Table of Content
- Effects of a Restraint Minimization Program on Staff Knowledge, Attitudes, and Practice: A Cluster Randomized Trial
- Intervention program
- Trial registration
- Process evaluation of a multicomponent intervention program (EXBELT) to reduce belt restraints in nursing homes.
- Research ArticleNursing Staff Views of Barriers to Physical Restraint Reduction in Nursing Homes
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].
Data will be collected at baseline , and four and eight months after baseline. Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts. Attitudes of relatives of nursing home residents toward physical restraints.
Effects of a Restraint Minimization Program on Staff Knowledge, Attitudes, and Practice: A Cluster Randomized Trial
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 .
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.
Intervention program
All authors critically reviewed the manuscript, read and approved the final manuscript. Before sharing sensitive information, make sure you’re on an official government site. Interventions for preventing falls in older people in care facilities and hospitals. The objective was to investigate restraint use and its associations with neuropsychiatric symptoms and personal characteristics in residential care. Before sharing sensitive information, make sure you’re on a federal government site. Forty registered nurse and geriatric care assistant informants participated in the first round of interviews and 16 of them participated in second confirmatory interviews.
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.
Trial registration
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.
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 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.
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 .
The baseline rate of falls was lowest in the control nursing home but, after the interventions, this nursing home had a higher rate of falls than the other two nursing homes. 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 is developed. To test the effects of a multicomponent intervention program to reduce the use of belt restraints in psychogeriatric nursing homes. Process evaluation of a multicomponent intervention program to reduce belt restraints in nursing homes.
The effects of a restraint minimization education program on staff knowledge and attitudes and use of physical restraints are evaluated. A quasi-experimental study is presented to investigate the effects of EXBELT on the use of belts on wards in psychogeriatric nursing homes. The study will be conducted in 26 wards in 13 psychogeriatric nursing homes.
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.
Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings. Comparability between the intervention and control groups will be assessed at baseline to check for differences between the two groups on socio-demographic characteristics . Outcomes at T2 and T3 will be compared between the intervention and control groups by both univariate and multivariate techniques.
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