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The concept of restraint in nursing home practice: a mixed-method study in nursing homes for people with dementia

Published online by Cambridge University Press:  06 January 2011

Sandra A. Zwijsen ,
Marja F. I. A. Depla ,
Alistair R. Niemeijer ,
Anneke L. Francke  and
Cees M. P. M. Hertogh
Sandra A. Zwijsen*
Affiliation:
Department of Nursing Home Medicine/EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
Marja F. I. A. Depla
Affiliation:
Department of Nursing Home Medicine/EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
Alistair R. Niemeijer
Affiliation:
Department of Nursing Home Medicine/EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
Anneke L. Francke
Affiliation:
NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands Department of Public and Occupational Health/EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
Cees M. P. M. Hertogh
Affiliation:
Department of Nursing Home Medicine/EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
*
Correspondence should be addressed to: Sandra A. Zwijsen, Department of Nursing Home Medicine. EMGO Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. Phone: +31 204 445681; Fax: +31 204448234. Email: s.zwijsen@vumc.nl.
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Abstract

Introduction: Although in most developed countries the use of restraints is regulated and restricted by law, the concept of restraint in nursing home care remains ambiguous. This study aims to explore how care professionals and family members of nursing home residents with dementia in the Netherlands experience and define the concept of restraint.

Methods: Individual interviews were held with relatives (n = 7) and key persons (n = 9) in seven nursing homes. We also conducted eight focus group discussions with nursing home staff. In addition, a structured questionnaire was administered to the nurses of participating nursing homes.

Results: In the questionnaire, over 80% of the respondents indicated considering “fixation” (e.g. use of belts) as a restraint and 50 to 70% of the respondents regarded other physical interventions, such as geriatric chairs and bedrails, as restraints. The interviews and focus group discussions show that the residents' perception of the intervention, the staff's intention behind the intervention and concerns of privacy are the criteria used by the respondents in defining an intervention as a restraint.

Conclusions: When trying to diminish restraint use, it is important to be aware of the “local logic” of care practice and to take into account the fact that, for staff and relatives, an intervention is only regarded as a restraint when it is bothering a resident or when an intervention is used for the sole purpose of restricting freedom and/or when interventions invade the privacy of a resident.

Keywords

focus groupsinterviewnursing homesnursing staffquestionnairesphysical restraint
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 5 , June 2011 , pp. 826 - 834
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Austin, W., Lemermeyer, G., Goldberg, L., Bergum, V. and Johnson, M. S. (2005). Moral distress in healthcare practice: the situation of nurses. HealthCare Ethics Committee Forum, 17, 33–48.Google Scholar
Corley, M. C., Elswick, R. K., Gorman, M. and Clor, T. (2001). Development and evaluation of a moral distress scale. Journal of Advanced Nursing, 33, 250–256.CrossRefGoogle ScholarPubMed
de Veer, A. J., Francke, A. L., de Kruif, A. and Bolle, J. J. (2007). Vrijheidsbeperkende interventies. Een inventarisatie onder verzorgenden. Tijdschrift voor Verpleeghuisgeneeskunde, 32, 7–11.CrossRefGoogle Scholar
de Veer, A. J., Francke, A. L., Buijse, R. and Friele, R. D. (2009). The use of physical restraints in home care in the Netherlands. Journal of the American Geriatrics Society, 57, 1881–1886.CrossRefGoogle ScholarPubMed
Engberg, J., Castle, N. G. and McCaffrey, D. (2008). Physical restraint initiation in nursing homes and subsequent resident health. Gerontologist, 48, 442–452.CrossRefGoogle ScholarPubMed
Evans, D., Wood, J. and Lambert, L. (2003). Patient injury and physical restraint devices: a systematic review. Journal of Advanced Nursing, 41, 274–282.CrossRefGoogle ScholarPubMed
Godin, B. and Waters, H. (2009). In solitary confinement: planning end-of-life well-being with people with advance dementia, their family and professional carers. Mortality, 14, 265–285.CrossRefGoogle Scholar
Hamers, J. P. and Huizing, A. R. (2005). Why do we use physical restraints in the elderly? Zeitschrift für Gerontologie und Geriatrie, 38, 19–25.CrossRefGoogle ScholarPubMed
Hamers, J. P., Meyer, G., Kopke, S., Lindenmann, R., Groven, R. and Huizing, A. R. (2008). Attitudes of Dutch, German and Swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study. International Journal of Nursing Studies, 46, 248–255.CrossRefGoogle ScholarPubMed
Hantikainen, V. and Kappeli, S. (2000). Using restraint with nursing home residents: a qualitative study of nursing staff perceptions and decision-making. Journal of Advanced Nursing, 32, 1196–1205.CrossRefGoogle ScholarPubMed
Hertogh, C. M, The, A. M. and Eefsting, J. (2004a). The law and the local fairness of care practice: reflections on the ethnographic field investigation concerning the failure of the Bopz Act in psychogeriatric nursing home care. Tijdschrift voor Gerontologie en Geriatrie, 35, 46–54 [in Dutch].Google ScholarPubMed
Hertogh, C. M., The, B. A., Miesen, B. M. and Eefsting, J. A. (2004b). Truth telling and truthfulness in the care for patients with advanced dementia: an ethnographic study in Dutch nursing homes. Social Science and Medicine, 59, 1685–1693.CrossRefGoogle ScholarPubMed
Jameton, A. (1984). Nursing Practice: The Ethical Issues. Englewood Cliffs: Prentice Hall.Google Scholar
Legemaate, J., Frederiks, B. J. M. and de Roode, R. P. (2007). De wet BOPZ in internationaal perspectief. Tijdschrift voor Gezondheidsrecht, 4, 268–281.Google Scholar
Mion, L. C. et al. (2001). Outcomes following physical restraint reduction programs in two acute care hospitals. Joint Commission Journal on Quality Improvement, 27, 605–618.Google ScholarPubMed
Moore, K. and Haralambous, B. (2007). Barriers to reducing the use of restraints in residential elder care facilities. Journal of Advanced Nursing, 58, 532–540.CrossRefGoogle ScholarPubMed
Neufeld, R. R., Libow, L. S., Foley, W. J., Dunbar, J. M., Cohen, C. and Breuer, B. (1999). Restraint reduction reduces serious injuries among nursing home residents. Journal of the American Geriatrics Society, 47, 1202–1207.CrossRefGoogle ScholarPubMed
Niemeijer, A. R., Frederiks, B. J. N., Riphagen, I. I., Legemaate, J., Eefsting, J. and Hertogh, C. M. P. M. (2010). Ethical and practical concerns of surveillance technologies in residential care for people with dementia or intellectual disabilities: an overview of the literature. International Psychogeriatrics, 22, 1129–1142.CrossRefGoogle ScholarPubMed
Pool, J., Hendriks, A. C. and Hertogh, C. (2002). Evaluatie van de Wet Bijzondere Opnemingen in Psychiatrische Ziekenhuizen. Conclusies en aanbevelingen van de Begeleidingscommissie. Den Haag: ZonMW.Google Scholar
Suen, L. K. et al. (2006). Use of physical restraints in rehabilitation settings: staff knowledge, attitudes and predictors. Journal of Advanced Nursing, 55, 20–28.CrossRefGoogle ScholarPubMed
United Nations (1991). Principles for Policy on Mental Health (Resolution 467/119). New York: United Nations.Google Scholar
World Health Organization (2005). Resource Book on Mental Health, Human Rights and Legislation. Geneva: WHO.Google Scholar