Restraints or alternatives: safety work in care of older persons

Abstract

The study has identified a process of 'safety work' that identified the risk associated with the problem, the work to cope with the problem and risk, the conditions that influenced the process and the consequences or outcomes of the work strategies to maintain the older person's safety.

Nursing practice with hospitalised older people: Safety and harm

“…The review yielded 23 articles that represented one mixed methods (Strumpf & Evans, ), seven quantitative (Farina‐Lopez, Estevez‐Guerra, Polo‐Luque, Pogranyiva, & Penelo, ; Janelli, Stamps, & Delles, ; Liukkonen & Laitinen, ; McCabe, Alvarez, McNulty, & Fitzpatrick, ; Myers, Nikoletti, & Hill, ; Suen et al, ; Werner, ) and 15 qualitative studies (Bok, Pierce, Gies, & Steiner, ; Boltz, Capezuti, & Shabbat, ; Brown, Williams, Woodby, Davis, & Allman, ; Chuang & Huang, ; Dahlke, Hall, & Baumbusch, ; Dahlke & Phinney, ; Goethals, Dierckx de Casterlé, & Gastmans, ; King, Pecanac, Krupp, Liebzeit, & Mahoney, ; Kneafsey, Clifford, & Greenfield, ; Lai, ; Lee, Chan, Tam, & Yeung, ; Ludwick, O'Toole, & Meehan, ; Nolan, ; Quinn, ; Schofield, Tolson, & Fleming, ). Nine were conducted in the United States, three in the United Kingdom, three in Hong Kong, two in Canada and one each in Spain, Taiwan, Belgium, Finland, Australia and Israel.…”

“…In 2 of the studies, nursing staff in the United States (US) (Janelli et al, ) and the United Kingdom (UK) (Schofield et al, ) discussed using chemical restraints to keep their older patients from harms that were defined as falling or removing medical equipment (e.g., catheters, intravenous lines). Studies from Taiwan (Chuang & Huang, ), Spain (Farina‐Lopez et al, ), the United States (King et al, ; Ludwick et al, ; McCabe et al, ; Quinn, ; Strumpf & Evans, ), Hong Kong (Lai, ; Lee et al, ; Suen et al, ), Finland (Liukkonen & Laitinen, ), Australia (Myers et al, ) and Israel (Werner, ) all reported nurses' use of physical restraints to keep their older patients safe. Four of the studies identified that once physical restraints had been applied to an older patient, nursing teams were reticent to remove them, even if the reason for using the restraint was no longer present (Chuang & Huang, ; Goethals et al, ; Ludwick et al, ; Suen et al, ).…”

“…Scholars, who have studied why nursing care processes contribute to functional decline (e.g., restraint use, limiting mobility) are employed, suggest that staffing resources being insufficient when nurses are dealing with sudden increases in numbers of patients or in patients' acuity and the lack of material resources (e.g., equipment, medications) contribute to nurses' decision‐making about care (Kalisch, Landstrom, & Williams, ). Ten of the studies in this review cited staffing resources as a factor in their decision to restrain older patients (Bok et al, ; Boltz et al, ; Brown et al, ; Dahlke et al, ; Dahlke & Phinney, ; Lai, ; Lee et al, ; Ludwick et al, ; Quinn, ; Suen et al, ). However, in our current economic climate, increasing staffing is unlikely and it is not necessarily going to improve care unless it is accompanied by a corresponding emphasis on viewing preventable functional losses as safety threats.…”

“…Sometimes, nurses perceived limiting mobility as a means of preventing falls. Ten of the studies revealed that nursing teams believed restraints and limiting older patients' mobility was necessary to manage their work (Boltz et al, 2011;Bok et al, 2016;Brown et al, 2007;Dahlke et al., 2017;Dahlke & Phinney, 2008;Lai, 2007;Lee et al, 1999;Ludwick et al, 2010;Quinn, 1993;Suen et al, 2006). In other words, they did not believe they had enough staff to manage any other way.…”

“…The older studies predominantly reported nurses' perception that physically restraining patients was necessary to promote safety (Janelli et al, 2006;Lee et al, 1999;Liukkonen & Laitinen, 1994;Myers et al, 2001;Quinn, 1993;Strumpf & Evans, 1988;Suen et al, 2006;Werner, 2002). Although the more recent studies provided a more nuanced examination of nurses' perceptions about safety and harm and how the context contributed to their decision-making related to patient safety, a majority of them reported nursing perceptions that restraint was necessary to keep older patients safe (Chuang & Huang, 2007;Dahlke et al, 2017;Dahlke & Phinney, 2008;Farina-Lopez et al, 2018;Goethals et al, 2013;Lai, 2007;Ludwick et al, 2010;McCabe et al, 2011). Two of these more recent studies highlighted the need for "sitters" who could monitor patients at risk for falls without the use of restraints (Dahlke et al, 2017;Ludwick et al, 2010).…”