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Study Offers Ways to Decrease Use of Restraints at Nursing Homes
Instilling a 'culture of care' can help, researchers say
Wednesday, May 23, 2012
Despite legal regulations and evidence that they are ineffective, physical restraints such as bed rails and belts still are frequently used in nursing homes. A recent survey found that the rate of physical-restraint use in U.S. nursing homes is more than 20 percent, according to background information included in the study.
The six-month controlled trial included 36 nursing homes in two German cities. Half the nursing homes were placed in a control group and the other half in an intervention group.
The intervention program included group sessions for all nursing staff, additional training for designated nurses and supportive materials for nurses, residents, relatives and legal guardians. The nursing homes in the control group received standard information.
At the start of the study, the rates of physical-restraint use were about the same for both groups, at 32 percent in the intervention group and 31 percent in the control group.
After six months, the rates of physical-restraint use in intervention-group nursing homes had fallen significantly to 23 percent, compared to 29 percent in the control group.
The study appears in the May 23/30 issue of the Journal of the American Medical Association.
"Nursing home care does not necessitate the administration of physical restraints," researchers from the University of Hamburg in Germany wrote in a journal news release. "We found pronounced center variation, with best-practice centers applying very few physical restraints. Reasons for differences between centers are unclear, but the 'culture of care,' as reflected in the attitudes and beliefs of nursing staff, may determine observed variation."
The researchers also found that both groups of nursing homes had similar rates of patient falls, fall-related fractures and prescriptions of psychotropic medications that alter mood and behavior.
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