The principles of physical restraint use for hospitalized elderly people: an integrated literature review

Sharifi, Azam; Arsalani, Narges; Fallahi-Khoshknab, Masoud; Mohammadi-Shahbolaghi, Farahnaz

doi:10.1186/s13643-021-01676-8

Cited by 20 publications

(36 citation statements)

References 46 publications

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“…Nevertheless, it is also important to note that decision-making also means weighing different options. With regard to restraint use, it is known that alternatives are not very common or known [ 17 , 50 ]. The lack (of awareness) of these alternative options in the decision-making process may be another reason why the attitude of nursing staff towards restraint use is neutral and hardly changes.…”

Section: Discussionmentioning

confidence: 99%

Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study

Thomann

Gleichner

Hahn

et al. 2022

IJERPH

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The attitude of nursing staff towards restraint use can be decisive for whether restraints are used. So far, nursing staff’s attitudes have been studied primarily in long-term and mental health care settings, while findings from somatic acute care hospital settings are largely lacking. Therefore, we aimed to investigate (a) the attitudes of hospital nursing staff towards restraint use, and (b) the construct validity and reliability of a measurement instrument for use in hospital settings that was developed and validated in long-term care settings (Maastricht Attitude Questionnaire (MAQ)). Using a cross-sectional design, the attitudes of 180 nursing staff towards restraint use were assessed. The data were analysed descriptively and by means of regression analysis and factor analysis. We found that nursing staff in hospitals have a neutral attitude towards restraint use and that the MAQ, with minor adaptations, can be used in hospital settings, although further testing is recommended. Neutral attitudes of nursing staff have also been observed in long-term and mental health care settings, where changing attitudes were found to be challenging. Interventions at the national level (e.g., legal regulations) and management level (e.g., providing alternatives and changing institutional culture) are suggested.

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Section: Discussionmentioning

confidence: 99%

Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study

Thomann

Gleichner

Hahn

et al. 2022

IJERPH

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“…Physical restraints were soft or hard (e.g., wrist restraints, lap belt, ankle restraints, mittens, side rails). Availability of physical restraint data varied by site [ 5 , 6 ]. All Alberta sites and two Ontario sites had data on physical restraints orders, three Ontario sites had data on physical restraint applications, and one Ontario site had no physical restraint data.…”

Section: Methodsmentioning

confidence: 99%

Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis

Jones

Goodarzi²,

Lee³

et al. 2022

PLoS ONE

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Background Chemical and physical restraints are associated with harm in older adults, but our understanding of their use during acute care hospitalizations is limited. Objectives To (1) describe restraint use during acute care hospitalizations of older adults at the onset of the COVID-19 pandemic compared to pre-pandemic levels and (2) describe between-hospital variability in restraint use. Design Retrospective cohort study with a time series analysis. Participants Acute care hospital inpatients, aged 65 years or older, who were discharged from one of four Alberta hospitals or six Ontario hospitals in Canada, between November 1, 2019, and June 30, 2020. Main measures We used autoregressive linear models with restricted cubic splines to compare proportions of chemical restraint (that is, psychotropic medications, namely antipsychotics, benzodiazepines, and trazodone) and physical restraint (e.g., mittens) use immediately after the onset of the COVID-19 pandemic with pre-pandemic levels. We describe between-hospital variability in restraint use using intraclass correlation coefficients (ICC) and median odds ratios (OR). Key results We included 71,004 hospitalizations. Adjusted for the prevalence of dementia and psychotic disorders, chemical restraint use increased in Ontario hospitals from a pre-pandemic average of 27.1% to 30.8% (p<0.001) before returning to pre-pandemic levels within eight weeks. Physical restraint orders in Ontario increased from 5.9% to 8.3% (p = 0.012) and remained elevated at eight weeks. No significant changes in restraint use were observed in Alberta. There was moderate between-hospital variability in chemical restraint use (ICC 0.041 and median OR 1.43). Variability in physical restraint use was higher (ICC 0.11 and median OR 1.83). Conclusions The COVID-19 pandemic impacted in-hospital use of chemical and physical restraints among older adults in Ontario but not Alberta. Substantial differences in chemical and physical restraint use by region and hospital suggests there are opportunities to improve best practices in geriatric care. Future research must support implementation of evidence-informed interventions that standardize appropriate restraint use.

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“…Note that the patient should be maintained in the supine position during this fastening for minimization of risks discussed above. The devices for restraint should be attached to areas of the bed that move freely with bed repositioning (namely elevation of the head of the bed) [33].…”

Section: Contemporary Topics In Patient Safety -Volumementioning

confidence: 99%

“…After the decision to initiate patient restraint, the choice of restrain has been agreed upon, and the patient has been adequately secured, documentation and reassessments are the hallmark components of physical restrain maintenance. Restraint documentation frequency has been cited with intervals ranging from 15 minutes to hourly [5,7,31,[33][34][35][36]. These time frames are constructed with the intention of prompting frequent reassessments with the desired goal of termination of restraint utilization as soon as possible.…”

Section: Restraint Maintenancementioning

confidence: 99%

“…It is paramount that after administration of restraints (both chemical or physical), the patient's vital signs, hydration, and mental status are documented. Documentation should also include the need for continued restraint utilization, failed alternatives that resulted in the initiation of physical restraint, number of limbs restrained, the type of restraint utilized, the time of application, the mental status of the patient (orientation, fear, anger, and aggression before, during, and after restraint), the patient's response to restraint, and the presence/occurrence of any injuries during or after restraint [33]. The patient should also be continually observed if they appear asleep/sedated, have other illicit substance onboard, have a concerning past medical history, or have experienced harm because of the intervention [33].…”

Section: Restraint Maintenancementioning

confidence: 99%

See 1 more Smart Citation

Emergency Department Restraint Safety

White¹,

Kustera²

2023

Contemporary Topics in Patient Safety - Volume 2

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Restraint use during patient care is a serious and important safety topic because it is often utilized in high stress, rapidly evolving, and unique situations in which patients not only pose harm to themselves, but harm to others. The scope of patient safety topic is a threefold approach: initiation, maintenance, and discontinuation. First, a briefly literature pertaining to evidence-based criteria for the initiation of patient restraints will be constructed. Secondly, restraint types and the resources required to maintain restraints will be explicated. Finally, the chapter will conclude with patient evaluation methods pertaining to the safe discontinuation of restraints and resource de-escalation. A succinct, pragmatic discussion on restraint utilization - a method that mitigates a patient’s threat to themselves and others – will be presented in this manuscript.

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The principles of physical restraint use for hospitalized elderly people: an integrated literature review

Cited by 20 publications

References 46 publications

Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study

Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study

Chemical and physical restraint use during acute care hospitalization of older adults: A retrospective cohort study and time series analysis

Emergency Department Restraint Safety

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