Restraint Reduction Can it Be Achieved This article describes a step-by-step process for implementing restraint reduction programs in two skilled nursing facilities. The combination of using standardized guidelines, customizing others, and involving direct-care staff in facing challenges led to success. A research-practice partnership enabled a formal evaluation of the program. A pre- and posttest study design revealed significant reductions in physical restraints without increasing staff. This project demonstrates that frail, elderly people in nursing homes need not be physically restrained to receive effective care, but that alternatives can include more dignified options. Read more
Falls Among Nursing Home Residents An Examination of Incident Resports Before and After Restraint Reduction Programs Objective: To examine changes in the rate of falling of an experimental group of restrained subjects who underwent restraint reduction, and to compare their rate of falling with a group of subjects who did not have restraint orders during the study period. Design: A quasi‐experimental, multiple time‐series study utilizing the principles of single‐subject design. Each subject was followed for 25 weeks before and 25 weeks after initiation of the intervention. Setting: Seven nursing homes. Intervention: Formal programs aimed at reducing all bed and chair restraints were initiated in all sites after staff received education and training. Multidisciplinary teams implemented the restraint reduction process on a case‐by‐case basis, beginning with 1 unit/floor at a time in each site. Most experimental subjects reached their optimum restraint‐elimination/reduced status within 2 weeks of intervention initiation. The implementation periods ranged from 4 months to more than a year. Participants: Subjects with chart orders for restraints at the start of the study comprised the experimental group and participated in the restraint reduction program (184 subjects). Subjects with no orders for restraints during the study period comprised the nonequivalent control group (111 subjects) and, therefore, did not undergo the intervention. Measurements: Incident reports documenting all falls during the study period were examined. Falls, the dependent variable, were classified as serious or nonserious. The independent variable (intervention) was the restraint reduction program offered to experimental subjects. Based on the principles of single subject design, the impact of the intervention on falls was calculated before and after the date the restraint reduction process was initiated for an individual (experimental group) subject. For the control group, the pre‐ and posttest period was calculated from the start date of the restraint reduction program on the unit on which each subject resided. Results: Serious falls did not increase, but nonserious falls increased significantly after restraints were removed or reduced in experimental subjects. The total mean weekly fall rate for this group increased from 1.87% of residents falling per week during preintervention to 3.01% during postintervention. The mean weekly fall rate of the control group was 3.18% at pretest and did not change statistically over time. Read more
Enhancing Mutual Respect Among Nursing Assistants, Residents, and Residents’ Families Interviews with nursing assistants and residents revealed ways in which they experience respect, disrespect, attachment, and distancing in their relationships with each other. As a result of these findings, an in-service session on interpersonal respect was developed for nursing assistants. Manifestations of disrespect and strategies for promoting mutually respectful relationships among residents, their families, and staff in the facility are presented. Read more
