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Effects of a restraint minimization programme on staff’s work environment and the quality of care: a cluster randomized trial
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
Yrkeshögskolan Novia, Vasa, Finland.
Umeå University, Faculty of Medicine, Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Nursing.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims and objectives. The aim of the study was to evaluate the effects of a restraint minimization education programme on staff’s work environment and the quality of care in group dwellings for persons with dementia.

Background. Nursing staff in dementia care frequently face ethically difficult situations and have a challenging work environment. The use of physical restraints is one factor found to be associated with an impaired work environment and to evoke negative feelings such as guilt and sadness among the staff.

Design. Cluster randomized controlled trial.

Methods. The intervention and control groups each consisted of 20 group dwellings for persons with dementia. Staff and resident data were gathered by means of questionnaires one month before and after the 6-month education programme. Staff’s work environment was measured using the Stress of Conscience Questionnaire, the Demand–Control–Social Support model, and an assessment of caring climate, while the quality of care was subjectively rated for each resident by the staff.

Results. Analyses showed that nursing staff’s work environment improved in the intervention group, as well as did the quality of care, while there was no significant change in the control group. Subgroup analysis within the intervention group indicated that the largest effect on staff’s work environment occurred in those group dwellings where the use of physical restraints was reduced or stayed constant.

Conclusions. Staff’s work environment and the quality of care can be improved by the implementation of staff education. The findings also indicate that there was a synergistic effect between the education programme and the change in physical restraints use.

Keyword [en]
Physical restraints, staff education, work environment, dementia care, RCT
National Category
Geriatrics
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-31948OAI: oai:DiVA.org:umu-31948DiVA: diva2:300027
Available from: 2010-02-24 Created: 2010-02-24 Last updated: 2010-03-01Bibliographically approved
In thesis
1. Physical restraint use and falls in institutional care of old people: effects of a restraint minimization program
Open this publication in new window or tab >>Physical restraint use and falls in institutional care of old people: effects of a restraint minimization program
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Physical restraint use and falls are common in institutional care of old people and various attempts have been made to reduce their occurrence. Falls and concomitant injuries are a major problem due to their negative effect on morbidity and mortality. Prevention of falls and injuries is the most common reason for physically restraining old people in institutional care. Its use has, however, been questioned both from an ethical perspective, since restraints can be perceived as coercive and also because of the lack of sound evidence of their effectiveness in preventing falls, as well as the adverse effects associated with their use.

The main purposes of this thesis were to investigate differences in the us of physical restraints over time, to identifify risk factors for falls among people with dementia, to evaluate the effects of a restraint minimization program on staff knowledge, attitudes, and work environment and use of physical restraints and the quality of care.

The present thesis is based on three main data collections, two census surveys conducted within institutional care for old people in the county of Västerbotten in 2000 (n=3,804) and 2007 (n=2,970) and one cluster-Randomized Controlled Trial (RCT) including 40 group dwellings for people suffering from dementia where the intervention consisted of staff education.

The use of physical restraints increased slightly between 2000 and 2007 (16.2% to 18.4%, p=0.016). Analyses suggest that the increase might be independent of any change in resident characteristics. Restrained residents were also subjected to restraints for longer times in 2007.

During a six-month follow-up 64/160 (40.0%) residents in group dwellings for those with dementia sustained at least one fall. Independent risk factors for falls were ‘requiring help with hygiene’, ‘displaying verbally disruptive/attention-seeking behavior’, ‘able to rise from a chair’, ‘walking with assistive devices’, and ‘participating in outdoor walks’, which explained 36.1% of the falls. The majority of the 191 falls were un-witnessed, 35% occurred during the night and anxiety and confusion were the most common symptoms preceding the falls.

A six-month restraint minimization program showed a positive impact on staff knowledge, attitudes and work environment as well as on the use of physical restraints and subjectively estimated quality of care. Residents in the intervention group present throughout the entire study period had lower odds, relative to the residents in the control group of being physically restrained at follow-up (OR= 0.21, CI 95%=0.08-0.57) after controlling for potential confounders and the cluster effect. Adjusted analyses including all residents present at either baseline or follow-up also showed that the use of physical restraints was less in the intervention group relative to the control group at follow-up. There was no change in the occurrence of falls or use of psychoactive drugs. The intervention also reduced stress of conscience, job demands and strain in the staff, and improved their job control and the caring climate. Subgroup analysis indicated a greater effect in units where the use of physical restraints had been reduced or remained constant.

In conclusion, physical restraint use and falls remains common in institutional care of old people. The practice of physical restraint seems to have changed. In the RCT it was found that it is possible to change restraint practice and also to improve staff work environment. Falls among residents with dementia require a certain mobility function and anxiety and confusion are common symptoms preceding falls.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2010. 101 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1336
Keyword
Physical restraints, falls, dementia, care of the elderly, risk factors, work environment, restraint minimization education program, staff knowledge and attitude, and quality of care.
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:umu:diva-31952 (URN)978-91-7264-960-6 (ISBN)
Public defence
2010-03-19, Aulan vårdvetarhuset, Institutionen för omvårdnad, 90187 Umeå, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2010-03-01 Created: 2010-02-24 Last updated: 2010-03-01Bibliographically approved

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