Restraint use in home care: a qualitative study from a nursing perspective

Abstract

BackgroundDespite the growing demand for home care and preliminary evidence suggesting that the use of restraint is common practice in home care, research about restraint use in this setting is scarce.MethodsTo gain insight into the use of restraints in home care from the perspective of nurses, we conducted a qualitative explorative study. We conducted semi-structured face-to-face interviews of 14 nurses from Wit-Gele Kruis, a home-care organization in Flanders, Belgium. Interview transcripts were analyzed using the Qualitative Analysis Guide of Leuven.ResultsOur findings revealed a lack of clarity among nurses about the concept of restraint in home care. Nurses reported that cognitively impaired older persons, who sometimes lived alone, were restrained or locked up without continuous follow-up. The interviews indicated that the patient’s family played a dominant role in the decision to use restraints. Reasons for using restraints included “providing relief to the family” and “keeping the patient at home as long as possible to avoid admission to a nursing home.” The nurses stated that general practitioners had no clear role in deciding whether to use restraints.ConclusionsThese findings suggest that the issue of restraint use in home care is even more complex than in long-term residential care settings and acute hospital settings. They raise questions about the ethical and legal responsibilities of home-care providers, nurses, and general practitioners. There is an urgent need for further research to carefully document the use of restraints in home care and to better understand it so that appropriate guidance can be provided to healthcare workers.

Behind Closed Doors: Involuntary Treatment in Care of Persons with Cognitive Impairment at Home in the Netherlands

“…Family plays an important role in choosing to use involuntary treatment in caring for persons with cognitive impairment, which is consistent with recent studies on physical restraints . Family caregivers, faced with complex care situations and in distress, reach for quick solutions such as involuntary treatment.…”

Restraint Use in Older Adults Receiving Home Care

“…At the start of the study, there was a lack of clarity about the definition of restraints in the literature. Based on the results of a qualitative study, a less‐conservative definition of restraints was chosen, one that includes not only physical devices to control behavior, but also other restrictive actions intended to limit the free movement of older persons being cared for at home (e.g., adaptation of the house, removal of aids). Finding an appropriate definition for restraints is a challenge for researchers in this field.…”

“…Professional home care nursing is part of the social security system in Belgium and is financed by the National Institute for Health and Disability Insurance. In Belgium, health insurance is mandatory and guarantees reimbursement for individuals who need home care nursing . The Wit‐Gele Kruis comprises five autonomous provincial organizations and is spread over 102 divisions.…”

“…Another study used a self‐report survey of home care nurses and found that almost 80% of these nurses had used physical restraints at least once . In Belgium, there are no prevalence studies on restraint use in home care; only one qualitative study is available . That study not only provided evidence of the use of restraints, but also suggested that the subject of restraint use in home care may be more complex than in nursing homes and hospitals.…”

Physicians’ attitudes toward home healthcare services in Turkey: A qualitative study

“…To the best of our knowledge, however, no qualitative studies have examined the experience of HCS delivery in Turkey. Our literature search revealed some quantitative (10)(11)(12)(13)(14)(15)(16) and qualitative studies (17)(18)(19)(20)(21)(22) dealing with different aspects of HCS. Several quantitative studies from Turkey are also available (23)(24)(25)(26).…”