Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway

“…The types of containment, main evidence, and article classification are described in chart 1. The use of different types of containment (19) was associated with the residential and organizational characteristics of long-stay institutions for the elderly. Being female, and being older than 85 years, were presented as factors which predisposed an individual to the use of physical or chemical restraint.…”

Section: Resultsmentioning

confidence: 99%

A prática da contenção em idosos: revisão integrativa

Backes¹,

Beuter²,

Venturini³

et al. 2019

Acta paul. enferm.

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Resumo Objetivo Analisar as evidências da literatura sobre a prática da contenção em idosos. Métodos Revisão integrativa de literatura, com busca dos estudos primários publicados de 2013 a 2017, realizada nas bases de dados eletrônicas LILACS e MEDLINE, nos meses de maio e junho de 2018. As buscas foram obtidas pelo cruzamento, nas bases de dados, dos seguintes descritores e palavras: contenção; restrição; restrição física; e idoso. Resultados Foram incluídos 17 artigos e, a análise indicou que as evidências disponíveis na literatura reportam à prática de contenções no cotidiano de idosos, às consequências frente ao uso de contenções em idosos, e a técnicas alternativas ao uso das contenções. Conclusões O uso de contenções, principalmente físicas e químicas, é permeado por maior probabilidade de declínio cognitivo do idoso, além de consequências à saúde física e psicológica, podendo, até mesmo, resultar em óbito. Programas de intervenção e políticas designadas à diminuição do uso de contenções em idosos mostram-se como estratégias alternativas, contribuindo assim, para a qualificação da assistência.

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“…The ndings imply that helping patients with intimate care and other activities of daily living can be troublesome, and often rises ethical challenges regarding coercive interventions. In Norwegian nursing homes, there has been extensive use of coercion and several studies report on how to reduce such practices (54)(55)(56). Coercion or restraint is a common ethical challenge in older people care, and programs aim to enhance care quality by implementing alternative strategies both in nursing homes and in acute care settings (57,58).…”

Section: Meeting Vulnerability Discomfort and Emotional Painmentioning

confidence: 99%

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

Rykkje

Holm

Hem

2020

Preprint

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Background: Many countries face an increasingly older population in need of health care services. There are reports of lack of qualified staff and resources, resulting in poor quality and undignified care. Care quality is depended upon factors like organization and staffing, but it is also recommended to focus on what staff members experience in clinical practice. In addition, ethical competence is a precondition for high quality care. The aim of this study is to provide knowledge about ethically challenging situations in caring for older people in institutions such as nursing homes and hospitals, and to gain insight into nurses’ written reflections about their experiences and management of ethical challenges in clinical practice.Methods: The data material consist of reflection notes by continuous education students in advanced gerontology in Norway. Data was collected in 2017–2018. We included 42 of 83 notes and utilized qualitative thematic analysis.Findings: “Doing what is in the patients’ best interest” is the guiding principle for the participants, portrayed through three themes as follows: a) Meeting vulnerability, discomfort and emotional pain, b) Collaboration with relatives, and c) Struggling to perform professional care. Within each theme, we provide a variety of ethically challenging situations in older people care. The findings represent the participants’ written experiences and reflections upon how they manage the situation and their effort to provide the best possible care.Conclusions: Health care professionals’ ethical competences may develop when reflecting upon their care performance. Therefore, building ethical competence should be a priority in education of healthcare professionals and in clinical practice. We acknowledge that ethical reflection does not automatically improve care quality, although we find that it fosters increased awareness of one’s action, and as such, it can act as a potential for change.Implications for practice: How nurses reflect upon and manage challenging situations indicates that quality in care is possible despite scarce resources, and this may contribute to reduce ageism and encourage health care personnel to be willing to work in older people care.

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Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway

Abstract: Educational initiatives targeting staff to reduce restraint must be sensitive towards fluctuating organisational constraints.

Cited by 25 publications

References 43 publications

Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants

Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants

A prática da contenção em idosos: revisão integrativa

Norwegian Nurses’ Reflections Upon Experiences of Ethical Challenges in Older People Care - A Qualitative Thematic Analysis

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