Despite lack of evidence for the efficacy of physical restraints with the elderly, little systematic research and no clinical trials in nursing homes have tested interventions aimed at decreasing their use. Therefore, the purpose of this prospective, controlled study is to: 1) Investigate the relative effects of two experimental interventions, restraint education and restraint education-with- consultation, on the use of physical restraints in nursing homes; 2) Examine the relative effects of these interventions on resident outcomes (functional, cognitive, affective, health, and care plans) and staff outcomes (burnout, employment stability, beliefs about restraint efficacy and knowledge of alternatives); and 3) Test the relationship between nursing hours or serious resident injuries and restraint use. A quasi-experimental, potentially nonequivalent control group design will be employed to compare three nursing homes which have been randomly assigned to one of three treatments. A minimum of 375 residents over age 60 and 156 clinical staff in three nursing homes will comprise the two subsamples. Intervention I, Restraint Education, consists of 10, 45-60 minute programs taught over a six month period to increase staff knowledge regarding physical restraint use and comprehensive assessment and management of problematic behaviors. Intervention II, Restraint Education-with-Consultation, consists of an identical program of Restraint Education supplemented by 12 hours per week of direct consultation to staff. A master's prepared gerontologic nurse specialist will implement the two experimental interventions. Intervention III, Control, consists of neither Restraint Education nor Restraint Education-with Consultation. Resident and staff subjects will be measured in two preliminary observations spaced three months apart; again immediately prior to and immediately following the interventions; and at 3 months and 6 months post-intervention to observe both immediate and sustained intervention effects. The design for hypothesis testing includes repeated measures, cross-sectional, and correlational analyses.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Nursing Research Study Section (NURS)
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University of Pennsylvania
Schools of Nursing
United States
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Bourbonniere, Meg; Strumpf, Neville E; Evans, Lois K et al. (2003) Organizational characteristics and restraint use for hospitalized nursing home residents. J Am Geriatr Soc 51:1079-84
Talerico, Karen Amann; Evans, Lois K; Strumpf, Neville E (2002) Mental health correlates of aggression in nursing home residents with dementia. Gerontologist 42:169-77
Happ, Mary Beth; Capezuti, Elizabeth; Strumpf, Neville E et al. (2002) Advance care planning and end-of-life care for hospitalized nursing home residents. J Am Geriatr Soc 50:829-35
Sullivan-Marx, E M; Strumpf, N E; Evans, L K et al. (1999) Predictors of continued physical restraint use in nursing home residents following restraint reduction efforts. J Am Geriatr Soc 47:342-8
Sullivan-Marx, E M; Strumpf, N E; Evans, L K et al. (1999) Initiation of physical restraint in nursing home residents following restraint reduction efforts. Res Nurs Health 22:369-79
Capezuti, E; Strumpf, N E; Evans, L K et al. (1998) The relationship between physical restraint removal and falls and injuries among nursing home residents. J Gerontol A Biol Sci Med Sci 53:M47-52
Siegler, E L; Capezuti, E; Maislin, G et al. (1997) Effects of a restraint reduction intervention and OBRA '87 regulations on psychoactive drug use in nursing homes. J Am Geriatr Soc 45:791-6
Evans, L K; Strumpf, N E; Allen-Taylor, S L et al. (1997) A clinical trial to reduce restraints in nursing homes. J Am Geriatr Soc 45:675-81
Patterson, J E; Strumpf, N E; Evans, L K (1995) Nursing consultation to reduce restraints in a nursing home. Clin Nurse Spec 9:231-5
Kolanowski, A; Hurwitz, S; Taylor, L A et al. (1994) Contextual factors associated with disturbing behaviors in institutionalized elders. Nurs Res 43:73-9