Abstract
BackgroundPhysical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily.MethodsWe conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated.ResultsThe prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7–88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1–87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents.ConclusionsThe prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.
Highlights
Physical restraint is a procedure used frequently in long-term care
All of them accepted, comprising a total of 1,238 beds in 30 units within nine centers. These centers had an average size of 153.5 ± 66.6; one of them had a dementia care unit and two operated a protocol regulating the use of physical restraint
A significant association was found between restraint use and the impaired cognitive status of residents (Table 4)
Summary
Physical restraint is a procedure used frequently in long-term care It is a controversial practice because its use is associated with numerous complications and affects freedom and individual autonomy. The prevalence in the use of these devices in long-term care varies greatly among countries, ranging from 6 to 68% [1, 2, 11,12,13]. This large variability could be explained by the different definitions of physical restraint, data collection techniques or characteristics of the facility [14]. The most commonly used devices are full-enclosure side rails, belts and chairs with an attached table [2, 12, 15]
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