A Clinical Trial to Reduce Restraints in Nursing Homes

Evans, Lois K.; Strumpf, Neville E.; Allen-Taylor, S L; Capezuti, Elizabeth; Maislin, Greg; Jacobsen, Barbara S.

doi:10.1111/j.1532-5415.1997.tb01469.x

Cited by 209 publications

(302 citation statements)

References 33 publications

Supporting

Mentioning

284

Contrasting

Unclassified

Order By: Relevance

“…4'9'1° Most reports on reducing restraint use have involved geriatric care programs. [11][12][13] Studies that have been conducted in both acute and long-term public psychiatric facilities have found that stafftraining, 14 improved staffing, 15 and medication 16 can successfully reduce restraints. Overall, there remains little published experience in reducing the use of restraint with acutely ill psychiatric patients.…”

Section: Introductionmentioning

confidence: 99%

Reducing restraint use in a public psychiatric inpatient service

McCue

Urcuyo

Lilu

et al. 2004

The Journal of Behavioral Health Services & Research

View full text Add to dashboard Cite

The use of behavioral restraint in psychiatric inpatients can have physically and emotionally damaging effects. However, staff may view the use of restraint as a routine and acceptable means of maintaining safety. The goal of this project was to reduce the use of restraint in a public psychiatric inpatient service that serves an economically disadvantaged urban population. Six interventions that primarily involved changing staff behavior were made to reduce the use of restraint. These included better identification of restraint-prone patients, a stress/anger management group for patients, staff training on crisis intervention, development of a crisis response team, daily review of all restraints, and an incentive system for the staff. The rate of restraint use (number of restraints/1000 patient-days) during the 3 years before the interventions was compared with the rate during the 2 years after the interventions. There was a significant decrease in the rate of restraint use after the restraint reduction initiatives were implemented. The reduction was not accompanied by a sustained increase in incidents of assault, suicidal behavior, or self-injury.

show abstract

Section: Introductionmentioning

confidence: 99%

Reducing restraint use in a public psychiatric inpatient service

McCue

Urcuyo

Lilu

et al. 2004

The Journal of Behavioral Health Services & Research

View full text Add to dashboard Cite

show abstract

“…A considerable amount of research is available on staff education. Appropriate staff education tends to reduce the use of physical restraints, and there are no apparent adverse effects to their removal (C. Cohen, Neufield, Dunbar, Pflug, & Breuer, 1996;Cruz, Abdul-Hamid, & Heater, 1997;Dunbar, Neufeld, White, & Libow, 1996;Evans & Strumpf, 1989;Evans, Strumpf, Allen-Taylor, Capezuti, Maislin, & Jacobsen, 1997). For example, residents do not have more falls, or more serious falls, when physical restraints are removed.…”

Section: Review Of the Literaturementioning

confidence: 99%

Dimensions of Care for Dementia Sufferers in Long-Term Care Institutions: Are They Related to Outcomes?

Chappell¹,

Reid²

2000

The Journals of Gerontology Series B: Psychological Sciences an

View full text Add to dashboard Cite

Objectives. This study empirically examined whether dimensions of care cluster in special care units (SCUs) compared with non-SCUs. The relationship between SCU status plus separate measures of the dimensions of care and outcomes for dementia sufferers was then investigated.Methods. Data were drawn from the Intermediate Care Facility Project. The sample ( N ϭ 510) included residents with dementia, aged 65 and older, in intermediate care facilities throughout the province of British Columbia, Canada. Longitudinal data included 6 outcomes: cognitive function, behavioral problems of agitation and social skills, physical functioning, and quality of life measured through affect and expressive language skills. Separate multiple linear regression equations were estimated, relating each of these outcomes to 5 dimensions of care: preadmission and admission procedures, staff training and education, nonuse of physical and chemical restraints, flexible care routines and residentrelevant activities, and the environment. Results.The results showed there is virtually no clustering of dimensions along SCU/non-SCU lines. Neither SCU status nor the individual dimensions were highly predictive of outcomes. Residents' affect at t 1 emerged as a characteristic that was significantly correlated with other outcomes.Discussion. This Canadian research can be added to the few but growing number of rigorous studies that suggest SCUs are not homogeneous and do not necessarily provide better care than non-SCUs. Moreover, it raises questions about the benefits of "best practice" dimensions of care, regardless of SCU status.S the demographic shift continues, the proportion of elderly persons and of old elderly persons in society is increasing. The risk of dementia rises rapidly with age among the oldest age groups, and thus the number of individuals with more severe levels of dementia has increased. Long-term care facilities, as a result, now tend to house higher proportions of residents who suffer from advanced dementia than was true in the past. To meet this demand, providers of care have of necessity been experimenting with management in this area. This experimentation has resulted in the identification, rethinking, and implementation of several dimensions of care , such as assessment and care planning, staff training, flexible care routines, individualized care plans, and the environmental setting.It is commonly thought that such dimensions of care, adequately implemented and in the right combination, will result in optimal outcomes for residents suffering from dementia (Holmes et al., 1994). Although these dimensions of care are in theory expected to result in superior outcomesand thus have become the philosophy behind the creation of special care units (SCUs)-their effects on outcomes are not fully known. In this study we empirically examined whether such "best practices" dimensions of care or a subset of them are, in fact, more likely to be implemented within SCUs. We also examined whether specific dimensions or combinations of dimensi...

show abstract

“…En experiencias similares en Estados Unidos, Alemania u Holanda, la retirada de sujeciones físicas no supone una reducción significativa en el número ni en la gravedad de las caídas 17,24,25,26,27,28 . Aunque en estos estudios la duración del análisis fue inferior a un año, las muestras eran más grandes, estaban implicados más centros y fueron seleccionados de manera aleatoria 24,29,30 .…”

Section: Discussionunclassified