Using a Behavior Assessment Tool to Decrease Restraint Use in the Emergency Department.

INTRODUCTION: Behavioral health visits to emergency departments have increased, increasing the risk of patient violent agitation that may require restraints to control. Our objective was to determine whether using the Behavioral Activity Rating Scale and treatment recommendations matched to patient scores would affect the number of patients who required physical restraints during their stay in the emergency department. METHODS: In this quality improvement project, nursing performed Behavioral Activity Rating Scale assessments on all behavioral health patients who presented to the emergency department, occurring during triage and at regular intervals with vital signs. Data were collected for a period before implementation and compared with data collected after implementing the Behavioral Activity Rating Scale workflow. Patients who required restraints during their stay, patients who required 2 or more restraints during their stay, and timing of restraint application were analyzed. RESULTS: Results show a decrease in the number of patients who required restraints during their ED stay, decreasing from a rate of 8.7% to 7.0% (P = .02). There was also a decrease in the number of patients who required multiple restraints, from a rate of 82.2% to 27.2% (P < .001). There was no difference in the number of patients who required restraints 1 hour after their arrival before versus after intervention (P = .40). DISCUSSION: Early recognition of patient agitation is essential in appropriate treatment of that agitation. The Behavioral Activity Rating Scale assessment is an effective tool to quantify a patient's agitation level. When coupled with treatment recommendations or protocols, it may decrease restraint use in the emergency department.

Assessment of Nurses' Knowledge, Attitude and Practice Regarding Physical Restraint: A Scoping Review.

The use of physical restraints (PR) in healthcare settings, especially in psychiatric units, is a controversial topic. The attitude, knowledge, and practices of nurses towards PR can influence its application, which raises concerns about the balance between patient safety and individual rights. With mental disorders being a leading cause of disability globally, understanding the complexities surrounding PR use becomes paramount. A comprehensive literature review was conducted using multiple databases, including PubMed, Medline, CINAHL, PsycINFO, ProQuest, The Cochrane Library, the Saudi Digital Library, and Google Scholar. The search spanned literature published up to December 2022, focusing on studies that explored the relationship between nurses' knowledge, attitudes, and practices regarding PR in psychiatric settings. Inclusion and exclusion criteria were applied to filter out relevant studies. From 220 records initially retrieved, 12 articles were identified for the final review. The reviewed studies highlighted a moderate knowledge and attitude among nurses concerning PR. Many nurses were found to be uncertain about the reasons for PR application and its alternatives. Educational interventions were emphasized in several studies as beneficial in improving nurses' knowledge, attitudes, and practices. However, inconsistencies were observed regarding the impact of these interventions on nurses' attitudes. Experience, higher education, and continuous training sessions were found to be correlated with better knowledge and more favourable attitudes towards PR. This review emphasizes the critical need for consistent training and education for nurses regarding PR, given the profound implications for patient care and safety. While educational interventions show promise in enhancing knowledge and practice, their impact on attitudes remains contested. Future research should consider the gaps identified in this review, including the exploration of alternatives to PR, larger sample sizes and longitudinal studies to understand the long-term effects of interventions.

Use of physical restraints and its associated risk factors in the aged care facilities: A multicentre cross-sectional study.

AIMS AND OBJECTIVES: To investigate the use of physical restraints in aged care facilities(ACFs)and analyse its associated risk factors. BACKGROUND: Physical restraints have been widely used in ACFs worldwide, but they can cause physical and mental harm to older people. It is important to regulate the use of physical restraint. DESIGN: A cross-sectional observational and correlational multicentre study. METHODS: By convenience sampling method, we selected eight ACFs in four representative regions of Hunan province, China, for this study. The ACF-related information was obtained by interviewing the managers and reviewing records. We conducted investigation and observation on the elderly in the ACFs to understand the use of physical restraints at three different times: 9:30-11:30, 16:00-18:00 and 19:30-21:30 on a working day. The STROBE checklist was followed for this cross-sectional study. RESULTS: This study found that the utilisation rate of physical restraints was 23.2%. The critical risk factors affecting the use of physical restrains include the following: (1) the ratio of nursing staff to the elderly residents; (2)whether there is a dementia care unit at the facility; (3) the number of elderly residents in each room; (4) the elderly residents' age, degree of education, marital status, care dependence and cognitive impairment; (5) whether the elderly has suffered from a stroke or senile dementia; (6) whether the elderly carries medical catheters. CONCLUSION: There is a lack of standardisation in the use of physical restraints in ACFs of central China. Chinese ACFs should develop guidelines and reduction measures to standardise the use of physical restraints, basing on the key factors affecting the use of physical restraints. RELEVANCE TO CLINICAL PRACTICE: The use of physical restraints in ACFs is threatening the safety of the elderly residents. Understanding the implementation of physical restraint in ACFs can provide reference for reducing the use of physical restraint.

Exploring the ethics of physical restraints: Students' questioning.

BACKGROUND: Physical restraints are routinely employed to ensure patient safety in Japanese acute care. Little is known about nursing students' perspectives and how they begin to question their value and knowledge in the face of restraint experiences in clinical practice. OBJECTIVE: To investigate nursing students' questions about patient restraints and how they understand the ethics of the use of restraints in nursing. RESEARCH DESIGN: Qualitative descriptive research using narrative analysis. PARTICIPANTS AND RESEARCH CONTEXT: Experiential data were generated and thematically analyzed from semi-structured interviews with 16 nursing students who had completed their bachelor's degree program requirements. ETHICAL CONSIDERATIONS: The study was approved by academic and clinical ethics agencies. Participants provided written informed consent. RESULTS: Physical restraints were encountered in 16 incidents, 3 with children and 13 with older patients with dementia. Students struggled to comprehend the policies and protocols of restraint use and worried their use was primarily for security rather than therapeutic purposes. Five themes were identified: (1). Questioning the tension between person-centered care, patient autonomy, and restraints, (2). Questioning the nature of restraints in which participants analyzed the policies and protocols around restraint use, (3). Questioning the professional nursing self whereby students reflected on how restraint use challenged their nursing values, and (4). Questioning professional nursing practice, in which students explored how restraints fit within a nursing perspective and positioned themselves as patient advocates. Students encountering physical restraints should ask questions based on values of patient-centeredness, autonomy, and advocacy. There is a need for education that facilitates reflection and questioning so that it informs students' ethical thinking which may enhance nurse advocacy to reduce restraint use. CONCLUSIONS: Restraints provide contexts in which students must face tensions between nursing values and clinical reality. Further research on nursing education strategies within non-psychiatric settings is needed to reduce physical restraints.

[Development and evaluation of complex interventions in nursing : Application of the medical research council's framework using the example of interventions to prevent physical restraints]. / Entwicklung und Evaluation komplexer Interventionen in der Pflege : Anwendung des Rahmenmodells des Medical Research Council am Beispiel von Interventionen zur Vermeidung freiheitsentziehender Maßnahmen.

Many nursing interventions are complex. They comprise different intervention elements (components) and aim to change processes or behaviours of individuals or groups. A framework of the British Medical Research Council comprises methodological recommendations for the development and evaluation of complex interventions. This narrative review describes the framework's methodological recommendations using an example of interventions to reduce physical restraints in hospital and long-term care settings, such as bedrails or belts in chairs and beds. In addition to the characteristics of the complex interventions, the development and theoretical foundation of the interventions as well as the feasibility test and evaluation is described.

[Physical restraints in acute hospitals: A quantitative observational study as a starting point for the further development of quality management]. / Mechanische freiheitsentziehende Maßnahmen im Krankenhaus.

Physical restraints in acute hospitals: A quantitative observational study as a starting point for the further development of quality management Abstract: Background: Despite the known associated risks and adverse events, physical restraints are mostly observed in daily care practice of long-term care. Comparatively few studies are available for normal wards. Research question/aim: The explorative cross-sectional study investigated prevalences, types and reasons of physical restraints in nine selected normal wards of a maximum care hospital. Methods: The prevalences and types of physical restraints were collected in the early and late shift in summer 2020 via direct observation using standardised observation forms. The reasons for the use were recorded via a standardised survey of the nursing staff. Results: In the early shift, 15 out of 167 patients had physical restraints (9%), in the late shift 23 out of 191 (12%). People over 80 years were most affected (n = 8; 23.5% and n = 14, 25.9%). The highest prevalence was found in the clinic for neurogeriatrics with 21.4% (n = 3) and 37.5% (n = 6). Bedside restraints were used particularly frequently (n = 14; 93.3% and n = 22, 95.7%, resp.). The physical restraints were predominantly justified with the protection against fall injuries (n = 8, 53.3% and n = 15, 65.2%). Conclusions: Raising awareness among nursing staff through training and other accompanying measures are starting points for reducing physical restraints. In order to achieve sustainable changes, the management level should initiate appropriate measures and consistently accompany their implementation.

Being tied down-The experience of being physically restrained while mechanically ventilated in ICU.

AIMS: To explore the experience of physical restraints during mechanical ventilation in intensive care from the perspectives of patients and family members. DESIGN: This research was a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHOD: In-depth, semi-structured conversations were conducted with five patients and six family members who had either personally experienced or witnessed their loved ones being physically restrained during mechanical ventilation in intensive care. Data collection occurred between March 2018 and June 2019. These conversations were audio-recorded and transcribed. Reflexive thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. These themes were: Being tied down; Feeling helpless; and Finding light in the darkness. CONCLUSION: The experience of physical restraints during mechanical ventilation in intensive care leads to traumatic experiences which can impact patients and families long after their ICU stay. Holistic care, which considers the physical, emotional and psychological needs of patients and families, should be more thoroughly explored when managing treatment interference to minimize harm. IMPACT: This study gained insight into the physical, emotional and psychological consequences of applying physical restraints to patients who are mechanically ventilated as an intervention for preventing treatment interference. The findings of this study have the potential to improve ICU patient and family outcomes by influencing current physical restraint practices. Recommendations from this research can contribute to practice change by informing policy, shifting workplace culture and norms about restraints, and encouraging education and training.

Nurse education to reduce physical restraints use in ICU: A scoping review.

BACKGROUND: Physical restraints are defined as a manual approach to reduce a patient's physical movement and has been regarded as a protective nursing measure in the intensive care unit (ICU) to avoid unplanned extubation, falls, and other unexpected events. However, the limitations and changes associated with physical restraints have been verified by several studies. Restraint minimization has been advocated by studies worldwide; however, the most effective interventions are still being explored. AIM: To identify and map nurse education strategies that reduce the use of physical restraints in the ICU. DESIGN AND METHODS: A systematic literature search that followed the steps of a scoping review was performed in the Cochrane, PubMed, Embase, CINAHL, CNKI, Wan Fang Data, and VIP databases. We included studies that focused on nurse education aiming to reduce the use of physical restraints and/or use physical restraints reasonably. RESULTS: The included studies (n = 12) described a variety of education strategies. Two delivery modes, eight common course durations, 14 main topics, two types of teaching methods with various materials, and two kinds of outcome measurements were identified and compared. CONCLUSION: There are a variety of nurse education activities that could effectively improve ICU nurses' knowledge, attitudes, and behaviours towards physical restraints. However, the strategies of nurse education, such as delivery mode, teaching methods, and outcome measurements, require further study. RELEVANCE TO CLINICAL PRACTICE: Nurse education on physical restraints should be carried out in ICUs. Online courses, practical sessions, and simulated scenarios should be a part of future nurse education. In addition to nurses' knowledge and attitude changes, frequency of physical restraints and other patient-related outcomes should also be considered for outcome evaluation.

[Development and feasibility of an intervention to reduce physical restraints in hospitals: A mixed methods study]. / Entwicklung und Machbarkeit einer Intervention zur Vermeidung freiheitsentziehender Maßnahmen im Krankenhaus.

Development and feasibility of an intervention to reduce physical restraints in hospitals: A mixed methods study Abstract. Background: Physical restraints (PR) are regularly used in people with dementia or delirium in general hospital settings. There is no clear evidence for the effectiveness of PR, but their use is associated with an increased risk for harm. Therefore, a restraint-free care is recommended. Aim: Development and feasibility test of an intervention to reduce PR in general hospital settings. Methods: Systematic literature reviews and theory-guided modelling of an intervention involving relevant clinical stakeholders and mixed methods study in two wards of a university hospital (geriatric traumatology and neurology). Results: The complex intervention comprises the following components: qualification of multipliers, interprofessional education about PR reduction, regular audit and feedback meetings, and the support regarding the aim of the intervention from nursing and medical leaders. The results of the feasibility test indicate that the intervention is feasible and helpful, but the interprofessional approach was not implemented as planned. An important barrier hampering PR reduction was the high workload. The results on the prevalence of PR could not be interpreted due to a very low number of measures applied. Conclusion: The complex intervention with a multiplier approach for preventing PR use was judged as feasible, but there is a need for further development to strengthen interprofessional cooperation. The feasibility of the intervention should also be tested in other departments.

Process evaluation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A mixed methods study.

AIMS: To describe the implementation process and fidelity of two versions of a guideline-based, multicomponent intervention to reduce physical restraints in nursing homes and to identify factors that might explain the heterogeneity of effects between different clusters. DESIGN: Mixed methods evaluation of the implementation process (dose delivered, dose received, response, and adaption) alongside a pragmatic three-arm cluster randomized controlled trial. METHODS: Quantitative and qualitative process data were collected during the study period (February 2015-February 2017). Quantitative data from questionnaires and short surveys were analysed by descriptive statistics. Qualitative data from focus groups and semi-structured interviews were analysed using content analysis. An in-depth analysis was conducted by contrasting responding and non-responding clusters regarding the intervention goal and primary outcome. RESULTS: Both interventions were implemented as planned in all clusters: we found no deviations from the protocol regarding the dose delivered to and received by the clusters. Satisfaction of staff targeted by the interventions was high. The in-depth analysis did not reveal any pronounced variation in the degree of implementation or adoption in clusters with a good or nearly no response to the interventions or factors explaining different study effects. CONCLUSION: Although both versions of a guideline-based multicomponent intervention to prevent physical restraints in nursing homes were implemented as planned and the response was generally acceptable, the interventions' goal to change nursing practice towards a least-restraint policy was not achieved by the entire nursing staff in all of the clusters. No factors could be identified that might explain the different effects of the interventions. IMPACT: For some nursing homes, different approaches than addressing nurses' attitudes and institutional policies might be needed to sustainably reduce the use of physical restraints; however, the process evaluation did not reveal characteristics that might have hampered or facilitated the effectiveness of the intervention.

Understanding nurses' perspectives of physical restraints during mechanical ventilation in intensive care: A qualitative study.

AIMS AND OBJECTIVES: This study explored the experiences of nurses using physical restraints on mechanically ventilated patients in intensive care. BACKGROUND: Physical restraints are frequently used to prevent treatment interference and maintain patient safety in intensive care units worldwide. However, physical restraints are found to be ineffective in preventing treatment interference and cause negative outcomes for patients. The practices surrounding physical restraints are inconsistent due to a lack of education, training and protocols. DESIGN: This research was conducted as a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. METHODS: Twelve in-depth, semi-structured conversations were conducted with registered nurses who have experience working in intensive care and have cared for patients who were physically restrained and mechanically ventilated. These conversations were audio-recorded and transcribed. Thematic analysis was used to analyse the data. RESULTS: Three major themes emerged from the data. The themes were as follows: the ICU culture and its impacts on physical restraint practices; the consequences of physical restraints through a nursing lens; and understanding the ways of learning. CONCLUSION: The insights into the ICU culture, the nurses' understanding of the consequences of physical restraints and the ways in which nurses learn physical restraint practices have provided a greater depth of knowledge and understanding of the realities of current practice in ICU. This new information demonstrates nurses' understanding of the potential harm caused by physical restraints and the way in which current practices are guided more-so by workplace norms and expectations rather than on critical thinking and decision-making. RELEVANCE TO CLINICAL PRACTICE: These insights provide valuable information to intensive care clinicians, educators and policymakers to guide future practice and improve patient outcomes by highlighting the importance of education on physical restraint practices and informing the development of policies and guidelines.

Reducing physical restraints by older adults in home care: development of an evidence-based guideline.

BACKGROUND: Restraint use is a complex and challenging issue in home care. Due to socio-demographic trends, worldwide home healthcare providers are faced with an increasing demand for restraint use from informal caregivers, patients and healthcare providers, resulting in the use of various types of restraints in home care. Awareness and knowledge of restraint use in home care, its implications and the ethical challenges surrounding it are of crucial importance to its reduction. This research aimed to describe the development process of an evidence-based practice guideline to support caregivers to optimize home care. METHOD: The practice guideline was developed according to the framework of the Belgian Centre for Evidence-Based Medicine and AGREE II. The guideline was developed over several stages: (1) determination of the target population and scope, (2) literature search, (3) drafting and (4) validation. A multidisciplinary working group determined the proposed purpose, target group, and six clinical questions for the guideline. A consensus procedure and consultation by experts were used to develop the guideline. RESULTS: The guideline provides an answer to six clinical questions and contains ten key recommendations based on the classification of GRADE, with the objective of increasing healthcare providers' awareness, knowledge and competence to adequately deal with situations or questions related to restraint use. The guideline also includes a flowchart for dealing with complex situations where the use of restraints is requested, already present or considered. CONCLUSIONS: The guideline was validated by the Belgian Centre for Evidence-Based Medicine. Increasing competence, awareness and knowledge related to restraint use are key objectives of the guideline for reducing restraint use in home care. A multicomponent intervention to support healthcare workers in implementing the guideline in clinical practice needs to be developed.

The use of physical restraints in Chinese long-term care facilities and its risk factors: An observational and cross-sectional study.

AIM: To investigate the use of physical restraints among Chinese long-term care facilities older adults and to identify its risk factors. DESIGN: Observational and cross-sectional study. METHODS: A total of 1,026 older adults from six long-term care facilities in Chongqing were recruited by cluster sampling method from July - November 2019. Data on physical restraint use and older adults' characteristics were collected using physical restraints observation forms and older adults' records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi-square test and binary logistic regression. RESULTS: The study found that the prevalence of physical restraints in six long-term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. CONCLUSION: The use of physical restraints among Chinese long-term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. IMPACT: This study will provide an effective reference for nursing staff in long-term care facilities to assess high-risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.

Interventions to reduce physical restraints in general hospital settings: A scoping review of components and characteristics.

AIMS AND OBJECTIVES: To describe the characteristics of interventions for reducing physical restraints in general hospital settings. BACKGROUND: Physical restraints, such as bedrails and belts in beds and chairs, are commonly used in general hospital settings. However, there is no clear evidence on their effectiveness but some evidence on potential risks for harm. DESIGN: Scoping review. METHODS: We conducted a systematic database search (MEDLINE via PubMed, CINAHL, Cochrane Library; March 2020) and snowballing techniques. We included both interventional studies and quality improvement projects conducted in general hospital settings and published in English or German language. Two reviewers independently performed the study selection and data extraction. The Scoping Reviews (PRISMA-ScR) Checklist was used. RESULTS: We included 31 articles (published between 1989 and 2018), 15 quality improvement projects and 16 intervention studies. Only five studies used a controlled design. Most studies and quality improvement projects investigated multicomponent interventions including education (predominantly for nursing staff) and additional components (e.g. case conferences). Three studies examined simple educational programmes without additional components. CONCLUSIONS: A large number of multicomponent interventions for preventing and reducing physical restraints in general hospital settings have been developed. The interventions differed widely regarding the components, contents and settings. Well-designed evaluation studies investigating the effects of such interventions are lacking. RELEVANCE TO CLINICAL PRACTICE: Multicomponent educational interventions might be one approach to change clinical practice, but only insufficient information is available about potential effects of these approaches.

[Death due to physical restraint in healthcare institutions]. / Overlijden door fysieke fixatie in zorginstellingen.

Physical restraint is frequently used in healthcare institutions, usually in situations where the safety of the person (e.g. fall risk) or that of others (e.g. aggressive behaviour) is compromised, or where essential medical treatment is at stake. The implementation has a major impact with possible psychological consequences, physical injury and even fatal outcomes. In this retrospective study, fifteen deaths due to physical restraint are described. These have been investigated by the Forensic Medicine departments of UZ Leuven (1998 - 2018) and UZ Antwerpen (1999 - 2018). Death was caused by mechanical suffocation in all instances, mainly as a result of inadequate use of bedrails or belt restraint. These avoidable deaths are an urgent plea for a cautious and careful policy on physical restraint. Institutional guidelines and (further) training of health care personnel are of utmost importance. Central aspects are multidisciplinarity (deliberate decision-making), treatment (provoking factors), reticence (search for alternatives), proportionality (least intrusive method), due care (technical implementation), safety (increased supervision), temporality (re-evaluation of moment and duration), registration (accountability and liability) and communication (with all involved).

[Use of sedating medication and physical restraints for patients with dementia in acute care hospitals : A non-randomized case control study]. / Einsatz von sedierenden Medikamenten und bewegungseinschränkenden Maßnahmen bei Patienten mit Demenz im Akutkrankenhaus : Eine nichtrandomisierte Fall-Kontroll-Studie.

BACKGROUND: The majority of acute care hospitals are not prepared for people with dementia with acute diseases in need of treatment. This results in an increased likelihood of the personnel being overtaxed. Dementia is the most frequent reason that hospital personnel administer sedating medication and use restraining measures. OBJECTIVE: The aim of this study was to investigate factors that influence the (inappropriate) use of sedating medication and physical restraints for patients with dementia in acute care hospitals. METHODS: A non-randomized case control study, including two internal medicine wards was conducted in Hamburg, Germany. In the intervention group a special care concept was implemented focussing on patients with dementia, while the control group received regular care without a special dementia care concept. Logistic regression models were conducted to investigate associations between factors, such as age, severity of dementia, conspicuous behavior, Barthel index and type of treatment and the use of sedating medication and physical restraint measures. RESULTS: Challenging behavior (odds ratio, OR = 1.32) and treatment in the control group (OR=1.94) were significantly associated with the use of sedating medication. A low Barthel index, longer periods of hospitalization and treatment in the control group were significantly associated with a higher probability of the implementation of physical restraining measures. DISCUSSION: The use of sedating medication as well as physical restraining measures varied greatly between the intervention and control groups. This is in line with other studies that came to similar results and suggests that multiple components of special care concepts can explain these differences. These include architectonic design and spatial aspects as well as dementia-specific training of employees and an appropriate personnel complement. Such interventions can also reduce agitation and behavioral problems of patients. The avoidance of sedation and restraining measures is also positively associated with an increase in the quality of life of patients with dementia.

Professional and family caregivers' attitudes towards involuntary treatment in community-dwelling people with dementia.

AIMS: The aim of this study was to gain insight into professional and family caregivers' attitudes towards involuntary treatment in community-dwelling people with dementia (PwD). BACKGROUND: The number of PwD with complex care needs living at home is increasing rapidly. In some situations, caregivers provide care against the will of PwD, referred to as involuntary treatment, which includes non-consensual care, psychotropic medication and physical restraints. DESIGN: A cross-sectional study. METHODS: A total of 228 professional (nursing staff, general practitioners (GPs) and other healthcare professionals such as physical therapists and psychologists) and 77 family caregivers of PwD completed the Maastricht Attitude Questionnaire-Home Care. This questionnaire measures attitudes towards involuntary treatment and perceived restrictiveness of and experienced discomfort in using involuntary treatment. Data were collected in the Netherlands between June and November 2016. RESULTS: Family caregivers and GPs had more positive attitudes towards involuntary treatment than nursing staff and other healthcare professionals, indicating that they are more accepting of involuntary treatment. A more positive attitude was associated with higher perceived caregiver burden and being a family caregiver. Family caregivers and GPs found the use of involuntary treatment less restrictive and indicated feeling more comfortable when using these measures. CONCLUSION: It is important to account for the differences in attitudes and foster dialogue among professional and family caregivers to find common ground about alternatives to involuntary treatment. These results will inform the development of an intervention that aims to prevent involuntary treatment in home care.

Nursing home care for people with dementia: Update of the design of the Living Arrangements for people with Dementia (LAD)-study.

AIM: The aim of the current study is to describe the extended design of the Living Arrangements for people with Dementia (LAD)-study. BACKGROUND: The demand for long-term care in care homes increases with the growing number of people with dementia. However, quality of care in care homes needs improvement. It is important to monitor quality of care in care homes for the purposes of conducting scientific research, providing input for policy, and promoting practice improvement. DESIGN: The Living Arrangements for people with Dementia -study monitors changes in - quality of - care in care homes since 2008. With its extended design, the Living Arrangements for people with Dementia -study now also focuses on additional topics that are considered to improve quality of care: implementation of person-centred care, involvement of family carers and volunteers and reducing psychotropic drugs and physical restraints using a multidisciplinary approach. METHODS: The data collection of the Living Arrangements for people with Dementia -study entails an interview with the manager and questionnaires are completed by care staff, family carers, volunteers, and multidisciplinary team members. This study is partly funded by the Dutch Ministry of Health, Welfare and Sports, grant number 323,088 and partly funded by the participating care homes. DISCUSSION: Results of the Living Arrangements for people with Dementia -study will shed more light on variables related to quality of care in care homes for people with dementia. IMPACT: Based on the obtained information, appropriate efforts to improve quality of care can be discussed and implemented. Furthermore, the results of this study guide policy making, because it expands knowledge about the effects of changing policies and exposes topics that need further attention. TRIAL REGISTRATION: Not applicable. This article does not report the results of a healthcare intervention on human participants.

Physical restraints in intensive care-An integrative review.

BACKGROUND: Physical restraints (PRs) are commonly used in intensive care units (ICUs) worldwide for the prevention of treatment interference. While PRs are fundamentally used to maintain patient safety, they can negatively impact the experiences of patients and their families and cause moral and ethical dilemmas for ICU nurses. OBJECTIVES: The aim of this integrative review was to explore the current literature on the use of PR in intensive care. METHODS: This article used an integrative review framework to explore the current literature available on the experiences of PR in ICU. Research published between January 2007 and July 2016 was considered. Databases searched included CINAHL, Proquest, Medline, PubMed, and Cochrane. Inclusion/exclusion criteria were used to screen for eligibility. Methodological quality was evaluated using a quality assessment checklist, adapted from Walsh and Downe, and based on the Critical Appraisal Skills Programme tool. The findings were analysed and synthesised into major themes. RESULTS: Seventeen articles from Europe, Asia, and the United States of America were included. Five major themes emerged: (i) prevention of treatment interference; (ii) nurses' role as primary decision-makers PR application and removal; (iii) adherence to PR protocols; (iv) moral and ethical dilemmas faced by nurses; and (v) experiences of patients and families. The literature identified the prevalence of PR in today's ICUs, the drawbacks of current practice, and the paucity of knowledge of the lived experiences of PR. CONCLUSION: PR is the first choice in preventing of treatment interference, and most clinicians believe there is a valid place for them in ICU. However, its effectiveness in preventing self-extubation is questionable, and there are obvious flaws within this practice including inconsistencies surrounding PR protocols and the shortage of education and training provided to nurses. Further research into lived experiences of PR to gain deeper insights may lead to possible solutions and improve current practice.

Investigating influencing factors of physical restraint use in China intensive care units: A prospective, cross-sectional, observational study.

OBJECTIVE: In this study, we characterised the use of physical restraints in three intensive care units (ICUs) in a general hospital in Nantong, China. Additionally, we explored risk factors potentially related to physical restraint use. BACKGROUND: Despite their numerous harmful effects, physical restraints are frequently used in ICUs worldwide. Few studies have investigated the factors that contribute to physical restraint use in Chinese hospitals. METHODS: We conducted a prospective, cross-sectional, observational study of 312 patients in three ICUs at a general hospital in China. The quantitative data were collected during a 5-month period using a physical restraint observation form and patient records. The data obtained were analysed using descriptive statistics. The independent risk factors for physical restraint use were assessed using a logistic regression model. RESULTS: Of the 312 patients in the three ICUs, 191 (61.2%) were restrained, and physical restraints were used more than once for 46 (24.1%) patients during their ICU stay. The median length of physical restrain use was 20 shifts (interquartile range = 10-36 shifts). Physical restraints were applied in 6664 of 12374 (53.9%) nurse shifts. The most common time at which physical restraints were applied was the beginning of the evening shift. According to the forward stepwise logistic regression analysis, delirium (P < 0.001), mechanical ventilation (P < 0.001), and age (P < 0.001) were independent risk factors for physical restraint use. The use of analgesics (P = 0.001) exerted an independent protective effect against physical restraint use. CONCLUSIONS: The overall prevalence of physical restraint use in Chinese ICUs was higher than that reported in previous investigations. The patients' nursing notes lacked complete physical restraint records, reflecting a need for standard guidelines and policies for physical restraint use in hospital ICUs in China. In addition, in this study, we explored the risk factors related to physical restraint use and found that age, delirium, mechanical ventilation, and analgesic use are associated with physical restraint use.