PT Critically Appraised Topics
 

Document Type

Critically Appraised Topic

Publication Date

2013

Clinical Scenario

The clinical situation that led me to pursue this question was the implementation of an education program for nursing staff to reduce the use of physical restraints (PR) on residents receiving care from a long term care (LTC) setting. PRs have been used in LTC facilities with the intent of providing patient protection. Some common rationales used by nursing staff for PR use include: enhancing poor patient physical functioning, patient behavioral problems, patient restlessness, (Pekkarinen et al, 2006), preventing patient falls and injuries (Shorr et al, 2002; Lane and Harrington, 2011), preventing disruption to therapeutic devices, controlling for patient agitation or patient wandering, providing legal protection to the facility, and providing nursing staff with comfort and reassurance (Lane and Harrington, 2011). However, several studies (Shorr et al, 2002; Lane and Harrington, 2011) have shown PR not only cause patient confusion, agitation, depression, and fear, but have been shown to cause decubiti, falls, loss of muscle strength, incontinence, and strangulation. Research supports the idea that not only does PR not provide patent protection from falls or injuries (Shorr et al, 2002; Capezuti 1995; Oliver 2007), but rather act as the cause of injury (Hantikainen and Kappeli, 2000; Myers et al, 2001) and have even led to patient death (Berzlanovich et al, 2012).

Clinical Question

Does a nursing staff education program significantly reduce the use of PR on residents living in a LTC facility?

Clinical Bottom Line

Based on the results of the outcomes from Huizing et al (2009), nursing staff PR reduction education may not significantly decrease the use of PR on residents living in a LTC facility. However, a significant threat to internal validity (Huizing et al, 2009) was having only 30% of the total nursing staff participated in PR reduction education. Based on the results of the outcomes from Pellfolk et al (2010), nursing staff PR reduction education program may not significantly decrease the use of PR, decrease the occurrence of a fall event, change staff attitudes towards the use of PR, or decrease staff perceived risk of residents’ falls. However, there was a significant increase in PR intensity within the control group and between groups suggesting that a lack of PR reduction education may increase the use of PR. Furthermore, residents receiving care from the treatment group (staff receiving PR reduction education) had a decreased likelihood of receiving PR showing that PR reduction education reduced the chances of residents receiving PR by 47%. The studies included participants who were similar to those residents and nursing staff in the LTC facility of interest. Also, the studies were similar between populations, interventions, comparisons, and outcomes measured. Treatment included nursing staff receiving PR reduction education. Controls included nursing staff refraining from participating in PR education. Outcome measures focused on PR intensity, fall event intensity, perceptions of restraints use questionnaire (PRUQ), and fall risk. In both of the studies, nursing staff PR reduction education did not significantly decrease the use of PR on residents living in a LTC facility as compared to within-group pre-treatment scores. All experiments included: randomization, acceptable external validity, fair to good internal validity, and feasible parameters. The primary cost of PR reduction education was time of nursing staff to attend the sessions and other associated costs with preparing and presenting education. From a clinical perspective, the benefits of treatment outweigh the costs.

Share

COinS