Restraint Use In Home Care Research Articles

Reducing the use of physical restraints in home care: development and feasibility testing of a multicomponent program to support the implementation of a guideline

BackgroundA validated evidence-based guideline was developed to reduce physical restraint use in home care. However, the implementation of guidelines in home care is challenging. Therefore, this study aims to systematically develop and evaluate a multicomponent program for the implementation of the guideline for reducing the use of physical restraints in home care.MethodsIntervention Mapping was used to develop a multicomponent program. This method contains six steps. Each step comprises several tasks towards the design, implementation and evaluation of an intervention; which is theory and evidence informed, as well as practical. To ensure that the multicomponent program would support the implementation of the guideline in home care, a feasibility study of 8 months was organized in one primary care district in Flanders, Belgium. A concurrent triangulation mixed methods design was used to evaluate the multicomponent program consisting of a knowledge test, focus groups and an online survey.ResultsThe Social Cognitive Theory and the Theory of Planned Behavior are the foundations of the multicomponent program. Based on modeling, active learning, guided practice, belief selection and resistance to social pressure, eight practical applications were developed to operationalize these methods. The key components of the program are: the ambassadors for restraint-free home care (n = 15), the tutorials, the physical restraint checklist and the flyer. The results of the feasibility study show the necessity to select uniform terminology and definition for physical restraints, to involve all stakeholders from the beginning of the process, to take time for the implementation process, to select competent ambassadors and to collaborate with other home care providers.ConclusionsThe multicomponent program shows promising results. Prior to future use, further research needs to focus on the last two steps of Intervention Mapping (program implementation plan and developing an evaluation plan), to guide implementation on a larger scale and to formally evaluate the effectiveness of the multicomponent program.

Reducing physical restraints by older adults in home care: development of an evidence-based guideline

BackgroundRestraint use is a complex and challenging issue in home care. Due to socio-demographic trends, worldwide home healthcare providers are faced with an increasing demand for restraint use from informal caregivers, patients and healthcare providers, resulting in the use of various types of restraints in home care. Awareness and knowledge of restraint use in home care, its implications and the ethical challenges surrounding it are of crucial importance to its reduction. This research aimed to describe the development process of an evidence-based practice guideline to support caregivers to optimize home care.MethodThe practice guideline was developed according to the framework of the Belgian Centre for Evidence-Based Medicine and AGREE II. The guideline was developed over several stages: (1) determination of the target population and scope, (2) literature search, (3) drafting and (4) validation. A multidisciplinary working group determined the proposed purpose, target group, and six clinical questions for the guideline. A consensus procedure and consultation by experts were used to develop the guideline.ResultsThe guideline provides an answer to six clinical questions and contains ten key recommendations based on the classification of GRADE, with the objective of increasing healthcare providers’ awareness, knowledge and competence to adequately deal with situations or questions related to restraint use. The guideline also includes a flowchart for dealing with complex situations where the use of restraints is requested, already present or considered.ConclusionsThe guideline was validated by the Belgian Centre for Evidence-Based Medicine. Increasing competence, awareness and knowledge related to restraint use are key objectives of the guideline for reducing restraint use in home care. A multicomponent intervention to support healthcare workers in implementing the guideline in clinical practice needs to be developed.

Factors associated with use of restraints on older adults with home care: A secondary analysis of a cross-sectional survey study

BackgroundAlthough there is evidence that use of restraints in home care is increasing, research into the factors associated with restraints in this setting is scarce. ObjectiveTo gain insight into the factors associated with restraints in older adults receiving home care. DesignA secondary analysis of a cross-sectional survey about restraint use in home care. SettingsOlder adults receiving home care in Belgium. Participants8000 subjects were randomly selected from a total of 45,700 older adults. The mean age of the sample (n = 6397) was 80.6 years, 66.8% were women and 46.4% lived alone. MethodsA cross-sectional survey of restraint use on older adults receiving home care from a nursing organisation in Belgium was completed by the patients’ primary care nurses. A binary logistic regression model with generalised estimating equations was used to evaluate factors associated with restraint use. Additional analyses focused on the subgroups with and without an informal caregiver and living alone / with others. Data from 6397 participants were analysed in detail. ResultsMultivariate logistic regression indicated that restraint use was associated with supervision [OR = 2.433, 95% CI = 1.948–3.038]; dependency in activities of daily living (i.e. eating [OR = 2.181, 95% CI = 1.212–3.925], transfer [OR = 2.131, 95% CI = 1.191–3.812] and continence [OR = 1.436, 95% CI = 0.925–2.231]; perceived risk of falling in the nurses’ clinical judgement [OR = 1.994, 95% CI = 1.710–2.324], daily behavioural problems [OR = 1.935, 95% CI = 1.316–2.846] and less than daily behavioural problems [OR = 1.446, 95% CI = 1.048–1.995]; decreased well-being of the informal caregiver [OR = 1.472, 95% CI = 1.126–1.925], the informal caregiver’s dissatisfaction with family support [OR = 1.339, 95% CI = 1.003–1.788]; patient’s cognitive impairment [OR = 1.398, 95% CI = 1.290–1.515]; and polypharmacy [OR = 1.415, 95% CI = 1.219–1.641]. The nurses’ perception of risk of falling, cognitive impairment (observed with the Cognitive Performance Scale) and supervision are the only variables consistently associated with restraint use across all the analyses. ConclusionThe study results provide insight into new and context-specific factors associated with restraint use in home care (e.g. supervision, informal caregiver’s decreased well-being and dissatisfaction with family support). These insights could support the development of interventions to reduce restraint use in home care.

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

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.

Restraint use in home care: A qualitative study about the experiences of home care nurses

Restraint use in home care: A qualitative study about the experiences of home care nurses

Why do we use physical restraints in the elderly?

The use of physical restraints in the elderly is a common practice in many countries. This paper summarizes the current knowledge on the use of restraints in home care, hospitals and nursing homes. Between 1999-2004 the reported prevalence numbers range from 41-64% in nursing homes and 33-68% in hospitals; numbers of restraint use in home care are unknown. Bed rails and belts have been reported as the most frequently used restraints in bed; chairs with a table and belts are the most frequently reported restraints in a chair. It is evident that physical restraints in most cases are used as safety measures; the main reason is the prevention of falls. In the hospital setting, the safe use of medical devices is also an important reason for restraint use. Predictors for the use of physical restraints are poor mobility, impaired cognitive status and high dependency of the elderly patient and the risk of falls in the nurses' opinion. Furthermore, there are indications that restraint use is related to organizational characteristics. Finally, many adverse effects of restraint use have been reported in the literature, like falls, pressure sores, depression, aggression, and death. Because of the adverse effects of restraints and the growing evidence that physical restraints are no adequate measure for the prevention of falls, measures for the reduction of physical restraints are discussed and recommendations are made for future research.

Attitudes of wives toward having their elderly husbands restrained: Professional caregivers should be mindful of the feelings of spouses, who may view the use of restraints on their loved one as the end of hope and dreams

To get insight into restraint use in older adults receiving home care and, more specifically, into the definition, prevalence and types of restraint, as well as the reasons for restraint use and the people involved in the decision-making process.Systematic review.Four databases (i.e. Pubmed, CINAHL, Embase, Cochrane Library) were systematically searched from inception to end of April 2017.The study encompassed qualitative and quantitative research on restraint use in older adults receiving home care that reported definitions of restraint, prevalence of use, types of restraint, reasons for use or the people involved. We considered publications written in English, French, Dutch and German. One reviewer performed the search and made the initial selection based on titles and abstracts. The final selection was made by two reviewers working independently; they also assessed study quality. We used an integrated design to synthesise the findings.Eight studies were reviewed (one qualitative, seven quantitative) ranging in quality from moderate to high. The review indicated there was no single, clear definition of restraint. The prevalence of restraint use ranged from 5% to 24.7%, with various types of restraint being used. Families played an important role in the decision-making process and application of restraints; general practitioners were less involved. Specific reasons, other than safety for using restraints in home care were noted (e.g. delay to nursing home admission; to provide respite for an informal caregiver).Contrary to the current socio demographical evolutions resulting in an increasing demand of restraint use in home care, research on this subject is still scarce and recent. The limited evidence however points to the challenging complexity and specificity of home care regarding restraint use. Given these serious challenges for clinical practice, more research about restraint use in home care is urgently needed.