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Rights, risks and restraint-free care of older people: person-centred approaches in health and social care
- Editors:
- HUGHES Rhidian, (ed.)
- Publisher:
- Jessica Kingsley
- Publication year:
- 2010
- Pagination:
- 224p., bibliog.
- Place of publication:
- London
This book provides health and social care professionals with an authoritative reading resource on the ethics and use of restraint. It provides an overview of the different forms of restraint, the conditions under which they are used and their implications for the health and wellbeing of older people. Practical approaches to minimising restraint are then explored, underlining the importance of person-centred care. Innovative programmes and approaches to reducing the use of restraint are described and assessed, and case studies are drawn upon to highlight practice challenges and their effective resolutions. The perspectives of older people and their carers and families, as well as of professionals, commissioners and regulators of health and social care, are also taken into account. The contributors are drawn from an international range of health and social care settings, as well as from the academic world.
The effect of staff training on the use of restraint in dementia: a single-blind randomised controlled trial
- Authors:
- TESTAD L., AASLAND A.M., AARSLAND D.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(6), June 2005, pp.587-590.
- Publisher:
- Wiley
The aim of this study was to reduce problem behaviour and the use of restraint in demented patients using a staff training program as intervention. The study was a randomised single-blind controlled trial and took place in Stavanger, Norway. Four nursing homes were randomised to a control or an intervention group after stratification for size. The intervention consisted of a full day seminar, followed by a one-hour session of guidance per month over six months. The content of the educational program focused on the decision making process in the use of restraint and alternatives to restraint consistent with professional practice and quality care. The primary outcome measures were number of restraints per patient in the nursing homes in one week and agitation as measured with the Brief Agitation Rating Scale (BARS). These were rated before and immediately after the intervention was completed. The assessments were performed blind to design and randomisation group. Results found clinical and demographic variables did not differ between the intervention and control groups at baseline. After the intervention period, the number of restraints had declined by 54 percent in the treatment group, and increased by 18 percent in the control group. Although the level of agitated behaviour remained unchanged or increased slightly, the educational program led to a significant reduction of the use of restraint in institutionalised elderly with dementia. These results suggest that educational programs can improve the quality of care of people with dementia.
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.
Institutional care for older people: the dark side
- Author:
- JUKLESTAD Olaug Nesje
- Journal article citation:
- Journal of Adult Protection, 3(2), May 2001, pp.32-41.
- Publisher:
- Emerald
This article looks at abuse of older people in institutions in Norway, using information and insights drawn from the author's own practice, newspaper articles and investigations carried out in nursing homes in 1994, 1999 and 2000. From these sources it is apparent that the use of force is widespread, although there is no legal basis for this. How Norway is responding to this worrying situation is examined.