The relationship between physical restraint removal and fall-related incidents and injuries among nursing home residents / Elizabeth Capezuti.

Format:

Book

Manuscript

Microformat

Thesis/Dissertation

Author/Creator:

Capezuti, Elizabeth.

Contributor:

Strumpf, Neville, advisor.

University of Pennsylvania.

Language:

English

Subjects (All):

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Nursing.

Academic Dissertations as Topic.

Medical Subjects:

Nursing.

Academic Dissertations as Topic.

Local Subjects:

Penn dissertations--Nursing.

Nursing--Penn dissertations.

Physical Description:

x, 184 leaves ; 29 cm

Production:

1995.

Summary:

Despite growing empirical evidence that use of physical restraints produces more problems than it solves, American nurses continue to act on the belief that physical restraints are an effective strategy for preventing falls and injuries in elders. Evidence that restraint reduction does not lead to a significant increase in falls and injuries is crucial to changing the practice of prolonged physical restraint. This study was a secondary analysis of data collected in a clinical trial which tested interventions meant to reduce restraint use. The study employed two different designs to test the relationship between restraint reduction and falls/injuries. First, multiple logistic regression was used to compare subjects who had their restraints removed ($n$ = 38) to those who continued to be restrained ($n$ = 88) while holding constant multiple potential confounding variables. Second, survival analysis was employed to assess the effect of several independent variables on fall/injury rates in subjects ($N$ = 633) of three nursing homes which underwent varying degrees of restraint reduction. The main effect of restraint removal in the multiple logistic regression was to lower fall risk, although the decrease was not significant (adjusted odds ratio: 0.8, 95% CI: 0.2, 2.5; p =.66). Restraint removal, however, significantly decreased the chance of fall-related minor injury (adjusted odds ratio: 0.3, 95% CI: 0.1, 0.9; P $<$.05) and seven of the eight serious injuries sustained were among residents who remained restrained. The survival analysis demonstrated that the nursing home which averaged an 11% restraint reduction had a 50% higher rate of falls (p $<$.01) and more than twice the rate of fall-related minor injuries (p $<$.001) when compared to the homes with 23% and 56% average restraint reduction. Subjects in the home which underwent the most restraint reduction (mean = 56%) experienced the lowest number of fall-related serious injuries. The study's key conclusion is that physical restraint removal/reduction does not lead to increases in falls or fall-related injuries in older nursing home residents.

Notes:

Supervisor: Neville Strumpf.

Thesis (Ph.D. in Nursing) -- Graduate School of Arts and Sciences, University of Pennsylvania, 1995.

Includes bibliographical references.

Local Notes:

University Microfilms order no.: 95-32149

OCLC:

187452800