The use of physical restraint in institutional care of older people in Finland: nurses' individual, communal and alternative modes of action.

摘要

AIMS AND OBJECTIVES: The aim of the study was to map nursing staff's individual, communal and alternative modes of action in situations where they used physical restraint of older people in Finland. BACKGROUND: The use of physical restraint in institutional care of older people involves modes of action that are linked to the personalities and modes of operation of individual nurses or to communal modes of operation mutually agreed on in the workplace. Nurse's individual modes of operation are linked to consideration towards older people when using physical restraint. Communal modes of operation include joint discussion among nurses, decision-making and written guidelines concerning the use of physical restraint. DESIGN: A quantitative survey. METHODS: The data were collected from nurses (n = 1148) working in healthcare centre wards, municipal and private nursing homes in Finland using a structured questionnaire (response rate 78%). RESULTS: Older nurses and those with the longest working experience were most active in using individual modes of operation in situations where physical restraint was applied. Nurses' participation in continuing education in care of older people increased the use of both individual and alternative modes of action. The alternative modes of action were one that understands the older person and one that focuses on negotiation. The use of physical restraint was often discussed in the workplace during information sessions or during work, but only 33% had written guidelines on the use of physical restraint. CONCLUSIONS: Education can be used to increase nurses' ability to use alternative modes of action and thus decrease the use of physical restraint in institutional care of older people. Nursing management has a key role in making sure that units caring for older people receive written guidelines on the use of physical restraint. RELEVANCE TO CLINICAL PRACTICE: Locums especially need more education to avoid the use of physical restraint.