Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis

Jones, Aaron; Goodarzi, Zahra; Lee, Justin; Norman, Richard; Wong, Eric; Dasgupta, Monidipa; Liu, Barbara; Watt, Jennifer

doi:10.1371/journal.pone.0276504

Cited by 9 publications

(6 citation statements)

References 29 publications

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“…For example, Okuno et al demonstrated that the lowered threshold for employing physical restraints on COVID-19 patients with dementia has been influenced by the heightened physical and psychological strain experienced by healthcare personnel during the pandemic, as well as the adoption of restrictive hospital policies to manage its impact [ 68 ]. Other authors have argued that the use of restraints was caused by restrictive hospital visitation hours, leading to increased social isolation and decreased chances for caregiver advocacy [ 69 , 70 ].…”

Section: Analysis Of Dignity In Dementia Patients During the Covid-19...mentioning

confidence: 99%

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection

Hostiuc,

Drima

2023

Medicina

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COVID-19 was initially considered a primary respiratory disorder associated with various short- and long-term complications, affecting many patients and imposing a significant burden. Patients who have dementia are especially vulnerable to the SARS-CoV2 infection, which is associated with an increased risk for neuropsychiatric complications. These patients need a unique approach to managing ethical issues related to the COVID-19 pandemic, including autonomy, veracity, non-maleficence, justice, compassion, and dignity. The latter is one of the most elusive and misunderstood concepts in medical ethics and is extremely important in debates surrounding the proper management of patients with dementia. However, it is often left out of ethical analysis, as most clinicians, when debating issues associated with clinical practice, often evaluate only the “classical” principles of biomedical ethics. In this article, we aim to assess the unique features of dignity in treating this group of patients during the COVID-19 pandemic. We will briefly analyze dignity as a bioethical concept. We will further explore its principal axes, namely compassion, creating a humane and purposeful environment, employing persuasion to meet the person’s essential needs, exerting a certain degree of mild restraint to meet the person’s critical needs, minimizing harm in terminal care, and justice, through the lens of people who had dementia during the COVID-19 pandemic. Applying this principle in clinical practice requires significant commitment from all healthcare workers. New approaches to the analysis of dignity, such as through the Ring Theory of Personhood, may facilitate its understanding by practitioners and aid its implementation in populations with multiple vulnerabilities, such as dementia patients, during an infectious outbreak that generates significant social and medical changes.

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Section: Analysis Of Dignity In Dementia Patients During the Covid-19...mentioning

confidence: 99%

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection

Hostiuc,

Drima

2023

Medicina

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“…For example, a substantial increase in the incidence rate of physical restraint use was observed in geriatric dementia patients presenting to an acute care hospital in Japan, reaching a 50% likelihood of a restraint event approximately four months after the enactment of nationwide public health measures [ 36 ]. Similarly, orders for physical restraint interventions among older adults during acute care hospitalization in Ontario, Canada, were found to have increased in prevalence by 2.4% [ 37 ], while children and youth presenting with mental health concerns to a pediatric hospital in Michigan, USA were found to be almost four times more likely to experience a restraint event after the onset of the COVID pandemic [ 38 ]. A retrospective study on youth and adolescent psychiatric hospitalizations in Israel also noted a small increase in R/S intervention use despite a significant decrease in the number of admissions after the onset of COVID [ 39 ].…”

Section: Introductionmentioning

confidence: 99%

The impact of the COVID-19 pandemic on the use of restraint and seclusion interventions in Ontario emergency departments: A population-based study

Weissflog,

Kim,

Rajack

et al. 2024

PLoS ONE

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While COVID-19 impacted all aspects of health care and patient treatment, particularly for patients with mental health/substance use (MH/SU) concerns, research has suggested a concerning increase in the use of restraint and seclusion (R/S) interventions, although results vary depending on facility type and patient population. Thus, the present study sought to explore COVID-related changes in the use of R/S interventions among patients presenting to Ontario emergency departments (EDs) with MH/SU complaints. To determine whether temporal and clinical factors were associated with changes in R/S use during COVID, binary logistic regression models were computed using data from the National Ambulatory Care Reporting System database. We then compared both prevalence rates and probability of an R/S event occurring during an ED visit in Ontario before and after the onset of COVID. The number of ED visits during which an R/S event occurred for patients presenting with MH/SU concerns increased by 9.5%, while their odds of an R/S event occurring during an ED visit increased by 23% in Ontario after COVID onset. Similarly, R/S event probability increased for patients presenting with MH/SU concerns after COVID onset (0.7% - 21.3% increase), particularly during the first wave, with the greatest increases observed for concerns associated with increased restraint risk pre-COVID. R/S intervention use increased substantially for patients presenting to Ontario EDs with MH/SU concerns during the first wave of COVID when the strain on healthcare system and uncertainty about the virus was arguably greatest. Patients with concerns already associated with increased R/S risk also showed the largest increases in R/S probability, suggesting increased behavioural issues during treatment among this population after COVID onset. These results have the potential to inform existing policies to mitigate risks associated with R/S intervention use during future public health emergencies and in general practice.

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“…Nurses also feel that given the risks and associated complications, they may not be thinking of the greatest benefit to the person [7,29], thus calling into question the ethical principle of beneficence and non-maleficence. Faced with this knowledge, decision making leads us to an ethical dilemma [9,27,30].…”

Section: Introductionmentioning

confidence: 99%

Nursing Ethical Decision Making on Adult Physical Restraint: A Scoping Review

Cortinhal,

Correia,

Deodato Fernandes

2024

IJERPH

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Objective: to map the existing knowledge on nursing ethical decision making in the physical restraint of hospitalised adults. (1) Background: physical restraint is a technique that conditions the free movement of the body, with risks and benefits. The prevalence of physical restraint in healthcare suffers a wide variation, considering the environment or pathology, and it raises ethical issues that hinders decision making. This article intends to analyse and discuss this problem, starting from a literature review that will provoke a grounded discussion on the ethical and legal aspects. Inclusion criteria are: studies on physical restraint (C) and ethical nursing decision making (C) in hospitalized adults (P); (2) methods: a three-step search strategy was used according to the JBI. The databases consulted were CINAHL Plus with Full Text (EBSCOhost), MEDLINE Full Text (EBSCOhost), Nursing and Allied Health Collection: Comprehensive and Cochrane Database of Systematic Reviews (by Cochrane Library, RCAAP and Google Scholar. All articles were analysed by two independent reviewers; (3) results: according to the inclusion criteria, 18 articles were included. The categories that influence ethical decision in nursing are: consequence of the decision, the context, the nature of the decision in terms of its complexity, the principles of the ethical decision in nursing, ethical issues and universal values; (4) conclusions: the findings of this review provide evidence that there is extensive knowledge regarding nursing ethical decision making in adult physical restriction, also, it is considered an ethical issue with many associated assumptions. In this article we aim to confront all these issues from a legal perspective.

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Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis

Cited by 9 publications

References 29 publications

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection

Dignity as a Central Issue in Treating Patients with Dementia Associated with COVID-19 Infection

The impact of the COVID-19 pandemic on the use of restraint and seclusion interventions in Ontario emergency departments: A population-based study

Nursing Ethical Decision Making on Adult Physical Restraint: A Scoping Review

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