Use Of Restraints In Hospitals Research Articles

Restraint use as a quality indicator for the hospital setting: a secondary data analysis.

A reduction in restraint use is recommended for all health care settings. For this purpose, local or national quality measurement and improvement initiatives have been implemented in various countries, primarily in the mental health and long-term care settings. However, restraints are also frequently used in the somatic acute care hospital setting, and strong variations in their prevalence rates have been reported. Therefore, the aim of this study was to reanalyse existing data on restraint use in Swiss hospitals in order to assess the potential of restraint use as a national quality indicator for the hospital setting. Using a cross-sectional, multicentre design, data were collected between 2016 and 2018 as part of the ANQ"s (Swiss National Association for Quality Development in Hospitals and Clinics) "falls and pressure ulcers" national prevalence measurement in acute care hospitals in Switzerland. The hospitals measured restraint use on a voluntary basis in addition to falls and pressure ulcers. All medical specialities and patients aged 18 and over who gave their informed consent were included in the measurement. Descriptive and multilevel regression analyses were performed using institutional, ward and patient-level data relating to restraint use. The sample consisted of 18,938 inpatients from 55 hospitals. The 30-day prevalence rate of patients with at least one restraint was 10.2% (n = 1933). The risk-adjusted hospital comparison revealed that hospitals in Switzerland differ significantly in their restraint use, even after adjusting for patient characteristics. In total, 10 hospitals used restraints significantly less and 12 used them significantly more than the national average. Restraint use varies significantly between Swiss hospitals: 40% of all hospitals used restraints either significantly more or significantly less often than the average. In comparison to the other quality indicators, this is a very high value, indicating potential for improvements in the quality of care. Since restraint use is associated not only with quality of care, but also with human rights, these large differences seem questionable from a professional, ethical and legal point of view. Clearer and binding regulations in combination with monitoring and benchmarking of restraint use in hospitals, such as with a national quality indicator, seem necessary. These would help to ensure that restraint use is in alignment with professional values, as well as ethical and legal requirements.

The use of physical restraints- knowledge and attitude of nurses of a tertiary care institute, Uttarakhand, India.

BACKGROUND:The use of physical restraint in health-care settings is common and complex practice as it has physical, psychological, judicial, ethical, and moral issues. Nurses are the key persons regarding physical restraint use in hospitals as they are managing the whole process beginning with decision-making, application, caring the restrained patients. Lack of understanding and negative attitude of nurses in the use of physical restraints will hamper patient safety.MATERIALS AND METHODS:A descriptive cross-sectional survey was carried out among 110 rando mly selected nurses working in various departments at a tertiary care center Uttarakhand, India, in 2019. The data were collected using self-reported questionnaires consisting of three parts: demographic information, knowledge assessment questionnaire, and attitude rating scale regarding the use of restraints. Data were analyzed using the SPSS version 23 descriptive (frequency, percentage, mean, mean percentage, and standard deviation) and inferential statistics (Mann–Whitney and independent t-test).RESULTS:The findings indicated that the mean knowledge and attitude of the nurses for physical restraints were 13.9 ± 1.9 (0–20 points), 35.2 ± 4.7 (28–55 points), respectively. The study revealed that there was no relationship found between knowledge and attitude of nurses regarding the use of physical restraints (r = 0.084).CONCLUSIONThe knowledge and attitude regarding the use of restraints among nurses were found to be moderate. In-service training is highly recommended for nurses to improve the knowledge and practices related to the use of physical restraint.

Investigating influencing factors of physical restraint use in China intensive care units: A prospective, cross-sectional, observational study

ObjectiveIn this study, we characterised the use of physical restraints in three intensive care units (ICUs) in a general hospital in Nantong, China. Additionally, we explored risk factors potentially related to physical restraint use. BackgroundDespite their numerous harmful effects, physical restraints are frequently used in ICUs worldwide. Few studies have investigated the factors that contribute to physical restraint use in Chinese hospitals. MethodsWe conducted a prospective, cross-sectional, observational study of 312 patients in three ICUs at a general hospital in China. The quantitative data were collected during a 5-month period using a physical restraint observation form and patient records. The data obtained were analysed using descriptive statistics. The independent risk factors for physical restraint use were assessed using a logistic regression model. ResultsOf the 312 patients in the three ICUs, 191 (61.2%) were restrained, and physical restraints were used more than once for 46 (24.1%) patients during their ICU stay. The median length of physical restrain use was 20 shifts (interquartile range = 10–36 shifts). Physical restraints were applied in 6664 of 12374 (53.9%) nurse shifts. The most common time at which physical restraints were applied was the beginning of the evening shift. According to the forward stepwise logistic regression analysis, delirium (P < 0.001), mechanical ventilation (P < 0.001), and age (P < 0.001) were independent risk factors for physical restraint use. The use of analgesics (P = 0.001) exerted an independent protective effect against physical restraint use. ConclusionsThe overall prevalence of physical restraint use in Chinese ICUs was higher than that reported in previous investigations. The patients' nursing notes lacked complete physical restraint records, reflecting a need for standard guidelines and policies for physical restraint use in hospital ICUs in China. In addition, in this study, we explored the risk factors related to physical restraint use and found that age, delirium, mechanical ventilation, and analgesic use are associated with physical restraint use.

Use of physical restraints in nursing homes and hospitals and related factors: a cross‐sectional study

The aim of the study was to investigate factors related to the use of restraints and to explore whether the rate of nurses was an influencing factor regarding the use of restraints in German nursing homes and hospitals. Restraints are frequently used measures in hospitals and nursing homes. Risks for falls and small nurse workforces are discussed in relation to the use of restraints. A secondary analysis of a cross-sectional study was carried out. Methods. Data were collected by trained nurses using standardised questionnaires in 76 nursing homes (n = 5521) and 15 hospitals (n = 2827). For data analysis, a 3-level random intercept logistic model was used. The prevalence of restraints (bed rails and/or belts) was 9·3% for hospital patients and 26·3% for nursing home residents. Amongst hospital patients, restraint use was more prevalent in women, older patients, patients with a high care dependency, patients who fell during the last two weeks, patients with a perceived risk of falls, polypharmacy, urinary incontinence, disorientation and confinement to bed. In the nursing homes, the restrained residents were significantly younger, more care dependent, had less falls and were more often urinary incontinent, disoriented and bedfast. The rate of nurses was not significantly related to the use of restraints in hospitals, and nursing homes according to the three-level random intercept model. Hospital patients with previous falls were more often restrained, but in the nursing homes, the restrained residents experienced less falls. The number of qualified nursing staff had no significant influence on the use of physical restraints. Lower nurse staffing ratios were not related to higher frequencies of restraint use in this study.

Physical Restraint Use in Turkish Intensive Care Units

This study aimed to determine intensive care nurses' reasons for the application and removal of physical restraint and physical restraint patterns used in Turkey intensive care units. This research was conducted using descriptive and cross-sectional research design. Data were collected in intensive care units of the 2 university hospitals and the 5 state hospitals in Izmir, West Turkey. Nurses were given the self-administered questionnaire with open-ended questions. The study participants were 190 nurses working in intensive care units of 7 hospitals. Most of the nurses (86.8%) reported that maintenance of the placement of medical devices was the main reason for physical restraint applications. The nurses (68.9%) reported improved mental status as the most important reason for removal of restraint from the patient. A total of 84.7% of nurses reported that wrist and ankle ties were the most common forms of physical restraint device; 84.7% used physical restraint without any verbal or written physician order. Identifying the reasons for application and removal of physical restraints can help clinical nurse specialist tailor education, impact policy, and serve as role models to reduce the use of restraints in hospitals.

Safety Work

This study examines the variations and complexities in nurses' decision making about the initiation, maintenance, and termination of physical restraints. This qualitative research used a semistructured interview of registered nurses on medical-surgical units at a midsized hospital in the Midwest. All the nurse respondents easily recalled caring for a patient in restraints and detailed in their accounts a complex trajectory of care that centered on safety. However, most nurses reported that the trajectory of restraint use was started by other departments, shifts, or nurses. The findings revealed a forceful interplay of patient, nurse, family, healthcare worker, and organizational factors that influence nurses' decision making about restraint use. This article discusses how a deeper understanding of the intricacies of the decision-making processes related to restraints can help clinical nurse specialists tailor education, impact policy, and serve as role models to reduce the use of restraints in hospitals.

Nurses’ feelings and thoughts about using physical restraints on hospitalized older patients

To explore nurses' feelings and thoughts about physically restraining older hospitalized patients. The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses' knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses' perceptions about the use of physical restraints, or on elderly patients' experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses' feelings and thoughts about the use of physical restraints in Taiwan. A qualitative approach was used to understand this phenomenon. Semi-structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data. Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings. Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients' autonomy and the practice of care. However, other nurses said they had 'no feelings' or 'feeling of security' while using physical restraints. The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in-service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical restraints.

Evidence-Based Guideline: Changing the Practice of Physical Restraint Use in Acute Care

Older adults are more likely to be restrained during hospital stays than are younger individuals. Use of physical restraints significantly undermines quality patient care and represents substandard care. Rather than using restraints, nursing staff should determine the source of the patient's behaviors through comprehensive assessment and try to detect patterns to move toward restraint-free care. This evidence-based practice guideline can be used to facilitate the recognition of older adults at risk for physical restraints use and the implementation of appropriate interventions to move toward restraint-free patient care. This, in turn, helps to maintain or promote older adults' quality of life.

Prevalence and patterns of physical restraint use in the acute care setting.

Nurse executives usually have the principal responsibility to respond to the national movement to reduce physical restraint use in hospitals. The results of this three-site, interdisciplinary, prospective incidence study (based on more than 49,000 observations collected on 18 randomly selected days) reveal new patterns in the rationale and types of restraints used. The authors discuss how the results can be used in measuring success and allocating resources for restraint reduction programs.

Legal aspects of restraint use in hospitals and nursing homes.

Legal aspects of restraint use in hospitals and nursing homes.