Reducing the use of physical restraints in home care: development and feasibility testing of a multicomponent program to support the implementation of a guideline

Abstract

Background A validated evidence-based guideline was developed to reduce physical restraint use in home care. However, the implementation of guidelines in home care is challenging. Therefore, this study aims to systematically develop and evaluate a multicomponent program for the implementation of the guideline for reducing the use of physical restraints in home care. Methods Intervention Mapping was used to develop a multicomponent program. This method contains six steps. Each step comprises several tasks towards the design, implementation and evaluation of an intervention; which is theory and evidence informed, as well as practical. To ensure that the multicomponent program would support the implementation of the guideline in home care, a feasibility study of 8 months was organized in one primary care district in Flanders, Belgium. A concurrent triangulation mixed methods design was used to evaluate the multicomponent program consisting of a knowledge test, focus groups and an online survey. Results The Social Cognitive Theory and the Theory of Planned Behavior are the foundations of the multicomponent program. Based on modeling, active learning, guided practice, belief selection and resistance to social pressure, eight practical applications were developed to operationalize these methods. The key components of the program are: the ambassadors for restraint-free home care (n = 15), the tutorials, the physical restraint checklist and the flyer. The results of the feasibility study show the necessity to select uniform terminology and definition for physical restraints, to involve all stakeholders from the beginning of the process, to take time for the implementation process, to select competent ambassadors and to collaborate with other home care providers. Conclusions The multicomponent program shows promising results. Prior to future use, further research needs to focus on the last two steps of Intervention Mapping (program implementation plan and developing an evaluation plan), to guide implementation on a larger scale and to formally evaluate the effectiveness of the multicomponent program.

Interdisciplinary Perspectives on Restraint Use in Aged Care

“…Community care nurses and PCAs also reported that they had little influence if the client or their family decided to use devices such as bedrails or low beds, both forms of restraint, as they were only responsible for practices that occurred while they were present providing care. Similar barriers were reported in a Dutch qualitative study of restraint use in community settings that concluded that informal caregivers, especially relatives, have a dominant role in the use of restraint [ 40 ]. They also reported that relatives were less aware of the harms associated with restraint use and had limited knowledge of alternative strategies.…”

“…They also reported that relatives were less aware of the harms associated with restraint use and had limited knowledge of alternative strategies. Due to their findings, the researchers have instituted a training program on restraint for informal caregivers, with promising results to date [ 40 ]. Similar education and training may be needed in Australia.…”

Prior to Implementation of Digital Pathology—Assessment of Expectations among Staff by Means of Normalization Process Theory

“…All three groups of professions score high in the following statement from NoMAD: “There are key people who drive DIPA forward and get others involved”. This could indicate a positive perception of the use of “implementation ambassadors” as a central part of the implementation process [ 29 , 30 , 31 ]. The laboratory technicians agree most with the statement.…”

Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: a systematic review

“…An example of a systematic approach to plan a health promotion program is the study of Vandervelde et al (2021) on reducing the use of physical restraints in home care. The authors developed and evaluated a multicomponent program to support the implementation of a guideline [ 81 ]. By using intervention mapping, they ensured that the program was theoretical, empirical, and practical grounded.…”

“…During this process, the authors obtained insight into the problem, the behaviour of healthcare professionals, the environment, and the determinants. Together with a stakeholder group, the authors selected theory and evidence-based methods to influence selected determinants; those methods were translated into practical applications (e.g., flyer, tutorials, ambassador for restraint-free home care) [ 81 ]. This review found that in falls prevention research, there is still a gap in the detailed description of implementation strategies and the effective use of implementation frameworks, models, and theories, making it difficult to know what does and does not work and to compare and replicate studies.…”