Restraint Prevalence Tools NURSING BEST PRACTICE GUIDELINES EVALUATION USER GUIDE November 2006 Disclaimer The opinions expressed in this publication are those of the authors. Publication does not imply any endorsement of these views by either of the participating partners of the Nursing Best Practice Research Unit, which include members of the University of Ottawa faculty and members of the Registered Nurses’ Association of Ontario (RNAO). 158 Pearl Street / 158, rue Pearl School of Nursing / Toronto ON M5H 1L3 CANADA École des sciences infirmières 451 Smyth 416 599-1925 Ottawa ON K1H 8M5 CANADA 416 599-1926 613 562-5800 (8407) 613 562-5658 http://www.nbpru.ca/ Nursing Best Practice Guidelines Evaluation User Guide Copyright © 2006 by the NBPRU Printed in Ottawa, Ontario, Canada All rights reserved. Reproduction, in whole or in part, of this document without the acknowledgement of the authors and copyright holder is prohibited. The recommended citation is: Davies B, Danseco E, Ploeg J, Heslin, K, Stansfield M, Santos J & Edwards, N. (2006). Nursing Best Practice Guideline Evaluation User Guide: Restraint Prevalence Tools. Nursing Best Practice Research Unit, University of Ottawa, Canada. pp. 1-20. Nursing Best Practice Guidelines Evaluation User Guide Acknowledgements This user guide was based on an evaluation project awarded to Barbara Davies and Nancy Edwards with the Registered Nurses’ Association of Ontario (RNAO) and funded by the Government of Ontario. The authors are grateful for the support of the Nursing Secretariat of the Ministry of Health and Long-Term Care (MOHLTC), in particular the Chief Nursing Officer, Sue Matthews. The authors would also like to acknowledge the contributions of Tazim Virani and RNAO staff, clinical sites that pilot-tested the evaluation tool, members of the evaluation team and project staff. The authors also thank Dianne Rossy and Marlene Mackey for permission to adapt their tool and the assistance they provided in the revisions to their tool. Colaborators Diane Buchanan, RN, MScN, DNSc, School of Nursing, Queen’s University Lucie Brosseau, PhD, School of Rehabilitation Sciences, University of Ottawa Patricia Griffin, RN, PhD, Canadian Association of Schools of Nursing Denyse Pharand, RN, PhD, School of Nursing, University of Ottawa Ariella Lang, RN, PhD, Canadian Institutes of Health Research Postdoctoral Fellow, School of Nursing, University of Ottawa Evaluation Project Staff Valerie C. Cronin, RN, MA Alexis Dmitruk Vanessa Lybanon, MA Andrea Perrier, RN, MBA Elana Ptack, RN, BA Cathy Zhang Nursing Best Practice Guidelines Evaluation User Guide Restraint Prevalence Tools Barbara Davies, RN, PhD University of Ottawa, School of Nursing Evangeline Danseco, PhD University of Ottawa, School of Nursing Jenny Ploeg, RN, PhD McMaster University, School of Nursing Kathleen Heslin, RN, MScN York Central Hospital Melanie Stansfield, RN(EC), MSc, PhD(C), Niagara Health System Josephine Santos, RN, MN Ontario Ministry of Health and Long-term Care Nancy Edwards, RN, PhD School of Nursing, Faculty of Health Sciences & Department of Epidemiology and Community Medicine University of Ottawa TableChapter 1 — Purpose ofof Document Contents Chapter 1 — Development of the Restraint Prevalence Tools .1 Background...................................................................................................... 1 The RNAO Best Practice Guidelines on Caregiving Strategies for Older Adults with Delirium, Dementia and Depression ............................................. 2 Approach to Scale Development..................................................................... 3 Chapter 2 — Administration, Scoring and Interpretation ........4 Description of the Restraint Prevalence Tools ................................................ 4 Administration.................................................................................................. 5 Restraint Prevalence Observation Tool............................................... 5 Restraint Prevalence Chart Audit Tool ................................................ 6 Scoring and Interpretation ............................................................................... 6 Restraint Prevalence Observation Tool............................................... 6 Restraint Prevalence Chart Audit Tool ................................................ 6 Chapter 3 — Overview of the Psychometric Properties of the Restraint Prevalence Tools ........................................................8 Summary ...................................................................................9 References ...............................................................................10 Appendix .................................................................................11 Appendix A: Restraint Prevalence Tools....................................................... 12 Appendix B: Reprint of Journal Article by Edwards et al. (2006) .................. 16 Appendix C: Resources................................................................................. 17 Appendix D: Quick Reference Guide ............................................................ 17 Development of the Restraint 1 Prevalence Tools Chapter highlights › Why evaluation tools for Best Practice Guidelines are necessary › Process used for developing the Restraint Prevalence Tools The Nursing Best Practice Research Unit (NBPRU) was formed in January 2005 as a partnership between the University of Ottawa, School of Nursing and the Registered Nurses’ Association of Ontario (RNAO). One of the research unit’s objectives is to develop and pilot test tools useful in the evaluation of the implementation of clinical nursing BPGs. BACKGROUND Clinical or best practice guidelines (BPGs) Ministry of Health and Long-Term Care has summarize the most up-to-date research on developed 30 BPGs to date. Each BPG includes various clinical topics. They contain evidence-based practice, education, and recommendations that are useful in helping organization/policy recommendations. Details healthcare providers practice evidence-informed about the RNAO Best Practice Guideline care and improve patients’ health outcomes. The Program may be obtained on the RNAO Registered Nurses’ Association of Ontario website: www.rnao.org/bestpractices (RNAO), with funding from the Ontario RESTRAINT PREVALENCE TOOLS 1 NOVEMBER 2006 When BPG recommendations are implemented the RNAO Best Practice Guideline on in a healthcare organization, the evaluation of its Caregiving Strategies for Older Adults with impact needs to be linked with changes in Delirium, Dementia, and Depression (DDD) nursing practice and improvements in patient (RNAO, 2004). The minimization of physical outcomes. The measures used to evaluate the restraint use in nursing care is a key patient BPG implementation need to be valid and outcome associated with nursing best practice reliable so that conclusions about the recommendations. relationships between the implementation and the outcomes can be established. These This user guide on the restraint prevalence tools measures also need to be feasible, acceptable, is intended for users who have experience and/or and meaningful to healthcare providers and graduate training in basic research and patients. Sound measures are crucial for evaluation. Edwards, Danseco, Heslin, Ploeg, effective decision-making on the Santos, Stansfield and Davies (2006; see implementation and evaluation of evidence- Appendix B) provide a more in-depth informed care. description of the development of the restraint prevalence tools, including the psychometric The Nursing Best Practice Research Unit properties. (NBPRU) was formed in January 2005 as a partnership between the University of Ottawa, School of Nursing and the Registered Nurses’ THE RNAO BEST PRACTICE Association of Ontario (RNAO). One of the GUIDELINES ON CAREGIVING research unit’s objectives is to develop and pilot STRATEGIES FOR OLDER ADULTS test tools useful in the evaluation of the WITH DELIRIUM, DEMENTIA AND implementation of clinical nursing BPGs. At a DEPRESSION symposium held in the spring of 2005, a team of The RNAO Best Practice Guidelines on leading researchers, administrators, government Caregiving Strategies for Older Adults with funders, and policy researchers identified a gap Delirium, Dementia and Depression is the in the availability of tools for measuring the second in a series of BPGs targeting older adults outcomes of guideline implementation. Hence, with delirium, dementia and depression (RNAO, the NBPRU has developed evaluation tools to 2004). In 2003, the RNAO developed a BPG on accompany various BPGs. The psychometric screening for DDD (RNAO, 2003). These two properties of these evaluation tools were BPGs are intended to be used together for examined in several studies. comprehensive nursing care for older adults who are at risk for DDD. This user guide presents a brief description of evaluation tools designed to measure the The BPG on Caregiving Strategies outlines frequency, type, and patterns of physical various interventions that nurses can utilize such restraint use among patients with delirium, as behavioural strategies, pharmacological dementia, or depression. A chart audit tool and interventions, and environmental support or an observation tool measuring physical restraint manipulation. Tenets of care underlying these were developed (Appendix A), to evaluate the caregiving strategies are also discussed. In implementation of recommendations targeted by addition, there