Nursing knowledge and use of restraint alternatives: Acute and chronic care

Bryant, Heather; Fernald, Lori N.

doi:10.1016/s0197-4572(97)90056-2

Cited by 27 publications

(21 citation statements)

References 6 publications

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“…Janelli and her colleagues suggest that misinformation or misconceptions about restraint use often relate to what nurses had observed and learned from practice. Bryant and Fernald (1997) suggest that a more insightful use of restraints was found among nurses who had taken continuing education courses on caring for elderly patients. These ndings therefore highlight the importance of nurses receiving continuing education about restraint use in patient care.…”

Section: Discussionmentioning

confidence: 95%

“…The ndings highlight the implications for nurses in terms of being aware of patients' adaptive behaviors and attempting to make environmental adjustments according to individual needs (Bryant & Fernald, 1997;Quinn, 1994). For example, the presence of inadequate lighting, especially at night, frequently creates confusion and discomfort for the elderly patients.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, as Bryant and Fernald (1997) point out, the provision of a therapeutic environment for patients that promotes their physiological and psychosocial well-being is a challenge facing all nurses and other health care workers. Cartner and Koroknay (1993) also suggest that a multi-disciplinary approach can be used in the process of creating and maintaining the least restrictive environment for patients.…”

Section: Discussionmentioning

confidence: 99%

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The Use of Physical Restraints to Psychogeriatric Patients in Hong Kong

Chien¹

1999

Issues in Mental Health Nursing

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The use of physical restraint has been a controversial intervention in the nursing management of hospitalized elderly patients in many countries. This ethnographic study was conducted in one psychogeriatric ward in Hong Kong in order to explore what determines psychiatric nurses' decisions to use restraints on their elderly patients. By comparing the findings of three data sources, comprising semistructured interviews, observations, and clinical records, five main themes were identified with regard to the nurses decision of restraint use. They included the rationale of physical restraint, consideration of alternative measures, consideration of adverse consequences, ethical considerations, and policy and documentation of restraint use. The findings of this study demonstrate that nurses must question the established practice myths about restraint use being the best way to maintain patient safety. Most importantly, nurses need cognitive and ethical preparation to face different situations in which physical restraint may be used.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Use of Physical Restraints to Psychogeriatric Patients in Hong Kong

Chien¹

1999

Issues in Mental Health Nursing

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“…Similar to the findings reported in Wynn's questionnaire-based survey [7], a majority of the participants in this study believed that they had used restraints correctly and that nothing more could have been done to facilitate restraint reduction except better staffing. Nurses consistently cited insufficient staffing as one of the major reasons for restraint use [15,16]. …”

Section: Discussionmentioning

confidence: 99%

Nurses using physical restraints: Are the accused also the victims? – A study using focus group interviews

Lai

2007

BMC Nurs

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BackgroundTo date, the literature has provided an abundance of evidence on the adverse outcomes of restraint use on patients. Reportedly, nurses are often the personnel who initiate restraint use and attribute its use to ensuring the safety of the restrained and the others. A clinical trial using staff education and administrative input as the key components of a restraint reduction program was conducted in a rehabilitation setting to examine whether there were any significant differences in the prevalence of restraint use pre- and post-intervention. Subsequent to the implementation of the intervention program, focus group interviews were conducted to determine the perspective of the nursing staff on the use of restraints and their opinions of appropriate means to reduce their use.MethodRegistered nurses working in units involved in the study were invited to participate in focus group interviews on a voluntary basis. Twenty-two registered nurses (three males [13.6%] and nineteen females [86.4%]) attended the four sessions. All interviews were audio taped and transcribed verbatim. Other than the author, another member of the project team validated the findings from the data analysis.ResultsFour themes were identified. Participants experienced internal conflicts when applying physical restraints and were ambivalent about their use, but they would use restraints nonetheless, mainly to prevent falls and injuries to patients. They felt that nurse staffing was inadequate and that they were doing the best they could. They experienced pressure from the management level and would have liked better support. Communication among the various stakeholders was a problem. Each party may have a different notion about what constitutes a restraint and how it can be safely used, adding further weight to the burden shouldered by staff.ConclusionStudies about restraints and restraint use have mostly focused on nurses' inadequate and often inaccurate knowledge about the use of restraints and its associated adverse effects. These studies, however, fail to note that nurses can also be victims of the system. Restraint use is a complex issue that needs to be understood in relation to the dynamics within an environment.

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“…Anecdotal reports imply that hospital unit staffing levels may explain interinstitutional differences with regard to restraint use 10,13 . Nurses consistently cite understaffing or inability to provide appropriate patient observation as reasons for restraint use 15,18,20,23–25 . Families and student nurses share these concerns 26,27 .…”

mentioning

confidence: 99%

Organizational Characteristics and Restraint Use for Hospitalized Nursing Home Residents

Bourbonniere

Strumpf

Evans

et al. 2003

J American Geriatrics Society

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OBJECTIVES: To examine the effect of organizational characteristics on physical restraint use for hospitalized nursing home residents. DESIGN: Secondary analysis of data obtained between 1994 to 1997 in a prospective phase lag design experiment using an advanced practice nurse (APN) intervention aimed at reducing physical restraint for a group of hospitalized nursing home residents. SETTING: Eleven medical and surgical units in one 600‐bed teaching hospital. PARTICIPANTS: One hundred seventy‐four nursing home residents aged 61 to 100, hospitalized for a total of 1,085 days. MEASUREMENTS: Physical restraint use, APN intervention, age, perceived fall risk, behavioral phenomena, perceived treatment interference, mental state, severity of illness, day of week, patient–registered nurse (RN) ratio, patient–total nursing staff ratio, and skill mix. RESULTS: Controlling for the APN intervention, age, and patient behavioral characteristics (all of which increased the likelihood of restraint use), weekend days as an organizational characteristic significantly increased the odds of restraint (weekend day and patient–RN ratio on physical restraint use: odds ratio (OR) = 1.92, 95% confidence interval (CI) = 1.38–2.68, P < .001; weekend day and patient–total staff ratio on physical restraint use: OR = 1.91, 95% CI = 1.37–2.66, P < .001; weekend day and skill mix on physical restraint use: OR = 1.91, 95% CI = 1.37–2.67, P < .001). CONCLUSION: Key findings suggest that organization of hospital care on weekends and patient characteristics that affect communication ability, such as severely impaired mental state, English as a second language, sedation, and sensory‐perceptual losses, may be overlooked variables in restraint use.

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Nursing knowledge and use of restraint alternatives: Acute and chronic care

Cited by 27 publications

References 6 publications

The Use of Physical Restraints to Psychogeriatric Patients in Hong Kong

The Use of Physical Restraints to Psychogeriatric Patients in Hong Kong

Nurses using physical restraints: Are the accused also the victims? – A study using focus group interviews

Organizational Characteristics and Restraint Use for Hospitalized Nursing Home Residents

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