The effects of research on clinical practice: the use of restraints.

The investigators have conducted a series of four descriptive, clinical studies to examine the nature of restraint use in extended care and nursing home units in a veterans' facility. Based on the findings of three of these studies, staff education and policy changes were implemented with the intent of decreasing the use of restraints. The present and fourth study in the series examines whether the use of restraints decreased from 1990 to 1993, after policy changes and staff education were initiated. Findings indicate that the frequency of restraint use decreased by almost half, from 25% to 14%. In addition, falls did not increase, but those falling were less likely to be restrained. These findings illustrate the importance of research in setting a course for positive change in clinical practice.

Extended care and nursing home staff attitudes toward restraints. Moderately positive attitudes exist.

1. The average score on the Restraint Questionnaire for Staff indicated that the extended care and nursing home staff members in the study presented had moderately positive attitudes toward using restraints. 2. There were no significant differences in attitude scores based on gender, position, education, or clinical experience. 3. Collaborating with another professional, especially a physician, was related to a more positive attitude toward restraints; this effect approached statistical significance. 4. Sixty-five percent of the staff could offer no alternatives to restraining a patient; for those who could offer an alternative, increasing staff size was cited most frequently.

Patient and family perceptions of restraints.

Based on a holistic philosophy that aging persons' most primary need is that of autonomy and freedom, this qualitative descriptive study examined patients' and their family members' perceptions of the restraint procedure. Twenty-five restrained patients were interviewed, and 19 of their family members completed mailed surveys to describe their perceptions about restraints. Results indicated that the majority of patients (52%) expressed negative feelings about being restrained. Family members expressed a wide variety of feelings and were ambivalent about seeing a loved one restrained. Implications are that nursing needs to become committed to the philosophy of autonomy and freedom for elderly persons.

Institutional policy: use of restraints in extended care and nursing homes.

1. The percentage of patients restrained on these nursing home and extended care units was 32%, similar to that for other nursing home studies. 2. The archetypical restrained patient was older, new on the unit, had altered thought processes and a high potential for injury, and required extensive nursing care. Typically, the type of restraint a patient wore was a vest posey, on the day shift while in his room. 3. The most frequent rationale given by nurses for applying restraints was to prevent patient falls; however, half the time, this rationale was not charted. 4. Upon examining institutional restraint policy, nurses should be prepared to implement changes in documentation format, provide staff education regarding restraint use and alternatives available, institute a rehabilitative and restorative nursing care and fall prevention program, redesign the physical environment, and designate adequate resources for an effective diversion activity program.