Data collection was carried out in 16 nursing units. Of these units, eight depicted skilled nursing home care units, seven nursing home care units, and one long-term care unit within a short-term care hospital. Information was collected for 377 residents with the help of 28 nurses. Residents' age ranged from 32 to 102 years, with a median of 80 years. The sample was 62% female, and median length of stay was 45 months (0 to 720 months). Benzodiazepines and neuroleptics were administered to 35% and 25% of the subjects, respectively.
A total of 6,744 observations over a possibility of 6,786 were made (377 residents by three direct observations and six types of restraints). Prevalence results on physical restraint use according to direct observations (interrater reliability = 92.7%; kappa coefficient = 0.86 (95% confidence interval (CI): 0.73–0.97)), interviews with nursing staff and reviews of clinical records are summarized in Table . Fixed tray tables were observed in 23.6% of residents, belts in 12.7% and vests in 4.0% whereas wrist, ankle or other restraints (including locally designed devices, straps or blankets) were used marginally. The nursing staff reported the use of lapboards, belts and vests in 27.6, 17.2 and 5.6% of residents, respectively. Medical and nursing records specified the use of lapboards in 17.2% of residents, the use of belts in 19.4% and the use of vests in 8%. Overall, one third (33.7%) of residents were observed restrained, 32.4% of residents were reported as such by members of the nursing staff, and 38.2% of residents in medical records. Siderails were observed in 62.9% of residents while they were reported by nursing staff in 63.7% of residents, and were mentioned in 72.1% of residents' clinical records.
Physical restraint use according to a) direct observation, b) interviews with the nursing staff, and c) reviews of medical and nursing records, among 377 nursing home residents
The interview with nursing staff and the review of medical and nursing orders were both highly associated with the observation data (Table ). The interview of nursing staff showed a somewhat stronger relationship with direct observation compared to the chart review (phi = 0.84 vs. 0.54). Sensitivity and specificity values of the information were highest when data was measured with the assistance of the nursing staff compared to chart reviews. Reported restraint use according to nursing staff (one nurse or more) gave a sensitivity value of 87.4% at a specificity of 93.7%. When data was reviewed from subjects' medical and nursing notes, sensitivity was reduced to 74.8%, and specificity to 86.3%. Restraint use was underreported in 12.6% (16/127) of interviews with nursing staff, and in 25.2% (32/127) of clinical records whereas it was over reported in 4.4% of interviews, and in 19.6% of clinical records.
Observed physical restraint use compared to restraint use reported a) by interview with the nursing staff, and b) by review of medical and nursing records, among 377 nursing home residents
Sensitivity values according to specific residents' characteristics and other reported variables are given in Table . Increased sensitivity values by 10% or over were observed for perceived risk for falls, agitated behaviors, body alignment problems, aggressive behaviors, urinary incontinence, fecal incontinence, and incapacity to transfer. Sensitivity of the measurement was similar when two or more nurses were interviewed compared to one nurse, although a higher value was noticed when two nurses were questioned (94.1% vs. 85.1%). Significant relationships between perceived risk for falls (p = 0.03), agitated behavior (p = 0.04), body alignment problems (p < 0.001) and aggressive behavior (p = 0.01), and reported restraint use by nursing staff were observed. No association was observed for residents' age and sex, number of nurses interviewed, history of falls, wandering problem, disorientation to time, space or people, recall troubles, speech troubles, urinary and fecal incontinence, and ability to transfer.
Sensitivity values of specific variables reported by nursing staff, among 377 nursing home residents