Effects of a restraint minimization program on staff knowledge, attitudes, and practice: a cluster randomized trial.

OBJECTIVES

To evaluate the effects of a restraint minimization education program on staff knowledge and attitudes and use of physical restraints.

DESIGN

Cluster-randomized controlled trial with nursing units as the basis for randomization.

SETTING

Forty group dwelling units for people with dementia.

PARTICIPANTS

At baseline, there were 184 staff and 191 residents in the intervention group and 162 staff and 162 residents in the control group. At the 6-month follow-up, there were 156 staff and 185 residents (36 newly admitted) in the intervention group and 133 staff and 165 residents (26 newly admitted) in the control group.

INTERVENTION

A 6-month education program for all nursing staff.

MEASUREMENTS

Staff knowledge and attitudes and physical restraint use were measured before and after the education program.

RESULTS

In the intervention group, staff knowledge about and attitudes toward restraint use changed, and the overall use of physical restraints decreased. A comparison including only residents present during the whole study period showed that the level of use was similar between the groups at baseline, whereas it was significantly lower in the intervention group at follow-up. Adjusted analyses showed that the odds of being restrained at follow-up were lower in the intervention group than in the control group. There was no significant change in the number of falls or use of psychoactive medication.

CONCLUSION

The results indicate that staff education can increase knowledge, change attitudes, and reduce the use of physical restraints without any change in the incidence of falls or use of psychoactive drugs.