[Methods paper on the development of a practice guideline for the avoidance of physical restraints in nursing homes]

Abstract

Physical restraints are routinely used in nursing home residents in Germany. Bedrails are applied to at least one of four residents. Belts, fixed tables and other measures are less frequent but are still used as routine measures. So far, beneficial effects of the use of physical restraints have not been shown, negative effects are likely. A recently completed observational study in 30 nursing homes in Hamburg showed great variations between centres concerning the frequency of restraint use. An evidence-based practice guideline could be the appropriate measure to reduce physical restraints and overcome centre variations. Currently, there are no evidence-based practice guidelines for the avoidance of physical restraints in nursing homes. This applies to nursing practice in Germany in general. The "German Network for Quality Development in Nursing (DNQP)" deliberately distinguishes their so-called "national expert standards" from "medical" practice guidelines. Funded by the German Ministry of Education and Science, a project aiming to develop an evidence-based practice guideline on the avoidance of physical restraints in nursing homes, for the first time applies internationally discussed methods to a nursing guideline in Germany. This article describes the methodological framework, instruments and processes of the guideline's development.