Validity and measurement invariance of the Physical Restraint Use Questionnaire (PRUQ) in nursing staff.

AIMS AND OBJECTIVES: To study the internal structure and measurement invariance of the Physical Restraint Use Questionnaire and to compare perceptions, experience and training, regarding use of physical restraint on the older people between nursing staff working in hospitals and nursing homes. BACKGROUND: Physical restraint of patients is still common in many countries, and thus, it is important to study the attitudes of nursing staff. One of the most common tools used to assess perceptions regarding its use is the Physical Restraint Use Questionnaire. However, gaps exist in its internal structure and measurement invariance across different groups of respondents. DESIGN: Cross-sectional multicentre survey. METHODS: Data were collected from nurses working in eight Spanish hospitals and 19 nursing homes. All registered nurses and nurse assistants (N = 3,838) were contacted, of whom 1,635 agreed to participate. Confirmatory factor analysis was performed to determine internal structure and measurement invariance of Physical Restraint Use Questionnaire, after which scale scores and other measures of experience and training were compared between hospital-based (n = 855) and nursing homes-based (n = 780) nurses. RESULTS: The Physical Restraint Use Questionnaire showed three invariant factors across type of facility, and also professional category and sex. Nursing staff working in both types of facility scored similarly; prevention of therapy disruption and prevention of falls were rated more important. Nurses working in nursing homes reported using restraint "many times" more frequently (52.9% vs. 38.6%), less severe lack of training (18.2% vs. 58.7%) being perceived as more adequate (33.4% vs. 17.7%), than hospital-based nurses. CONCLUSIONS: These findings support Physical Restraint Use Questionnaire as a valid and reliable tool for assessing the importance given to the use of physical restraint in the older people by nursing professionals, regardless of the setting being studied. RELEVANCE TO CLINICAL PRACTICE: The information would help design more specifically the physical restraint training of nursing staff and to plan institutional interventions aimed at reducing its use.

[Medical prescription and informed consent for the use of physical restraints in nursing homes in the Canary Islands (Spain)]. / Prescripción facultativa y consentimiento informado ante el uso de restricciones físicas en centros geriátricos de las Islas Canarias.

OBJECTIVE: To identify the frequency of completion of informed consent and medical prescription in the clinical records of older patients subject to physical restraint, and to analyse the association between patient characteristics and the absence of such documentation. METHODS: A cross-sectional and descriptive multicentre study with direct observation and review of clinical records was conducted in nine public nursing homes, comprising 1,058 beds. RESULTS: 274 residents were physically restrained. Informed consent was not included in 82.5% of cases and was incomplete in a further 13.9%. There was no medical prescription in 68.3% of cases and it was incomplete in a further 12.0%. The only statistical association found was between the lack of prescription and the patients' advanced age (PR=1.03; p <0.005). CONCLUSIONS: Failure to produce this documentation contravenes the law. Organisational characteristics, ignorance of the legal requirements or the fact that some professionals may consider physical restraint to be a risk-free procedure may explain these results.

Physical Restraint Use With Elderly Patients: Perceptions of Nurses and Nursing Assistants in Spanish Acute Care Hospitals.

BACKGROUND: Physical restraint is often used during the hospitalization of elderly people. However, this procedure is associated with adverse outcomes; therefore, it is necessary to be aware of the circumstances that promote restraint use, such as the perceptions of professionals who use it. OBJECTIVES: The purpose of the research was to determine the situations in which nursing staff considered the use of physical restraint as most important and to evaluate the possible associations with the sociodemographic and professional variables. METHODS: A descriptive cross-sectional multicenter study was carried out in 52 units of eight Spanish acute hospitals. A survey of registered nurses and nursing assistants was used to collect data related to sociodemographic characteristics, experience, training in restraint use, and the Perception of Restraint Use Questionnaire (PRUQ)-which assesses the perceived importance of reasons frequently given for the use of physical restraint. RESULTS: The sample comprised 508 registered nurses and 347 nursing assistants. Almost all (98%) had used physical restraint, and 82% thought their training in the use of physical restraint was insufficient. Nursing assistants scored higher than registered nurses (p < .005, d = .68) on PRUQ total score and individual item scores, suggesting they thought the factors were more important in restraint use. Both registered nurses and nursing assistants considered restraint as most important in the prevention of falls and in the removal of medical devices such as intravenous lines and urinary catheters. Associations between PRUQ total score and other variables (unit type, sociodemographic factors, hospital) were nonsignificant. DISCUSSION: The professionals considered restraint as very important in preventing safety problems. In order to improve the quality of care, it is essential to identify the factors that can have an effect on the application of physical restraint. Educational programs are of fundamental importance, but to be more effective in reducing the use of physical restraint, they should address commonly held views on rationale for restraint use and be accompanied by institutional policies promoting a restraint-free environment.

The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study.

BACKGROUND: Physical restraint is a procedure used frequently in long-term care. It is a controversial practice because its use is associated with numerous complications and also affects freedom and individual autonomy. The objective of this study was to examine the use of physical restraint of long-term care residents with the ability to move voluntarily. METHODS: We conducted a cross-sectional observational and correlational multi-center study. Nine centers agreed to participate. Of the 1,200 people present at the time of data collection, those without voluntary movement or in the facility for less than a month were excluded. Thus, the final sample was 920 residents. Data on the use of restraints was collected by direct observation. Information about the age, gender, length of stay, falls, mobility, cognition and functional status of residents was gathered by reviewing clinical records and interviewing nursing staff. A descriptive analysis of the data obtained was conducted. The generalized linear model was used, considering only the principal effects of each variable and using the logit link function. The model has been adjusted for clusters and for other possibly confounding factors. For all analyses, a confidence interval (CI) of 95% was estimated. RESULTS: The prevalence of residents with at least one physical restraint was 84.9% (95% CI: 81.7-88.1), with variability between centers of 70.3 to 96.6% (p-value Kruskal Wallis test <0.001). Full-enclosure side rails were most often used (84.5; 95% CI: 81.1-87.9), but other types of restraints were also used frequently. Multivariate analysis showed that the degree of functional impairment increased the probability of the use of restraint. A significant association was also found between restraint use and the impaired cognitive status of residents. CONCLUSIONS: The prevalence was higher than in studies from other countries. The results emphasize the need to improve the training of nursing staff in the care of residents with impairments in functional and cognitive status. The use of alternative devices and nurse consultants need to be evaluated, and the introduction of specific laws considered.

Perception of spanish nursing staff on the use of physical restraints.

PURPOSE: To examine the perception of registered nurses and nursing assistants regarding the use of physical restraints with residents of nursing homes located in four of the regions of Spain; and to evaluate the relationship of these perceptions to the staff respondents' level of training. DESIGN: Cross-sectional multicenter and correlational study. The research was conducted in 2013 in 19 Spanish nursing homes with 2,940 residential beds. A total of 785 nurses (170 registered nurses and 615 nursing assistants) participated in the study. METHODS: The Perception of Restraint Use Questionnaire (PRUQ), consisting of 17 of the most cited reasons for using these devices, was used, as was a questionnaire capturing the sociodemographic characteristics and educational or experience level of staff respondents. FINDINGS: Nurses reported the most important uses for restraints as prevention of falls and avoidance of medical device interference. As indicated by an average PRUQ score of 3.47, staff respondents supported restraint use, especially nursing assistants (3.59) as compared to registered nurses (3.00). With regard to training: 83.7% had participated in little, if any, training and only 29.2% had read three or more documents related to restraint use; 66.6% believed that their training was inadequate. No correlation was found between the results of the PRUQ and the respondents´ sociodemographic characteristics or participation in training activities. No differences were found among nurses by region. CONCLUSIONS: In contrast to papers published in other countries, nurses in this study still consider it necessary to apply restraints in everyday practice. The education of nursing staff regarding restraint and knowledge of alternatives is needed; they should at least be aware of international standards of care regarding physical restraint use. CLINICAL RELEVANCE: Most of the staff perceived their training related to the use of these devices as insufficient. Nursing assistants considered the use of restraints more important than did the registered nurses.

[Use of physical restraints on the elderly: attitudes, knowledge and practice among nursing staff]. / Actitudes, conocimientos y práctica de los profesionales de enfermería en el uso de restricciones físicas con personas mayores.

OBJECTIVES: To investigate the attitudes, knowledge and practice on the use of physical restraints by nursing staff working with the elderly, as well as the relationship existing between these variables. MATERIAL AND METHODS: A cross-sectional descriptive and correlational study was conducted among professionals from eight nursing homes. Three questionnaires asking about the mentioned variables were used. RESULTS: A total of 378 questionnaires were finally included (94 nurses and 284 auxiliary nurses). The professionals' attitude was generally against the use of restraints, although they were in favour of using them to avoid falls. With regard to knowledge, they obtained 66% of the correct answers; only 32% believed that there were alternatives to restraints, and 69.1% were unaware that these procedures could cause the death of patients. A total of 69.8% said that their training regarding restraint was limited. The practice could be considered acceptable, although the 61.9% thought it was not necessary to get informed consent from the family, and only 47.1% of the nurses always recorded its use in the patient's history. Differences between attitudes, knowledge and practice were found among the two groups. A relationship between the variables was confirmed; less knowledge and more favourable attitude towards physical restraints correlate with a worst practice. CONCLUSIONS: The attitude of the staff to physical restraints is ambiguous, and erroneous concepts have been detected in their knowledge and practice. Given the influence of knowledge on the rest of the variables, the training of the professionals needs to be improved.

[Historical aspects of the use of physical restraint: from antiquity to the era of moral treatment]. / Uso de la restricción físic. A abordaje hasta la era moral.

The implementation of harsh methods of restriction has been seen since ancient times as an acceptable solution to the problems caused by mental illness. This practice was hardly questioned and only a few professionals struggled to improve the hard living conditions of the patients. Amongst these can be mentioned some physicians of ancient Greece and Rome: such as, Caelius Aurelianus, Asclepiades or Soranus of Ephesus, who objected to this procedure. During the Middle Ages, Arabic culture also helped to humanize care in the first hospitals for the insane, Avicenna being one of the most important figures. By contrast, in Medieval Europe madness was seen as a form of sin, and punishment was the way to treat it. Already by the fifteenth century asylums in Valencia and Zaragoza were pioneering the removal of chains and more humane treatment. Although, undoubtedly the most notable advances in the care of mental patients occurred during the eighteenth century through moral treatment, Philippe Pinel being its most well-known practioner. Also at this time, the benevolent efforts of the Quakers stood out. As an alternative to shackles, they introduced occupational programmes to stimulate patients; in fact, this type of therapy had already been applied centuries before. To put this phenomenon in perspective, it can be said that discussions about physical restraint have been taking place since ancient times, causing debate amongst professionals for many centuries, when considering its advisability.

[Physical restraint of patients: historical notes relating to the nineteenth and twentieth century]. / La restricción física de los pacientes. Siglos XIX y XX.

Physical restraint has been historically considered a necessary procedure to control the behaviour of the mentally ill. In the late eighteenth century moral treatment would pave the way for new initiatives against restraint, such as those instituted by British psychiatrists. They stressed the importance of training and supervision, as well as a minimum staff ratio, as being determining factors in reducing the use of restraint. This philosophy of treatment, despite its benefits, was introduced later and to a lesser extent in the rest of Europe, although, in other countries care was also made more humane through new therapeutic procedures. By contrast, in the United States most psychiatrists disagreed with those who advocated non-restraint, and continued using controversial methods to control the behaviour of patients. In Spain many difficulties hindered the improvement of conditions in institutions, many of which were in a sorry state. The initiatives of a few professionals and some cautious legal advances tried to alleviate the harshness of the treatment methods used. In the early twentieth century professional manuals were already available, which included the care to be given during the application of physical restraints. However it was not until the 1950, when the emergence of new psychotropic drugs and the distribution of important guidelines on the protection of the rights of patients that the widespread use of this procedure would be successfully reduced.

[Accidents associated with the use of physical restraints in the elderly with cognitive disorders: a study of three cases]. / Accidentes asociados al uso de restricciones físicas en ancianos con trastornos cognitivos: estudio de tres casos.

INTRODUCTION: Physical restraint is normally applied to the elderly with cognitive disorders in the belief that it improves their safety. However, several studies warn about the risk of a serious accident when these people become trapped by the equipment when trying to get up from a bed or chair. It is estimated that in the USA alone, as many as 200 deaths are caused annually by these devices. MATERIAL AND METHODS: The circumstances resulting in the deaths of three elderly people with cognitive impairment and an abdominal belt restraint at the time of death were studied. The information was collected from clinical histories and through a semi-structured interview with the professionals in charge of the patients. RESULTS: Among the possible contributing factors to these incidents could be the patients' disorientation and inability to recognize risks, the lack of adequate supervision, incorrect application of the devices, a low staff ratio on some shifts and insufficient staff training. CONCLUSIONS: Both the literature review and the cases analyzed show a common pattern. A probable combination of factors could increase the possibility of an accident occurring.

[Descriptive study of the attitudes of family caregivers to the use of physical restraints: preliminary results]. / Estudio descriptivo sobre la actitud de la familia ante el uso de restricciones físicas en mayores: resultados preliminares.

OBJECTIVE: To evaluate the attitudes of families caring for elderly dependents to the use of physical restraints and to identify the factors that could influence these attitudes. MATERIAL AND METHODS: A descriptive, cross sectional study was carried out in a consecutive sample of the population, using a questionnaire investigating the various aspects that influence attitudes to restraints. Responses were obtained from 50 family caregivers, of which seven were discarded due to lack of knowledge about restraints (N=43). The characteristics of the sample, frequencies, the main trends and dispersion measures were analyzed. RESULTS: Most of the family caregivers considered the use of restrains to be appropriate and 90.7% were willing to use them with a relative; 41.9% believed that their use was unavoidable and were unaware of alternatives, while 23.3% were unaware that physical restraints can cause physical and psychological problems. None of the family caregivers believed that this method of restraint was a form of abuse. CONCLUSIONS: Relatives had a positive attitude to physical restraints and considered their use appropriate. This finding could be related to their limited knowledge of alternatives and of the complications that can be caused by restraints. Training programmes on alternatives to these devices should be instigated.

[An extended version of the Font-Roja job satisfaction questionnaire]. / Una propuesta destinada a complementar el cuestionario Font-Roja de satisfacción laboral.

INTRODUCTION: Several studies have shown the need to include the physical work environment among the dimensions included in job satisfaction evaluation. However, this dimension was not included in the Font-Roja questionnaire. The present study introduces two items exploring this dimension and adheres to the hypothesis that physical work environment has a significant impact on job satisfaction evaluation. METHOD: A total of 227 geriatric workers participated in this study. The participants completed the Font-Roja job satisfaction questionnaire with 2 additional items exploring the physical work environment. Factor analysis and principal components analysis with rotation varimax were used to determine the diverse components of job satisfaction. To determine the coherence of the scales and the consistency of the added items, Cronbach's a was used. These methods were applied to both questionnaires, the classical 24-item questionnaire and the extended 26-item questionnaire. RESULTS: The classical Font-Roja questionnaire was composed of 8 factors, explaining 60.02% of the variance. The extended questionnaire was structured into 9 factors, explaining 61.81% of the variance. The new factor was composed of both added items. The internal consistency of the Font-Roja classical scale was alpha = 0.773 and that of the extended scale was alpha = 0.791. DISCUSSION: The extended scale is superior to the classical scale. The results obtained seem to support the hypothesis that, for analysis of job satisfaction, the instruments used should contain items on the physical work environment.