Running Head: CONCEPT OF RESTRAINT IN NURSING HOME PRACTISE

Topic: A review of The concept of restraint in nursing home practice: a mixed-method study in
nursing homes for people with dementia
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CONCEPT OF RESTRAINT IN NURSING HOME PRACTISE

The research article selected is the concept of restraint in nursing home practice. By Sandra A.
Zwisjen. It focusses on a mixed method study in nursing homes for people with dementia.
Dementia is a general loss of brain function that occurs with certain diseases. It affects memory,
language, thinking, behavior, and judgment. In non-technical language, it is a decline in mental
ability severe enough to inhibit daily life activities.
The research problem is, understanding the different concepts of restraint as practiced in nursing
homes, more specifically, understanding how professional caregivers in nursing homes and
family members of people living with dementia perceive the concept of restraint.
The main aim or the purpose of this research is to explore and gain more insight on how both
care professionals of nursing home residents with dementia and family members of people
having dementia in the Netherlands experience and define the concept of restraint.
The method of restraint is the independent variable, as the different methods of restraint used
raised different opinions and effect on the dependent variables. The dependent variable included
both the professional caregivers of the nursing homes and the family members or relatives of the
dementia patients. The extraneous variables are the dementia patients, the dependents variables
reaction to the various restraining methods used on them may affect the study also their reaction
to the different restraints used must be taken into account.
The research questions asked included, what interventions used by the nurses were regarded as
restraints by the professional caregivers and the family members. In addition, which forms of
restraints caused them which levels of moral distress. The research hypothesis was that the
definition and understanding of the concept of restraints by professional caregivers and in

CONCEPT OF RESTRAINT IN NURSING HOME PRACTISE

nursing home cares were not only unrestricted but also ambiguous, in that the caregivers did not
fully understand the rules or regulations governing restraint use.
The nursing theory and or framework practiced by the nursing homes
The use of various physical restraints have not only led to various negative side effects but also
in some instances death. Further, nurses who use these restraints on people at times report moral
distress. This cannot only affect their ability to give patients good attention and care, but it can
also decrease their self-esteem. Attempts have been made to not only decrease but also guide the
use of restraints on patients and even alternatives methods of to using restraints are being
researched on. When trying to not only curtail the use of restraints but also find alternative
methods, it is imperative for the view of the nurses and caregivers on the concept of restraints to
be considered. The importance of this is to define clearly, where exactly restriction of freedom
and restraint differ. (Moyle, 2010)
The nursing theory and or framework practiced by the nursing homes is the practice theories,
more specifically Betty Neumanns system model framework which focusses more on the
response of the client system to either actual or potential environment stressors. It goes ahead to
advise the use of several levels of nursing prevention intervention for retaining, attaining, and
maintaining optimal client system wellness. By this, she defines; the major concern of a nurse is
preventing stress. If stress is not well prevented then the nurse should protect the patients basic
structure and find or maintain a maximum level of wellness. (Parker (2010)
The research method and design were not only sound but also valid in that the researcher used
relied more on the primary data sources than secondary data sources such as literature reviews,
further, the researcher conducted both quantitative and qualitative research to further increase the

CONCEPT OF RESTRAINT IN NURSING HOME PRACTISE

solidness of the study. The researcher used interviews, questionnaire, and focus group
discussions that involved all affected parties and hence avoided getting a biased result.
The researcher, however failed to consider the effect of these restraints to the comforts of the
patients and instead used a representative of the family to give their views on the restraining
method used. As much as a dementia patient has problems with their thinking capacity, it is
important that the researcher could have factored the effects of some of these restraints to not
only their physical comfort, but to what level they affected them. An example fixation might lead
to hurting the patient where the belts have been tired be it around the arms or the legs or the head
and also having them for a long period will have a toll on the patient by making them get tired
quickly.
The study however was able to fully resolve the question by getting the different opinions from
the caregivers and the family members; the researcher was able to prove that the different
perspectives of the different professionals caused ambiguity in the definition of the concept of
restraints. The sample size selected was representative of the population and hence feasible to
give a non-biased result. The caregivers were 278 whilst seven nursing homes participated in the
research. Nine family members were also included in the research.
The legal and ethical issues observed included the protection of the humans used by
anonymizing the participants, and informed consent to be included in the study was sought.
Further, a medical ethics governing committee approved the study protocol. In Netherlands, the
health laws do not clearly define the concepts of restriction of freedom or restraint but it only
touches on interventions that are considered as restraints. Hence, the culture of the people in this

CONCEPT OF RESTRAINT IN NURSING HOME PRACTISE

country was right for this study as it did not curtail or influence the results or did not interfere
with any of the interventions the nurses were to use
By using both qualitative and quantitative in nursing homes that used both surveillance
technology and those that used it rarely, the researchers were able to find similar results on the
perceptions and definitions of the concept of restraint. Most nurses regarded fixation (use of
belts), a tabletop on chair, geriatric chairs, and bed rails as restraints.
The research also found that these restraints, as well as the use of surveillance technology and
safety belts, were a cause of moral distress to the caregivers.
The qualitative part of the research was a three-part investigation of the presumed perception of
the resident, the intention of the care professionals and the degree of invasion of privacy
The results showed that the different people, the key people, nursing physicians, and the family
members had different views on defining the concept of restraints with some stating that as long
as it was for the benefit of the patients, it was not a restraint at all.
The results of this study may affect nursing practice as it may lead to the distinguishing of what
exactly restraint is and give guidelines in the future on the maximum standard that countries can
use.
Nursing students can apply the results of these study to not only help them whilst practicing so as
to avoid the adverse side effects of some restraining methods on them such as moral distress and
low self-esteems, but to help them provide good patient care to their clients. Further, it can help
the nursing students avoid some restraining methods that will be intruding into their clients
privacies.

CONCEPT OF RESTRAINT IN NURSING HOME PRACTISE

References
Capezuti, E., Strumpf, N. E., Evans, L. K., Grisso, J. A., & Maislin, G. (1998). The Relationship
Between Physical Restraint Removal and Falls and Injuries Among Nursing Home
Residents. The Journals of Gerontology Series A: Biological Sciences and Medical
Sciences , 53A(1), M47-M52.
Hughes, R. (2010). Rights, risk and restraint-free care of older people person-centred
approaches in health and social care. London: Jessica Kingsley Publishers.
McCormack, B. (2013). Practice development in nursing and healthcare (2nd ed.). Chichester,
West Sussex: John Wiley & Sons.
Moyle, W., Borbasi, S., Wallis, M., Olorenshaw, R., & Gracia, N. (2011). Acute care
management of older people with dementia: a qualitative perspective. Journal of
Clinical Nursing, 20(3-4), 420-428.