IJCNMH ARCpublishing

Issue: Issue 5 – 2018


Persisting use of physical restraint: Knowledge Translation vs. Attitudes

Nicole Walker, Theresa Scott, Nadeeka N. Dissanayaka, Fiona Kate Barlow, and Nancy A. Pachana
Physical restraint in residential aged care (RAC) 
The use of physical restraint in residential aged care (RAC) is relatively common [1]. Existing research suggests that the proportion of residents physically restrained in RAC facilities ranges from 12% to 47% [2]. The last two decades have seen much research discussing both the potential benefits and adverse consequences of physical restraint [3]. While at a global level, there are distinctive factors that determine both the prevalence and justification for employing physical restraint on a case by case basis rather than an umbrella explanation [4], the prevalence of physical restraint use in RAC is concerning. If knowledge about the negative impact on quality of care and quality of life could be presumed to decrease the use of physical restraint in RAC, then additional factors could also be presumed to be simultaneously (and strongly) promoting the use of physical restraint. In this paper, in the moment affective processes (e.g., emotions, negative attitudes) are suggested as one such likely factor, potentially overriding knowledge-based interventions and thus maintaining the use of physical restraint. Specifically, negative attitudes towards residents residing in RAC may exist in many populations, and these, in addition to the unique environment associated with working in RAC (including high levels of one on one care, frailty and decrease mobility), perhaps promotes behaviour that is driven by affect, rather than knowledge. Multiple studies reveal that physical restraint harms residents [2]. In particular, serious injury and mortality are often directly related to both proper and improper use (selection and application) of physical restraint on residents [1], and physical restraint is likewise associated with reduced psychological well-being, and mobility [2]. Further, residents who are managed via physical restraint exhibit rapid cognitive decline compared to those who are not restrained [2, 5]. Despite this evidence, physical restraint is frequently referenced as a protective measure [6]. For example, it is argued that physical restraint reduces the risk of personal injury to residents and employees [2], controls wandering, and facilitates medical treatment [7, 8]. However, the literature suggests that such justifications are not evidence-based and in fact are not supported by the data [8, 9]. (Continues)

International Journal of Clinical Neurosciences and Mental Health 2018; 5:1
DOI: https://doi.org/10.21035/ijcnmh.2018.5.1
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