Association of surveillance technology and staff opinions with physical restraint use in nursing homes: Cross-sectional study

BACKGROUND: Physical restraints are used in nursing homes (NHs) despite their negative consequences. Use of surveillance technologies as alternatives to physical forms of restraints and negative staff opinions about the appropriateness of restraint use have been postulated to reduce this practice; however, these have rarely been investigated alongside resident outcome data. This study aimed to measure physical restraint prevalence in Swiss NHs and its associations with (a) the use of surveillance technologies and (b) staff's opinion about the appropriateness of physical restraint use.

METHODS: This cross-sectional multicenter study analyzed data on 3,137 staff and 6,149 residents of 292 units in 86 Swiss NHs (2018-2019). Based on routine resident data, we measured the prevalence of two classes of physical restraint: (a) bedrails or (b) trunk fixation or seating option that prevents standing. To assess potential factors associated with restraint use, we applied a logistic multilevel model.

RESULTS: A 11.1% of residents were restrained with at least one form of physical restraint. Against our hypothesis, surveillance technologies were not significantly associated with restraint use, and staff members' opinion that the use of physical restraints was appropriate on their unit was associated with decreased odds of residents being restrained (odds ratio (OR): 0.48; 95% confidence interval (CI) 0.29-0.80).

CONCLUSIONS: Although Swiss NHs have a low prevalence of physical restraint use, only a minority of NH units do not use any restraints with their residents. Surveillance technologies seem to be used concurrently with restraints and not as an alternative. Further research should investigate staff's current and intended uses of surveillance technologies in practice. Staff members' opinion that they use restraints inappropriately might correctly reflect overuse of restraints on their unit. If so, staff ratings of inappropriate restraint use may identify units that need improvement.