Successful cases of transiting from restraints to restraint-free care of older residents in long-term care facilities: Perspectives of multi-disciplinary staff

Abstract

Background: In recent decades, considerable attention has been given to efforts to reduce and eliminate restraint use in older institutionalized people. Previous research showed that staff expressed varying views of restraint-free care. Yet, no qualitative research has described this phenomenon in Hong Kong.

Purposes: This paper will present and compare the views of staff towards the care of three older people who transited from using restraints and becoming restraint-free in long-term care facilities (LTCFs) for older people.

Methods: A large qualitative study was conducted in six LTCFs in Hong Kong. A mix of staff including 27 senior managers, nurses, allied health professionals and frontline workers from two LTCFs were interviewed, and data were analyzed using latent content analysis.

Results: During the regular review of residents who used restraints, staff could vividly describe the restraint care that was provided and criteria for identifying residents that could be given an opportunity to ‘try off-restraint’. Although strategies to try-off restraints were used, not all cases were successful. Three successful case reviews will be presented to describe the restraints received, the process of implementing and time allowed to trial restraint-free practice, and barriers to implementing restraint-free care for residents with particular predicament. Findings supported that training and education, institutional culture, additional resources, innovative ideas and collective efforts of all multi-disciplinary staff are key elements to promoting restraint-free care.

Conclusion: Although restraint-free practice has yet to actualize, extensive efforts have already been made to move towards using lesser physical restraint in LTCFs through teamwork.