Huizing Anna R, Hamers Jan P H, Gulpers Math J M, Berger Martijn P F
Department of Health Care Studies, Section of Nursing Science, Maastricht University, Maastricht, The Netherlands.
BMC Geriatr. 2006 Oct 26;6:17. doi: 10.1186/1471-2318-6-17.
Physical restraints are still frequently used in nursing home residents despite growing evidence for the ineffectiveness and negative consequences of these methods. Therefore, reduction in the use of physical restraints in psycho-geriatric nursing home residents is very important. The aim of this study was to investigate the short-term effects of an educational intervention on the use of physical restraints in psycho-geriatric nursing home residents.
A cluster randomized trial was applied to 5 psycho-geriatric nursing home wards (n = 167 residents with dementia). The wards were assigned at random to either educational intervention (3 wards) or control status (2 wards). The restraint status was observed and residents' characteristics, such as cognitive status, were determined by using the Minimum Data Set (MDS) at baseline and 1 month after intervention.
Restraint use did not change significantly over time in the experimental group (55%-56%), compared to a significant increased use (P < 0.05) in the control group (56%-70%). The mean restraint intensity and mean multiple restraint use in residents increased in the control group but no changes were shown in the experimental group. Logistic regression analysis showed that residents in the control group were more likely to experience increased restraint use than residents in the experimental group.
An educational programme for nurses combined with consultation with a nurse specialist did not decrease the use of physical restraints in psycho-geriatric nursing home residents in the short term. However, the residents in the control group experienced more restraint use during the study period compared to the residents in the experimental group. Whether the intervention will reduce restraint use in the long term could not be inferred from these results. Further research is necessary to gain insight into the long-term effects of this educational intervention.
尽管越来越多的证据表明身体约束措施无效且会带来负面后果，但养老院居民中仍频繁使用此类措施。因此，减少老年精神科养老院居民身体约束措施的使用非常重要。本研究旨在调查教育干预对老年精神科养老院居民身体约束措施使用的短期影响。
对5个老年精神科养老院病房（共167名痴呆症患者）进行整群随机试验。病房被随机分为教育干预组（3个病房）和对照组（2个病房）。在基线和干预后1个月观察约束措施的使用情况，并使用最小数据集（MDS）确定居民的特征，如认知状态。
与对照组（56%-70%）显著增加的使用情况（P<0.05）相比，实验组（55%-56%）的约束措施使用随时间未发生显著变化。对照组居民的平均约束强度和平均多次约束使用情况增加，而实验组未显示出变化。逻辑回归分析表明，与实验组居民相比，对照组居民更有可能增加约束措施的使用。
针对护士的教育计划结合与专科护士的会诊在短期内并未减少老年精神科养老院居民身体约束措施的使用。然而，与实验组居民相比，对照组居民在研究期间经历了更多的约束措施使用。从这些结果无法推断该干预措施是否会长期减少约束措施的使用。有必要进行进一步研究以深入了解该教育干预的长期效果。
