Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-11T00:14:04.476Z Has data issue: false hasContentIssue false
  • English
  • Français

A Longitudinal Evaluation of Restraint Reduction within a Multi-site, Multi-model Canadian Continuing Care Organization*

Published online by Cambridge University Press:  31 March 2010

Doris L. Milke ,
T. Scott Kendall ,
Iris Neumann ,
Connie F. Wark  and
Alana Knopp
Doris L. Milke*
Affiliation:
CapitalCare, Edmonton, AB University of Alberta
T. Scott Kendall
Affiliation:
CapitalCare, Edmonton, AB
Iris Neumann
Affiliation:
CapitalCare, Edmonton, AB
Connie F. Wark
Affiliation:
CapitalCare, Edmonton, AB
Alana Knopp
Affiliation:
CapitalCare, Edmonton, AB
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Doris L. Milke, Ph.D., Senior Researcher, CapitalCare, Adjunct Associate Professor, Faculty of Rehabilitation Medicine, Department of Psychology, and Faculty of Nursing, University of Alberta, McConnell Place North, 9113 144 Avenue, Edmonton, AB T5E 6K2, (dorismilke@capitalcare.net)
Get access Rights & Permissions [Opens in a new window]

Abstract

While American literature on sustaining restraint reduction is relatively robust, there is a lack of research published on the same issue in Canadian continuing care (CC) settings. Statistics from Canada's largest publicly funded and operated CC organization have revealed telling patterns in mechanical restraint use. Over a 4-year study period during a campaign to reduce mechanical restraint use, the organizational prevalence dropped from 24.68 per cent to 16.01 per cent. There was substantial variability in restraint prevalence among the organization's 11 centres (range: 0–39.86% of residents restrained) and all but 1 was able to achieve mechanical restraint reduction. Specific facilitators to achieving and sustaining restraint reduction are identified, including small facility size, provision of specialized care (e.g., Alzheimer's disease), and an on-site champion. Specific barriers, such as large facility size and an off-site champion are also discussed.

Résumé

Bien que la documentation américaine sur la réduction de l'usage des moyens de contention soit relativement importante, les travaux de recherche publiés sur cette même question sont moins nombreux sur les pensionnaires d'un établissement canadien de soins de longue durée. Les statistiques des plus importants établissements de ce type financés et exploités au Canada ont mis au jour des attitudes révélatrices envers les moyens mécaniques de contention. Durant les quatre années d'une étude comportant une campagne visant à réduire l'utilisation de moyens mécaniques de contention, la prévalence organisationnelle est passée de 24,68 % à 16,01 %. Il existait une variabilité substantielle en matière de contention parmi les 11 centres de l'organisation (échelle de 0 à 39,86 % des pensionnaires faisant l'objet de contention) et tous sauf un ont pu réduire la contention mécanique. Des facilitateurs particuliers à la réalisation et au maintien de la réduction de la contention sont indiqués, notamment les établissements de petite taille, la fourniture de soins spécialisés (par ex., maladie d'Alzheimer), et un «champion» résidant sur place. Des obstacles particuliers, comme la grande taille d'un établissement et un champion résidant à l'extérieur font aussi l'objet de discussion.

Keywords

vieillissementagingcontinuing caremechanical restraintslong-term carerestraint reductionphysical restraints
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 27 , Issue 1 , Spring/Printemps 2008 , pp. 35 - 43
Copyright
Copyright © Canadian Association on Gerontology 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

The authors would like to thank the following people for their involvement in this project's data collection and analysis: Susan Rosenkranz, G. Peggy McFall, and Stacy Greening. In addition, the authors would like to thank three anonymous reviewers for their constructive comments on the draft manuscript.

References

Brush, B.L., & Capezuti, E. (2001). Historical analysis of siderail use in American hospitals. Journal of Nursing Scholarship, 33(4), 381–385.CrossRefGoogle ScholarPubMed
Burton, L.C., German, P.S., Rovner, B.W., Brant, L.J., & Clark, R.D. (1992). Mental illness and the use of restraints in nursing homes. Gerontologist, 32(2), 164–170.CrossRefGoogle ScholarPubMed
Capezuti, E., Maislin, G., Strumpf, N.E., & Evans, L.K. (2002). Side rail use and bed-related fall outcomes among nursing home residents. Journal of the American Geriatric Society, 50, 90–96.CrossRefGoogle ScholarPubMed
CapitalCare (1999). Restraints, safety and positioning devices policy ADM-b-130. CapitalCare policy manual. Edmonton, AB: Author.Google Scholar
Castle, N.G., & Fogel, B. (1998). Characteristics of nursing homes that are restraint free. Gerontologist, 38, 181–188.CrossRefGoogle ScholarPubMed
Coleman, E.A. (1993). Physical restraint use in nursing home patients with dementia. Journal of the American Medical Association, 270, 2114–2115.CrossRefGoogle ScholarPubMed
Department of Health and Human Services. (2000, September). Medicare State Operations Manual Provider Certification: Appendix PP: Guidance to Surveyors—Long Term Care Facilities. 7 Retrieved 15 Aug. 2006 from http://www.cms.hhs.gov/manuals/Downloads/som107ap_pp_guidelines_ltcf.pdf.Google Scholar
Dimant, J. (2003). Avoiding physical restraints in long-term care facilities. Journal of the American Medical Directors Association, 4, 207–215.CrossRefGoogle ScholarPubMed
Dunbar, J.M., Neufeld, R.R., Libow, L.S., Cohen, C.E., & Foley, W. (1997). Taking charge: The role of nursing administrators in removing restraints. Journal of Nursing Administrators, 27(3), 42–48.CrossRefGoogle ScholarPubMed
Ejaz, F.K., Folmar, S.J., Kaufmann, M., Rose, M.S., & Goldman, B. (1994). Restraint reduction: Can it be achieved? Gerontologist, 34, 694–699.Google ScholarPubMed
Ejaz, F.K., Rose, M.S., & Jones, J.A. (1996). Changes in attitudes toward restraints among nursing home staff and residents' families following restraint reduction. Journal of Applied Gerontology, 15(4), 433–449.CrossRefGoogle Scholar
Evans, L.K., & Strumpf, N.E. (1989). Tying down the elderly: A review of the literature on physical restraints. Journal of the American Geriatrics Society, 37, 65–74.CrossRefGoogle Scholar
Evans, L.K., Strumpf, N.E., Allen-Taylor, S.L., Capezuti, E., Maislin, G., & Jacobsen, B. (1997). A clinical trial to reduce restraints in nursing homes. Journal of the American Geriatrics Society, 45(6), 675–681.CrossRefGoogle ScholarPubMed
Garrard, J., Makris, L., Dunham, T., Heston, L.L., Cooper, S., Ratner, E.R., et al. (1991). Evaluation of neuroleptic drug use by nursing home elderly under proposed Medicare and Medicaid regulations. Journal of the American Medical Association, 265, 463–467.CrossRefGoogle ScholarPubMed
Godkin, M.D., & Onyskiw, J.E. (1999). A systematic overview of interventions to reduce physical restraint use in long-term care settings. Online Journal of Knowledge Synthesis for Nursing, 6 (Document No. 6) Retrieved 18 July 2003 from http://www.stti.iupui.edu/library/ojksn/case_study/060006.pdf.Google ScholarPubMed
Golden-Biddle, K., Hinings, C.R., Casebeer, A., Pablo, A., & Reay, P. (2006). Organizational change in health care with special reference to Alberta. Canadian Health Services Research Foundation. Retrieved 27 June 2006 from http://www.bus.ualberta.ca/hos/text_materials/OrgChangeInHealthCare_Final_Report.pdf.Google Scholar
Hamers, J.P.H., Gulpers, MJM, & Strik, W. (2004). Use of physical restraints with cognitively impaired nursing home residents. Journal of Advanced Nursing, 45, 246–251.CrossRefGoogle ScholarPubMed
Hammond, M., & Levine, J.M. (1999). Bedrails: Choosing the best alternative. Geriatric Nursing, 20, 297–300.CrossRefGoogle ScholarPubMed
Hantikainen, V. (2001). Nursing staff perceptions of the behaviour of older nursing home residents and decision making on restraint use: A qualitative and interpretive study. Journal of Clinical Nursing, 10, 246–256.CrossRefGoogle Scholar
Hirdes, J.P., Mitchell, L., Ljunggren, G., & Schroll, M. (1999). International and regional variations in restraint use: Implications for selecting benchmarks. Canadian Journal of Quality in Health Care, 15(2), 19–23.Google Scholar
Hospital Report Research Collaborative. (2005). Hospital report 2005: Complex continuing care. Retrieved 11 Aug., 2006 from http://www.hospitalreport.ca/downloads/2005/ccc/2005CCCExecRpt_FINAL_Sept30.pdf.Google Scholar
Kane, R.L., Williams, C.C., Williams, T.F., & Kane, R.A. (1993). Restraining restraints: Changes in a standard of care. Annual Review of Public Health, 14, 545–584.CrossRefGoogle Scholar
Koch, S., & Lyon, C. (2001). Case study approach to removing physical restraint. International Journal of Nursing Practice, 7, 156–161.CrossRefGoogle ScholarPubMed
Laurin, D., Voyer, P., Verreault, R., & Durand, P.J. (2004). Physical restraint use among nursing home residents: A comparison of two data collection methods. BMC Nursing, 3(5), 1–7.CrossRefGoogle ScholarPubMed
Levine, J.M., Marchello, V., & Totolos, E. (1995). Progress toward a restraint-free environment in a large academic nursing facility. Journal of the American Geriatric Society, 43, 914–918.Google Scholar
Locock, L., Dopson, S., Chambers, D., & Gabbay, J. (2001). Understanding the role of opinion leaders in improving clinical effectiveness. Social Sciences and Medicine, 53(2001), 745–757.CrossRefGoogle ScholarPubMed
Mackey, M., & Rossy, D. (2002). Physical restraint practices. Canadian Nurse, 98(6), 28–31.Google ScholarPubMed
Macpherson, D.S., Lofgren, R.P., Granieri, R., & Myllenbeck, S. (1990). Deciding to restrain medical patients. Journal of the American Geriatrics Society, 38(5), 516–520.CrossRefGoogle ScholarPubMed
Mahoney, D.F. (1995). Analysis of restraint-free nursing homes. Image: The Journal of Nursing Scholarship, 27(2), 155–160.Google ScholarPubMed
Marcy-Edwards, D. (2005). Bed rails: Is there an upside? Canadian Nurse, 101(1), 30–34.Google Scholar
McDonnell, A., Wilson, R., & Goodacre, S. (2006). Evaluating and implementing new services. BMJ 2006, 332, 109–112 Retrieved 14 Feb 2008 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1326943.Google ScholarPubMed
McHutchinson, E., & Morse, J.M. (1989). Releasing restraints: A nursing dilemma. Journal of Gerontological Nursing, 15(2), 16–21.CrossRefGoogle Scholar
Miles, S.H., & Irvine, P. (1992). Deaths caused by physical restraints. Gerontologist, 32(6), 762–766.CrossRefGoogle ScholarPubMed
Mion, L., Frengley, J.D., Jakovcic, C.A., & Marino, J.A. (1989). A further exploration of the use of physical restraints in hospitalized patients. Journal of the American Geriatrics Society, 37(10), 949–956.CrossRefGoogle ScholarPubMed
Phillips, C.D., Hawes, C., Mor, V., Fries, B.E., Morris, J.N., & Nennstiel, M.E. (1996). Facility and area variation affecting the use of physical restraints in nursing homes. Medical Care, 34, 1149–1162.CrossRefGoogle ScholarPubMed
Powell, C., Mitchell-Pedersen, L., Fingerote, E., & Edmund, L. (1989). Freedom from restraint: Consequences of reducing restraints in the management of the elderly. Canadian Medical Association Journal, 141, 561–564.Google ScholarPubMed
Rantz, M., Hicks, L., Grando, V., Petroski, G., Madsen, R., Mehr, D., et al. (2007). Nursing home quality, cost, staffing, and staff mix. Gerontologist, 44, 24–38.CrossRefGoogle Scholar
Rycroft-Malone, J., Kitson, M., Harvey, G., McCromack, B., Seers, K., Titchen, A., & Estabrooks, C. (2006). Ingredients for change: Revisiting a conceptual framework. Quality and Safety in Health Care, 11(2), 174–180.CrossRefGoogle Scholar
Strumpf, N.E., Robinson, J.P., Wagner, J.S., & Evans, L.K. (1998). Restraint-free care: Individualized approaches for frail elders. New York: Springer.Google Scholar
Sullivan-Marx, E.M., Strumpf, N.E., Evans, L.K., Baugarten, M., & Maislin, G. (1999). Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts. Journal of the American Geriatric Society, 47, 342–348.CrossRefGoogle ScholarPubMed
Sundel, M., Garrett, R.M., & Horn, R.D. (1994). Restraint reduction in a nursing home and its impact on employee attitudes. Journal of the American Geriatric Society, 42, 381–387.CrossRefGoogle Scholar
Verbecke, W., Volgering, M., & Hessels, M. (1998). Exploring the conceptual expansion within the field of organizational behaviour: Organizational climate and organizational culture. Journal of Management Studies, 35, 303–329.CrossRefGoogle Scholar
Werner, P., Cohen-Mansfield, J., Braun, J., & Marx, M.S. (1989). Physical restraints and agitation in nursing home residents. Journal of the American Geriatrics Society, 37(12), 1122–1126.CrossRefGoogle ScholarPubMed
Zinn, J.S. (1993). The influence of nurse wage differentials on nursing home staffing and resident care decisions. Gerontologist, 33(6), 721–729.CrossRefGoogle ScholarPubMed