Restraint reduction in general hospital care by preventive patient involvement: a pilot study

For general hospital settings, effective restraint reduction strategies are lacking. Patient involvement is proven to be useful in restraint reduction in mental healthcare and in long-term care settings. Since such an approach has never been investigated in a general hospital setting, we investigated whether and how patient involvement regarding restraint reduction is feasible in such a setting.

A pilot study following a participatory action research design was conducted. Qualitative and quantitative approaches were applied to develop and pilot an intervention to reduce restraint by preventive involvement of patients (aged 65+) in Switzerland. The intervention entailed reflecting on the potential risk of restraint use together with the patient within 24 h of admission and jointly defining possible prevention measures. The intervention was piloted for one month on one ward. Data collection for the qualitative evaluation included interviews with eight patients, five nurses, two ward managers and one clinical nurse specialist. These data were analysed by means of content analysis. Data collection for the quantitative evaluation consisted of a survey of nurses and an extraction of data from the electronic patient files. These data were descriptively analysed.

The evaluation comprised the files of 177 patients (pre to post pilot). It was found that that prevalence of restraint was lower during the pilot phase than before (4.8% vs. 10.2%), although a similar number of patients were found to be at a potential risk of restraint use (51.6% vs. 53.3%). In addition, considerably more patients with a potential restraint risk had restraint prevention measures documented (53.1% vs. 10.2%). From the perspective of the nursing staff, feasibility and acceptability of the intervention was not provided. The intervention was considered to be too time-consuming and the target group too unspecific.

The proactive and structured involvement of patients (aged 65+) in the prevention of restraint use might be an approach to reduce restraint use in a general hospital. Patients were positive about being addressed on the topic during the nursing admission interview. However, the effort was regarded to be high. Limiting the intervention to electively admitted patients should be considered to lower the burden.