Effects of Physical Restraints in Reducing Falls PICOT paper Larisa Myers
Nova Southeastern University

Effects of Physical Restraints in Reducing Falls
Physical restraints are described as equipment attached to a patient’s body that limits movement. Physical restraints are commonly used in an adult medical facility to prevent patient’s falls or injuries, interference with clinical therapies, and protect patient from harming themselves or others (Kope et al., 2012). However, there is great debate whether or not physical restraints prevent falls. Evidence-based research can be used to expedite the recognition of adults at risks for physical restraints use and assists nurses to find alternative methods (Kope et al., 2012). Background
Physical restraints are a common practice in industrialized countries (Kope et al., 2010). Older adults, who are confused, psychotic, and demented, have the greatest risk for being restrained in medical facilities (Kope et al., 2012). Physical restraints include hand mitts, waist belts, and wrist restraints to prevent body movements. The most common misconception among nurses is that restraints prevent falls or injuries (Kope et al., 2012). Data Bases and Key Terms
The data base used to research effects of physical restraints in reducing injuries was CINAHL. The key words used for the search were adults, physical restraints, falls and injuries, alternative methods, education, knowledge, attitudes, and evidence-based practice. Interventional Study One
In 2010, the Department of Nursing Research, University of Sweden conducted a study on restraint minimization. The focus of the study was on dwelling units for dementia patients (Pellfolk et al., 2010). The objective was to analyze the effects of a 6 month restraint reduction program (Pellfolk et al., 2010). Emphasis was placed on staff view points and awareness in relation to restraint use and alternative methods. The design was a cluster-randomized controlled trial which groups of subjects were randomized (Pellfolk et al., 2010). The researchers utilized nursing units as the groundwork for their experiment.
There study included 184 staff members and 191 patients in the intervention group and 162 staff and 162 patients in the control group. The subject’s data was collected on questionnaire forms. Participant’s awareness and viewpoints towards physical restraints were measure before and after the training (Pellfolk et al., 2010). The training programs included 30 minutes lectures and video vignettes on physical restraint, dementia, and restraint-free environments (Pellfolk et al., 2010).
The evidence concluded that comprehensive training improved staff awareness, changed viewpoints, and reduced the use of physical restraints on the dementia unit without increasing the occurrence of falls or injuries (Pellfolk et al., 2010). The evidence also suggests that there is a significant connection between staff awareness and viewpoints in relation to physical restraints (Pellfolk et al., 2010). Interventional Study Two
In 2011, the Department of Nursing Research, University of Netherlands conducted a study on belt restraint reduction. The purpose of this study was to analyze the effects of an 8 month multi-component intervention program to reduce the use of belt restraints and fall reduction in psycho-geriatric facilities (Gulpers et al., 2011). A quasi-experimental longitudinal design was used to evaluate the participant’s behavior.
The study included 26 psycho-geriatric wards from 13 adult living facilities in the Netherlands. Four hundred five residents agreed to participate in the study. There were 403 residents from 15 wards in the intervention group and 311 residents from 11 wards in the control group (Gulpers et al., 2011).
The researchers focused on several key components in reducing belt restraints and falls. For example, applying guidelines that banned the use of physical restraints, intensive educational programs that focused on the adverse effects of physical restraints use, staff view points toward physical restraint use, and fall prevention programs (Gulpers et al., 2011). Clinical nurse specialists delivered the 9 hours of education per week to the nursing staff (Gulpers et al., 2011). The study concluded that a multi-component intervention program managed to reduce belt restraint use without increasing the use of other physical restraints, falls, or fall-related injuries. When nurses are introduced to adequate and appropiate education, they are able to make well informed decisions (Gulper et al., 2011). The study also established that belt restraints placed patients at a greater risk for falls (Gulpers et al., 2011). Interventional Study Three
In 2012, the Nursing Research Institute, University of Lubeck conducted an 8 month study on the effects of physical restraints in nursing homes. The purpose of this study was to reduce physical restraints use in nursing homes by implementing guideline and theory-based multi-component intervention (Kope et al., 2012). The design was a cluster randomized control trial conducted over a 6 months period in 18 German nursing homes (Kope et al., 2012). There were 2283 residents in the intervention group and 2166 residents in the control group.
A multi-component intervention program allows nurses to provide the best clinical practice. The fundamental theory of intervention focuses on planned behavior which has been proven to be an essential part of explaining nurses’ intentions and actions (Kope et al., 2012). A guided theory, addresses attitudes, subjective norms, and perceived behaviors towards the use of physical restraints (Kope et al., 2012).
The literature concluded that a guideline and theory based multi-component intervention compared with basic evidence, decreased physical restraint use. There was a 30.5% reduction in restraint use compare to the baseline 23.9%. However, there were no significant differences in falls or fall-related injuries. The study also suggests that nurses who receive intensive education are able to identify solid research findings and apply them in healthcare (Kope et al., 2012). PICOT QUESTION
In an adult nursing home setting, how effective are physical restraints over an 8 month period compared to a restraint-free environment in reducing the occurrences of falls? P: Older adults in nursing homes. I: Implementation of multi-component education programs. C: Nurse’s without specialized training in alternative methods to restraints. O: Reduction in restraint use and falls. T: Data collect over an 8 months period. Conclusion
Evidence-based research suggests that physical restraints undermine optimal patient care. Older adults who are at risk for physical restraint use rely on nurses to apply the best clinical practices to find alternative methods (Gulpers et al., 2011). Nurses play a pivotal role as agents of change in reforming current practices. By implementing multi-component interventions, nurses can effectively reduce physical restraint use and falls or fall related injuries (Kope et al., 2012). References
Gulpers, J.M., Bleijlevens, H.C., Ambergen, T., Capezuti, E., Van Rossum, E., & Hamers, P.H., (2011). Belt restraint reduction in nursing homes: Effects of a multicomponent intervention program. American Journal of Geriatrics, 59(11), 2029-2036. Retrieved from: CINAHL Plus with full Text database.
Kope, S., Muhlhauser, I., Gerlach, A., Haut, A., Haastert, B., Mohler, R., & Meyer, G. (2012). Effect of a guideline-based multicomponent intervention on use of physical restraints in nursing homes: A randomized controlled trial. The Journal of American Medical Association, 307(20), 2177-2184. Retrieved from: CINAHL Plus with full Text database.
Pellfolk, J. E., Gustafson, Y., Bucht, G., & Karlsson, S. (2010). Effects a of restraint minimization program on staff knowledge, attitudes, and practice: A cluster randomized trial. American Journal of Geriatrics, 58(1), 62-69. Retrieved from: CINAHL Plus with full Text database.