A Review of the Literature on Restraint in Care Homes

Introduction: Restraint is a term that is used in healthcare to broadly describe the practice of restricting movement or liberty (RCN, 2008). It includes physical/mechanical (i.e. bed rails), technological (i.e. surveillance), psychological (i.e. telling someone they are unable to do something) & chemical (i.e. prescription of sedative medications). Older people who live in care home settings are at risk of being inappropriately restrained and the purpose of this review is to synthesise the empirical research on the phenomenon with regards to care home and residential settings. Methodology: A review of the literature was conducted in May 2017 using five healthcare databases and following Aveyard’s (2014) approach. A total of 53 empirical studies met the inclusion criteria and were included in this review. The findings were critically appraised using CASP tools & thematically analysed using Braun and Clark’s (2006) framework. To the authorship team knowledge, this is the first review of its kind. Results: Four main themes emerged from this review which related to the prevalence and practices of restraint, personal attitudes to restraint, the importance of organisational culture in influencing restrictive practice and interventions to reduce restraint. Discussion: Restraint is undoubtedly a complex issue as evidenced by this review. The prevalence and practice of restraint is inconsistent and widespread. There are many different forms of restraint but it is a poorly defined and understood topic within care home settings. Despite often being used as a measure for safety, there is a strong evidence base to suggest that restraint usually causes more harm than good.