Factors Relating to the Use of Physical Restraints in Geriatric Care Settings

Abstract

Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross-sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint-free, low-use, and high-use wards in 63.6% of the cases, with the highest figures for restraint-free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.

Use of constraints and their correlates in Norwegian nursing homes

“…The education level of the staff had no effect on the use of constraints. These findings are in accordance with the results from most of the studies on associations (Tinetti et al, 1991;Sullivan-Marx et al, 1999b;Karlsson et al, 2001;Gallinagh et al, 2002). Philips et al (1996) found that wards with higher nurse staffing rates used less mechanical restraint and SulivanMarx et al (1999a) found that a high proportion of registered nurses compared to licensed practical nurses and nursing assistants, was a risk factor for the use of physical restraint.…”

Use of constraints and surveillance in Norwegian wards for the elderly

“…Neither this study nor other studies confirm this (Tinetti et al, 1991;Karlsson et al, 2001), and we have found only one study concluding that facilities with higher staffing use less physical restraints (Phillips et al, 1996). However, our results regarding a lack of association between staff density and constraints should be interpreted with some caution, as the staff density did not vary much between the wards.…”

“…In this study, physical restraints were used in 38% of the wards, while a Swedish study found that physical restraints were used in 76% (Karlsson et al, 2001). The organization of institutional care for the elderly, the legislation and the staffing are quite similar in Norway and Sweden and we would not expect any difference.…”

An audit of physical restraint and seclusion in five psychogeriatric admission wards in Victoria, Australia

“…In the USA, rates varied widely from one nursing home to another and from one locality to another (Levine et al, 1995). Factors associated with restraint in Sweden included dementia, behavioural disturbance, gait abnormality and nurses' attitudes (Karlsson et al, 2001). Low staffing levels were implicated in one North America study (Phillips et al, 1996).…”