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Results for “Restraint, Physical”

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At least 73 records · Page 4Linked to original sources

PubMed2003

Patient injury and physical restraint devices: a systematic review.

OBJECTIVE: To investigate physical restraint-related injuries. Areas of interest were the prevalence of injury, types of injuries, risk of sustaining an injury and specific restraint devices associated with injury. DEFINITIONS: Injury in the context of this review was considered to be either direct injury, such as lacerations and strangulation, or indirect injury considered to be an adverse outcome such as increased mortality rates or duration of hospitalization. METHOD: A comprehensive search was undertaken that involved all major databases and the reference list of all relevant papers. To be included in the review studies had to involve people in acute or residential care settings and report data related to injury caused by restraint devices. A number of different types of research designs were included in the review. The findings of studies were pooled using odds ratio and narrative discussion. RESULTS: The search identified 11 papers reporting the findings of 12 observational studies. These studies were supplemented with the findings of a number of other types of studies that reported restraint-related data. The review highlights the potential danger of using physical restraint in acute and residential health care facilities. Observational studies suggest that physical restraint may increase the risk of death, falls, serious injury and increased duration of hospitalization. However, there is little information to enable the magnitude of the problem to be determined. DISCUSSIONS: Many of the findings highlight the urgent need for further investigation into the use of physical restraint in health care facilities. Further research should investigate the magnitude of the problem and specific restraint devices associated with injury. However, given the limited nature of the evidence, this association should be investigated further using rigorous research methods.

Asphyxia↗

PubMed1998

Physical restraints in the acute care setting: issues and future direction.

The pattern and prevalence of physical restraint in hospital settings have changed over the past decade. The challenge to health professionals who wish to reduce or eliminate the use of restraints includes clinical, ethical, and legal concerns. Factors that influence health care providers' decisions regarding whether to use physical restraints include organizational characteristics and systems of care, environmental characteristics, and specific clinical guidelines or protocols, as well as individual patient characteristics. To reduce the incidence of physical restraint, hospital professionals need to develop and test feasible alternative practices using an interdisciplinary approach that addresses organizational, environmental, and patient-specific factors.

Acute Disease↗

PubMed2005

Use of physical restraints in nursing homes: current practice in Singapore.

INTRODUCTION: One of the indicators of quality care in nursing homes is the proper use of physical restraints. Restraints have been associated with multiple complications, such as pressure ulcers, incontinence and immobility. The aim of our study was to assess the indication, use and complications related to physical restraints in Singapore nursing homes. MATERIALS AND METHODS: All residents aged >65 years old from 3 nursing homes were included in the study. A geriatrician reviewed the medical records of all elderly residents on restraints. Nursing staff interviews were also done to assess their knowledge regarding restraint use. A brief medical record review was also done for the elderly residents without restraints. RESULTS: Out of 390 elderly residents, 91 were on physical restraints. The mean age of these residents were 80.1 years; 67% were female, 90.1% were Chinese and 82.4% belonged to functional category IV. Both urinary and faecal incontinence were observed in 97.8% of residents. Forty-six (50.5%) residents had no documented indication for restraints. It was noted that 20 (22%) residents were restrained to prevent dislodgement of the feeding tube, 17 (18.7%) were restrained to prevent falls and 8 (8.8%) were restrained for agitation. There were documented trials of removal of restraints for only 21 (23.1%) residents. Alternative approaches, such as diversion technique, were used for 31 (34.1%) residents to avoid restraint use. CONCLUSION: Our study revealed a high rate of restraint use in the nursing homes. A restraint protocol should be available in every nursing home, requiring physician approval for the long-term application of physical restraints and intermittent reviews by physicians to assess the continued need for restraints.

Aged↗

PubMedDate not supplied

Physical restraint use on people with dementia: a review of the literature.

OBJECTIVE: To provide a critical review of contemporary literature published between 1992 and 2003 on the use of physical restraints on residents with dementia in long-term care. DESIGN: Forty-two manuscripts related to dementia (cognitive impairment) and physical restraint in long-term care settings were examined. RESULTS: Four dominant themes were identified in the literature: relationship between restraint use and cognitive decline; falls/related injuries and associated mortality; reduction/removal/alternatives to use; and, nurses' attitudes to restraints. It appears that despite nurses' desire to use physical restraint for protection there is no scientific evidence that physical restraint actually protects residents against injuries. A discussion of the methodological issues arising in the literature and recommendations for further research and implications for nursing practice are outlined. CONCLUSION: To curb the practice of restraint use the concentrated assistance of Australia federal and state governments and peak geriatric and dementia organisations may be required.

Accidental Falls↗

PubMed2004

[Physical restraint in old people's homes. Evaluation of skills following specific training].

AIM: The use of physical restraint in elderly patients is sometimes necessary but not without risk. We studied the prevalence and modalities of physical restraint in elderly patients in 6 old people's homes in the urban area of Toulouse, and emphasized the need for better use by the nursing staff of physical restraint in such patients with a specific training course. METHODS: Other than the prevalence of restraint, we also examined the modalities of its use in elderly patients. We studied the respect of the Anaes (Agence nationale d'accréditation et d'évaluation en santé) guidelines regarding the use of restraint in such patients, before and after an intervention that associated first a collective training course of all the staff in the old people's homes, and then specific individual training by a visiting practitioner. The information concerning the number of patients in whom restraint was used was obtained from the manager of the home or from the head nurse and was then checked by the investigator. RESULTS: The prevalence of restraint was of 22.2% (n=110 patients) at the start of the study, 15.9% following training sessions (at 6 months) and 15.5% at the end of the study (at 9 months). Skills improved regarding the benefit/risk assessment, the installation of the person restrained and the regular removal of the restraint during the day. CONCLUSION: Our strategy helped to underline this problem for the staff. The Anaes guidelines are too strict to be applied in old people's homes. One of the key points in improved management would be the presence of a coordinating physician and nurse in all the institutions caring for the elderly.

Accreditation↗

PubMed1994

Reasons for uses of physical restraint and alternatives to them in geriatric nursing: a questionnaire study among nursing staff.

This study is part of a major research project that is concerned with disruptive behaviour among elderly patients and the use of physical restraint in geriatric nursing. The purpose of this study was to describe the use of physical restraint and alternatives as reported by professional nurses. The data were collected by a structured questionnaire. Nursing staff (n = 287) from a geriatric unit of a health centre, a nursing home, and the medical and psychiatric clinics of a university hospital in one city in central Finland, volunteered for the study. The clear majority (85%) of the nurses stated that physical restraint had been used on the ward during the week preceding the questionnaire. Reasons cited most often for restraint use were reduced physical and cognitive capacity of demented patients. The most common alternative was to try to understand the reasons for the elderly patient's disruptive behaviour. A major challenge for future research and for field experiments is to provide new alternatives to the use of physical restraint in geriatric nursing.

Aged↗

PubMed2005

Patient autonomy in physical restraint.

Despite initiatives to raise the awareness of patient autonomy among healthcare providers, the use of physical restraints on frail or confused older patients continues to be a common practice in many healthcare settings. This paper examines the relationship between patient autonomy and the use of physical restraints by drawing on the literature contradicting its efficacy and the assumption that its use is necessary to protect the welfare of patients. It argues that the paternalistic use of physical restraints without patient's informed consent is morally unjustified and is an unequivocal violation of their autonomy. The duty to respect individual autonomy should be extended to a duty to respect the autonomy of older people who are being restrained. Only in this way can their human dignity and quality of life be enhanced.

Aged↗

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.

Aged↗

PubMed2002

A review of physical restraint minimization in the acute and residential care settings.

OBJECTIVES: The objective of this review was to investigate physical restraint minimization in acute and residential care settings. The first aim was to determine the effectiveness of attempts to minimize the use of physical restraint, and the second was to generate a description of the characteristics of restraint minimization programmes. METHOD: A comprehensive search was undertaken involving all major databases and the reference lists of all relevant papers. To be included in the review studies had to be an evaluation of restraint minimization in an acute or residential care setting. As only a single randomized controlled trial (RCT) was identified, it was not possible statistically to pool the findings of different studies on the effectiveness of restraint minimization. To generate a description of the characteristics of restraint minimization programmes, the reported components of these programmes were identified and categorized. RESULTS: A total of 16 studies evaluating restraint minimization were identified: three in acute care and 13 in residential care. Of these, only one was an RCT, with the most common approach being the before and after study design. Based on the findings of the single RCT, education supported by expert consultation effectively reduced the use of restraint in residential care. There has been little evaluation of restraint minimization in acute care settings. The common approach to restraint minimization has involved a programme of multiple activities, with restraint education being the characteristic common to most programmes. DISCUSSION: Evidence suggests that physical restraint can be safely reduced in residential care settings through a combination of education and expert clinical consultation. There is little information on restraint minimization in acute care settings. The major finding of this review is the need for further investigation into all aspects of restraint minimization.

Accidental Falls↗

PubMed1981

Physical restraint as positive reinforcement.

The reinforcing function of physical restraint was analyzed for three retarded individuals who had a history of restraint and appeared to enjoy it. Using a preference paradigm with one participant and a reversal design with two others, we found that an arbitrary response systematically increased for each participant when followed by brief periods of restraint. No comparable increases occurred in conditions in which responses were not reinforced or were followed by stimuli designed to control for the nonrestraint components of the restraint consequence. Results were discussed in terms of three clinical issues: determining the possible role of restraint in maintaining behavior problems such as self-injury in natural settings, preventing or eliminating the reinforcing function of restraint, and using restraint reinforcement in treating behavior problems when this consequence is the only identifiable reinforcer for an individual.

Adolescent↗

PubMedDate not supplied

Acute/critical care nurses' knowledge of physical restraints--implications for staff development.

The use of physical restraints in acute care facilities has become a routine practice. Although nursing home settings have been federally mandated to reduce reliance on restraints, there has been no indication of a reduction in hospital settings. Staff development educators can provide guidance in the proper use of restraints. A total of 235 acute/critical care nurses from 17 states were asked to complete an 18-item knowledge questionnaire about the proper use and application of restraints. A majority (n = 142; 60.4%) had 13 of the 18 questions correct. The results suggest variability in knowledge about restraints due most likely from lack of information rather than misinformation. One hundred fifty-four nurses (65.6%) stated they were unsure about caring for a restrained patient. The authors describe implications of the study findings for nursing staff development and offer an outline for an inservice program on restraint use.

Adult↗

PubMed1998

Physical restraint: a descriptive study in Swiss nursing homes.

This article focuses on the reasons for using physical restraints, their prevalence and nurses' experiences of their use. The data were collected by means of a questionnaire from nurses, trained nurse's aids and auxiliary staff (n = 173) in seven Swiss nursing homes. The results showed that physical restraints are used in nursing units, the mean number of restrained residents in each being 3.7 (SD 3.9). However, nursing staff did not necessarily understand and consider the term 'restraint' as a restrictive device in its negative sense. The most common reasons indicated for the use of restraint were related to the protection and safety of the residents themselves, the prevention of disturbance of other residents, and the residents' restlessness and aggressiveness. As for the reasons related to staffing, reference was made to understaffing, a lack of competence on the part of nurses, and the demands of residents, their next of kin and doctors. It was not common practice to inform the elderly residents that they would be restrained, and therefore they were not always aware of what was happening to them and why. Twenty-nine per cent of the respondents reported that the flexbility of their work was affected by the use of physical restraint.

Adult↗

PubMed1996

Safety and efficacy of physical restraints for the elderly. Review of the evidence.

OBJECTIVE: To critically review evidence on the safety and efficacy of physical restraints for the elderly and to provide family physicians with guidelines for rational use of restraints. DATA SOURCES: Articles cited on MEDLINE (from 1989 to November 1994) and Cinahl (from 1982 to 1994) under the MeSH heading "physical restraints." STUDY SELECTION: Articles that specifically dealt with the safety and efficacy of restraints and current patterns of use, including prevalence, risk factors, and indications, were selected. Eight original research articles were identified and critically appraised. DATA EXTRACTION: Data extracted concerned the negative sequelae of restraints and the association between restraint use and fall and injury rates. General data about current patterns of restraint use were related to safety and efficacy findings. DATA SYNTHESIS: No randomized, controlled trials of physical restraint use were found in the literature. A variety of study design, including retrospective chart review, prospective cohort studies, and case reports, found little evidence that restraints prevent injury. Some evidence suggested that restraints might increase risk of falls and injury. Restraint-reduction programs have not been shown to increase fall or injury rates. Numerous case reports document injuries or deaths resulting from restraint use or misuse. CONCLUSIONS: Although current evidence does not support the belief that restraints prevent falls and injuries and questions their safety, further prospective and controlled studies are needed to clarify these issues. Information from review and research articles was synthesized in this paper to produce guidelines for the safe and rational use of restraints.

Accidental Falls↗

PubMed1998

Physical restraints in nursing homes: a review of the literature since the Nursing Home Reform Act of 1987.

The use of physical restraints is one of the most negative features of nursing home care. Their use significantly affects the quality of life of residents. In an attempt to limit the use of restraints, the Nursing Home Reform Act (NHRA) of 1987 contained provisions regulating their use. In this article, the authors review the literature on the use and consequences of physical restraints in nursing homes since the passage of the NHRA. First, they describe the history behind the use of restraints and define what is considered to be a physical restraint. Second, they examine the four most common justifications for restraint use. Third, they describe the incidence and prevalence of restraint use. Fourth, they address demographic and clinical characteristics of residents that have been found to be associated with restraint use. Fifth, they examine negative outcomes of restraining residents. Finally, they describe alternatives to using restraints.

Activities of Daily Living↗

PubMedDate not supplied

Physical restraint management of hospitalized adults and follow-up study.

During the winter of 1998 the management of 118 (N = 118) physically restrained adult patients in a 238-bed urban acute care hospital were assessed by 26 registered nurse (RN) data collectors. In the spring of 1999, following a comprehensive hospital-wide staff development program and revised physical restraint protocol, 10 RN data collectors conducted a follow-up study of 53 (N = 53) restrained adults in the same institution. In both studies, data regarding restraints management were gathered using a Restraint Management Improvement Indicator. Following a program of restraint management education, substantial improvements were found for virtually all of the physical restraint indices studied. The findings suggest that future educational efforts should be undertaken to further improve the documentation in hospital medical records regarding medical orders and ongoing observation, assessment, and interventions for physically restrained patients. Future research should further document and study interventions to reduce or eliminate the use of physical restraints.

Adult↗

PubMed1992

Physical restraints in the practice of medicine. Current concepts.

OBJECTIVE: This article reviews the current status of the utilization of physical restraints in the practice of medicine. Based on current data from the reference sources, appropriate guidelines for the utilization of physical restraints in the practice of medicine are presented. DATA SOURCES: A review of the current literature as referenced in the article. Only English-language references were used. STUDY DESIGN: Articles were selected based on a review of articles from Index Medicus, English-language only. Articles were reviewed by the author for validity and appropriateness. DATA EXTRACTION: The guidelines of data quality, validity, and appropriateness were applied to all articles by the author. DATA SYNTHESIS: Restraints are frequently used in the practice of medicine. As many as 85% of nursing home patients will be restrained at some time and up to 17% of hospitalized medical patients will be restrained. This treatment is not always appropriate but there are no current guidelines available for the practicing physician to assist him or her in these decisions. The current use of physical restraints is discussed. The risks of restraints are reviewed and the reasons for restraint use are cited. The question regarding the efficacy of restraints is directly addressed for each of the situations in which restraints are most commonly used. The ethical and legal considerations concerning the use of restraints are reviewed, current concepts are summarized, and guidelines for improved usage of restraints are suggested. CONCLUSIONS: Despite their extensive use, there is virtually no evidence to support the efficacy of restraints. The risks of using mechanical restraints are numerous and well documented. The detrimental psychologic impact of restraints needs to be emphasized. Restraints are inappropriately used if employed because of fear of liability should a patient fall. The proper approach to the patient at risk of falling is to address the contributing factors that place the patient at risk and, where possible, correct them. Restraints are overused in medicine. Guidelines are given to help improve the employment of this potentially harmful practice.

Accidental Falls↗

PubMedDate not supplied

Use of physical restraints. 2: Alternatives.

The first article in this two-part series considered the consequences of physical restraints. This article considers the alternatives to physical restraints and argues that their use in daily nursing practice raises the quality of care provided to elderly patients.

Aged↗

PubMed1998

The effects of short-term physical restraint and isoflurane anesthesia on hematology and plasma biochemistry in the island flying fox (Pteropus hypomelanus).

The effects of short-term physical restraint and isoflurane anesthesia on hematologic and serum biochemistry parameters were evaluated in 12 island flying foxes (Pteropus hypomelanus). Physical restraint was associated with significantly decreased calcium, cholesterol, globulin, albumin, hemoglobin concentrations, red blood cell count, and hematocrit and increased glucose, phosphorus, and potassium concentrations. Isoflurane restraint was associated with significantly decreased calcium, cholesterol, albumin, globulin, and glucose concentrations, aspartate transaminase and alkaline phosphatase activities, white blood cell count, red blood cell count, hemoglobin, hematocrit, and total neutrophil and lymphocyte counts and significantly increased phosphorus and chloride concentrations. For those variables where both restraint forms produced an alteration (red blood cell count, hemoglobin, hematocrit, calcium, phosphorus, glucose), the magnitude of change was always significantly greater for the physically restrained animals. This study indicates that in adult flying foxes isoflurane anesthesia is preferable to physical restraint for collection of blood samples for hematologic and plasma biochemical analysis. Additionally, blood samples should be collected as soon as possible after capture, regardless of restraint technique.

Anesthesia, Inhalation↗