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A Longitudinal Evaluation of Restraint Reduction within a Multi-site, Multi-model Canadian Continuing Care Organization*

Published online by Cambridge University Press:  31 March 2010

Doris L. Milke ,
T. Scott Kendall ,
Iris Neumann ,
Connie F. Wark  and
Alana Knopp
Doris L. Milke*
Affiliation:
CapitalCare, Edmonton, AB University of Alberta
T. Scott Kendall
Affiliation:
CapitalCare, Edmonton, AB
Iris Neumann
Affiliation:
CapitalCare, Edmonton, AB
Connie F. Wark
Affiliation:
CapitalCare, Edmonton, AB
Alana Knopp
Affiliation:
CapitalCare, Edmonton, AB
*
Requests for offprints should be sent to:/Les demandes de tirés-à-part doivent être adressées à: Doris L. Milke, Ph.D., Senior Researcher, CapitalCare, Adjunct Associate Professor, Faculty of Rehabilitation Medicine, Department of Psychology, and Faculty of Nursing, University of Alberta, McConnell Place North, 9113 144 Avenue, Edmonton, AB T5E 6K2, (dorismilke@capitalcare.net)
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Abstract

While American literature on sustaining restraint reduction is relatively robust, there is a lack of research published on the same issue in Canadian continuing care (CC) settings. Statistics from Canada's largest publicly funded and operated CC organization have revealed telling patterns in mechanical restraint use. Over a 4-year study period during a campaign to reduce mechanical restraint use, the organizational prevalence dropped from 24.68 per cent to 16.01 per cent. There was substantial variability in restraint prevalence among the organization's 11 centres (range: 0–39.86% of residents restrained) and all but 1 was able to achieve mechanical restraint reduction. Specific facilitators to achieving and sustaining restraint reduction are identified, including small facility size, provision of specialized care (e.g., Alzheimer's disease), and an on-site champion. Specific barriers, such as large facility size and an off-site champion are also discussed.

Résumé

Bien que la documentation américaine sur la réduction de l'usage des moyens de contention soit relativement importante, les travaux de recherche publiés sur cette même question sont moins nombreux sur les pensionnaires d'un établissement canadien de soins de longue durée. Les statistiques des plus importants établissements de ce type financés et exploités au Canada ont mis au jour des attitudes révélatrices envers les moyens mécaniques de contention. Durant les quatre années d'une étude comportant une campagne visant à réduire l'utilisation de moyens mécaniques de contention, la prévalence organisationnelle est passée de 24,68 % à 16,01 %. Il existait une variabilité substantielle en matière de contention parmi les 11 centres de l'organisation (échelle de 0 à 39,86 % des pensionnaires faisant l'objet de contention) et tous sauf un ont pu réduire la contention mécanique. Des facilitateurs particuliers à la réalisation et au maintien de la réduction de la contention sont indiqués, notamment les établissements de petite taille, la fourniture de soins spécialisés (par ex., maladie d'Alzheimer), et un «champion» résidant sur place. Des obstacles particuliers, comme la grande taille d'un établissement et un champion résidant à l'extérieur font aussi l'objet de discussion.

Keywords

vieillissementagingcontinuing caremechanical restraintslong-term carerestraint reductionphysical restraints
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 27 , Issue 1 , Spring/Printemps 2008 , pp. 35 - 43
Copyright
Copyright © Canadian Association on Gerontology 2008

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Footnotes

*

The authors would like to thank the following people for their involvement in this project's data collection and analysis: Susan Rosenkranz, G. Peggy McFall, and Stacy Greening. In addition, the authors would like to thank three anonymous reviewers for their constructive comments on the draft manuscript.

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