SEARCH · PubMed Health

Results for “Restraint, Physical”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 91 records · Page 5Linked to original sources

PubMed2004

Attitudes towards the use of hand over mouth (HOM) and physical restraint amongst paediatric specialist practitioners in the UK.

PURPOSE: To assess the views of paediatric specialist dental practitioners in the United Kingdom of the use of the hand over mouth technique and physical restraint. METHODS: Questionnaire survey of all specialist dental practitioners in paediatric dentistry in the United Kingdom (n = 216). Replies were received from 179 individuals (82.8%). RESULTS: The majority of the sample (over 80%) described HOM as having three components, broadly mirroring the description of the technique in clinical textbooks. Approximately 60% of the respondents reported that HOM should never be used (106 individuals, 59.2%). Those who endorsed the use of HOM suggested it should be used with cases of hysterical, tantrum behaviour (57 respondents, 32%). The use of physical restraint was endorsed for certain disabled patients by 110 individuals (62%); for very young patients by 69 respondents (39%); premedicated patients by 35 respondents (20%); physically resistive patients by 25 respondents (14%). Forty-three respondents (24%) felt there were no psychological consequences of the use of HOM or physical restraint; 91 (51%) felt that HOM would result in the child fearing dental treatment. CONCLUSIONS: Specialist paediatric dental practitioners in the UK are familiar with the technique of HOM although they also feel that this technique should never be used. A large proportion of practitioners felt that the use of physical restraint was appropriate with certain disabled patients. The most commonly anticipated psychological sequeala which may accompany the use of these techniques was subsequent fear of dental treatment.

Attitude of Health Personnel↗

PubMed1995

Physical restraint use in acute care settings.

Increasing reliance on physical restraint devices within hospital settings can be attributed to many reasons, perhaps including litigation. Restraint use represents a quality improvement issue; therefore, a review of all studies involving restraints in acute care settings was conducted. Results of a descriptive study using focus groups is also included. The focus groups explored the decision-making process nurses used in restraining or releasing a patient from a mechanical device.

Acute Disease↗

PubMed2001

Elderly patients' reports of physical restraint experiences in intensive care units.

BACKGROUND: Use of physical restraints has undesirable sequelae. As they weigh the risks and benefits of protocols for reducing the use of restraints, staff members in intensive care units, where restraints are most used in hospitals, need to know how well elderly patients remember being restrained and how patients perceive the use of restraints. OBJECTIVES: To estimate the proportion of patients who remember being restrained, describe the experience from the patients' perspectives, and describe any distress caused by use of restraints within the overall experience of being in the intensive care unit. METHODS: Transcripts of semistructured, audiotaped interviews of patients who had been in the medical or surgical intensive care unit in any of 3 eastern and midwestern medical centers were analyzed by question and for overall themes. RESULTS: Six patients (40%) remembered some aspect of being restrained but did not report great distress. Patients accepted restraints as needed because of the lack of alternatives. Patients reported remembering that they should not perform certain behaviors but being unable to stop themselves. Patients cited hallucinations and intubation as major stressors in the intensive care unit. Patients' continuing health problems after discharge from the intensive care unit severely limited recruitment of subjects. CONCLUSIONS: Patients do not remember great distress specifically related to the use of restraints, but the overall situation leading to use of restraints is disturbing if remembered. The discovery of methods to reduce the distress of intubation and hallucinations could decrease use of restraints.

Aged↗

PubMed1986

Effects of physical restraint on leukemogenesis by Friend virus.

The effects of physical restraint on the development of Friend erythroleukemia in ddY mice were examined. Restraint was applied by immobilizing the mice in wire cages. In both sexes there was a reduction in the weight of the whole body, thymus and spleen, though the food intake was not reduced. The incidence of leukemia was reduced in the males, but not in the females, while the latent period was prolonged in both sexes. This sex dependency is characteristic of the stress response.

Animals↗

PubMed2006

Development and testing of tools to assess physical restraint use.

BACKGROUND: To implement best practice in restraint use, healthcare providers and decision makers require current, accurate, and easily accessible information about restraint practices in their setting. There is a need for a reliable and valid instrument that is feasible for use in these settings to rapidly assess physical restraint use. METHOD: Two instruments to assess physical restraint use were developed and tested: an observation tool and a chart audit. The instruments were tested in complex continuing care units and rehabilitation units at two healthcare organizations. The restraint use observation tool was administered by trained observers in a series of five observations over a 2-week period. Chart audits were conducted for a sample of residents. Inter-rater agreement of the observation tool and chart audit was assessed. Point prevalence estimates were obtained for each site. The time required to use the observation tool and complete chart audits as well as the comparability of findings from the two data sources were described. FINDINGS: Restraint use observations were completed for 289 patients and chart audits were completed for 207 patients. Prevalence and patterns of restraint use varied between sites and across time periods. Observations took an average of 2.6 (Site A) and 0.6 (Site B) minutes per patient. There was excellent inter-rater agreement for most items on the observation tool with the exception of whether or not the patient was able to release or loosen the restraint. There was significant concordance but as expected, not complete agreement between paired estimates of prevalence using the observational tool and the chart audit. CONCLUSION: The observation and chart audit tools are feasible to use and reliably assess physical restraint use in healthcare organizations. The patient's physical capacity to move independently, the patient's waking status, and the restraint's restriction of mobility are items that should be added to the observation tool. The tools are complementary and should be used in tandem to capture the multifaceted complexity of restraint use in health service organizations.

Adolescent↗

PubMed2006

Effect of physical restraint on oxidative stress in mice fed a selenium and vitamin E deficient diet.

Physical restraint has been associated with increased oxidative damage to lipid, protein, and DNA. The purpose of this experiment was to determine whether physical restraint would further exacerbate oxidative stress in mice fed a selenium (Se) and vitamin E (VE) deficient diet. Three-week- old mice were fed a Torula yeast diet containing adequate or deficient Se and VE. Menhaden oil was added to the deficient diet to impose an additional oxidative stress. After 4 wk feeding, half the mice in each group were restrained for 5 d in well-ventilated conical tubes for 8 h daily. Mice fed the Se and VE deficient diets had increased liver thiobarbituric acid-reactive substance (TBARS) levels and decreased liver glutathione peroxidase (GPX1) activity and alpha-tocopherol levels. Plasma corticosterone levels were elevated in restrained mice fed the deficient diet compared to unrestrained mice fed the adequate diet. Restraint had no effect on liver TBARS or alpha-tocopherol levels. Liver GPX1 activity, however, was lower in restrained mice fed the adequate diet. In addition, liver superoxide dismutase (SOD) activity was lower in the restrained mice fed the adequate or deficient diet. Thus, under our conditions, Se and VE deficient diet, but not restraint, increased lipid peroxidation in mice. Restraint, however, decreased antioxidant protection in mice due to decreased activities of GPX1 and SOD enzymes.

Animals↗

PubMed1998

Do physical restraints prevent patients from removing invasive therapeutic devices?

Many critical care nurses have cared for patients who have removed invasive therapeutic devices such as endotracheal tubes or intravenous lines despite secure physical restraints. Recently medical and nursing authors have begun to question the effectiveness and appropriateness of physical restraints. Through a literature review, this article explores the question: "Do physical restraints prevent patients from removing invasive therapeutic devices?" and identifies some alternatives to restraints that may be appropriate for use in critical care areas.

Confusion↗

PubMed2002

The experience of physical restraint: a systematic review of qualitative research.

The objective of this review was to summarise the experience of physical restraint from the perspectives of the person subject to restraint and of their family. A review of interpretive and descriptive research was undertaken that entailed a comprehensive literature search. Studies were included in the review if they provided qualitative data on this experience. An interpretive data synthesis was undertaken to generate a composite description of the experience of restraint. Findings highlight the predominantly negative impact of physical restraint on the person restrained and their family. These findings support minimal use of restraint in health care and give voice to a relatively powerless and vulnerable group of people.

Anger↗

PubMed2004

Psychiatric inpatients' perceptions of positive and negative aspects of physical restraint.

This qualitative study explored the experiences and feelings of psychiatric inpatients concerning their first encounter with physical restraint. Its purpose was to determine whether restraint has any other effects, other than the intended one of protection. Thirty psychiatric inpatients who had experienced physical restraint in two acute admission wards within the previous two days, were interviewed by the principal researcher. About two-thirds of the participants expressed positive feelings towards staff who had shown concern about their needs and had been willing to help. Positive therapeutic effects, other than physical protection, were largely related to the caring attitudes and behavior demonstrated by the staff. Negative effects were related to the inability of staff to satisfy patients' needs for: concern, empathy, active listening, and information about restraint during and after its use. The conclusion of the study was that physical restraint could be a therapeutic intervention when health professionals were able to provide psychological and informational support to patients throughout the procedure. A perceived unsatisfactory caring attitude and behavior by the restraint provider would cause negative feelings in the patient and would be more likely to result in the patient struggling physically with the restrainer. Additional physical and psychological harm would also be experienced by patients in these circumstances.

Adult↗

PubMed2005

Factors relating to the use of physical restraints in psychogeriatric care: a paradigm for elder abuse.

The purpose of this study was to address one component of the complex topic "elder abuse". A prospective observational study in the psychogeriatric unit of an acute psychiatric hospital demonstrated that 30% (n=37) of all included patients (n=122) were physically restrained. The highest incidence (48%) was found in elderly patients with severe cognitive impairments (diagnosis of dementia and/or delirium) (n=60). The most commonly used devices of physical restraints were bed rails (100%), belts (trunk 93%, limbs 40%) and chair-tables ("gerichair") (41%). Most restraints occurred at the beginning of hospitalization (83%). Physical restraints were continued for many days and on average of many hours a day. Patients with low cognitive status and serious mobility impairments showed a very high risk of being restrained (p=0.015; OR 32.0 [95% CI:2.0-515.1]). Inability to perform ADL activities increased the frequency of restraint use (p=0.035; OR27.7 [95%CI: 1.3-604.1]). As possible co-factors repetitive disruptive behaviors were found. There was no significant difference between the frequency of falls in restrained or unrestrained patients during the observational period, but fall-related fractures (n=2) only occurred in restrained patients. It is possible that restraints increase the use of benzodiazepines and classical neuroleptics. These results confirm that physical restraints remain a common practice in psychogeriatric care. No evidence-based data support the value of restraints in regard to fall prevention and control of behavioral disturbances in elderly people with serious mental illness. In contrast, these devices can have serious adverse effects and mean one of the most severe interventions in fundamental human rights.

Accidental Falls↗

PubMed1998

The relationship between physical restraint removal and falls and injuries among nursing home residents.

BACKGROUND: A major reason cited for continued restraint use in American nursing homes is the widely held belief that restraint reduction will lead to fall-related incidents and injuries. METHODS: This study represents an analysis of data collected in a clinical trial of interventions aimed at reducing the use of restraints in nursing homes. Two different designs were employed to test the relationship between restraint reduction and falls/injuries. First, multiple logistic regression was used to compare fall/injury rates in subjects who had restraints removed (n = 38) to those who continued to be restrained (n = 88); second, survival analysis was employed to test the relationship between physical restraint removal and falls/injuries at the institutional level by comparing fall/injury rates among three nursing homes (n = 633) with varying rates of restraint reduction. RESULTS: Based on the multiple logistic regression analysis, there was no indication of increased risk of falls or injuries with restraint removal. Moreover, restraint removal significantly decreased the chance of minor injuries due to falls (adjusted odds ratio: 0.3, 95% CI: 0.1, 0.9; p < .05). The survival analysis demonstrated that the nursing home that had the least restraint reduction (11%) had a 50% higher rate of falls (p < .01) and more than twice the rate of fall-related minor injuries (p < .001) when compared to the homes with 23% and 56% restraint reduction, respectively. CONCLUSIONS: Physical restraint removal does not lead to increases in falls or subsequent fall-related injury in older nursing home residents.

Accidental Falls↗

PubMed1996

Physical restraint of elderly patients in critical care: historical perspectives and new directions.

The use of physical restraints in health care settings is being examined carefully at all levels. Experience with the elderly in long-term care settings teaches us that in many instances physical restraints are not only unnecessary, they are also not the best available therapy. There can be little doubt that careful evaluation of the use of restraints in the critical care unit is likely to reveal alternatives to their use in many situations. In the American health care system, nurses primarily determine restraint use. Professional nurses are leading the movement to find alternatives to restraints, and critical care nurses can contribute much to the effort. Nurses must recognize restraint application as a serious treatment decision, and must apply risk-to-benefit analysis to each decision. Continuing nursing education and nursing research on restraint reduction will lead to improved care for our elderly patients.

Accidental Falls↗

PubMed2001

The detrimental effects of physical restraint as a consequence for inappropriate classroom behavior.

Functional analyses produced inconclusive results regarding variables that maintained problem behavior for 2 students with developmental disabilities. Procedures were modified to include a contingent physical restraint condition based on in-class observations. Results indicated that tinder conditions in which physical restraint (i.e., basket-hold timeout) was applied contingent on problem behavior, rates of these behaviors increased across sessions for both subjects. Implications for the use of physical restraint in the classroom are discussed.

Adolescent↗

PubMed1997

Effects of handling and physical restraint on rectal temperature, cortisol, glucose and leucocyte counts in the silver fox (Vulpes vulpes).

The present paper describes the effects of handling and one hour of physical restraint on rectal temperature (Trec), plasma cortisol, plasma glucose and leucocyte counts in six 8-months old silver fox vixens (Vulpes vulpes). Mean Trec in silver foxes 5 min after capture was 40.1 degrees C and increased during restraint, showing a maximum of 40.8 degrees C at 30 min thereafter. Supplementary, deep body temperature (Tb) was recorded with surgically implanted biotelemetry devices in 6 adult silver fox vixens kept isolated from environmental disturbances in a barn. Mean Tb in these foxes ranged between 38.0-38.4 degrees C, showing a diurnal variation and being at the lowest between 0700-1600 hour. When a person approached a fox and was present for 5 min, Tb increased rapidly. The results indicated that a stress-induced hyperthermia (SIH) was evoked rapidly within the first registration at 5 min after capture, and that this response continued during one hour of physical restraint. Plasma glucose and plasma cortisol levels increased during one hour of physical restraint, whereas numbers of lymphocytes, total white blood cell counts, and total granulocytes decreased. Furthermore, previously reported base levels of plasma cortisol and plasma glucose were exceeded. The results indicate that the hypothalamic-pituitary-adrenal (HPA) axis and the sympathoadrenal medullary (SAM) system were activated within 5 min of handling and restraint. Furthermore, hyperthermia is a promising indicator of acute stress in silver foxes.

Animals↗

PubMed1993

Nursing personnel's perceptions of physical restraint use in long-term care.

The use of physical restraints as an accepted clinical intervention was dramatically changed by enactment of legislation in the United States. As a result, nursing personnel's notions of restraints as a therapeutic intervention were challenged. This study was initiated to obtain a better understanding of the underlying motivations for restraint use as a clinical intervention and to provide data helpful to nursing staff as they make the transition to restraint-free care. In the study, 124 long-term-care nursing personnel were surveyed regarding their perceptions of restraint use, and were asked whether or not they would recommend using restraints in selected clinical situations. Results of stepwise regression showed that 40% of the variation in the recommendation to use restraints can be explained by the type of nursing personnel (licensed nurse vs. nursing assistant), liability and treatment concerns related to restraint use, age of the nursing staff, and a belief that reducing restraints increases the need for psychoactive medications.

Attitude of Health Personnel↗

PubMed1998

[What carries more weight, safety or freedom? Contact persons on physical restraint of psychogeriatric nursing home patients].

All representatives of psychogeriatric patients of two Dutch nursing homes (in Nijmegen and Amsterdam) were asked for their opinion about the use of (physical) restraints. Questions referred to characteristics of the respondents and their relatives in the nursing home, information provided by the nursing home, and decision-making. Furthermore respondents' opinion was studied by means of statements on six patient cases for whom respondents could choose the application of any type of restraint or no restraint. 77% (321) of all 416 representatives who were sent a questionnaire responded. The majority (75%) was well informed on the existence of several types of physical restraints, one third of the respondents, however, answered that information provided by the nursing home in this respect was lacking. 55% of the respondents answered that there was only a need for information on physical restraint when a problem concerning their family member actually occurs. Almost 90% of the respondents wanted to play an active role in decision-making or at least be informed before or shortly after application of a restraint. From the answers on the statements a majority of the respondents may be concluded to choose for safety above freedom for their relatives. Belts tied to a chair or bed, but also chairs with tables across, were judged to be the most restraining and influential on the mood of the relatives. The answers regarding the six patient cases show that a majority of the respondents choose any type of restraint. In most cases they choose for less restraining devices and for devices with less or no influence on the mood. About one-third of the representatives of the Amsterdam nursing home answered that their relatives ever had had any application of a restraint, while in the Nijmegen nursing home this prevalence was twice as high. In many aspects Amsterdam respondents were more critical about the application of restraints. This could probably be explained by the difference in policy of restraint application between the two nursing homes.

Aged↗

PubMed2004

A program to reduce use of physical restraint in psychiatric inpatient facilities.

The authors describe a program to reduce the use of physical restraint on three psychiatric units of a university hospital. One component of the program involved interviewing patients to determine their stress triggers and personal crisis management strategies. The second consisted of training staff members in crisis de-escalation and nonviolent intervention. During the first two quarters after implementation of the program, physical restraint rates declined significantly and remained low on all three units for the remainder of the year after implementation. Hospitals should consider instituting comprehensive staff training that encourages adaptive patient behaviors and nonviolent staff intervention to reduce the physical and mechanical restraint of children and adults in inpatient facilities.

Adolescent↗

PubMed2001

The effect of physical restraints on fall rates in older adults who are institutionalized.

Since the Omnibus Budget Reconciliation Act (OBRA) of 1987, there has been a significant reduction in the use of physical restraints to prevent falls in older adults who are institutionalized because of the developing awareness of the physical and psychological problems associated with them. The purpose of this ex post facto descriptive study was to determine if there is a difference in falls when physical restraints are allowed or prohibited in one older adult population. Data from incident reports from a purposive sample of 97 older adults in one long-term care facility were analyzed before and after the implementation of a restraint-free policy. The results indicated no significant difference in the number of falls before and after the policy change. However, there was a significantly lower number of falls with injuries and a significantly higher number of falls without injuries. These findings suggest older adults will continue to fall with or without the use of physical restraints because of changes associated with the aging process and risk factors. Removing physical barriers from older adults and allowing freedom of movement may decrease the severity of injury sustained in a fall.

Accidental Falls↗