 |
Two
Penn Nursing researchers, Drs. Neville
E. Strumpf and Lois
K. Evans, developed a new model
of individualized care for frail elders
with their pathbreaking work on the elimination
of physical restraints in nursing homes
and hospitals.
Neville
Strumpf and Lois Evans were the first researchers
to carry out a systematic, randomized trial to reduce
restraints in nursing homes. Their
findings have influenced the care of older people
not only at the bedside but at the policy level
as well. |
|
Drs.
Lois Evans and Neville Strumpf |
Their
research has been supported by the National Institute
on Aging, The Commonwealth Fund, and the Alzheimer's Association.
They were honored for their achievements
by the Gerontological Society of America (GSA) with its
prestigious Doris Schwartz Gerontological
Nursing Research Award.
In
1986, nearly 40% of elders in nursing homes were physically
restrained each day. Today, physical restraints in nursing
homes and hospitals are far less prevalent due in great
part to the efforts of Penn Nursing researchers Lois Evans,
DNSc, RN, FAAN, and Neville Strumpf, PhD, RN, FAAN. Their
benchmark studies to reduce the use of physical restraints
brought international attention to the problems of frail
elders in nursing homes and hospitals and has been influential
in setting clear standards and policy for care.
Over
the last two decades, Evans and Strumpf have repeatedly
demonstrated that physical restraint, intended to keep
frail elders from harm, does not protect patients from
falling, wandering, or removing tubes or dressings. On
the contrary, physical restraints may actually cause serious
injuries and emotional and physical problems. The research
team has helped change practice with an educational program
for health professionals that, when combined with consultation
by advanced practice nurses, helps institutions apply
individualized, restraint-free care without increased
staff, psychotropic drug use, or patient injuries.
In
related research, Eileen
Sullivan-Marx, PhD, RN, FAAN, has documented the conditions
that lead nursing homes and hospitals to use physical
restraints. She found that physical restraints were used
most often when residents were disoriented or suffered
from dementia, and in nursing homes where there was a
higher ratio of licensed practical nurses to registered
nurses. This work is now being linked to outcomes research
showing how nursing care influences the quality of life,
health, and well-being of elders.
The
research of Mary
Beth Happ, PhD, RN, HCGNE faculty associate and Assistant
Professor at the University of Pittsburgh, has begun to
make major contributions to our understanding of treatment
interference among older adults who are hospitalized in
intensive care. Building on her concept development work
on individualized care, published in 1996, Happ's description
of 'voiceless' and its outcomes in intubated older patients
hold great promise for the design of appropriate individualized
interventions. Her current studies explore the feasibility
of electronic voice output communication aides with intensive
care unit (ICU) patients and post-operative head and neck
cancer patients who are unable to speak.
INSTRUMENTS from the Program of Research on Individualized
Care/Restraint Reduction ....(available
as html and PDF files)
The manual, depicted on the right, is the culmination
of a research program, begun in 1986 with inspiration
from Doris Schwartz, who urged the Penn researchers "to
do something about the widespread problem of physical
restraint." Over the years, Evans' and Strumpf's
research has contributed to a better understanding of
the negative consequences associated with physical restraints
for older adults; however, their ultimate goal, individualized
restraint-free care is not, as yet, a reality.
Other Selected
Publications on Restraint-Free Care
Happ,
M.B., Williams, C.C., Strumpf, N.E., Burger, S.G.
(1996) Individualized care for frail elders: theory
and practice. Journal of Gerontological Nursing. 22(3):6-14,
1996. [online
abstract]
Evans,
L., Strumpf, N.E., Allen-Taylor, S., Capezuti, E.,
Maislin, G. & Jacobsen, B. (1997). A clinical
trial to reduce restraints in nursing homes. Journal
of the American Geriatrics Society, 45(6), 675-681. [online
abstract]
Siegler, E., Capezuti, E., Maislin, G., Baumgarten, M.,
Evans, L. & Strumpf, N.E. (1997). Effects of a restraint
reduction intervention and OBRA '87 regulations on
psychoactive drug use in nursing homes. Journal of
the American Geriatrics Society, 45(7), 791-796. [online
abstract]
Capezuti, E., Strumpf, N.E., Evans, L. & Maislin,
G. (1998). The relationship between physical restraint
removal and falls and injuries among nursing home residents.
Journal of Gerontology: Medical Sciences, 53A(1), M47-M52. [online
abstract]
Kolanowski, A., Garr, M., Evans, L.K. & Strumpf,
N.E. (1998). Behavioral syndromes in institutionalized
elders. American Journal of Alzheimer's Disease, 13(5),
245-256.
Capezuti, E., Talerico, K., Strumpf, N.E. & Evans,
L. (1998). Individualized assessment and interventions
in bilateral siderail use. Geriatric Nursing,19(6),
322 - 330.
Capezuti, E., Strumpf, N., Evans, L. & Maislin, G.
(1999). Outcomes of nighttime physical restraint removal
for severely impaired nursing home residents. American
Journal of Alzheimer's Disease, 14(13), 1 - 8.
Sullivan-Marx, E., Strumpf, N.E., Evans, L., Baumgarten,
M. & Maislin, G. (1999). Predictors of continued
physical restraint use in nursing home residents following
restraint reduction efforts. Journal of the American
Geriatrics Society, 47, 342-348. [online
abstract]
Sullivan-Marx, E., Strumpf, N., Evans, L., Baumgarten,
M. & Maislin, G. (1999). Initiation of physical
restraint in nursing home residents following restraint
reduction. Research in Nursing & Health, 22, 369-379. [online
abstract]
Capezuti, E., Talerico, K.A., Cochran, I., Strumpf, N.,
Evans, L. & Becker, H. (1999). Individualized interventions
to reduce bilateral siderail use and falls from bed.
Journal of Gerontological Nursing, 25(11), 26-34. [See
also, NCPS Tools Kit: Interventions (pdf)]
Strumpf, N.E. (2000). Improving care for the frail elderly:
The challenge for nursing. Journal of Gerontological
Nursing, 26(7), 36-44.
Happ
M.B. (2000) Interpretation of nonvocal behavior and
the meaning of voicelessness in critical care. Social
Science
& Medicine. 50(9):1247-55. [online abstract]
Happ,
M.B., Capezuti, E., Strumpf, N.E., Wagner, L., Cunningham,
S., Evans, L.K., Maislin, G. (2002) Advance care planning
and end-of-life care for hospitalized nursing home
residents. Journal of the American Geriatrics Society,
50(5):829-35. [online
abstract]
Capezuti,
E,. Maislin, G., Strumpf, N., Evans, L.K. Side rail
use and bed-related fall outcomes among nursing home
residents. (2002) Journal of the American Geriatrics
Society, 50(1):90-6. [online
abstract]
BOOKS
Strumpf,
N.E., Robinson, J., Wagner, J. & Evans, L. (1998).
Restraint
free care: Individualized approaches for frail elders. New York: Springer Publishing Company.
Cotter, V.T. & Strumpf, N.E. (2001). Advanced
practice nursing with older adults. New York: McGraw-Hill.
Strumpf, N.E., Associate Editor. (2001). The
Encyclopedia of Elder Care. New York: Springer.
SELECTED
RECENT BOOK CHAPTERS
Strumpf, N.E. & Evans, L. (1998). Physical restraints
for the elderly. In J. Fitzpatrick, (Ed.), Encyclopedia
of nursing research. New York: Springer. 436-438.
Sullivan-Marx, E., Strumpf, N.E. & Evans, L.K. (1999).
Restraint-free care of the elderly. In J. Stone, S. Salisbury,
& J. Wyman (Eds.), Clinical gerontological nursing:
A guide to advanced practice, 2nd ed. Orlando: Saunders,
573-588.
Mion, L.C., Strumpf, N. & NICHE faculty. (1999). Use
of physical restraints in the hospital setting. In I.
Abraham, M.M. Bottrell, Fulmer T.& Mezey M.D. (Eds.)
Geriatric nursing protocols for best practice, New York.:
Springer, 159- 172.
Strumpf, N., Evans, L. & Bourbonniere, M. (2001).
Restraints. In M. Mezey (Ed.), The encyclopedia of elder
care. New York: Springer, 567-569.
 For
more information, contact Dr.
Neville Strumpf or Dr.
Lois Evans
| The
above listed initiative is just one of many
ongoing studies or projects by our Penn Nursing
scholars. For
more information on other Penn Nursing experts,
or to
request a CONSULTATION, please contact |
|
|
|
