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Results for “Restraint, Physical”

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At least 19 recordsLinked to original sources

PubMed2001

Thrombosis associated with physical restraints.

OBJECTIVE: Physical restraint is controversial, but still frequently used in psychiatric units. We describe two cases of thromboembolic phenomena, one with a fatal outcome, in association with physical restraint. METHOD: The world literature on physical restraint and thrombosis was reviewed by undertaking a search of electronic databases. RESULTS: To our knowledge, we are the first to report thrombosis associated with physical restraint. CONCLUSION: Immobilization and trauma to the legs while restraining a patient are adequate explanations for the occurrence of thrombosis. Special attention should be paid to thrombosis when employing restraints in psychiatric wards. Further systematic research into physical restraints in psychiatry is clearly needed.

Acute Disease↗

PubMed1999

Canadian critical care nurses and physical restraints.

While physical restraints are frequently used in Canadian critical care units, a limited number of studies related to this practice have been conducted. In this article, the author describes the findings from a survey about physical restraints which was completed by nurses who attended a 1998 conference of the Manitoba chapter of the Canadian Association of Critical Care Nurses. The purpose of the study was to identify Canadian critical care nurses' knowledge, practice, and attitudes related to the use of physical restraints. Major findings included a mean score of 77% in knowledge of restraints, a lack of uniform restraint practices, and the fact that many nurses experience negative emotions related to the use of restraints. Participants typically used wrist restraints to prevent injury or removal of invasive therapeutic devices. The most commonly suggested alternatives for restraints included constant observation or medications. The results of this survey suggest that critical care nurses require further education in order to improve their knowledge and to standardize nursing practice protocols related to the use of restraints. Further research to identify appropriate restraint alternatives, specifically for critical care, is required.

Adult↗

PubMed1989

Freedom from restraint: consequences of reducing physical restraints in the management of the elderly.

Physical restraint is commonly used in the management of elderly people in North American hospitals and nursing homes. Between December 1981 and March 1982 the Department of Geriatric Medicine, St. Boniface General Hospital, Winnipeg, changed its practice regarding the use of such restraints. In the fiscal year 1980-81 the rate of application of physical restraints was 52 per 1000 patient-days and the frequency of falls 7 per 1000 patient-days. By 1986-87 the figures were 0.3 and 8.7 per 1000 patient-days respectively; the increase in falls was not clinically significant. During the study period there was a 40% reduction in the use of chemical restraints (psychotropic drugs other than hypnotic and antidepressant agents). Here we record how this change in practice occurred and persisted.

Accidental Falls↗

PubMed2005

[Relationship between physical restraint in nursing homes and their institutional characteristics].

OBJECTS: To clarify relationship between physical restrain in nursing home and its institutional characteristics. METHODS: The subjects consisted of all 103 nursing homes in Okayama prefecture which were open in 2002 with a total of 6,829 residents. Data were obtained by questionnaire through the "Welfare ombudsman Okayama" in 2002 and audited by local government in the same year. We then performed multiple regression analysis. The parameter in question was the ratio of residents who were physically restrained to the residents at high risk of needing physically restraint (physically restrained ratio). Independent valuables were institutional characteristics. To increase the accuracy of estimation, we hypothesized that the residents likely to be the physically restrained were elderly with serious dementia who were defined as IV and over in the dementia elderly daily living independence rank. We also performed analysis with the definition of heavy dementia elderly graded as III and over. RESULTS: We obtained data of 72 institutes housing 1,700 elderly with serious dementia, which did not have any missing values. Of these 74% had at least one resident being physically restrained. The average physically restrained ratio was 24.2%. The institutional characteristics which correlated with use of physical restraint were intensive staffing, holding periodical care conference, and having unit care. The results were robust with regard to change in the serious dementia definition. CONCLUSION: The institutional characteristics which correlate with use of physical restraint are intensive staffing, holding periodical care conference, and having unit care.

Aged↗

PubMed1986

Physical restraint in Polish psychiatric facilities.

Physical restraint in the form of direct force, forced feeding and medication, mechanical restriction of bodily movement, or the threat of force was administered to close to 30% of patients admitted and hospitalized for a period of at least fourteen days. In transporting the patient to the admission room and then to his treatment ward, the dominant form of restraint used was direct force, or the threat of such force. During the following fourteen days of hospitalization, mechanical restraint and forced medication predominated. Restraint was applied most often, across each of the four phases of the study, to patients deemed dangerous to self or others. This relationship became significantly stronger as the period of hospitalization continued. Across the four phases, patients who protested their hospitalization were more likely to be restrained than patients who agreed to it or who did not object. During each of the four phases of the study, numerous patients who did not object to their hospitalization and who were not deemed dangerous were nevertheless subjected to restraint. The pervasiveness of physical restraint, the wide inter-hospital differences in its use, the apparent over-prediction of patient dangerousness, and the use of restraint with patients who were not deemed dangerous and who did not object to their hospitalization, confirms the need for legal and ethical regulation of physical restraint of psychiatric patients.

Commitment of Persons with Psychiatric Disorders↗

PubMed2005

The use of physical restraints on paediatric intensive care units.

BACKGROUND: Physical restraints are used in critical care units in an attempt to reduce the risk of treatment interference. Their use remains controversial and there are concerns regarding the effectiveness and safety of restraint techniques. There are few data available on the prevalence of physical restraint use in Paediatric Intensive Care Units (PICU) in the UK and we have therefore conducted a cross-sectional survey to define current clinical practice. METHODS: A postal questionnaire was sent to all UK PICU with questions on the use of physical restraint techniques, including the use of splints across the joints of limbs and of securing limbs to the bed. Consent issues were also addressed. RESULTS: Of those units responding 68% reported that physical restraint techniques were used within those units. Ten units (36% of those responding) reported the use of manual holding of patients, 16 units (57% of those responding) reported the use of splints across the joints of limbs, three units reported the use of swaddling as a restraint technique while one unit secured limbs of patients to the bed. None of the units obtained written consent prior to the use of physical restraints and 53% obtained verbal consent. CONCLUSIONS: Physical restraint is a commonly used technique on PICU in the UK. There is considerable variation in clinical practice and current clinical guidelines which are available do not deal specifically with children. Prospective randomized trials would be necessary to fully investigate the role of physical restraints amongst critically ill children.

Age Factors↗

PubMed2005

Why do we use physical restraints in the elderly?

The use of physical restraints in the elderly is a common practice in many countries. This paper summarizes the current knowledge on the use of restraints in home care, hospitals and nursing homes. Between 1999-2004 the reported prevalence numbers range from 41-64% in nursing homes and 33-68% in hospitals; numbers of restraint use in home care are unknown. Bed rails and belts have been reported as the most frequently used restraints in bed; chairs with a table and belts are the most frequently reported restraints in a chair. It is evident that physical restraints in most cases are used as safety measures; the main reason is the prevention of falls. In the hospital setting, the safe use of medical devices is also an important reason for restraint use. Predictors for the use of physical restraints are poor mobility, impaired cognitive status and high dependency of the elderly patient and the risk of falls in the nurses' opinion. Furthermore, there are indications that restraint use is related to organizational characteristics. Finally, many adverse effects of restraint use have been reported in the literature, like falls, pressure sores, depression, aggression, and death. Because of the adverse effects of restraints and the growing evidence that physical restraints are no adequate measure for the prevention of falls, measures for the reduction of physical restraints are discussed and recommendations are made for future research.

Accidental Falls↗

PubMed1984

Suppression of pica by overcorrection and physical restraint: a comparative analysis.

Overcorrection and physical restraint procedures have been shown to be effective in controlling certain classes of maladaptive behavior in mentally retarded persons. In the present study, an alternating treatments design was used to measure the differential effects of overcorrection and physical restraint procedures in the treatment of pica. Changes in collateral behaviors were also monitored. Each occurrence of pica was followed by either an overcorrection procedure or a physical restraint procedure. Although both procedures reduced the occurrence of pica and had a similar effect on the occurrence of collateral behaviors, physical restraint was clinically more effective in terms of immediate response reduction.

Adult↗

PubMed2001

Factors relating to the use of physical restraints in geriatric care settings.

Physical restraints are commonly used on older persons living in geriatric care settings. The aim of this study was to investigate the influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence. In this cross-sectional study of 33 nursing home wards and 12 group living units for old persons with dementia in two municipalities in northern Sweden, 540 residents (mean age 82) and 529 staff members were evaluated for resident and staff characteristics and organizational and environmental variables. The proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff's attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. A classification function analysis showed that these three variables could correctly classify the wards as restraint-free, low-use, and high-use wards in 63.6% of the cases, with the highest figures for restraint-free wards (91%). This study has shown that the use of physical restraints is strongly connected with residents' functional status and nursing staffs' attitudes toward their use.

Aged↗

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.

Aged↗

PubMedDate not supplied

The impact of education on the use of physical restraints in the acute care setting.

BACKGROUND: Physical restraints have become an acceptable standard of practice for managing safety and behavior control in acute care settings. Although the primary intent for using physical restraints is for patient protection, there are many negative outcomes related to their use. Heightened awareness by recent Joint Commission on Accreditation of Healthcare Organizations and the Center for Medicare and Medicaid Services standards for restraint use has led health care administrators and nursing staff to explore methods of reducing or eliminating the use of restraints. An educational program was planned and implemented for nursing staff emphasizing the risks of physical restraints and the benefits of innovative optional measures including nonrestraint devices. The program was tested to determine whether increased awareness through education would reduce the use of restraints. METHOD: After current practice patterns and restraint utilization were established, a comprehensive educational program was provided to all nursing personnel. Twenty-three formal classroom inservice offerings were provided with follow-up reinforcement of self-study modules. Education included nursing assessment strategies and practical restraint optional interventions for managing patients exhibiting disruptive behaviors. FINDINGS: After the educational program, the overall use of physical restraints decreased as well as the length of time patients were restrained. CONCLUSION: Results of this study reinforce the need to increase staff awareness and knowledge of nonrestraint interventions to manage disruptive behaviors in the acute care setting.

Acute Disease↗

PubMed2006

Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial.

BACKGROUND: Physical restraints are still frequently used in nursing home residents despite growing evidence for the ineffectiveness and negative consequences of these methods. Therefore, reduction in the use of physical restraints in psycho-geriatric nursing home residents is very important. The aim of this study was to investigate the short-term effects of an educational intervention on the use of physical restraints in psycho-geriatric nursing home residents. METHODS: A cluster randomized trial was applied to 5 psycho-geriatric nursing home wards (n = 167 residents with dementia). The wards were assigned at random to either educational intervention (3 wards) or control status (2 wards). The restraint status was observed and residents' characteristics, such as cognitive status, were determined by using the Minimum Data Set (MDS) at baseline and 1 month after intervention. RESULTS: Restraint use did not change significantly over time in the experimental group (55%-56%), compared to a significant increased use (P < 0.05) in the control group (56%-70%). The mean restraint intensity and mean multiple restraint use in residents increased in the control group but no changes were shown in the experimental group. Logistic regression analysis showed that residents in the control group were more likely to experience increased restraint use than residents in the experimental group. CONCLUSION: An educational programme for nurses combined with consultation with a nurse specialist did not decrease the use of physical restraints in psycho-geriatric nursing home residents in the short term. However, the residents in the control group experienced more restraint use during the study period compared to the residents in the experimental group. Whether the intervention will reduce restraint use in the long term could not be inferred from these results. Further research is necessary to gain insight into the long-term effects of this educational intervention.

Activities of Daily Living↗

PubMed1996

Physical restraints in geriatric care in Sweden: prevalence and patient characteristics.

OBJECTIVE: Physical restraints are used frequently in geriatric care to promote the safety of frail older patients. This study investigated the prevalence of the use of physical restraints in geriatric care and the way in which patient characteristics are related to the use of physical restraints. DESIGN: A point prevalence study of patients cared for in various types of geriatric settings. SETTING: Eight nursing homes, 15 old people's homes, a somatic geriatric clinic, and a psychogeriatric clinic in a health care district in northern Sweden. PARTICIPANTS: A total of 1325 patients, mean age 82 years, 64% of whom were women. MEASUREMENTS: The Multi-Dimensional Dementia Assessment Scale (MDDAS) was used to measure motor function, vision, hearing, speech, ADLs, behavioral symptoms, psychiatric symptoms, use of psychoactive drugs, and the physical and psychological workload of the staff. In addition, questions concerning the use of physical restraints were added to the instrument. RESULTS: Twenty-four percent of the patients were physically restrained. The highest prevalence was found in nursing homes and psychogeriatric care. Physical restraints were found to relate most strongly to cognitive impairment, impaired ADLs, and speech and walking ability. Ninety-four percent of the restrained patients were cognitively impaired. Other variables relating to the use of physical restraints were psychiatric symptoms and behavioral disturbances. CONCLUSIONS: This study has shown that physical restraints are used frequently in geriatric care in Sweden and that cognitive and physical impairments relate very closely to the use of physical restraints.

Activities of Daily Living↗

PubMed2000

[Physical restraints and older adults].

Physical restraints are used to restrain-clients whose physical or mental state could endanger their safety or that of others. Divergent opinions can be found in the literature on this subject. On the one hand, restraints are necessary to ensure the client's protection. On the other, they are perceived to be a form of physical and psychological abuse. Restraints can also have psychological consequences on clients and their families. They may also cause injuries that can be life-threatening. This paradox concerns both nurses and their clients' families. The goal of this article is to make nurses aware of the physiological and psychosocial factors involved in the use of restraints. The authors use Callista Roy's conceptual model to illustrate their point. In their conclusion, they emphasize the implications of restraints for nursing practice, education and research.

Aged↗

PubMedDate not supplied

Perceptions of older people who have experienced physical restraint.

It is well documented that the use of physical restraints on older people has been linked to negative clinical outcomes. However, less is known about the personal perspective of those who have been restrained. This study examines the perceptions of older people who have experienced physical restraints in a rehabilitation ward. A purposive sample was used of 17 male and female patients who were restrained. The patients were interviewed using the Subjective Experience of Being Restrained instrument (Strumpf and Evans, 1988) which is a semi-structured interview schedule. The most commonly used restraint devices included side rails, screw-on tabletops and reclining chairs. The data were analysed using content analysis. The results indicate mixed feelings regarding physical restraints. Patients' impressions of physical restraints included indifference of the devices to their perceived safety value. Overall, a minority of patients (n = 4) had positive feelings about physical restraints as they provided a sense of security to them. However, the negative comments of the patients were more prevalent and their responses were categorized in terms of institutional control, ritualised care, entrapment and discomfort, and possible alternatives.

Activities of Daily Living↗

PubMed1996

[The use of involuntary commitment and other compulsory treatment in psychiatry. A study of registered compulsory treatment, physical restraint and the use of physical force].

The study covers nine psychiatric hospitals in Denmark that together account for 20% of all admissions to mental hospitals in the country. The period of investigation was from 1. January 1990 to 31. December 1991. Compulsory treatment, mechanical restraint and physical coercion were investigated. The number of patients that are submitted to compulsory treatment is relatively small compared to the total number of patients admitted to psychiatric hospitals. The use of the different kinds of coercion may among other factors depend upon the severity of the patient's disease, the bed occupancy and the amount of staff available including the number of doctors. The study shows differences among the participating departments in the use of mechanical restraint with wrist and/or ankle cuffs but not with a waist-belt. This may depend more upon different traditions on the wards than upon demographic differences. According to Danish law a doctor must attend a patient experiencing mechanical restraint. In an emergency situation the staff are permitted to effectuate the restraint without the doctor being present but a doctor must see the patient immediately afterwards and sign a protocol. This was the case in only about one third of all cases.

Adult↗

PubMed2006

Does access to bed-chair pressure sensors reduce physical restraint use in the rehabilitative care setting?

BACKGROUND: The common use of physical restraints in older people in hospitals and nursing homes has been associated with injurious falls, decreased mobility and disorientation. By offering access to bed-chair pressure sensors in hospitalized patients with perceived fall risk, nurses may be less inclined to resort to physical restraints, thereby improving clinical outcomes. AIMS AND OBJECTIVES: To investigate whether the access of bed-chair pressure sensors reduces physical restraint use in geriatric rehabilitation wards. DESIGN: Randomized controlled trial. METHODS: Consecutively, patients admitted to two geriatric wards specialized in stroke rehabilitation in a convalescent hospital in Hong Kong, and who were perceived by nurses to be at risk of falls were randomly assigned to intervention and control groups. For the intervention group subjects, nurses were given access to bed-chair pressure sensors. These sensors were not available to control group subjects, as in usual practice. The trial continued until discharge. The primary outcomes were the proportion of subjects restrained by trunk restraint, bedrails or chair-board and the proportion of trial days in which each type of physical restraint was applied. The secondary outcomes were the proportions of those who improved in the mobility and transfer domains of modified Barthel index on discharge and of those who fell. RESULTS: One hundred and eighty subjects were randomized. Fifty (55.6%) out of the 90 intervention group subjects received the intervention. There was no significant difference between the intervention and control groups in the proportions and duration of having the three types of physical restraints. There was also no group difference in the chance of improving in mobility and transfer ability, and of having a fall. CONCLUSION: Access to bed-chair pressure sensor device neither reduced the use of physical restraints nor improved the clinical outcomes of older patients with perceived fall risk. RELEVANCE TO CLINICAL PRACTICE: The provision of bed-chair pressure sensors may only be effective in reducing physical restraints when it is combined with an organized physical restraint reduction programme.

Accidental Falls↗

PubMedDate not supplied

Physical restraint during procedures: issues and implications for practice.

Physical restraint or holding down a child or young person with cancer is generally accepted to ensure success in carrying out the various procedures involved throughout the disease trajectory. Over the past several years, health care staff have become more aware of the issues surrounding physical restraint. However, the research around the effects of being involved in physical restraint is extremely limited. Nurses continue to have little education in the pertinent issues, restraint techniques, and alternative strategies. This article aims to highlight areas that nurses caring for children and young people with cancer need to consider. Strategies for improving practice are also discussed with the thought that nurses will be stimulated to re-evaluate the use of physical restraint in this group of children and young people.

Adolescent↗