Abstract
BackgroundAlthough many countries have implemented strict legal rules, the prevalence of physical restraints in nursing homes seems to remain high. In Switzerland, data related to the frequency of physical restraints are scarce and little is known about associations with resident and nursing home characteristics. The aim of this study was to investigate the prevalence and types of physical restraints in nursing homes in two Swiss cantons and to explore whether resident-related and organisational factors are associated with the use of physical restraints.MethodsWe conducted a multicentre cross-sectional study. Twenty nursing homes with 1362 residents from two culturally different cantons were included. Data on physical restraints and residents’ characteristics were extracted from residents’ records (11/2013 to 2/2014). Organisational data were collected by questionnaires addressing nursing home directors or nursing managers. Sample size calculation and outcome analysis took cluster-adjustment into account. Descriptive statistics and multiple logistic regression analysis with nursing homes as random effect were used for investigation.ResultsThe prevalence of residents with at least one physical restraint was 26.8 % (95 % confidence interval [CI] 19.8–33.8). Centre prevalence ranged from 2.6 to 61.2 %. Bilateral bedrails were most frequently used (20.3 %, 95 % CI 13.5–27.1). Length of residence, degrees of care dependency and mobility limitation were significantly positively associated with the use of physical restraint, but none of the organisational characteristics was significantly associated.ConclusionApproximately a quarter of the nursing home residents included in our study experienced physical restraints. Since variation between nursing homes was pronounced, it seems to be worthwhile to explore nursing homes with particularly low and high use of physical restraints in future research, especially by using qualitative methods. There is a need for effective interventions aiming at restraint-free nursing care. Development of interventional approaches should consider specific residents’ characteristics associated with restraint use.
Highlights
Many countries have implemented strict legal rules, the prevalence of physical restraints in nursing homes seems to remain high
We aimed to determine how often all types of physical restraints are applied among nursing home residents in two Swiss cantons, St.Gallen and Fribourg, and whether specific characteristics of residents and nursing homes are associated with a higher likelihood of restraint use
Our study results show substantial variation in the frequency of physical restraint use between nursing homes. This suggests that a reduction could be possible and the use of bedrails could be minimized in order to respect the persons’ autonomy and mobility
Summary
Many countries have implemented strict legal rules, the prevalence of physical restraints in nursing homes seems to remain high. In Switzerland, data related to the frequency of physical restraints are scarce and little is known about associations with resident and nursing home characteristics. Even though there are strict legal regulations in many countries, the prevalence of physical restraints in nursing homes seems still to be high [1, 2]. Decisions about the use of physical restraints in the care of older persons are complex and influenced by different factors like attitudes of health care staff, characteristics of residents as well as nursing home and environmental characteristics [9]. Staffing level seems not to be associated with the use of physical restraints [9, 11]
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