Judith Braun

Physical restraints and agitation in nursing home residents.

An observational study was performed to determine whether the use of physical restraints in agitated nursing home residents leads to decreased or increased agitation. Results indicate that restraint use does not decrease agitation in nursing home residents. Residents exhibited either the same amount or more agitated behaviors when they were restrained than when they were not restrained, suggesting that the act of restraining may itself contribute to manifestations of agitation. The implications of the use of restraints in agitated nursing home residents are discussed, with particular reference to the prevention of falls.

Individualized Care Alternatives Used in the Process of Removing Physical Restraints in the Nursing Home

To describe the individualized care alternatives used during the process of removing physical restraints in a nursing home.

REDUCING RESTRAINTS: Impact on Staff Attitudes

1. Changing the practice of using physical restraints must include nursing staff members as one of the main targets for change. 2. Following education and the implementation of a restraint-reduction program, 58% of the nursing staff participants found restraint use to be less important in caring for the elderly. Changes were more significant, however, immediately after the mandatory inservice program. 3. Nursing staff members whose perceptions changed tended to be registered nurses or licensed practical nurses who had more years of experience and more seniority at work. 4. The provision of ongoing education to nursing staff members is a necessary step to decrease feelings of frustration and stress and to assist the staff in being aware of alternatives to restraints.

Maintaining ambulation in the frail nursing home resident: a nursing administered walking program.

This article describes a walking program that was implemented at a 550-bed long-term care facility. The program was developed in order to promote functional mobility in the frail nursing home population. The aim of the program is to establish a nursing procedure that focuses on the individual residents need to walk, and to improve or maintain the ambulatory status of the frail elderly. Twenty nursing home residents from the first three units on which the program was implemented were evaluated before and after the implementation of the program. The data show that the participants improved their ambulatory status after participating in the walking program. This improvement was accompanied by a decrease in the proportion of residents falling.

Description of a Program for Psychiatric Consultations in the Nursing Home

The authors describe a psychiatric consultation program ad-ministered by a geropsychiatric clinical nurse specialist in a nursing home and present data on its effectiveness. Residents referred for psychiatric consultation were similar with regard to demographic characteristics, but were more cognitively intact. The most common reasons for referral were depressive symptoms, agitated behavior, and perceptual distortions. Interventions involving medication were the most frequently used, followed by relocating the resident, staff interventions, and psychotherapy. Treatments that involved moving the resident were rated as less effective. Overall, significant improvement was noted in slightly more than half of all residents referred for psychiatric consultation.

Facilitating Clinician-Initiated Research: A Program of a Research Institute Based in a Nursing Home

This article describes the processes, scope, strengths, and weaknesses involved in the development of a program aimed at facilitating clinician-initiated research in a nursing home. The benefits such a program provides to clinicians, residents, researchers, and the institution are discussed, and examples of specific programs are provided. Some of the general areas that need to be addressed in making such a program successful include bridging the gap between the clinicians and the researchers orientation, generating a working agreement regarding division of work and benefits, and developing a resourceful, creative, and realistic approach to the limitation of resources. Despite these obstacles, this program offers unique opportunities for narrowing the gap between research and practice to benefit both.