Nursing Staff Views of Barriers to Physical Restraint Reduction in Nursing Homes

Table of Content

• Study aim and research questions
• Staffing levels and the use of physical restraints in nursing homes: a multicenter study.
• Trial registration
• Nursing staff views of barriers to physical restraint reduction in nursing homes
• Checking if the site connection is secure
• Physical Restraint Reduction
• Physical Restraints: Consensus of a Research Definition Using a Modified Delphi Technique

The recent expansion of the pilot to other wards in the same nursing home has shown similar results. However, this home does not represent a typical Dutch facility since it is considered as 'best practice' regarding restraint reduction initiatives and research. Thus, further testing of the EXBELT intervention is needed on wards in other nursing homes prior to widespread dissemination. A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents.

Several attempts have been made to reduce restraint use in clinical practice [17–22]. Most interventions used educational approaches, aiming to improve nursing staff knowledge and confidence to avoid physical restraints and to use alternative measures that target the resident's underlying problems . These intensive training sessions were delivered to staff by a nurse specialist provided to the nursing home as a consultant from the study team. The success rate of these interventions differs between countries; a successful educational intervention in the USA proved to be ineffective in the Netherlands . It is unclear whether these contradictory results can be explained by cultural differences, differences in health care systems, or difference in educational level of nursing staff in nursing homes between the USA and the Netherlands. The results of a recent study among Dutch, German and Swiss nursing staff indicate that opinions and attitudes towards physical restraints hinder attempts to reduce restraint use .

Study aim and research questions

Several attempts have been made to reduce the use of physical restraints. Most studies used educational approaches and introduced a nurse specialist as a consultant. We developed a new multi-component intervention comprising an educational intervention for nursing home staff in combination with a policy change , availability of a nurse specialist and nursing home manager as consultants, and availability of alternative interventions. The first aim of this study is to further develop and test the effectiveness of EXBELT on belt restraint reduction in Dutch psychogeriatric nursing homes.

The relative effects of two experimental interventions on the use of physical restraints are compared to show the importance of prior experience in deciding whether or not to use physical restraints. For conducting the process evaluation, other samples will be recruited in comparison with the effect evaluation. Depending on the study question, residents' relatives, nursing home staff, educators , nursing home management, and the Netherlands Health Care Inspectorate will be invited to participate in different parts of the process evaluation. The primary outcome measure of the effect evaluation is the use of belts. Belt use will be measured at baseline, T2 and T3 using the observation tool developed by Huizing and colleagues .

Staffing levels and the use of physical restraints in nursing homes: a multicenter study.

Data regarding the process evaluation will be gathered regarding the eight month period between baseline and T3. First, to investigate the opinion of nursing home staff, the nursing home management and the residents' relatives about EXBELT and the effectiveness of alternative interventions, structured interviews will be used. Second, intervention fidelity, including the dose delivered, and dose received , will be obtained by conducting interviews with nursing home staff, nursing home management, educators and consultants. In addition, checklists and observation forms will be used to document fidelity of the intervention across nursing home units assigned to the intervention group. Finally, to examine the influence of the EXBELT on attitudes and opinions regarding restraint use, we will measure attitudes of nursing home staff using the MAQ at baseline, after the education program and at the end of the project. No change occurred in the number of staff hours per resident, and no increase was seen in psychoactive drug use in the two nursing homes that underwent intervention.

Use of vest restraints decreased by 41 percent in the nursing home that provided education sessions and by 77 percent in the nursing home that provided education and consultation. Geriatric chair use was not signficantly affected by any of the interventions. For years, physical restraints have been viewed as an appropriate intervention to prevent falls, to manage wandering and/or behavioral disturbances, or to minimize tampering with medical devices (intravenous lines, feeding tubes, indwelling bladder catheters, etc.). A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes. In November 2008 the Medical Ethics Committee of the University Hospital Maastricht and Maastricht University has approved the study design and protocols. Representatives of the residents received written information and were asked to give written informed consent for the use of personal data on the residents in the study.

Trial registration

The findings of this study provide a valuable basis for developing restraint reduction education programs. This paper presents the design of a quasi-experimental study, which aims to explore the effect and feasibility of an intervention program that aims to reduce the use of belts in Dutch psychogeriatric nursing homes. Some methodological and practical drawbacks, concerning the current design, exist. However, under the current circumstances it is the most feasible method the assess data on the effectiveness of the intervention program.

The six-month, 10-session restraint education program was taught by a gerontologic nurse specialist. The 30- to 40-minute sessions focused on the effects of physical restraints, the behavior of residents, ways to minimize the risk of falls and ways to cope with problem behaviors such as wandering and agitation. The consultations focused on residents who posed a challenge because of their behavior. The process evaluation will monitor the content and feasibility of the intervention program.

Restraint Toolkit helps nursing home staff with restraint reduction efforts. NoteYou must complete the free registration to access the information on this website. Restraint Clinical Tools & Resources can help nursing facilities reduce physical restraint use with technical assistance and interventions directed at process and system redesign. Information and resources about reducing the use of physical restraints in Nursing Facilities.

We selected the wards in a manner that contamination between control- and intervention group is prevented. There are few studies globally regarding the barriers to restraint-reduction. The purpose of this study was to describe the views of nursing staff regarding the barriers to reducing physical restraint use in Korean nursing homes. An advanced practice nurse intervention on restrictive side rail usage in four nursing homes and with a sample of 251 residents found no link between intervention and falls. Improving knowledge and skills of NH staff to better deal with restlessness/agitation, mobility problems, and risk for falls is encouraged to decrease the use of physical restraints in NH residents. The management boards of the four participating nursing home associations agreed with the implementation of the EXBELT program.

Checking if the site connection is secure

However, the reduction of belts should not result in an increase of other restrictive restraints or psychoactive drug use. The overall aim is an effective and feasible intervention that can be employed on a large scale in Dutch nursing homes. Effects of EXBELT will be studied in a quasi-experimental longitudinal study design. Alongside the effect evaluation, a process evaluation will be carried out in order to further develop EXBELT. Data regarding age, gender, use of physical restraints, the number of falls and fall related injuries, psychoactive drug use, and the use of alternative interventions will be collected at baseline and after four and eight months of follow-up. Data regarding the process evaluation will be gathered in a period of eight months between baseline and the last measurement.

Data resulting from the effect evaluation will be primarily analyzed according to the intention-to-treat principle, i.e., including all participants with valid data, regardless of whether they remained in the setting which they were measured at baseline. Subsequently, the results of the intention-to-treat analysis will be compared with the results of a per-protocol analysis, to assess whether protocol deviations have caused bias. In all analyses effect estimates will be adjusted for baseline differences. Data resulting from the process evaluation will mainly be analyzed by means of descriptive techniques. Description of an advanced practice nursing consultative model to reduce restrictive siderail use in nursing homes. This work aims to develop an internationally accepted research definition of physical restraint and to establish a baseline for this definition in the context of sports medicine.

Physical Restraint Reduction

In this study, almost all nursing staff assessed the use of physical restraints in their clinical practice as appropriate. Moreover, Dutch nursing staff consistently assessed restraint measures as less restrictive than German and Swiss nursing staff and reported less discomfort in using restraints . Furthermore, this and other studies indicate that the availability of alternative interventions is essential for effective restraint reduction [19, 23–25].

The use of belts will be measured by a single trained observer, who is blinded to the group assignment, on four times during a 24-hour period . The day each of the participating wards is visited will be unannounced in order to prevent any artificial removal of belts by nursing home staff. The greatest reduction in restraint use occurred in the nursing home in which the staff received education and consultation. The average absolute decline in restraint use at this nursing home was 18 percent, and this reduction was maintained during the follow-up period.

Physical Restraints: Consensus of a Research Definition Using a Modified Delphi Technique

Barriers to reducing the use of restraints in residential elder care facilities. However, recent research has demonstrated that restraints do not prevent falls. In fact, people who are restrained still fall, and are more likely to be seriously injured if the fall occurs while restrained. And other methods for managing wandering, behavioral issues and interference with medical devices have been found to be more effective. Physical restraints should only be used in rare circumstances, and only as a short-term measure. Using a restraint should be the last resort, even when a justifiable medical indication is present.

Overlap of nursing home staff between the intervention and control wards was averted. In addition, based on the geographical location of the participating wards, wards from each of the four nursing associations that were situated closely together were allocated to the same group. The wards allocated to the control group will receive care as usual, while the wards allocated to the intervention group will receive the EXBELT program. After one month follow up, no belt was used, but after three and nine months follow up 1 belt was used. This reduction in belt use did not result in either an increase in the number of falls and related injuries or the use of other restrictive measures such as chairs with a locked tray table or psychoactive medication. Belts were replaced with, resident-centered interventions, such as movement and balance training, lower beds, hip protectors, extra supervision and monitoring devices .