charite Universitatsmediz in Berlin Campus Benjamin Franklin, Berlin, Germany
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Brugnolli A, Canzan F, Mortari L, Saiani L, Ambrosi E, Debiasi M. The Effectiveness of Educational Training or Multicomponent Programs to Prevent the Use of Physical Restraints in Nursing Home Settings: A Systematic Review and Meta-Analysis of Experimental Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186738. [PMID: 32947851 PMCID: PMC7558973 DOI: 10.3390/ijerph17186738] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/02/2020] [Accepted: 09/14/2020] [Indexed: 01/07/2023]
Abstract
This review assesses the effectiveness of interventions to reduce physical restraint (PR) use in older people living in nursing homes or residential care facilities. A systematic search of studies published in four electronic databases (MEDLINE, CINHAL, PsycINFO, Cochrane Central Register of Controlled Trials). The review included individual and cluster randomized controlled trials that compared educational training and multicomponent programs to avoid PR use. Risk bias of randomized controlled trials (RCTs) was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions. This review includes 16 studies in a qualitative synthesis that met the inclusion criteria, nine of them offered a multicomponent program and seven offered only educational training. The results of the 12 studies included in the meta-analysis showed a significant trend in favor of intervention over time and intensity of PR use tends to decrease. The review indicates that educational programs and other supplementary interventions should be effective, but the heterogeneous operative definition of physical restraints can make difficult data generalization.
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Affiliation(s)
- Anna Brugnolli
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Luigina Mortari
- Department of Human Sciences, University of Verona, 37134 Verona, Italy;
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (F.C.); (L.S.); (E.A.)
| | - Martina Debiasi
- Centre of Higher Education for Health Sciences, 38122 Trento, Italy;
- Correspondence:
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Wilfling D, Dichter MN, Trutschel D, Köpke S. Nurses' burden caused by sleep disturbances of nursing home residents with dementia: multicenter cross-sectional study. BMC Nurs 2020; 19:83. [PMID: 32943980 PMCID: PMC7487724 DOI: 10.1186/s12912-020-00478-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 09/01/2020] [Indexed: 11/16/2022] Open
Abstract
Background Sleep disturbances are common in people with dementia. In nursing homes, this is frequently associated with residents’ challenging behavior and potentially with nurses’ burden. This study examined nurses’ burden associated with nursing home residents’ sleep disturbances. Methods A multicenter cross-sectional study was conducted. Nurses’ burden associated with residents’ sleep disturbances was assessed using the Sleep Disorder Inventory (SDI). Additionally, the proportion of nurses’ total burden associated with sleep disturbances of residents with dementia was assessed. A linear mixed regression model was used to investigate the association with nurses’, residents’ and institutional characteristics. Results One hundred eleven nurses from 38 nursing homes were included. 78.4% stated to be regularly confronted with residents’ sleep disturbances during nightshifts, causing distress. The mean proportion of nurses‘ total burden caused by residents‘ sleep disturbances was 23.1 % (SD 18.1). None of the investigated characteristics were significantly associated with nurses’ total burden. Conclusions Nurses report burden associated with sleep disturbances as common problem. There is a need to develop effective interventions for sleep problems and to train nurses how to deal with residents’ sleep disturbances.
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Affiliation(s)
- Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Martin N Dichter
- Institute of Nursing Science, University Hospital Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany.,German Center of Neurodegenerative Diseases, Stockumer Straße 12, 58453 Witten, Germany.,School of Nursing Science, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455 Witten, Germany
| | - Diana Trutschel
- German Center of Neurodegenerative Diseases, Stockumer Straße 12, 58453 Witten, Germany
| | - Sascha Köpke
- Institute of Nursing Science, University Hospital Cologne, Gleueler Straße 176-178, 50935 Cologne, Germany
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Spoon D, Rietbergen T, Huis A, Heinen M, van Dijk M, van Bodegom-Vos L, Ista E. Implementation strategies used to implement nursing guidelines in daily practice: A systematic review. Int J Nurs Stud 2020; 111:103748. [PMID: 32961463 DOI: 10.1016/j.ijnurstu.2020.103748] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Research specifically addressing implementation strategies regarding nursing guidelines is limited. The objective of this review was to provide an overview of strategies used to implement nursing guidelines in all nursing fields, as well as the effects of these strategies on patient-related nursing outcomes and guideline adherence. Ideally, the findings would help guideline developers, healthcare professionals and organizations to implement nursing guidelines in practice. DESIGN Systematic review. PROSPERO registration number: CRD42018104615. DATA SOURCES We searched the Embase, Medline, PsycINFO, Web of Science, Cochrane, CINAHL and Google Scholar databases until August 2019 as well as the reference lists of relevant articles. REVIEW METHODS Studies were included that described quantitative data on the effect of implementation strategies and implementation outcomes of any type of a nursing guideline in any setting. No language or date of publication restriction was used. The Cochrane Effective Practice and Organisation of Care taxonomy was used to categorize the implementation strategies. Studies were classified as effective if a significant change in either patient-related nursing outcomes or guideline adherence was described. Strength of the evidence was evaluated using the 'Cochrane risk of bias tool' for controlled studies, and the 'Newcastle-Ottawa Quality Assessment form' for cohort studies. RESULTS A total of 54 articles regarding 53 different guideline implementation studies were included. Fifteen were (cluster) Randomized Controlled Trials or controlled before-after studies and 38 studies had a before-after design. The topics of the implemented guidelines were diverse, mostly concerning skin care (n = 9) and infection prevention (n = 7). Studies were predominantly performed in hospitals (n = 34) and nursing homes (n = 11). Thirty studies showed a positive significant effect in either patient-related nursing outcomes or guideline adherence (68%, n = 36). The median number of implementation strategies used was 6 (IQR 4-8) per study. Educational strategies were used in nearly all studies (98.1%, n = 52), followed by deployment of local opinion leaders (54.7%, n = 29) and audit and feedback (41.5%, n = 22). Twenty-three (43.4%) studies performed a barrier assessment, nineteen used tailored strategies. CONCLUSIONS A wide variety of implementation strategies are used to implement nursing guidelines. Not one single strategy, or combination of strategies, can be linked directly to successful implementation of nursing guidelines. Overall, thirty-six studies (68%) reported a positive significant effect of the implementation of guidelines on patient-related nursing outcomes or guideline adherence. Future studies should use a standardized reporting checklist to ensure a detailed description of the used implementation strategies to increase reproducibility and understanding of outcomes.
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Affiliation(s)
- Denise Spoon
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands.
| | - Tessa Rietbergen
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Anita Huis
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Maud Heinen
- Radboud university medical centre, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands
| | - Monique van Dijk
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, section Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Erwin Ista
- Department of Internal Medicine, Section Nursing Science, Erasmus MC University Medical Centre, Room Rg-532, P.O. Box 2040, Rotterdam, CA 3000, The Netherlands; Department of Paediatric Surgery and Intensive Care, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Wang J, Liu W, Peng D, Xiao M, Zhao Q. The use of physical restraints in Chinese long-term care facilities and its risk factors: An observational and cross-sectional study. J Adv Nurs 2020; 76:2597-2609. [PMID: 33463735 DOI: 10.1111/jan.14486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/28/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022]
Abstract
AIM To investigate the use of physical restraints among Chinese long-term care facilities older adults and to identify its risk factors. DESIGN Observational and cross-sectional study. METHODS A total of 1,026 older adults from six long-term care facilities in Chongqing were recruited by cluster sampling method from July - November 2019. Data on physical restraint use and older adults' characteristics were collected using physical restraints observation forms and older adults' records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi-square test and binary logistic regression. RESULTS The study found that the prevalence of physical restraints in six long-term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. CONCLUSION The use of physical restraints among Chinese long-term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. IMPACT This study will provide an effective reference for nursing staff in long-term care facilities to assess high-risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.
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Affiliation(s)
- Jun Wang
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weichu Liu
- Department of Gynecology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Daomei Peng
- The First Social Welfare Home of Chongqing, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Schulz M, Tsiasioti C, Czwikla J, Schwinger A, Gand D, Schmidt A, Schmiemann G, Wolf-Ostermann K, Rothgang H. Claims data analysis of medical specialist utilization among nursing home residents and community-dwelling older people. BMC Health Serv Res 2020; 20:690. [PMID: 32711516 PMCID: PMC7382069 DOI: 10.1186/s12913-020-05548-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 07/15/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Most older people, and especially those in need of long-term care, suffer from one or more chronic diseases. Consequently, older people have an increased need of medical care, including specialist care. There is little evidence as yet whether older people with greater medical care needs obtain adequate medical care because existing studies do not sufficiently control for differences in morbidity. In this study we investigate whether differences in medical specialist utilization exist between older people with and without assessed long-term care need in line with Book XI of the German Social Code, while at the same time controlling for individual differences in morbidity. METHODS We used data from the 11 German AOK Statutory Health and Long-term Care Insurance funds of 100,000 members aged 60 years or over. Zero-inflated Poisson regression analyses were applied to investigate whether the need for long-term care and the long-term care setting are associated with the probability and number of specialist visits. We controlled for age, gender, morbidity and mortality, residential density, and general practitioner (GP) utilization. RESULTS Older people in need of long-term care are more likely to have no specialist visit than people without the need for long-term care. This applies to nearly all medical specialties and for both care settings. Yet, despite these differences in utilization probability the number of specialist medical care visits between older people with and without the need for long-term care is similar. CONCLUSION Older people in need of long-term care might face access barriers to specialist care. Once a contact is established, however, utilization does not differ considerably between those who need long-term care and those who don't; this indicates the importance of securing an initial contact.
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Affiliation(s)
- Maike Schulz
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | | | - Jonas Czwikla
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Antje Schwinger
- WIdO - AOK Research Institute, P.O. Box 11 02 46, 10832 Berlin, Germany
| | - Daniel Gand
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Annika Schmidt
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Guido Schmiemann
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Karin Wolf-Ostermann
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
- Institute for Public Health and Nursing Research (IPP), University of Bremen, Grazer Straße 4, 28359 Bremen, Germany
| | - Heinz Rothgang
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359 Bremen, Germany
- High-Profile Area Health Sciences, University of Bremen, Bremen, Germany
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Silies K, Schnakenberg R, Berg A, Kirchner Ä, Langner H, Köberlein-Neu J, Meyer G, Hoffmann F, Köpke S. Process evaluation of a complex intervention to promote advance care planning in community-dwelling older persons (the STADPLAN study)-study protocol. Trials 2020; 21:653. [PMID: 32678005 PMCID: PMC7366302 DOI: 10.1186/s13063-020-04529-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 06/18/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Process evaluation addresses the implementation, mechanisms of impact, and context of participants in complex interventions. The STADPLAN study assesses the effects of conversations on advance care planning (ACP) led by trained nurse facilitators. The complex intervention consists of several components that may lead to various changes in attitude and behavior regarding personal ACP activities. With the process evaluation, we aim to assess how changes were achieved in the STADPLAN intervention. METHODS The planned process evaluation study will be conducted alongside a cluster-randomized controlled trial on ACP in home care services (HCS). Trained nurse facilitators will deliver the ACP intervention consisting of an information brochure and two ACP conversations. A logic model depicts the assumed change processes of the intervention: the educational program enables nurses to conduct ACP conversations with patients and their caregivers. Patients gain knowledge and reflect upon and engage in their own ACP. Caregivers better understand patients' wishes and feel reassured in their role as surrogates. Designation of a surrogate and communication on ACP are facilitated. We will assess the effects of the educational program with questionnaires and a focus group including all participating nurses. We will measure ACP engagement, and prevalence of advance directives in patients, and ask for their experiences with the intervention. We will conduct semi-structured interviews with caregivers about their expectations and experiences regarding ACP in general and the intervention. We will address context factors, e.g., basic characteristics of the HCS (such as ownership, number of clients, staff and qualification). Analysis will be based upon the logic model, integrating qualitative and quantitative data. DISCUSSION The comprehensive process evaluation will provide essential information on the feasibility of implementation strategies and the clinical relevance of a nurse-led ACP intervention in home care recipients and its generalizability and transferability to other settings. TRIAL REGISTRATION German Clinical Trials Register: DRKS00016886 . Registered retrospectively on June 4, 2019, first participant included on May 29, 2019.
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Affiliation(s)
- Katharina Silies
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.
| | - Rieke Schnakenberg
- Department for Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany.
| | - Almuth Berg
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Änne Kirchner
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Henriette Langner
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Straße 21, 42119, Wuppertal, Germany
| | - Gabriele Meyer
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany
| | - Falk Hoffmann
- Department for Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany.,Institute for Nursing Science, University of Cologne, Gleueler Straße 176 - 178, 50935, Köln, Germany
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Schnakenberg R, Silies K, Berg A, Kirchner Ä, Langner H, Chuvayaran Y, Köberlein-Neu J, Haastert B, Wiese B, Meyer G, Köpke S, Hoffmann F. Study on advance care planning in care dependent community-dwelling older persons in Germany (STADPLAN): protocol of a cluster-randomised controlled trial. BMC Geriatr 2020; 20:142. [PMID: 32303198 PMCID: PMC7164271 DOI: 10.1186/s12877-020-01537-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In Germany, advance care planning (ACP) was first introduced by law in 2015. However, ACP is still uncommon in Germany and only few people have advance directive forms. This study aims to evaluate an ACP program in care dependent community-dwelling persons, compared to optimised usual care. METHODS A cluster-randomised controlled trial of 12 months duration will be conducted in 3 German study sites comparing the pretested ACP-counselling offered by trained nurses with a control group receiving optimised usual care. Using external concealed randomisation, 16 home care services each will be included in the intervention and the control group (30 participants per cluster; n = 960). Eligibility criteria for patients are: ≥60 years, somehow care dependent, adequate German language skills, assumed life-expectancy of ≥4 weeks, and cognitive ability for participation. ACP will be delivered by trained nurse facilitators of the respective home care services and communication will include proxy decision-makers. The primary endpoint will be patient activation, assessed by the Patient Activation Measure (PAM-13). Secondary endpoints include ACP-engagement, proportion of prepared advance directives, number and duration of hospitalisations, quality of life as well as depression and anxiety. Further, comprehensive economic and process evaluations will be conducted. DISCUSSION STADPLAN is the first study in Germany that assesses an adapted ACP intervention with trained nurses in home care services and the first international study focusing on cost effectiveness of ACP in community-dwelling older persons. The results will help to improve the understanding and communicating of patients' preferences regarding medical treatment and care and thereby contribute to patients' autonomy. TRIAL REGISTRATION German Clinical Trials Register: DRKS00016886 (Date of registration: 04.06.2019).
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Affiliation(s)
- Rieke Schnakenberg
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Silies
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Almuth Berg
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Änne Kirchner
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Henriette Langner
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Yuliya Chuvayaran
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | | | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Gabriele Meyer
- Medical Faculty, Institute for Health- and Nursing Science, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Sascha Köpke
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Faculty of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Estabrooks CA, Straus SE, Flood CM, Keefe J, Armstrong P, Donner GJ, Boscart V, Ducharme F, Silvius JL, Wolfson MC. Restoring trust: COVID-19 and the future of long-term care in Canada. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0056] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the characteristics of older adults living in nursing homes, their caregivers, and the physical environment of nursing homes as important contributors to the COVID-19 crisis. Finally, the report articulates principles for action and nine recommendations for action to help solve the workforce crisis in nursing homes.
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Affiliation(s)
| | - Sharon E. Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Janice Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, NS, Canada
| | - Pat Armstrong
- Department of Sociology, York University, Toronto, ON, Canada
| | - Gail J. Donner
- Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Véronique Boscart
- CIHR/Schlegel Industrial Research Chair for Colleges in Seniors Care, Conestoga College, Kitchener, ON, Canada
| | | | - James L. Silvius
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael C. Wolfson
- School of Epidemiology and Public Health and Faculty of Law, University of Ottawa, Ottawa, ON, Canada
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Nguyen N, Thalhammer R, Beutner K, Saal S, Servaty R, Klingshirn H, Icks A, Freyberg K, Vomhof M, Mansmann U, Le L, Müller M, Meyer G. Effectiveness of a complex intervention to improve participation and activities in nursing home residents with joint contractures (JointConEval): study protocol of a multicentre cluster-randomised controlled trial [DRKS-ID:DRKS00015185]. Trials 2019; 20:305. [PMID: 31142350 PMCID: PMC6542100 DOI: 10.1186/s13063-019-3384-6] [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] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents are frequently affected by joint contractures, which impacts their participation and daily activities. A complex intervention, the Participation Enabling Care in Nursing (PECAN), was previously developed and pilot tested to address their needs. Its effectiveness and safety will be evaluated in the present study. METHODS/DESIGN This multicentre cluster-randomised controlled trial will be conducted in 32 nursing homes spread over two regions of Germany. A total of 578 residents over 65 years old with joint contractures will be included. To compare the effect of the PECAN intervention with optimised standard care (usual care and an information session), randomisation will take place at a cluster level. The individually tailored intervention was designed using the biopsychosocial model in the International Classification of Functioning, Disability and Health (ICF) to reduce activity limitations and participation restrictions resulting from existing joint contractures by addressing barriers and by strengthening supportive factors on an individual level and an organisational level. The implementation strategy comprises a facilitators' workshop, a peer mentoring approach including a peer mentor visit and telephone peer counselling, an in-house information event, an information session for the nursing team and a training session on collegial consultation for the facilitators. The in-house information event will also take place in the nursing homes of the control group. The primary outcome is the residents' participation and activities after 12 months of follow-up as assessed using the PaArticular Scales. The secondary outcome is the residents' quality of life. A cost-effectiveness analysis (costs per additional resident who experienced a decrease of ten points in the participation or activities subscale of the PaArticular Scales) and a cost-utility analysis (costs per additional quality adjusted life year) will be conducted. We will investigate barriers and facilitators in a comprehensive process evaluation. DISCUSSION We expect a clinically relevant improvement of participation and activities in residents with joint contractures. Our findings will provide important insights regarding participation in the situation of the affected individuals. TRIAL REGISTRATION DRKS, DRKS00015185 . Registered on 1 August 2018. Universal Trial Number U1111-1218-1555. Registered on 26 July 2018.
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Affiliation(s)
- Natalie Nguyen
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Regina Thalhammer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Katrin Beutner
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Susanne Saal
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
| | - Ricarda Servaty
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Hanna Klingshirn
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Kristina Freyberg
- Department of Medical Controlling, University Hospital Bonn, Bonn, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Lien Le
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Müller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstraße 1, 83024 Rosenheim, Germany
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Saale Germany
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