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Use of constraints and their correlates in Norwegian nursing homes
- Authors:
- KIRKEVOLD Oyvind, SANDVIK Leiv, ENGEDAL Knut
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(10), October 2004, pp.980-988.
- Publisher:
- Wiley
Primary carers in 222 wards in Norwegian nursing homes were asked about use of constraints towards 1926 patients during seven days. Constraints were grouped as mechanical restraints, non-mechanical restraints, electronic surveillance, force or pressure in medical examination or treatment, and force or pressure in ADL. The patients' mental capacity (CDR score), activity in daily living (ADL) and behaviour (BARS score) were rated. Type and size of ward, staffing level and educational level of the staff was recorded. In all 758 of the patients were subjected to any constraint. Degree of dementia, aggressive behaviour and loss of function in ADL had significant impact on all types of constraint except for electronical surveillance. The strongest associations were found between degree of dementia and mechanical restraint, impaired ADL and mechanical restraint and aggression and force or pressure in ADL. Mechanical restraint was less used towards patients in special care units for persons with dementia (SCU) compared to patients in regular units (RU), whereas non-mechanical restraint was more frequent used in SCUs. Type of ward had no significant impact on use of other types of constraints. Staff level and education level of the staff had no significant impact on the use of constraint. Constraint is frequently used in nursing homes, and most frequent toward patients with severe dementia, aggressive behaviour or low ADL function.
Use of constraints and surveillance in Norwegian wards for the elderly
- Authors:
- KIRKEVOLD Oyvind, LAAKE Knut, ENGEDAL Knut
- Journal article citation:
- International Journal of Geriatric Psychiatry, 18(6), June 2003, pp.491-497.
- Publisher:
- Wiley
Questionnaires were sent to 975 institutions and returned by 623 (64%) with 1398 wards. The wards' head nurses were asked whether any patient was currently subjected to physical restraints, electronic surveillance, force or pressure in medical examination or treatment, and force or pressure in ADL. The reporting of constraints was found reliable. In all, 79% of the head nurses reported daily or occasional use of constraints in their wards. Most frequently reported were force or pressure in the performing of activities of daily living (reported by 61%, 95% Confidence Intervals (CI) 59-64), use of force or pressure in medical treatment or examination (49%, 95% CI 47-53) and use of physical restraints (38%, 95% CI 36-41). Electronic surveillance was used less frequently (14%, 95% CI 13-16). All classes of constraints, except physical constraints, were used significantly more frequently in special care units for persons with dementia than in ordinary nursing home units. The methodology does not allow conclusions to be drawn regarding the role of ward size and person characteristics. The staffing was unrelated to the use of constraints which varied significantly across the counties. Constraints are widely used in Norwegian institutions for the elderly. A different pattern in use of constraints was found between special care units for demented patients and ordinary units in nursing homes.