RESTRAINT REDUCTION IN A NURSING-HOME AND ITS IMPACT ON EMPLOYEE ATTITUDES

Objective: To reduce physical restraint use in a nursing home and incr ease employee support for the restraint-reduction program. Design: A o ne-group pretest-posttest design with repeated measures was used to de termine changes in restraint use with participants over a 14-month int erval. All individuals employed at the nursing home were surveyed at t wo time periods to determine their opinions on restraint use. Setting: A 265-bed private, non-profit nursing home in Dallas, Texas. Particip ants: 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. Intervention: Formation of a project tea m that planned and supervised restraint removal. Inservice training on restraint use was conducted for all employees. Measurements: Type and frequency of restraint use among the restrained cohort at four evalua tion points within a 14-month interval. The frequency of restraint use in the nursing home population was also recorded. Survey measures inc luded employee responses to a 16-item closed-end questionnaire before and after training. Results: The mean number of restraints used with e ach resident in the restrained cohort decreased from 1.56 to 0.67. The number of residents on restraints in the nursing home was reduced dur ing 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 th e second survey, more than twice as many employees indicated that rest raints should be removed from almost all residents who have them (15.2 % vs 36.3%, P < 0.0001). Conclusion: A restraint-reduction program in a nursing home can produce positive results in terms of decreased rest raint use and supportive employee attitudes. More practical alternativ es to restraints need to be developed for application in the training of nursing home employees. Future studies on resident, employee, and f amily attitudes about restraint use are suggested.