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Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway

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  • Christine Øye
  • Frode Fadnes Jacobsen
  • Tone Elin Mekki

Abstract

Aims and objectives To investigate (1) what kind of restraint is used in three nursing homes in Norway and (2) how staff use restraint under what organisational conditions. Background Restraint use in residents living with dementia in nursing homes is controversial, and at odds with fundamental human rights. Restraint is a matter of hindering residents’ free movement and will by applying either interactional, physical, medical, surveillance or environmental restraint. Previous research has identified use of restraint related to individual resident characteristics such as agitation, aggressiveness and wandering. Design This model is embedded in an overall mixed‐method education intervention design study called Modelling and evaluating evidence‐based continuing education program in dementia care (MEDCED), applying ethnography postintervention to examine the use of restraint in 24 nursing homes in Norway. Method Based on restraint diversity measured in the trial, ethnographic investigation was carried out in three different nursing homes in Norway over a 10‐month period to examine restraint use in relation to organisational constraints. Results Several forms of restraint were observed; among them, interactional restraint was used most frequently. We identified that use of restraint relates to the characteristics of individual residents, such as agitation, aggressiveness and wandering. However, restraint use should also be explained in relation to organisational conditions such as resident mix, staff culture and available human resources. Conclusion A fluctuating and dynamic interplay between different individual and contextual factors determines whether restraint is used – or not in particular situations with residents living with dementia. Relevance to clinical practice Educational initiatives targeting staff to reduce restraint must be sensitive towards fluctuating organisational constraints.

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  • Christine Øye & Frode Fadnes Jacobsen & Tone Elin Mekki, 2017. "Do organisational constraints explain the use of restraint? A comparative ethnographic study from three nursing homes in Norway," Journal of Clinical Nursing, John Wiley & Sons, vol. 26(13-14), pages 1906-1916, July.
    • Handle: RePEc:wly:jocnur:v:26:y:2017:i:13-14:p:1906-1916
    DOI: 10.1111/jocn.13504
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    References listed on IDEAS

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    1. Huizing, Anna R. & Hamers, Jan P.H. & de Jonge, Jan & Candel, Math & Berger, Martijn P.F., 2007. "Organisational determinants of the use of physical restraints: A multilevel approach," Social Science & Medicine, Elsevier, vol. 65(5), pages 924-933, September.
    2. Reetta Saarnio & Arja Isola, 2010. "Nursing staff perceptions of the use of physical restraint in institutional care of older people in Finland," Journal of Clinical Nursing, John Wiley & Sons, vol. 19(21‐22), pages 3197-3207, November.
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    1. Lauren M. Robins & Den-Ching A. Lee & J Simon Bell & Velandai Srikanth & Ralph Möhler & Keith D. Hill & Terry P. Haines, 2021. "Definition and Measurement of Physical and Chemical Restraint in Long-Term Care: A Systematic Review," IJERPH, MDPI, vol. 18(7), pages 1-20, March.
    2. Alba Carrero-Planells & Ana Urrutia-Beaskoa & Cristina Moreno-Mulet, 2021. "The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol," IJERPH, MDPI, vol. 18(14), pages 1-11, July.
    3. Elisa Ambrosi & Martina Debiasi & Jessica Longhini & Lorenzo Giori & Luisa Saiani & Elisabetta Mezzalira & Federica Canzan, 2021. "Variation of the Occurrence of Physical Restraint Use in the Long-Term Care: A Scoping Review," IJERPH, MDPI, vol. 18(22), pages 1-11, November.

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