Knowledge, Practice, and Attitude of Nursing Home Staff Toward the Use of Physical Restraint: Have They Changed Over Time?

Kor, Patrick Pui Kin; Kwan, Rick Yiu Cho; Liu, Justina Yat Wa; Lai, Claudia Kam Yuk

doi:10.1111/jnu.12415

Cited by 18 publications

(28 citation statements)

References 27 publications

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“…There is a trend of reducing the use of ICU physical restraint in recent years (14). In this present study, the incidence of restraint use among the 16 ICUs is 59.07%, which is slightly higher than that previous reports (15,16).…”

Section: Discussioncontrasting

confidence: 59%

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

Zhang¹,

Liu²,

He³

2021

Ann Palliat Med

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Background: The use of physical restraint has been a common phenomenon in clinical practice. However, the current status of physical restraints in intensive care unit (ICU) patients and related potential factors in China remains unclear. We aimed to evaluate the status of physical restraint use of patients in ICU, and to identify the potential factors affecting the physical restraint use.Methods: Patients in 16 ICUs of five hospitals from September 15 to October 15, 2019 were included.The ICU Patients' Physical Restraint Evaluation Scale was used for survey investigation. The basic information, the behavioral, treatment and muscle strength level with 35 detailed items were collected and evaluated. Multivariate logistic regression analyses were performed to identify the potential risks of physical restraint use.Results: A total of 386 ICU patients were included, the incidence of physical restraint use was 59.07%.The incidence of physical restraint uses in patients with irritability, unconsciousness and disorientation, Richmond agitation-sedation scale (RASS) ≥2 or -3< RASS <2 were significantly higher that other conditions (all P<0.05); the incidence of physical restraint uses in patients with continuous renal replacement therapy (CRRT), temporary pacemaker, intracranial pressure (ICP) monitor, invasive blood pressure monitoring, tracheotomy, central venous catheter (CVC), extracorporeal membrane oxygenation (ECMO), peripheral intravenous infusion were significantly higher that other conditions (all P<0.05); the male gender, mechanical ventilation, retained catheters or tubes with level II or irritability were the independently influencing factors for the physical restraint use (all P<0.05). Conclusions:The incidence of physical restraint use is rather high in ICU, clinical attentions are needed especially for those patients with male gender, mechanical ventilation, retained catheters or tubes with level II or irritability.

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Section: Discussioncontrasting

confidence: 59%

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

Zhang¹,

Liu²,

He³

2021

Ann Palliat Med

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“…China, long-term care facilities, nursing, older adults, physical restraints, risk factors adopt the principle of 'minimum restraint' (Kor et al, 2018). However, in Chinese mainland, only the National Mental Health Law men- Chongqing, the largest and youngest municipality in China, is located in the western region, with an economic backwardness compared with central and eastern regions.…”

Section: Introductionmentioning

confidence: 99%

“…Decisions about physical restraint use among older adults in LTC facilities are complicated and are affected by various factors, such as characteristics of older adults, LTC facilities, and medical staff. For example, the knowledge and attitudes of nursing staff influenced their practice towards the use of physical restraint (Kor, Kwan, Liu, & Lai, 2018; Mayerl, Trummer, Stolz, Rásky, & Freidl, 2019), even they have negative feelings towards physical restraint, a need for use in specific circumstances is identified (Leahy‐Warren, Varghese, Day, & Curtin, 2018). The dependence of care, cognitive impairment, mobility restriction, or a history of falls was contributed to the use of physical restraint (Hofmann & Hahn, 2014; Hofmann, Schorro, Haastert, & Meyer, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…In 2009, the Taiwan Hospital Quality Indicator Project stipulated that family members must sign an agreement before using restraints on patients and care workers must loosen the restrained parts for 15 min every 2 hr (Taiwan Joint Commission on Hospital Accreditation, 2009). The Hong Kong Social Welfare Department required aged care homes to develop staff training for restraint use and adopt the principle of ‘minimum restraint’ (Kor et al., 2018). However, in Chinese mainland, only the National Mental Health Law mentioned the requirements for psychiatric patients physical restraint use and Chinese Nursing Association formulated the group standard of nursing care for inpatients with physical restraint (Chinese Nursing Association, 2019; Xin, 2012).…”

Section: Introductionmentioning

confidence: 99%

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The use of physical restraints in Chinese long‐term care facilities and its risk factors: An observational and cross‐sectional study

Wang

Liu

Peng³

et al. 2020

Journal of Advanced Nursing

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Aim To investigate the use of physical restraints among Chinese long‐term care facilities older adults and to identify its risk factors. Design Observational and cross‐sectional study. Methods A total of 1,026 older adults from six long‐term care facilities in Chongqing were recruited by cluster sampling method from July ‐ November 2019. Data on physical restraint use and older adults’ characteristics were collected using physical restraints observation forms and older adults’ records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi‐square test and binary logistic regression. Results The study found that the prevalence of physical restraints in six long‐term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. Conclusion The use of physical restraints among Chinese long‐term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. Impact This study will provide an effective reference for nursing staff in long‐term care facilities to assess high‐risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.

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“…The percentage of inpatients to whom physical restraints are applied in Taiwan has reached as high as 46.6% (Huang et al, 2005). Relatedly, despite the growing attention paid to restraint usage and improvements in restraint evaluations, the ethical knowledge of healthcare providers is rarely considered (Kor, Kwan, Liu, & Lai, 2018). In Europe and America, special educational courses aimed at the construction of non-restrained long-term care environments and the reduction of the use of physical restraints by nurses have been conducted for many years, providing a reference for restraint policies in Taiwanese long-term care institutions and effectively reducing the rate at which restraints are applied to inpatients (Huang et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

The Effects of an Advanced Movable Restraint Design on the Elderly Residents at Long-Term Care Facilities in Taiwan

Tsao

2018

ESJ

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Purpose: The purpose of this study was to evaluate the effects, both initially and after 6 months, of an “advanced movable restraint” with openended palm sleeve restraint bands for the elderly residents at long-term care facilities in northern Taiwan. Background. Elderly residents in long-term care facilities are often forced to remain bed-ridden by traditional bed restraint bands due to their irritable, confused conditions and the associated risks of self-extubating their nasogastric (NG) tubes, urinary catheters, etc. However, the traditional bed restraint bands can themselves lead to further physical and mental complications such as skin damage, depression, hostility, and even rhabdomyolysis, increasing the risk of death. Design. Quasiexperimental design. Methods: This parallel-design study was conducted with elderly residents at eight long-term care facilities. The newly designed advanced movable restraint featuring movable open-ended palm sleeve restraint bands was applied to the elderly residents in the experimental group, allowing them greater freedom of movement such that they were not required to remain bed-ridden. In contrast, the elderly residents in the control group were restrained with traditional bed restraints requiring that they remain bedridden. The following four instruments and indicators were then used to compare the effects of the two types of restraints: (1) an activities of daily living (ADL) survey based on the Barthel Index, (2) a muscle power test, (3) an exercise frequency and duration survey, and (4) self-extubation rates. The effects of the interventions were tested by using the t test or chi-square test to compare pre-test results for the ADL survey, muscle power test, exercise frequency and duration survey, and self-extubation rates to those at a 6-month follow-up. Results: A total of 80 elderly residents were included in the experimental group, while 80 elderly residents were included in the control group. At the 6-month follow-up, the residents restrained with the advanced movable restraint had a significantly increased mean muscle power score (χ2 =17.212, P < 0.001), significantly decreased self-extubation rate (χ2 =40.733, P < .001), and significantly increased exercise frequency and duration per week (χ2=27.095 P < 0.001; 26.241 P < 0.001). Conclusions: This study showed that the advanced movable restraint can improve muscle power scores, self-extubation rates, and exercise frequencies and durations by allowing residents greater freedom of movement without the need to remain bed-ridden. It is thus crucial to use such advanced movable restraints and develop standardized technology systems to support the elderly residents and nurses in long-term care facilities.

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Knowledge, Practice, and Attitude of Nursing Home Staff Toward the Use of Physical Restraint: Have They Changed Over Time?

Cited by 18 publications

References 27 publications

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

The characteristics of ICU physical restraint use and related influencing factors in China: a multi-center study

The use of physical restraints in Chinese long‐term care facilities and its risk factors: An observational and cross‐sectional study

The Effects of an Advanced Movable Restraint Design on the Elderly Residents at Long-Term Care Facilities in Taiwan

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