Page 436 - Encyclopedia of Nursing Research

PHYSICAl ReSTRAINTS n 403

perceptions, and outcomes of restraint, orig- injuries or hiring more staff (evans et al., 1997;
inating primarily from europe, Asia, the Pellfolk, Gustafson, Bucht, & Karlsson, 2010).
Middle east, and Australia, which reflect U.S. Data show that caring for nursing home resi- P
studies from the early 1990s. dents without restraints is less costly than
Physical restraints are applied in hospi- caring for those who are restrained (Phillips,
tals and nursing homes primarily for three Hawes, & Fries, 1993).
reasons: fall risk, treatment interference, Too often, hospitals and nursing homes
and behavioral symptoms. To date, no scien- lack personnel with specialized expertise in
tific basis of support demonstrates the effi- aging or with the requisite skills for assess-
cacy of restraints in safeguarding patients ing and treating clinical problems specific
from injury, protecting treatment devices, to older adults. Studies provide promis-
or alleviating behavioral symptoms such ing evidence that a model of care using
as “wandering,” agitation, or aggression. advanced practice nurses specializing in
Several studies, in fact, suggest relationships geriatrics can reduce restraint use in nurs-
between physical restraints and falls, serious ing homes and hospitals through staff edu-
injuries, increased behavioral symptoms, cation and consultation (evans et al., 1997;
or worsened cognitive function (Capezuti, Sullivan-Marx, Strumpf, evans, Capezuti,
Strumpf, evans, Grisso, & Maislin, 1998; & Maislin, 2003).
Castle & engberg, 2009). Continued use of physical restraints is
Nevertheless, health care profession- paradoxical in view of mounting knowledge
als and other caregivers perceive few alter- about their considerable ability to do harm.
natives to restraint use in some situations, Physical restraints are known to reduce func-
especially in critical care (Minnick, Mion, tional capacity and exert physical and psy-
Johnson, Catrambone & leipzig, 2007). chological effects (Castle & engberg, 2009;
Misplaced fears about legal liability, lack of evans & Strumpf, 1989; Saarnio & Isola, 2009).
interdisciplinary discussions about deci- Furthermore, restraint use can lead to acci-
sions to restrain, and staff perceptions about dental death by asphyxiation (Miles & Irvine,
patients’ behavior also influence restraint 1992). Persons who are likely to be restrained
practices. Insufficient staffing levels and are usually those of advanced age who are
outdated models of care assignments have physically and cognitively frail, prone to
long been regarded as obstacles to minimal injury and confusion, and experiencing inva-
use of physical restraints. Hospital studies sive treatments. The evidence is compelling
offer indirect support for this conclusion by that prolonged physical restraint further
demonstrating that night shifts and week- contributes to frailty, dysfunction, and poor
end day shifts are the most frequent times quality of life.
when restraints are used (Bourbonniere, Restraint-free care can be accomplished
Strumpf, evans, & Maislin, 2003; Whitman, through implementing a range of alternative
Davidson, Sereika, & Rudy, 2001). Prevalence approaches to assessment, prevention, and
studies that demonstrate wide variation in responding to the behaviors routinely lead-
restraint use across facilities in one system ing to restraint. For such approaches to take
strongly suggest that organizational culture hold, however, changes in fundamental phi-
and norms play an important role (Meyer, losophy, culture, and attitudes within insti-
Kopke, Haastert, & Mühlhauser, 2008). tutions and among caregivers must occur. In
Several reports of restraint reduction in nurs- settings where restraints have been reduced,
ing homes and two clinical trials show that there is strong emphasis on individualized,
prevalence of physical restraints can be sig- person-centered care; normal risk taking;
nificantly reduced without increasing serious rehabilitation and choice; interprofessional