The Prevalence and Correlates of the Use of Restraint and Force in Older Hospital Patients: A Study of Nurses and Nursing Assistants in Hong Kong.

Abstract

Aims. This study examined the prevalence and correlates of the use of restraint and force in care for older people in the hospital setting in Hong Kong.

Background. The use of restraint and force is common in care for older people. Although some knowledge exists on the potential consequences and characteristics of patients where restraint is used, little is known about the profiles of the nursing staff administering restraint.

Design. Descriptive cross-sectional study.

Method. Data were collected in 2006. A total of 187 nursing staff provided information on their demographic characteristics, coworker emotional support, burnout symptoms, attitudes toward patients with dementia, as well as their perceptions of the use of restraint and force in care for older people and their experiences with it.

Results. More than two-thirds (73·8%) of the participants reported using restraint or force in the past three months, with physical restraint endorsed by 69%, the use of force in examination or treatment endorsed by 48·1% and the use of force in activities of daily living endorsed by 46·5% of the participants. Pearson correlation analysis results show that use of physical restraint was negatively correlated with the age of participants (r = −0·44, p<0·01) and coworker emotional support (r = −0·20, p<0·05), but positively correlated with emotional exhaustion (r = 0·21, p<0·01). Use of force in examination or treatment and in relation to activities of daily living was negatively correlated with the age of participants (r = −0·32 & −0·18, p<0·01 & 0·05), but positively correlated with emotional exhaustion (r = 0·16 & 0·15, p<0·05) and lack of personal achievement (r = 0·18 & 0·19, p<0·05). Years of experience in dementia care, training in dementia care, attitudes toward people with dementia and perception of the use of restraint were not related to the use of physical restraint or force (p > 0·05).

Conclusion. The use of restraint and force is common among nurses in hospital medical wards in Hong Kong. To reduce restraint use in patient care, steps need to be taken to mitigate feelings of burnout and to foster sense of social support among nurses.

Relevance to clinical practice. The hospital administration can take a leading role in restraint reduction by setting standards of care and by formulating institutional policy regarding the use of restraint or force.