Restraint in the Elderly

Restraining the Elderly

Project Management

The Project Management path for this research proposal will follow the path of quantitative research in a 'quasi-experimental' environment. Adhering as closely as possible to quantitative experiments designed to establish the causal factors or interdependent links between grouped variables, the researcher will follow a natural course of progression in administering dependent and independent variables, designing the sampling set, determining the optimal time(s) and location(s) for conducting the research, developing the measures and instruments necessary for evaluation of non-empirical evidentiary conclusion (i.e., the thought processes and reasoning of medical staff), measuring the response to education and procedural methodology, documentation to include evaluation materials, response forms, and restraint logs, preparing the education program, delivering the lectures, and evaluating the results in change or lack of change in care providers attitudes toward patient restraint.

Project Limitations

Any project that measures the process of learning, comprehension, acceptance or denial, and implementation has inherent limitations. Human variables such as attendance at scheduled lectures, attention to content, understanding or the demonstration of non-understanding in the classroom, full participation, attendee focus, pre-determined opinions, biases, tradition, and workplace procedures can affect the outcome of the results. Direct research, test, and application is not easily done with this process as the patient is ultimately the one to approve or disapprove the process of restraint; measuring full capability to provide this consent is a decided limitation which could violate the human ethic of individual patients. Lastly, the project may be limited if the medical professionals in the study choose to refrain from modifying their behavior over a long period of time; demonstrable change and internalized change are different issues requiring an entirely different study.

Data Analysis

Sampling

Many extraneous variables must be considered when determining the participants in a study of this nature; for example, age could play a vital factor in determining some of the reasons for routine restraint. Educational levels, tenure with a facility, status or rank within the organization, and other factors must all be considered. To avoid a biased selection criteria, sampling will be done on a random basis. Smaller sampling sizes will provide efficiency in collecting and evaluating data.

Measures and Instrumentation

Two separate questionnaires (PRUQ and RALT) will be used to measure the random RN sampling for their unique understandings on the reasons for using restraints, the staff perceptions on the reasons to use alternatives to restraint, and the staff's knowledge of the use and methods for use of alternatives to restraints. A restraint log will be implemented to measure the prevalence of restraint usage throughout the hospital.

The Restraint Education Program

Developed by Strumpf and Collages, the education program offered during this study is to be adapted from their educational product. For the convenience and requirements of staffing needs, the education program will be offered in one and two hour sessions.

Baseline Data Collection (Phase One)

Baseline data will be collected from the hospital one month prior to the onset of the restraint education program. Each nurse randomly selected to participate will be asked to fill out a perception of restraint use questionnaire (PRUQ) and a reasons for using alternatives questionnaire (RALT). Each nurse will be instructed to maintain a restraint log at this time.

Educational Program (Phase Two)

Ten restraint education sessions will be provided over a course of ten weeks time. Each session will last no longer than an hour to accommodate patient and staffing needs. Interim measurements will be taken throughout this class time, such as evaluation forms, pre and post assessments, and so on.

Evaluation Data Collection (Phase Three)

Each participant will be asked to fill out the RALT and PRUQ questionnaires again and additional evaluation data are collected at this time.

Review and Data Collection Three Months Following Classes (Phase Four)

Each participant will again be asked to fill out the RALT and PRUQ questionnaires and the restraint logs will be collected at this time.

Review and Data Collection Six Months Following Classes (Phase Five)

Each participant will again be asked to fill out the RALT and PRUQ questionnaires and the restraint logs will be collected at this time.

The Restraint Log

The restraint log will be used consistently to measure and monitor the use of any form of restraint at the site of the study (i.e., the hospital). One will be filled out for each phase of the study and one nurse participating in the study will maintain the log by making appropriate entries daily.

Data Analysis Summary

Careful and meticulous collection of accumulating data will be paramount to successful measurement and analysis of the efficacy of the program. Due to the condition of inherent and uncontrollable variables (e.g., human element, historical perspective ((we've always done it this way)), perception of the ethicality involved in human restraint, and so on) what empirical data that can be collected will be vital to the research results and final evaluation.

A measure of response anonymity will be included to encourage an honest and accurate data sampling.

Conclusion

This study will contribute to the body of knowledge pertaining to the prevalence and acceptance of restraint usage with senior and disabled adults. Whether physical (i.e., bindings or restraints), implied (i.e., barrier placement, apparel selection), or pharmacological (i.e., sedatives, relaxants), restraint usage remains a tool in nursing arsenals around the world.

From very subtle inference to blatant usage, people are often subjected to restraint in its many forms without their informed consent. Accordingly, the use of restraints carries numerous implications for the medical provider - legal, ethical, moral, accountability... The list winds on and on.