More freedom for patients in hospital

Why did the researchers carry out the project?

Nursing staff in hospitals regularly use freedom-restraining measures to protect patients from falling, for example. This despite the fact that there is no evidence to date that such measures actually help to protect patients. For example, the risk of falls increases the longer a person lies in bed and is unable to move. Nursing staff often lack knowledge or ideas about what alternatives they could use in order to avoid restricting patients’ freedom.

What are freedom-restraining measures in a medical setting?

Such measures include strapping patients to their beds or using bed rails or electronic systems that sound an alarm if a patient stands up unassisted. These restrictive measures are mainly put in place for older people. There are two reasons for this: on the one hand, they are more prone to falls, and on the other, anaesthesia is more likely to cause confusion in them than in younger people. Dementia can also be a reason for the use of freedom-restraining measures.

How did the researchers proceed?

Together with patient representatives and professionals, the researchers developed an approach that has proven to be effective in psychiatry and long-term care. This approach involves patients in the development of alternatives that seek to avoid the use of freedom-restraining measures as much as possible.

For a month, the procedure was tested in the department of medicine and surgery of a hospital in the canton of Bern. During admissions, the nursing staff discussed the risk of using restraints and worked with patients to determine the alternatives that should be used if necessary.

What were the results of the study?

The proportion of freedom-restraining measures used in the department fell from around 10 percent to just under 5 percent. At the same time, significantly more alternative interventions were documented. While the patients’ reactions were consistently positive, the professionals were more sceptical, as involving patients was time-consuming for them. In view of the short duration of the project and the comparatively small number of patients, the impact has yet to be confirmed in a larger project.

What was the main challenge you had to overcome?

The main challenge was the work situation in the care sector. Any change in the way professionals work involves an initial increase in effort, which often weighs more heavily on carers, who are often under pressure, than the long-term benefits that might be gained from a new approach. In particular, the long-term benefits of the new approach were not sufficiently clear to the nursing staff.

How does the project benefit society?

Alternatives to freedom-restraining measures enhance the quality of healthcare and improve the patients’ well-being. The project is also helping to ensure that the needs of patients are taken into account to a greater extent. As a result, the measures are in line with the core concerns of a caring society.

What will happen after the study?

The researchers plan to adapt the project based on their findings and to test it in a hospital over a longer period of time. One of the adjustments could be to include only patients who are at high risk for the use of restraints. The researchers hope that this will make the positive effects of the new approach more apparent to carers.