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1.
J Healthc Qual Res ; 36(5): 263-268, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1712800

ABSTRACT

INTRODUCTION: During the worldwide pandemic of COVID-19 caused by coronavirus SARS-CoV-2, hospitals developed contingency plans that transformed and reorganized the hospital activity. One of the measures was to restrict access to family members of hospitalized patients. The presence of the patient's family is considered an alternative to physical restraint. The aim of this study is to compare the use of physical restraint in hospitalized patients in an acute care hospital during the previous period of the pandemic of COVID-19 with the post-confinement period with hospitals being still closed to family. MATERIAL AND METHODS: We made an observational study that compares the prevalence of physical restraint in an acute care hospital during the previous period to the alarm state (February 2020) with the second period, when visits where restricted (May 2020). From the clinical history of the patients with physical restraint we collected the following variables: sex, diagnostic, hospital admission unit, reason for using physical restraint, localization, length, type of material, registration in the medical record, information given to the family, alternatives to the physical restraint and injuries related to the physical restraint. RESULTS: We evaluated 690 patients: 388 during the previous period and 320 during the second period. From all patients, 29 needed physical restraint. The use of physical restraint went from 8 (2%) to 21 (7%) (p=0.003). In the second period, a not statistically significant increase in continuous physical restraint was identified compared to the first period. CONCLUSIONS: The physical restraint prevalence has been superior during the second period in which families were not present with the hospitalized patients.


Subject(s)
COVID-19/therapy , Family , Restraint, Physical/statistics & numerical data , Visitors to Patients , Acute Disease , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Hospitals , Humans , Male , Middle Aged
2.
J Contin Educ Nurs ; 53(2): 70-76, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1662730

ABSTRACT

BACKGROUND: The objective of this study was to implement an educational intervention on an inpatient, behavioral health care unit with the goal of reducing the number of crisis interventions of seclusion or restraint. METHOD: A quasi-experimental pretest and posttest design using De-escalate Anyone, Anywhere, Anytime training was employed with a focus of an increased understanding of a range of de-escalation techniques to use instead of restraint and seclusion. RESULTS: A convenience sample of 21 mental health employees participated in the training. The rates of restraint declined from a mean of 6 preintervention to 2 postintervention. The number of seclusions on the designated unit declined from a mean of 4.33 preintervention to a mean of 1.667 postintervention. CONCLUSION: These data suggest that an educational intervention to increase the knowledge of direct care staff in a broad range of de-escalation techniques resulted in a reduction in the use of restraint and seclusion. Ongoing training for nursing staff may reassure them of the efficacy of alternative methods for dealing with aggressive patients. [J Contin Educ Nurs. 2022;53(2):70-76.].


Subject(s)
Mental Disorders , Patient Isolation , Hospitals, Psychiatric , Humans , Inpatients , Mental Disorders/therapy , Restraint, Physical
3.
J Psychosoc Nurs Ment Health Serv ; 60(6): 27-32, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1547523

ABSTRACT

Seclusion practices have traditionally been used in psychiatry to maintain patient and staff safety. Despite negative emotional consequences for all involved parties and the movement toward patient-centered care, these practices continue in in-patient psychiatric units across the United States. The purpose of the current quality improvement project was to decrease the rate of seclusion events on an adult inpatient psychiatric unit through the implementation of a standard debriefing process based on the National Association of State Mental Health Program Directors' Six Core Strategies for Reducing Seclusion and Restraint Use. In 2020, the seclusion rates at the project site were above state and national benchmarks. Post-intervention, the seclusion hours per 1,000 patient care hours increased by 16% (0.38 to 0.44); however, the mean duration of each seclusion episode decreased by 10% (158 minutes to 142 minutes). Intervention compliance was low, including interprofessional participation. These findings demonstrate the need to address seclusion practices with an evidence-based solution, such as debriefing, coupled with adequate support from interprofessional leadership. [Journal of Psychosocial Nursing and Mental Health Services, 60(6), 27-32.].


Subject(s)
Inpatients , Mental Disorders , Adult , Hospitals, Psychiatric , Humans , Inpatients/psychology , Mental Disorders/therapy , Patient Isolation/psychology , Quality Improvement , Restraint, Physical , United States
4.
PLoS One ; 16(11): e0260446, 2021.
Article in English | MEDLINE | ID: covidwho-1528731

ABSTRACT

INTRODUCTION: The coronavirus disease (COVID-19) pandemic has caused unprecedented challenges for the medical staff worldwide, especially for those in hospitals where COVID-19-positive patients are hospitalized. The announcement of COVID-19 hospital restrictions by the Japanese government has led to several limitations in hospital care, including an increased use of physical restraints, which could affect the care of elderly dementia patients. However, few studies have empirically validated the impact of physical restraint use during the COVID-19 pandemic. We aimed to evaluate the impact of regulatory changes, consequent to the pandemic, on physical restraint use among elderly dementia patients in acute care hospitals. METHODS: In this retrospective study, we extracted the data of elderly patients (aged > 64 years) who received dementia care in acute care hospitals between January 6, 2019, and July 4, 2020. We divided patients into two groups depending on whether they were admitted to hospitals that received COVID-19-positive patients. We calculated descriptive statistics to compare the trend in 2-week intervals and conducted an interrupted time-series analysis to validate the changes in the use of physical restraint. RESULTS: In hospitals that received COVID-19-positive patients, the number of patients who were physically restrained per 1,000 hospital admissions increased after the government's announcement, with a maximum incidence of 501.4 per 1,000 hospital admissions between the 73rd and 74th week after the announcement. Additionally, a significant increase in the use of physical restraints for elderly dementia patients was noted (p = 0.004) in hospitals that received COVID-19-positive patients. Elderly dementia patients who required personal care experienced a significant increase in the use of physical restraints during the COVID-19 pandemic. CONCLUSION: Understanding the causes and mechanisms underlying an increased use of physical restraints for dementia patients can help design more effective care protocols for similar future situations.


Subject(s)
COVID-19/epidemiology , Dementia/therapy , Restraint, Physical/statistics & numerical data , Aged , Aged, 80 and over , Dementia/epidemiology , Female , Hospitals/statistics & numerical data , Humans , Japan , Male
5.
Int J Environ Res Public Health ; 18(21)2021 10 20.
Article in English | MEDLINE | ID: covidwho-1512275

ABSTRACT

Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected 'Restraint' as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the 'last resort'. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint; 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly 'low-level' forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.


Subject(s)
Delivery of Health Care , Restraint, Physical , Aged , Attitude of Health Personnel , Australia , Focus Groups , Humans , Qualitative Research
6.
BMJ Open ; 11(11): e055073, 2021 11 03.
Article in English | MEDLINE | ID: covidwho-1501724

ABSTRACT

OBJECTIVES: To understand why critical care clinicians still implement physical restraints, to prevent unplanned extubation and to explore the driving factors influencing the decision-making of physical restraints use. DESIGN: A qualitative descriptive design was used. The data were collected through one-to-one, semistructured interviews and analysed through the framework of thematic analysis. PARTICIPANTS AND SETTING: The study was conducted from December 2019 to May 2020 at one general intensive care unit (ICU) and one emergency ICU in a general tertiary hospital with 3200 beds in Hangzhou, China. The sampling strategy was combined maximum variation sampling and criterion sampling. RESULTS: A total of 14 clinicians participated in the study. The reason why critical care clinicians implemented physical restraints to prevent unplanned extubation was that the tense healthcare climate was caused by family members' rejection of mismatched expectations. As unplanned extubation was highly likely to create medical disputes, hospitals placed excessive emphasis on unplanned extubation, which resulted in a lack of analysis of the cause of unplanned extubation and strict measures for dealing with unplanned extubation. The shortage of nursing human resources, unsuitable ward environments, intensivists' attitudes, timely extubation for intensivists, nurse experiences and the patient's possibility of unplanned extubation all contributed to the decision-making resulting in the use of physical restraints. CONCLUSIONS: Although nurses played a crucial role in the decision-making process of using physical restraints, changing the healthcare climate and the hospital management mode for unplanned extubation are fundamental measures to reduce physical restraints use.


Subject(s)
Critical Care , Restraint, Physical , Airway Extubation , Humans , Intensive Care Units , Qualitative Research
7.
J Healthc Qual Res ; 36(5): 263-268, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1275478

ABSTRACT

INTRODUCTION: During the worldwide pandemic of COVID-19 caused by coronavirus SARS-CoV-2, hospitals developed contingency plans that transformed and reorganized the hospital activity. One of the measures was to restrict access to family members of hospitalized patients. The presence of the patient's family is considered an alternative to physical restraint. The aim of this study is to compare the use of physical restraint in hospitalized patients in an acute care hospital during the previous period of the pandemic of COVID-19 with the post-confinement period with hospitals being still closed to family. MATERIAL AND METHODS: We made an observational study that compares the prevalence of physical restraint in an acute care hospital during the previous period to the alarm state (February 2020) with the second period, when visits where restricted (May 2020). From the clinical history of the patients with physical restraint we collected the following variables: sex, diagnostic, hospital admission unit, reason for using physical restraint, localization, length, type of material, registration in the medical record, information given to the family, alternatives to the physical restraint and injuries related to the physical restraint. RESULTS: We evaluated 690 patients: 388 during the previous period and 320 during the second period. From all patients, 29 needed physical restraint. The use of physical restraint went from 8 (2%) to 21 (7%) (p=0.003). In the second period, a not statistically significant increase in continuous physical restraint was identified compared to the first period. CONCLUSIONS: The physical restraint prevalence has been superior during the second period in which families were not present with the hospitalized patients.


Subject(s)
COVID-19/therapy , Family , Restraint, Physical/statistics & numerical data , Visitors to Patients , Acute Disease , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Hospitals , Humans , Male , Middle Aged
9.
Med Sci Law ; 61(4): 275-285, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1124915

ABSTRACT

BACKGROUND: Restraint is widely practised within inpatient mental health services and is considered a higher-risk procedure for patients and staff. There is a sparsity of evidence in respect of the efficacy of personal protective equipment (PPE) used during restraint for reducing risk of infection. METHODS: A series of choreographed restraint episodes were used to simulate contact contamination in research participants playing the roles of staff members and a patient. For comparison, one episode of simulated recording of physical observations was taken. Ultraviolet (UV) fluorescent material was used to track the simulated contact contamination, with analysis undertaken using established image registration techniques of UV photographs. This was repeated for three separate sets of PPE. RESULTS: All three PPE sets showed similar performance in protecting against contamination transfer. For teams not utilising coveralls, this was dependent upon effective cleansing as part of doffing. There were similar patterns of contamination for restraint team members assigned to specific roles, with hands and upper torso appearing to be higher-risk areas. The restraint-related contamination was 23 times higher than that observed for physical observations. DISCUSSION: A second layer of clothing that can be removed showed efficacy in reducing contact contamination. PPE fit to individual is important. Post-restraint cleansing procedures are currently inadequate, with new procedures for face and neck cleansing required. These findings leave scope for staff to potentially improve their appearance when donning PPE and engaging with distressed patients.


Subject(s)
COVID-19/transmission , Health Personnel/education , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Personal Protective Equipment/standards , Restraint, Physical , Simulation Training , Behavior Control , Humans , Inpatients , SARS-CoV-2 , United Kingdom/epidemiology
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