This study is a clinical decision analysis of management strategies aimed at reducing the risk of falling among elderly patients in a nursing home or nonpsychiatric hospital. Physical restraint is a common but increasingly controversial practice in the United States. Currently, intervention recommendations are typically based on anecdotal evidence and nurses are often divided as either proponents or opponents to use of physical restraints. Due to ethical and feasibility concerns, randomized controlled trials will not resolve the controversy surrounding this clinical problem. a clinical decision analysis is suitable because it is a method to formulate and quantitatively evaluate conflicting styles of care. To assess the physical restraint issue related to patient falls, three specific phases are proposed: (1) to convene a panel of national experts to form a consensus opinion on probabilities needed to quantitate and evaluate the decision analysis, (2) to assess nurses' and elderly patients's preferences of the potential outcome health states resulting from falling and the nursing approaches to prevent falls, and (3) to conduct a formal decision analysis on physical restraint versus alternative nursing management for preventing a fall from the prespectives of nurses and elderly patients in both the nursing home and general hospital settings. Seven registered nurses, nationally recognized and published in the area of gerontological nursing care, have agreed to participate in a modified- Delphi process for expert consensus opinion that will fill=gaps in the medical and nursing literature. Nurses (N=126) and elderly patients (N=126) will be recuited from the nirsing home and general hospital settings. After obtaining verbal consent, each patients will be aksed to complete short demographic questionnaire and to answer questions regarding prior experience with physical restraint and falls. The participants will be asked to rank order their preferences for 26 scenarios of health outcomes, representing combinations of health outcomes that are consequences of the management approach and/or consequences of falls. Evaluation of the clinical decision analysis will result in favoring one management strategy over the other in relation to the likelihood of health outcomes and the trade-offs among health outcome preferences. From an individual perspective, separate decision analyses will be conducted using each nurses's and elderly patient's direct rankings. The societal perspective will be examined using preference values derived from conjoint analysis. The results of these decision analyses will: (1) provide insight into the complex and difficult nursing decision, whether or not to restrain an elderly patient at risk of falling, and (2) help guide policy regarding use of physical restraints in the nursing home and general hospital setting.
