Shielding or caging? Healthcare staffs' views on fall risk and protection in Stockholm

Aim.  To describe Registered Nurses' and enrolled nurses' views and reasoning on falls, fall risk, use of physical restraints and patients' safety and security in nursing homes. Background.  Nursing home patients frequently suffer from diseases which require medication. Both Registered Nurses and enrolled nurses must make decisions about how to protect patients from falls and fall-related injuries. Physical restraints are frequently used. When patients are unable to understand or do not wish to limit their freedom of movement, staff must consider each decision carefully. Method.  A qualitative approach was used. Data were analysed using a thematic content analysis method. Findings.  Staff have sufficient knowledge about which pathologically related conditions lead to fall risk. An insufficient number of staff on duty jeopardizes patient safety. Wheelchairs with safety belts, and bed rails, are sometimes used. For Registered Nurses it was not an easy decision to use restraints. Enrolled nurses' actions were based on standard procedure, to protect and supervise patients. Conclusion.  Staff often use restraints to protect their patients, even though this may mean compromising the patient's integrity. Relevance to clinical practice.  Nurses, occupational therapists, physiotherapists and physicians should plan the care together. Restrictive measures should be adapted to each individual patient.