Likelihood of Ordering Physical Restraints: Influence of Physician Characteristics

Abstract

Physician characteristics and lack of restraint knowledge are associated with likelihood of ordering restraints. Results will guide medical education initiatives to reduce restraint rates.

Effect of Situational and Clinical Variables on the Likelihood of Physicians Ordering Physical Restraints

“…5,8,9,28 The extent to which education alone can influence this belief is uncertain. 12,13 Nevertheless, few evidence-based clinical guidelines exist for effective hospital fall prevention or prevention of therapeutic device disruptions in critical care settings that could guide clinicians. [33][34][35][36][37][38] A number of fall prevention strategies in acute care have been promoted, including more observation, standardized risk assessment, treatment of risk factors, nursing processes such as toileting rounds, and equipment or furniture (e.g., proximity alarms, low beds, etc.).…”

“…[10][11][12] The heterogeneity of patient populations within acute care settings, the lack of evidence for effective non-restraint strategies especially within critical care units, and the lack of education regarding acute care geriatric medicine and physical restraint use may all contribute to the large variation seen between physicians and nurses in the likelihood of using physical restraint. [3][4][5]13,14 In a recent study of 439 units in 40 hospitals, the rate of physical restraint use varied more than 10-fold between hospitals as well as between matching units. 3 For example, in 70 adult medical units, the prevalence of physical restraint use ranged from 3 to 123 restraint-days per 1,000 patient-days.…”

Knowledge, perceptions, and experiences of family caregivers and home care providers of physical restraint use with home-dwelling elders: a cross-sectional study in Japan

“…However, the actual state of physical restraint use by family caregivers has not been extensively studied [3,4]. One study has investigated physical restraint use by nursing staff in home care settings [2], and several studies have examined how care providers such as nurses perceive the issue of physical restraint use in nursing homes and hospitals and how families perceive the use with institutionalized elders [7-10]. However, no studies have investigated how home care providers who support family caregivers perceive physical restraints used in elders’ homes.…”

Disentangling Consumer and Provider Predictors of Advance Care Planning

“…Yet professional judgments and decisions, especially in the absence of strong practice standards can be driven by both biases about a patient as well as provider education, attitudes, and experiences. 17 –19…”

“…Yet professional judgments and decisions, especially in the absence of strong practice standards can be driven by both biases about a patient as well as provider education, attitudes, and experiences. [17][18][19] Figure 1 displays a framework that shows how patient and provider characteristics interact with evidence-based guidelines to predict professional judgments about the need for ACP. The model was adapted from the transdisciplinary model of evidence-based practices as developed by Satterfield et al 20 In their modification of the original evidence-based medicine model of 3 overlapping circles developed by Haynes et al, 21,22 Satterfield et al put clinical decision making at the center of the model and added an outside circle representing how environmental and organizational contextual factors interact with patient, provider, and evidence factors to influence clinical decision making.…”