AUTHOR=Wang Jun , Liu Weichu , Li Xuelian , Li Luyong , Tong Jinyan , Zhao Qinghua , Xiao Mingzhao 

TITLE=Effects and implementation of a minimized physical restraint program for older adults in nursing homes: A pilot study

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.959016

DOI=10.3389/fpubh.2022.959016

ISSN=2296-2565

ABSTRACT=Purpose: Physical restraint (PR) reduction interventions are currently exploring in developed regions with well-established welfare systems, whereas, developing countries with fast population aging have not attracted enough attention. This China’s pilot study evaluated the effects of a minimized PR program on restraint reduction and nursing assistants’ knowledge, attitudes, intention, and practice toward PR, and explored nursing assistants’ experience of the program.
Patients and Methods: This was a one-group, pretest and posttest pilot trial with a nested qualitative descriptive study. A minimized PR program was obtained by summarizing best evidence and was implemented in one Chinese nursing home with 102 older adults from December 18, 2020, to March 21, 2021. An education included 3 theoretical lectures and 1 operation training was first conducted for nursing assistants one-month period. The primary outcome was PR rate at 3 months. The secondary outcomes contained duration of restraints, types of restraints, the rate of correct PR use, the incidence of falls and/or fall-related injuries, antipsychotics use at 3 months. Data on PR use and older adults’ characteristics were collected through physical restraints observation forms and older adults’ medical records. Nursing assistants’ knowledge, attitude, intention, and practice toward PR were measured using the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR at one month. A semi-structured interview for two administrative staff and a focus group discussion with 13 nursing assistants were analyzed using content analysis to explore perspectives of intervention implementation at 3 months.
Results: A significant increase in knowledge, attitude, and practice and a decrease in intention of nursing assistants after one-month educational intervention (P<0.001). Furthermore, only the rate of correct PR increased and duration of restraint in the daytime decreased significantly at 3 months (P<0.05). No significant effects on PR rate and other secondary outcomes at follow-up. Qualitatively, nursing assistants demonstrated overtly supportive perspectives and that assistance from the program enhanced their knowledge and practice. They noted several challenges that impeded implementation. 
Conclusions: The intervention has acknowledged some benefits and was valued by nursing assistants. Implementation barriers should be addressed before delivering in larger trials.