Guideline
Lois K Evans, Valerie T CotterAvoiding Restraints in Patients with Dementia
American Journal of Nursing
01 March 2008, 108/3 (40-50)
- Submitted by:Stefan Tino Kulnik - Physiotherapist
- Institution:Imperial College Healthcare NHS Trust
- Date submitted:24th November 2009
1
Objectives and hypotheses
1.1
Are the objectives of the guideline clearly stated?
Yes.
This paper is a practice guide on how to avoid restraints in older adults with dementia. The guide is aimed at registered nurses in the United States and can be used as a resource to obtain continuing education credit online authorized by the American Nurses Credentialing Center's Commission on Accreditation.
This paper is a practice guide on how to avoid restraints in older adults with dementia. The guide is aimed at registered nurses in the United States and can be used as a resource to obtain continuing education credit online authorized by the American Nurses Credentialing Center's Commission on Accreditation.
2
Design
2.1
Is the study design suitable for the objectives?
Not applicable.
No study has been conducted. Rather, the authors summarise recommended practice and provide references and links to online educational materials.
No study has been conducted. Rather, the authors summarise recommended practice and provide references and links to online educational materials.
2.2
Who / what was studied?
Not applicable
2.3
Was this the right sample to answer the objectives?
Not applicable
2.4
Is the study large enough to achieve its objectives? Have sample size estimates been performed?
Not applicable
2.5
Were all subjects accounted for?
Not applicable
2.6
Were all appropriate outcomes considered?
Not applicable
2.7
Has ethical approval been obtained if appropriate?
Not applicable
2.8
Are the professionals involved in guideline development described?
The paper is part of a series ('How to Try This' series) of publications funded by a grant from the John A Hartford Foundation to the Hartford Institute for Geriatric Nursing at the New York University's College of Nursing in collaboration with American Journal of Nursing. The paper is endorsed by the Alzheimer's Association.
The professional background of the authors is described (LK Evans, van Ameringen Professor in Nursing Excellence and director of the Psychiatric Mental Health Advanced Practice Program at the University of Pennsylvania School of Nursing in Philadelphia; VT Cotter, advanced senior lecturer at the University of Pennsylvania School of Nursing in Philadelphia and program director in the Adult Health Nurse Practitioner Program)
The professional background of the authors is described (LK Evans, van Ameringen Professor in Nursing Excellence and director of the Psychiatric Mental Health Advanced Practice Program at the University of Pennsylvania School of Nursing in Philadelphia; VT Cotter, advanced senior lecturer at the University of Pennsylvania School of Nursing in Philadelphia and program director in the Adult Health Nurse Practitioner Program)
2.9
Is the method of derivation of the guideline appropriate?
Development of the practice guide is not described.
2.10
Was all the evidence considered?
29 references provided. Authors do not comment on how references were obtained or on extent of consideration of available evidence used to devise the practice guide.
3
Measurement and observation
3.1
Is it clear what was measured, how it was measured and what the outcomes were?
Not applicable
3.2
Are the measurements valid?
Not applicable
3.3
Are the measurements reliable?
Not applicable
3.4
Are the measurements reproducible?
Not applicable
3.5
Is it clear what evidence was considered?
For most recommendations a reference is provided. 29 references in total.
3.6
How was the evidence analysed?
Not commented on.
3.7
Are variations in clinical practice accounted for?
Not commented on.
4
Presentation of results
4.1
Is the evidence on which the guideline is based adequately described?
29 references provided. Authors do not discuss the evidence/levels of evidence/grades of recommendations that their practice guide is based on. Probably this would not fit the format of this paper, which is meant as a continuing education tool and as a practical guide for nurses.
4.2
Is this evidence presented clearly, objectively and in sufficient detail to enable readers to make their own judgement?
As 4.1. of this appraisal.
4.3
Are the results internally consistent, i.e. do the numbers add up properly?
Not applicable
5
Analysis
5.1
Is the evidence suitable for analysis?
Not applicable
5.2
Are the methods appropriate to the data?
Not applicable
5.3
Are any statistics correctly performed and interpreted?
Not applicable
6
Discussion
6.1
Is the guideline discussed in relation to existing knowledge on the subject and study objectives?
The practice guide is put in context with the current standard of care (presumably for the United States, 2 references provided), which is providing safe care without using restraints of any form, whether physical or chemical.
The authors discuss why restraint use in people with dementia is problematic.
The authors discuss why restraint use in people with dementia is problematic.
6.2
Is the discussion biased?
Overall, the authors strongly advocate the avoidance of restraints in older adults with dementia. The opposing view is not discussed, carers' concerns for the individual's safety (especially with regards to falls related health risks) are very briefly discussed.
7
Interpretation
7.1
Are the authors' conclusions justified by the data?
Unable to comment. See 2.9. and 2.10. of this appraisal.
7.2
What level of evidence has this paper presented? (using CEBM levels )
CEBM level of evidence: 5 (expert opinion).
7.3
Does this paper help me answer my problem?
Yes.
Even though the paper is aimed at nurses and discusses nursing interventions for fall prevention while avoiding restraints, and does not discuss typical physiotherapy interventions, it is interesting to know about this viewpoint, especially when working with a multidisciplinary approach.
To pursue the issues raised and recommendations made in this paper, further exploration would be warranted, as the presented level of evidence is low.
Even though the paper is aimed at nurses and discusses nursing interventions for fall prevention while avoiding restraints, and does not discuss typical physiotherapy interventions, it is interesting to know about this viewpoint, especially when working with a multidisciplinary approach.
To pursue the issues raised and recommendations made in this paper, further exploration would be warranted, as the presented level of evidence is low.
8
Implementation
8.1
Can this guideline be implemented in practice?
As this practice guide is presenting low level evidence, is aimed at nurses, and is devised within the context of the American health system, the relevance of the recommendations should be assessed for a UK setting, preferably by professionals from a nursing background.
8.2
What aids to implementation exist?
Raised awareness of dementia and dementia care in the UK in recent years, e.g. supported by recently published national guidelines (NICE guidelines for dementia, 2007).
8.3
What barriers to implementation exist?
Organisational/institutional barriers to changes in practice can be anticipated.