Restraint reduction in a nursing home and its impact on employee attitudes

To reduce physical restraint use in a nursing home and increase employee support for the restraint-reduction program.

A one-group pretest-posttest design with repeated measures was used to determine changes in restraint use with participants over a 14-month interval. All individuals employed at the nursing home were surveyed at two time periods to determine their opinions on restraint use.

A 265-bed private, non-profit nursing home in Dallas, Texas.

A restrained cohort of 170 residents with a mean age of 84 years; 84% were female. A total of 182 employees participated in the first survey and 209 in the second.

Formation of a project team that planned and supervised restraint removal. Inservice training on restraint use was conducted for all employees.

Type and frequency of restraint use among the restrained cohort at four evaluation points within a 14-month interval. The frequency of restraint use in the nursing home population was also recorded. Survey measures included employee responses to a 16-item closed-end questionnaire before and after training.

The mean number of restraints used with each resident in the restrained cohort decreased from 1.56 to 0.67. The number of residents on restraints in the nursing home was reduced during the course of the study (67.5% vs. 36.7%, P < 0.0001). Changes in employee opinions about restraint use were found after training. On the second survey, more than twice as many employees indicated that restraints should be removed from almost all residents who have them (15.2% vs 36.3%, P < 0.0001).

A restraint-reduction program in a nursing home can produce positive results in terms of decreased restraint use and supportive employee attitudes. More practical alternatives to restraints need to be developed for application in the training of nursing home employees. Future studies on resident, employee, and family attitudes about restraint use are suggested.