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Biomedical subjects

L K Evans

Publications and source records attributed to L K Evans.

14 recordsLinked to original sources
PubMed1992

Reducing physical restraints: developing an educational program.

1. Philosophical premises for an educational program aimed at restraint reduction include beliefs about quality of care, commitment to understanding the meaning of behavior, and desire to shift practice from control of behavior to individualized approaches to care. 2. If change is to occur, an educational program aimed at restraint reduction must recognize the potential contributions of all staff members, use an interactive teaching style, and promote discussion and problem solving. 3. Results of testing a Restraint Education Program suggested that altering staff beliefs and increasing knowledge produced a change in restraint practices, at least in the short term.

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PubMed1991

The ethical problems of prolonged physical restraint.

The rising prevalence of physical restraint warrants careful examination of the moral, ethical, and legal dimensions of the practice. For the frail elderly, quality of life, decision making, and informed consent are significant issues. The ethical dilemmas created by the use of physical restraints, and the need to consider restraint as an issue fundamental to the nursing home milieu and beliefs about quality of life, require understanding of and commitment to care that is individualized and person-centered. The elements identified in care settings where restraints are rarely, if ever, used evolve from an awareness of the needs of the individual resident, continuous monitoring of health status, and appropriate adjustments in the care plan.

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PubMed1989

Tying down the elderly. A review of the literature on physical restraint.

The apparently widespread practice of physical restraint of the elderly has received little systematic research, despite reported clinical awareness of its iatrogenic effects on frail elders. Prevalence rates in various settings range between 6% and 86%, with cognitive impairment an important risk factor for restraint. Despite strongly held beliefs, efficacy of restraints for safeguarding patients from injury has not been demonstrated clinically. This paper reviews the current status of knowledge regarding physical restraint use with the elderly and suggests a research agenda and implications for ethical practice.

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PubMed1987

Sundown syndrome in institutionalized elderly.

To describe sundown syndrome and determine factors related to its occurrence, 59 demented and 30 nondemented nursing home residents aged 60 years and above were observed in the morning and the evening over two consecutive days using a Confusion Inventory. Physiologic, psychosocial, and environmental data were also recorded. In addition, Pfeiffer's Short Portable Mental Status Questionnaire, the Philadelphia Geriatric Center Morale Scale, Face-Hand Test, and sensory screening were completed. Among the 89 subjects, 11 were found to be sundowners, a prevalence rate of one in eight in the facility. No clear pattern of behaviors evolved but sundowners were found to increase restless and verbal behavior as evening approached. Sundowners were more likely to be demented, with greater mental impairment and organic involvement than nonsundowners. Among physiologic factors, odor of urine, being awakened frequently on the evening shift, and fewer medical diagnoses were significantly associated with sundowning. Significant psychosocial factors were current room residence of less than one month, more recent admission to the facility, and higher evening levels of confusion. No environmental factors were related.

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PubMed1975

Attempted prevention of diarrheal disease in Apache children with a non-absorbable broad-spectrum antimicrobial.

A double-blind study was conducted to test the prophylactic effect of a non-absorbable broad-spectrum antimicrobial (oral colistin sulfate) against acute diarrhea in Apache children. Children 1 to 6 months old had over twice the morbidity from diarrhea if assigned to the antimicrobial group as compared to placebo, while the toddler group (7-30 months) taking the antimicrobial had somewhat less diarrhea. Enteropathogenic E. coli were significantly more often isolated from the antimicrobial group (but only in well children). No special effect on the children's growth by the antimicrobial was discerned.

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PubMedDate not supplied

Physical restraint of the hospitalized elderly: perceptions of patients and nurses.

Twenty elderly restrained patients and their primary nurses (N = 18) were studied to determine (a) the subjective impact of physical restraints on the patient and (b) the nurses' beliefs about use of restraints. Despite reported cognitive impairments, patients vividly described anger, discomfort, resistance, and fear in response to the experience of physical restraint. The decision to restrain posed a conflict between protection of the patient and beliefs about professional behavior for the nursing staff. Lack of interdisciplinary collaboration in decisions to use a physical restraint was also apparent. The findings suggest that the use of physical restraint is not a benign practice and support the need for developing alternatives more consistent with professional practice and quality care.

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