Use of Physical Restraints

Chapter 1

Introduction

Physical restraints have been widely used in hospitals, nursing homes and the older population are the most likely to be restrained (Chaung & Haung 2007). According to Forrester et al (2000) 1 in 5 adults over the age of 65 have been physically restrained at some point of their time spent in hospital. Studies have reported that it is nurses that initiate the use of physical restraints on theses older people (Haung et al 2003). Restraints are used to avoid a number of clinical situations such as preventing patients from falling, removing medical equipment, drains, i.v lines etc and causing harm to themselves.

Physical restraints are defined commonly as any device placed on or near the body which limits the freedom of movement and access to ones body (Centers of Medicare and Medicaid Services 2005). The most commonly used form’s of restraints include bed rails, restraining chairs, chair ties, (Hammers et al 2004), mitts and wrist ties and vest jackets (Cotter 2005).

Investigation of these factors that promote the use of physical restraints in older person care services need to be considered. The attitudes and feelings of nurses towards the use of physical restraints needs to be considered, since quality of care older persons receive may depend on the attitudes of the health professionals (Courtney et al 2000). This proposed study will aid to uncover nurse’s attitudes and feelings towards the use of restraints from an Irish perspective, where no such study has been carried out in Ireland.

Chapter two

Literature Review

2.1 Introduction

The aim of this literature review is to,

Investigate nurse’s reason for using physical restraints.

Explore nurse’s knowledge of any guidelines within their clinical settings in relation to using physical restraints.

Identify nurse’s feelings and perceptions on the use of physical restraints.

Explore the attitudes of nurses regarding their use of physical restrains in older person care.

A physical restraint is defined as, “Any manual method or physical or mechanical device, material or equipment to involuntary restrain the movement of the whole or a portion of a patient’s body as a means of controlling his/her physical activities in order to protect him/her or others from injury” (Oxford Medical Dictionary 2007).

The proposed study of a literature review is to inform the various stages of a project and to put into context what is already known on the topic (Parahoo 2006). In this chapter the author will explore current literature relating to physical restraints, the main themes emerging from the literature include, prevalence, rational for their application, consequences of their use, nurse’s knowledge on procedures and guidelines on physical restraints, and nurse’s attitudes towards physical restraints. For the purpose of this preliminary review of literature to support the rationale, need, and continuation of the project, an exhaustive literature search was conducted. Electronic databases such as CINHAL, Crochane Database, Medline and Pubmed along with the Google Scholar Internet Search engine and High Wire Press were looked for. The key words that were used for search were physical restraints, restraint usage, elderly care, nursing care, nursing attitudes. In this paper the researcher intends to present and provide a strong supportive basis for the proposed project paper including a brief critique of their methodologies, so a comparison is done among the presented studies to arrive at a final conclusion. The researchers aim is formulated so that readers and researchers have a clear understanding of what is being researched (Parahoo 2006). The aim of this proposed research is to explore nurse’s feelings and attitudes towards the use of physical restraints in older person care settings in Ireland.

2.1 prevalence of physical restraint usage

Population trends show an increase in the number of elderly people in Ireland. In 1926 the average life expectancy of Irish males was 57.4 years and of females was 57.9 years (CSO 2007). Currently it is 71.1 and 81.8 years respectively (CSO 2007). Those aged over 65 years account for 11% of the population in Ireland (CSO 2007). By the year 2026 this figure is expected to rise, further more according to the (CSO 2007) 41.5% of people over the age of 85 in Ireland are being cared for in long term care facilities. This figure reflects a growing number of elderly people living in residential care settings in Ireland. In response to the growing elderly population standards for residential care settings for older people in Ireland were introduced in August 2007 in conjunction with the Department of Health And Children. The Health Information and Quality Authority is an independent organization set up to drive quality and safety and monitor care provided to people using health and social services. The authority developed national quality standards for residential care settings for older people in Ireland to improve and ensure the safety and quality of care provided. One such standard is that residents are free from any physical restraints, which are imposed for the purpose of discipline or convenience that is not required to treat his/ her medical treatment (H.I.Q.A 2007) there are no published statistics in the Republic of Ireland on the prevalence of physical restraints in residential care settings. However many other studies have been published in other countries revealing the extent of physical restraints usage.

Galan et al (2008) carried out a quantitative study in Madrid involving 5346 residents from 25 public