Initiation of physical restraint in nursing home residents following restraint reduction efforts

Abstract

In this pilot study a one group pretest posttest design was employed to identify resident characteristics and environmental factors associated with initiation of physical restraint. Predictors of restraint initiation for older adults were examined using secondary analysis of an existing data set of nursing home residents who were subjected to a federal mandate and significant restraint reduction efforts. Lower cognitive status (OR ϭ 1.5 [for every 7-point decrease in Mini-Mental State Examination], 95% CI ϭ 1.0, 2.1) and a higher ratio of licensed nursing personnel (OR ϭ 3.7, 95% CI ϭ 1.2, 11.9) were predictive of restraint initiation. Key findings suggest that restraint initiation occurs, despite significant restraint reduction efforts, when a nursing home resident is cognitively impaired or when more licensed nursing personnel (predominantly licensed practical nurses) are available for resident care. Achievement of restraint-free care in nursing homes requires specific and individualized approaches for residents who are cognitively impaired, as well as greater attention to staff mix of registered nurses, licensed practical nurses, and nursing aides.

The dark side of Norwegian nursing homes: factors influencing inadequate care

“…On the other hand, staff members educated to high school level have more than double the odds of committing acts of an emotional character when compared to the group with no relevant health education. Our results have some support from a study (Sullivan-Marx et al, 1999) that 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 restraints. Different types of inadequate care might reflect different attitudes.…”

Preventing belt restraint use in newly admitted residents in nursing homes: A quasi-experimental study

“…Poor mobility, high dependency and impaired cognitive status are the strongest predictors of restraint usage (Burton et al, 1992;Capezuti, 2004;Gallinagh et al, 2002;Hamers et al, 2004;Sullivan-Marx et al, 1999). Several studies demonstrated that in almost all cases, physical restraints are used as safety measures (Capezuti, 2004;Hamers et al, 2004;Werner, 2002), mainly to prevent falls (more than 90%) (Capezuti, 2004;Hamers et al, 2004;Werner and Mendelsson, 2001).…”

Prevalence of patients subjected to constraint in Norwegian nursing homes

“…Physical restraint is usually defined as restriction of movement or normal access to the body, or to the use of mechanical device (8)(9)(10)(11)(12)(13)(14). According to various studies in nursing homes, 4-86% of the patients have been reported as being physically restrained (9,12,13,15,16), and approximately one of three wards has reported that restraints are applied in them (17)(18)(19).…”