Clinical Practice Question | No. | Recommendations | GRADE |
---|---|---|---|
1. What is meant by physical restraint use in home care? | 1. | A definition of physical restraint should be used in home care. The following definition is suggested: as ‘Physical restraint is any device, material or equipment, attached to or near a person’s body and which cannot be controlled or easily removed by the person and which (is) deliberately (intended to) prevent(s) a person’s free body movement to a position of choice and\or a person’s normal access to their body’ (Retsas, 1998). (e.g. bedrails, bed-against-the-wall (positioned in a way that the person will not fall out of bed), locked room or house doors, deep chair that prevents rising and restrictive clotting and belts). | 1 C |
2. | Healthcare providers should be aware that the application of any measure that limits free movement of the patient, regardless of its purpose, is a form of restraints. | 1 C | |
2. What factors affect the probability of physical restraint use in home care? | 3. | Healthcare providers should take the complex set of risk factors into account that affect the probability of physical restraint use in home care: | 1 B |
- personal (e.g., poor mobility) and contextual factors | |||
- knowledge and attitudes of healthcare providers | |||
- culture of home care organisation | |||
- legislation | |||
3. What are the consequences and the impact of physical restraint use in home care? | 4. | The use of physical restraints should be avoided as much as possible due to the negative physical and psychosocial consequences for the patient. | 1 A |
5. | Healthcare providers should be aware of the negative impact of physical restraints on the informal caregiver and should pay attention to support them. | 1 C | |
6. | Healthcare organizations should be aware of the impact of using physical restraints on the involved healthcare providers. | 1 B | |
4. What ethical and legal framework can support healthcare providers in decisions about the use of physical restraint in home care? | 7. | Consider carefully the different values, norms and reasons in the context of humane care. | 1 C |
8. | Physical restraints may only be used as a last resort and exception. A clear reporting of the careful decision-making process in the patient record is necessary. | 1 * | |
* No strength of evidence because it is based on legal texts | |||
5. How can healthcare workers reduce physical restraint use in home care? | 9. | Healthcare providers should reduce restraint use in home care. The following elements should be considered: | 1 B |
1. Gain insight into personal and contextual factors: thorough assessment | |||
2, Collaborate with interdisciplinary team (including patient and family) and take personal responsibility. | |||
3. Communicatie proactively and transparently with all involved persons. | |||
4. Develop a care plan with the involved persons (formal and informal caregivers) to determine the aims and preventive actions. | |||
6. What steps and persons need to be involved in the decision-making process regarding and the application of physical restraints in home care? (see flowchart Fig. 1) | 10. | A successful decision-making process to reduce physical restraints in home care should consists of the following components: | 1 C |
- carefully and consciously dealing with situations where means of physical restraints are considered, requested or already used; | |||
- taking the preferences of the patient into account; | |||
- involving the patient and the family and all other involved healthcare providers from the beginning of the process. | |||
Physical restraint is a last resort and should only be used after first considering alternatives, over a short period of time, with careful supervision and with materials that are in proportion to the patient’s behaviour. |