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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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