Reduction of physical restraints on patients during hospitalisation/rehabilitation : a clinical trial

Background. This study reports on the experience and insights of a clinical trial to reduce physical restraints on patients during hospitalisation/rehabilitation. Staff education and management input were the key components of the restraint reduction programme. Methods. This study involved one control hospital, one intervention hospital, and a school of nursing. The restraint reduction programme consisted of staff education and setting up of a restraint reduction committee. A stepwise cyclical model of identifying goals and obstacles, determining strategies, and evaluating outcomes was used. A number of alternatives to the use of restraints were introduced to the staff, and family involvement was encouraged. Interviews were conducted before and after intervention using a physical restraint questionnaire to examine any change in staff knowledge, attitudes, and behaviours on physical restraints. The restraint and fall rates before and after intervention were also compared. Results. This intervention succeeded in bringing about positive changes in the use of restraints, as the staff tended to use less restrictive measures when applying restraints, although the restraint rates remained unchanged. Implementation of the project was beset by numerous challenges. The threat from severe acute respiratory syndrome, the dynamics of human relationships in a bureaucratic organisation, territorial issues among professional disciplines, and interactions with the broader environment of health service manpower and provision limited the research team's control over the way the study was conducted, and the staff became generally frustrated with the project. Conclusion. When embarking on a project of this type, the interests of multiple stakeholders need to be balanced, and personal, professional, and inter-disciplinary dynamics should be considered. Cultivating hospital management and its staff a sense of ownership over a project is important for a project to succeed. Restraint reduction projects should be initiated by health care facilities.School of Nursin