Skip to main content Accessibility help
×
Home

Programme d'intervention visant à réduire l'utilisation des contentions physiques dans des unités de soins de longue durée — mise en oeuvre et effets sur le personnel soignant*

  • Pierre J. Durand (a1) (a2) (a3), Jean-Paul Ouellet (a1), Line Beauchesne (a1), André Tourigny (a1), René Verreault (a1) (a2) (a3), Louise Dicaire (a1) (a4), Louise Lévesque (a5), Sylvie Lauzon (a6), Robin Gagnon (a7) and Louis Rochette (a1)...

Abstract

This study aimed at (a) developing a restraint reduction program, (b) describing its implementation in long-term care units, and (c) examining its effects on care staff's perceptions of and knowledge about the use of restraints. The program was composed of three parts: consciousness-raising meetings, staff education, and clinical follow-up. The study was a randomized, controlled clinical trial with eight intervention care units (five nursing homes) and 11 controls (five additional nursing homes). Care staff was surveyed at two time intervals over a 7-month period (pre- and post-test intervention; intervention care units: N = 171 [T0] and N = 158 [T1]; controls: N = 181 [T0] and N = 166 [T1]). The implementation of the program was successful and results showed significant changes in care staff perceptions of and knowledge about the use of restraints.

Les buts de cette étude étaient de développer un programme d'intervention visant à réduire L'utilisation des contentions physiques, de décrire son implantation dans des unités de soins de longue durée et d'évaluer ses effets sur le personnel soignant en termes de connaissances et de perceptions quant à L'utilisation de ces contentions. Le programme comportait trois composantes: sensibilisation, formation et suivi clinique. Le devis méthodologique est celui d'un essai clinique randomisé à mesures répétées. Le questionnaire auto-administré a été rempli avant (T0) et sept mois (T1) après le début du programme par le personnel soignant de huit unités de soins expérimentales réparties dans cinq centres (N = 171 [T0]) et N = 158 [T1]) et de onze unités témoins provenant de cinq autres centres (N = 181 [T0] et N = 166 [T1]). Le programme a été implanté avec succès et s'est avéré efficace pour modifier les connaissances et les perceptions du personnel soignant en regard de L'utilisation des contentions physiques.

Copyright

Corresponding author

Les demandes de tirés à part doivent être addressées à : / Requests for offprints should be sent to: Pierre J. Durand, M.D., M.Sc., Unité de recherche en gériatrie de l'Université Laval, Centre d'hébergement Saint-Augustin du CHA, 2135, Terrasse-Cadieux, Beauport (Québec) G1C 1Z2. (pierre.durand@msp.ulaval.ca)

Footnotes

Hide All
*

Nous exprimons toute notre gratitude aux infirmières de recherche, mesdames Maryse Bernard, Thérèse Harrisson et Diane Richard qui ont recueilli les questionnaires dans les unités de soins. Nous tenons aussi à remercier la direction et le personnel des centres d'hébergement et de soins de longue durée (CHSLD) qui ont accepté de participer au projet de recherche.

Footnotes

References

Hide All
AHQ. (1996). L'utilisation de la contention physique chez les personnes âgées: une pratique à réviser. Bibliothèque Nationale du Québec, 158.
Ashmore, M. (1988). Reducing physical restraints-ethical and legal implications. Canadian Health Care Management Supplement (Methuen Dispatch) (December).
Bernard, S. (1999). Étude descriptive de L'utilisation des contentions physiques auprès des personnes âgées hébergées en centres d'hébergement et de soins de longue durée. Mémoire de maîtrise non-publiée, Université Laval, Québec.
Bradley, L., Siddique, C. M., & Dufton, B. (1995). Reducing the use of physical restraints in long-term care facilities. Journal of Gerontological Nnursing, 21, 2134.
Bryant, H., & Fernald, L. (1997). Nursing knowledge and use of restraint alternatives: Acute and chronic care. Geriatric Nursing, 18(2), 5760.
Burton, L. C., German, P. S., Rovner, B. W., Brant, L. J., & Clark, R. D. (1992). Mental illness and the use of restraints in nursing homes [see comments]. Gerontologist, 32(2), 164170.
Cape, R. (1983). Freedom from restraint. Gerontol, 23, 217.
Charpentier, M. (1999). L'hébergement des personnes âgées à L'aube de L'an 2000: tendances et enjeux cliniques. Dans Edisem (Éd.), Autonomie et vieillissement, actes du congrès scientifique. Sherbrooke.
Chien, W. T. (2000). Use of physical restraints on hospitalized psychogeriatric patients. Journal of Psychosocial Nursing and Mental Health Services, 38(2), 1322.
Cohen, C., Neufeld, R., Dunbar, J., Pflug, L., & Breuer, B. (1996). Old problem, different approach: Alternatives to physical restraints. Journal of Gerontological Nursing, 22(2), 2329.
Cohen-Mansfield, J., & Billig, N. (1986). Agitated behaviors in the elderly. American Geriatrics Society, 34, 711721.
Collerette, P., et Delisle, G. (1982). Le changement planifié. Une approche pour intervenir dans les systèmes organisationnels. Montréal.
Cooper, C. J. (2000). Reducing the use of physical restraints in nursing homes: Regulatory harassment or good medicine? Postgraduate Medicine, 107(2), 15.
Cruz, V., Abdul-Hamid, M., & Heater, B. (1997). Researsh-based practice: Reducing restraints in an acute care setting - phase 1. Journal of Gerontological Nursing, 23(2), 3140.
Durand, P. J, Ouellet, J.P., Beauchesne, L., Tourigny, A., Verreault, R., Dicaire, L., Lévesque, L., Lauzon, S., Gagnon, R., et Rochette, L. (2000). Modifications de pratiques de soins en milieu d'hébergement: impact d'un programme d'intervention visant à réduire L'utilisation des contentions physiques. Québec: Unité de recherche en gériatrie de L'Université Laval.
Durand, P. J. (1993). Concordance entre la déclaration et L'observation de la contention physique en soins de longue durée. Mémoire de maîtrise non-publiée, Université Laval, Québec.
Ejaz, F. K., Folmar, S. J., Kaufmann, M., Rose, M. S., & Goldman, B. (1994). Restraint reduction: Can it be achieved? The Gerontologist, 34(5), 694699.
Ejaz, F. K., Rose, M. S., & Jones, J. A. (1996). Changes in attitudes toward restraints among nursing home staff and residents' families following restraint reduction. Journal of Applied Gerontology, 15(4), 433449.
Evans, L. K., & Strumpf, N. E. (1989). Tying down the elderly: A review of the literature on physical restraint. JAGS, 36, 6574.
Evans, L. K., Strumpf, N. E., AllenTaylor, S. L., Capezuti, E., Maislin, G., & Jacobsen, B. (1997). A clinical trial to reduce restraints in nursing homes. Journal of the American Geriatrics Society, 45(6), 675681.
Frank, C., Hodgetts, G., & Puxty, J. (1996). Safety and efficacy of physical restraint for the elderly. Review of the evidence. Canadian Family Physician, 42, 24022409.
Frengley, J. D., & Mion, L. C. (1986). Incidence of physical restraints on acute general medical wards. American Geriatrics Society, 34, 565568.
Gouvernement du Québec (1987). Décès par contention. Rapport d'enquête du coroner Anne-Marie David. Montréal: Bureau du coroner en chef.
Gutheil, T., & Tardiff, K. (1984). Indication and contraindication for seclusion and restraint. Washington DC: APA Press.
Hagan-Hennessy, C., McNeely, E. A., Whittington, F. J., Strasser, D. C., & Archea, C. K. (1997). Perceptions of physical restraint use and barriers to restraint reduction in a long-term care facility. Journal of Aging Studies, 11(1), 4962.
Hantikainen, V. (1998). Physical restraint: A descriptive study in Swiss nursing homes. Nursing Ethics, 5(4), 330346.
Hardin, S. B., Magee, R., Stratmann, D., Vinson, M., Owen, M., & Hyatt, E. (1994). Extended care and nursing home staff attitudes toward restraints. Journal of Gerontological Nursing, 20(3), 2331.
Hill, J., & Schirm, V. (1996). Attitudes of nursing staff toward restraint use in long-term care. Journal of Applied Gerontology, 15(3), 314324.
Janelli, L. M., Kanski, G. W., Scherer, Y. K., & Neary, M. A. (1992). Physical restraints: Practice, attitudes and knowledge among nursing staff. The Journal of Long-Term Care Administration, Summer, 2225.
Karlsson, S., Bucht, G., Eriksson, S., & Sandman, P. O. (1996). Physical restraints in geriatric care in Sweden: Prevalence and patient characteristics. JAGS, 44, 13481354.
Karlsson, S., Bucht, G., & Sandman, P. (1998). Physical restraints in geriatric care: Knowledge, attitudes and use. Scandinavian Journal of Caring Sciences, 12(1), 4856.
Katz, F., Weber, F., & Dodge, P. (1981). Patient restraint and safety vests: Minimizing the hazards. Dimensions Health Serv, 58, 10.
Koepsell, T. D., Wagner, E. H., Cheadle, A. C., Patrick, D. L., Martin, D. C., Diehr, P. H., & Perrin, E. B. (1992). Selected methodological issues in evaluating community-based health promotion and disease prevention programs. Annual Review of Public Health, 13, 3157.
Lee, D. T. F., Chan, M. C., Tam, E. P. Y., & Yeung, W. S. K. (1999). Use of physical restraints on elderly patients: An exploratory study of the perceptions of nurses in Hong Kong. Journal of Advanced Nursing, 29(1), 153159.
Levine, J. M., Marchello, V., & Totolos, E. (1995). Progress toward a restraint-free environment in a large academic nursing facility. Journal of the American Geriatrics Society, 43(8), 914918.
Lewin, L. (1951). Field theory in social science. New York.
Liukkonen, A., & Laitinen, P. (1994). Reasons for uses of physical restraint and alternatives to them in geriatric nursing: A questionnaire study among nursing staff. Journal of Advance Nursing, 19, 10821087.
Ljunggren, G., Phillips, C. D., & Sgadari, A. (1997). Comparisons of restraint use in nursing homes in eight countries. Age Aging, 26 Suppl 2, 4347.
Macpherson, D. S., Lofgren, R. P., Granieri, R., & Myllenbeck, S. (1990). Deciding to restrain medical patients. JAGS, 38, 516520.
Magee, R., Hyatt, E. C., Hardin, S. B., Stratmann, D., Vinson, M. H., & Owen, M. (1993). Use of restraints in extended care and nursing homes. Journal of Gerontological Nursing, 19(4), 3139.
Marangos-Frost, S., & Wells, D. (2000). Psychiatric nurses' thoughts and feelings about restraint use: A decision dilemma. Journal of Advanced Nursing, 31(2), 362369.
Marks, W. (1992). Physical restraints in the practice of medicine. Current concepts. Arch Inter Med, 152, 22032206.
Matthiesen, V., Lamb, K. V., McCann, J., Hollinger-Smith, L., & Walton, J. C. (1996). Hospital nurses' views about physical restraint use with older patients. Journal of Gerontological Nursing, 22(6), 816.
McHutchion, E., & Moise, J. (1989). Releasing restraints a nursing dilemma. Journal of Gerontological Nursing, 15, 1621.
Middleton, H., Keene, R. G., Johnson, C., Elkins, A. D., & Lee, A. E. (1999). Physical and pharmacologic restraints in long-term care facilities. Journal of Gerontological Nursing, 25(7), 2633.
Miller, M. (1975). Iatrogenic and nursigenic effects of prolonged immobilization of the ill aged. JAGS, 397398.
Ministère de la santé et des services sociaux (1999). Évolution des places internes du réseau en hébergement et soins de longues durée selon la région de 1991 à 1998. Gouvernement du Québec.
Mion, L., Frengley, J., & Adams, M. (1986). Nursing patients 75 years and older. Nursing Management, 17, 24.
Mion, L. C., Frengley, J. D., Jakovcic, C. A., & Marino, J. A. (1989). A further exploration of the use of physical restraints in hospitalized patients. American Geriatrics Society, 37, 949956.
Mitchell-Pederson, L., Edmund, L., & Fingerote, E. (1985). Let's untie the elderly. OAHA Quartely, 21, 10.
Moretz, C., Dommel, A., & Deluca, K. (1995). Untied: A safe alternative to restraints. Medsurgical Nursing, 4(2), 128132.
Murray, D. (1998). Design and analysis of group-randomized trials (Vol. 27). New York: Oxford University Press.
Neary, A. M., Kanski, G., Janelli, L., Scherer, Y., & North, N. (1991). Restraints as nurse's aides see them. Geriatric Nursing, July/August, 191192.
Neufeld, R. R., Libow, L. S., Foley, W., & White, H. (1995). Can physically restrained nursing-home residents be untied safely? Intervention and evaluation design. Journal of the American Geriatrics Society, 43, 12641268.
O'keeffe, S., Jack, C., & Lye, M. (1996). Use of restraints and bedrails in a British Hospital. JAGS, 44, 10861088.
Palmer, L., Abrams, F., Carter, D., & Schluter, W. W. (1999). Reducing inappropriate restraint use in Colorado's long-term care facilities. Journal on Quality Improvement, 25(2), 7894.
Phillips, C., Hawes, C., Mor, V., Fries, B., Morris, J., & Nennstiel, M. (1996). Facility and area variation affecting the use of physical restraints in nursing homes. Medical Care, 34(11), 11491162.
Powell, C., Mitchell-Pedersen, L., Fingerote, E., & Edmund, L. (1989). Freedom from restraint: Consequences of reducing physical restraints in the management of the elderly. Canadian Medical Association, 141, 561564.
Quinn, C. A. (1993). Nurses' perceptions about physical restraints. Western Journal of Nursing Research, 15(2), 148162.
Restrained in Canada-Free in Britain (Editorial) (1980). Health Care, 22, 22.
Retsas, A. P. (1997). Use of physical restraints in South Australia's nursing homes. Australian Journal on Aging, 16(4), 169173.
Retsas, A. P., & Crabbe, H. (1998). Use of physical restraints in nursing homes in New South Wales, Australia. International Journal of Nursing Studies, 35(3), 177183.
Robbins, L. J., Boyko, E., Lane, J., Cooper, D., & Jahnigen, D. W. (1987). Binding the elderly: A prospective study of the use of mechanical restraints in an acute care hospital. American Geriatrics Society, 35, 290296.
Roberge, R., et Beauséjour, R. (1988). L'usage des contentions en milieu d'hébergement pour les personnes âgées. Canadian Journal on Aging, 7, 372376.
Rubenstein, H., Miller, F., & Postel, S. (1984). Standards of medical care based on consensus rather than evidence: The case of routine bedrail use for the elderly. Law Medical Health Care, 11, 271.
Schott-Baer, D., Lusis, S., & Beauregard, K. (1995). Use of restraints changes in nurses' attitudes. Journal of Gerontological Nursing, 21(2), 3944.
Scott, T., & Gross, J. (1989). Brachial plexus injury due to vest restraints (letter). New England Journal of Medecine, 320, 598.
Stratmann, D., Vinson, M. H., Magee, R., & Hardin, S. B. (1997). The effects of research on clinical practice: The use of restraints. Applied Nursing Research, 10(1), 3943.
Strumpf, N. E., & Evans, L. K. (1988). Physical restraint of the hospitalized elderly: Perceptions of patients and nurses. Nurs Res, 37, 132137.
Sundel, M., Garret, R., & Horn, R. D. (1994). Restraint reduction in a nursing home and its impact on employee attitudes. Journal of the American Geriatrics Society, 42(4), 381387.
Tadsen, J., & Brandt, R. (1973). Rules for restraints: Hygiene and humanity. Modern Nursing Home, 30, 57.
Terpstra, T. L., Terpstra, T. L., & Doren, E. V. (1998). Reducing restraints: Where to start. The Journal of Continuing Education in Nursing, 29(1), 1016.
Tinetti, M. E. (1987). Factors associated with serious injury during falls by ambulatory nursing home residents. American Geriatrics Society, 35, 644648.
Tinetti, M. E., Liu, W. L., & Ginter, S. F. (1992). Mechanical restraint use and fall-related injuries among residents of skilled nursing facilities. Annals of Internal Medicine, 116, 369374.
Tinetti, M. E., Liu, W. L., Marottoli, R. A., & Ginter, S. F. (1991). Mechanical restraint use among residents of skilled nursing facilities: Prevalence, patterns, and predictors. Journal of the American Medical Association, 265, 468471.
Unité de recherche en gériatrie de L'Université Laval (1997). Caractéristiques des résidants, du personnel, de L'utilisation des contentions physiques et de L'environnement de travail dans les unités de soins de longue durée - Rapport aux établissements. Québec: Centre d'hébergement Saint-Augustin.
Walshe, A., & Rosen, H. (1979). A study of patient falls from bed. Journal of Nursing Administration, 9, 3135.
Warshaw, G., Moore, J., & Friedman, J. (1982). Functional disability in the hospitalized elderly. JAMA, 248, 847.
Werner, P., Cohen-Mansfield, J., Korokay, V., & Braun, J. (1994). The impact of a restraint-reduction program on nursing home residents. Geriatric Nursing, 15(3), 142146.
Wieman, H., & Obear, M. (1986). Falls and restraint use in a skilled nursing facility. JAGS, 12, 907.
Yarmesh, M., & Sheaford, M. (1984). The decision to restrain. Geriatric Nursing, 5, 242244.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed