Physical restraints from the perspective of advocates of nursing home residents - a qualitative Study

Background: Physical restraints are commonly used in nursing homes despite clear evidence of the lack of effectiveness and a high risk of negative consequences. Beside nurses, other persons acting as advocates of nursing home residents like relatives, legal guardians and members of the resident council, could also influence the use of physical restraints. Objective: To describe the perceptions and attitudes of advocates of nursing home residents regarding the use and reduction of physical restraints. Methods: Four semi-structured interviews and four focus groups with a total of 22 participants (five relatives, one legal guardian, 16 members of resident councils) were conducted for the process evaluation of a pragmatic cluster-randomised controlled trial and analysed through qualitative content analysis. Results: Five categories regarding physical restraints were identified: 1. Use in nursing home setting; 2. Evaluation of use and reduction; 3. Information on use and reduction; 4. Decision about use and reduction; 5. Effects of use and reduction. Overall, the three groups of advocates describe physical restraints as necessary to prevent falls and to control challenging behaviour and have little knowledge regarding alternatives. Conclusions: Relatives, legal guardians and members of the nursing home resident council showed uncritical attitudes and a lack of knowledge towards physical restraints. Addressing these groups through information and education in interventions aiming to avoid physical restraints in nursing homes could be supportive.