Use Of Restraint Measures Research Articles

Practitioner Explanations for the Increasing Use of Restraint Measures in the Care of People With Intellectual Disabilities in Norway 2000–11

AbstractThe use of restraint measures in the care of people with an intellectual disability (ID) and challenging behavior (CB) is recognized as problematic around the world and attempts have been made to reduce reliance upon this coercive approach. In Norway, legislation was enacted to restrict the use of restraint but paradoxically since it was implemented in 1999 there has been a very large increase in the use of one form of restraint: statutory or planned interventions. This study examined professionals' explanations for this unexpected increase. ID care staff (n = 178) and local government supervisors (n = 17) completed a semi‐structured questionnaire (total n = 195). All participants were involved directly or indirectly in implementing restraint. Comparisons were made between the different levels of care staff and the supervisors. The care staff interpreted the increase as due to greater awareness of the regulations and restraint interventions. Supervisors had low expectations of a decrease in restraint rates in the future. It was felt that the new regulations on the use of restraints in the care of people with ID and CB had raised awareness of ethical issues and improved education on this topic. Future research should address possible strategies for sustaining these improvements and at the same time stabilizing or reducing the number of people receiving restrictive care.

Fagpersonells forståelse av økt registrert tvangsbruk overfor personer med utviklingshemming

Norwegian legislation concerning restraint measures in the care and treatment to people with intellectual disability (ID) has been established since 1999. This study examined the social workers’ explanations for the increased number of people with ID being legally restrained since 1999. This article discussed both staff and the supervisors perspectives of the increase. Although an increasingly number of people with ID are treated by restraint measures, respondents (n = 206) report that care services has evolved in a positive direction. The strong increase is explained by a higher ethical awareness and changes in legal rules along the way. When asked about the future development, most respondents expect a continuing growth in the number of people with ID treated with the use of restraint measures.

Effects of Housing, Management, and Health of Dairy Heifers on First-Lactation Udder Health in Southwest Sweden

Data on health, management, and housing from birth to first calving were collected for 2,126 heifers on semi-monthly visits made by project veterinarians to 107 dairy herds from southwest Sweden. Additional data were obtained from the official milk- and health-recording program. Factors associated with incidence of veterinarian-treated clinical mastitis (VTCM) in the period 7 d before (d −7) to 30 d after first calving and of elevated cow composite somatic cell count (SCC, ≥200,000 cells/mL) at first test milking after first calving, respectively, were investigated using a 2-level (animal and herd) logistic regression analysis after initial screening by univariate analyses. The incidence risk of VTCM during the complete first lactation (305 d) was 10.8%. Ten percent of the diseased animals had more than 1 case of VTCM and 51% of total cases occurred from −7 to 30 d postcalving. The incidence rate of VTCM during the complete first 305-d lactation was 1.13 cases per 100 cow-mo. In total, 18.1% of the animals had elevated SCC at first test milking (mean 21 d) after calving. Veterinarian-treated clinical mastitis at −7 to 30 d postcalving was associated with higher overall incidence of mastitis in the herd and with reproductive disorders (i.e., retained placenta, endometritis, pyometra, dystocia, or twin birth). The risk of elevated SCC increased with increasing percentage of cows in the herd that, some time during the year, had had an increased udder disease score (chronically increased SCC). Other factors associated with increased risk of elevated SCC were increasing amounts of concentrates fed to 11- to 16-mo-old heifers, moving to confined housing the day of calving instead of earlier, and use of restraint measures at milking. In addition, growth rate from birth to weaning, and several feed-related variables (e.g., amount of concentrates and type of roughage given) were associated with VTCM at −7 to 30 d post-calving or elevated SCC at first test milking in the univariate analyses.