Objective: To describe the procedures for the use of constraints in patients in Norwegians nursing homes. Materials and Methods: Interviews with the primary carers of 1442 patients in Regular Units (RUs) and in Special Care Units for persons with dementia (SCUs) were carried out to measure the use of constraints the last seven days. Five types of constraints were recorded; mechanical restrains, non-mechanical physical restraints, electronic surveillance, use or force or pressure in medical treatment and use of force or pressure in ADL. Of the 1442 patients 35% in RUs and 45% in RUs, were subjected to one or more types of constraints during one week, 557 in all. Reasons for use of constraints, the profession of the person who decided the use of constraints, and documentation of constraints, were registered.
Results: A total of 8316 episodes of use of constraints, 5253 in RUs and 3063 in SCUs, involving 557 patients, were recorded. Of these, 215 episodes were quoted as sporadic, and 8101 as constraints used routinely, corresponding to 903 records of constraints in 490 patients. Thus we had detailed information of 1118 cases of constraint use. The most frequent reason for use of constraints was “to carry out necessary care” (27%). Next came “to protect the patient from falling out of bed or chair” (23%), “patient spits out or denies medication” (10%), “problems with swallowing” (7%), “needed to carry out necessary treatment” (5%), “to protect staff during interaction with patient” (5%), “to protect other patients” (4%).
In 924 of 1118 cases we got answers about the profession of the person who decided to use constraints, see table. The medical consultants was responsible in less than 10% of the cases, except for situations were constraints were found necessary to perform medical treatment, where the physician took the decision in 23% of the cases. The administrative leaders of the nursing home were decision makers primarily in cases were electronic surveillance were used (14 of 19 cases).
Use of constraints was seldom recorded in the patients’ files or medical records. For routine use of constraints, we found written documentation 38% of the cases, and in 27% for sporadic use of constraints. >
| Table: Who decided to use a constraint? n = 924 |
| | Any constraint |
| Administrative leader of institution | 19 (2.1) |
| Physician | 79 (8.5) |
| Head of ward (nurse) | 76 (8.2) |
| Nurse on duty | 421 (45.6) |
| Nurse assistant | 97 (10.5) |
| Assistant | 8 (0.9) |
| The person in the situation | 146 (15.8) |
| Not recorded (don’t know) | 78 (8.4) |
Conclusion: The reasons stated for using a constraint in nursing homes are mainly protection of the patients, and the decision is mainly made by a nurse. Uses of constraints are seldomly recorded in the patient notes.