Restraint use in home care: a qualitative study from a nursing perspective.
BACKGROUND
Despite the growing demand for home care and preliminary evidence suggesting that the use of restraint is common practice in home care, research about restraint use in this setting is scarce.


METHODS
To gain insight into the use of restraints in home care from the perspective of nurses, we conducted a qualitative explorative study. We conducted semi-structured face-to-face interviews of 14 nurses from Wit-Gele Kruis, a home-care organization in Flanders, Belgium. Interview transcripts were analyzed using the Qualitative Analysis Guide of Leuven.


RESULTS
Our findings revealed a lack of clarity among nurses about the concept of restraint in home care. Nurses reported that cognitively impaired older persons, who sometimes lived alone, were restrained or locked up without continuous follow-up. The interviews indicated that the patient's family played a dominant role in the decision to use restraints. Reasons for using restraints included "providing relief to the family" and "keeping the patient at home as long as possible to avoid admission to a nursing home." The nurses stated that general practitioners had no clear role in deciding whether to use restraints.


CONCLUSIONS
These findings suggest that the issue of restraint use in home care is even more complex than in long-term residential care settings and acute hospital settings. They raise questions about the ethical and legal responsibilities of home-care providers, nurses, and general practitioners. There is an urgent need for further research to carefully document the use of restraints in home care and to better understand it so that appropriate guidance can be provided to healthcare workers.
Kristien
K
Scheepmans
Bernadette
B
Dierckx de Casterlé
Louis
L
Paquay
Hendrik
H
Van Gansbeke
Steven
S
Boonen
Department of Public Health and Primary Care, Centre for Health Services and Nursing Research, KU Leuven, Kapucijnenvoer 35, 4th Floor, 3000 Leuven, Belgium. koen.milisen@med.kuleuven.be.
Koen
K
Milisen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology; D036301:Qualitative Research; D012149:Restraint, Physical / Q000523:psychology / Q000706:statistics & numerical data*; D055815:Young Adult