Page 31 - Reduction of coercive measures
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                                during one shift was asked to register 10 shifts independently of his or her colleague. Shifts were not randomly selected but chosen based on the presence of the staff member who was asked to maintain an independent registration.
All independent observers were trained to recognize and register coercive measures using registration standardized list (see instruments). The training consisted of exposure to coercive measures in different situations by using images and learning the terms or phrases used by support staff to indicate the use of coercive measures. All observed coercive measures were registered, irrespective of the purported aims or the presence or absence of resident resistance. This four hour training was provided once by the first author of this paper.
Instruments
Previous to this study, the health care organization had little experience with the registration of coercive measures; the use of a registration system was limited and inconsistent. There were no standardized definitions of coercive measures nor an unequivocal guideline of which coercive measures should be registered.
Therefore, a list of 57 coercive measures was developed, based on studies on coercive measures (Dörenberg et al., 2018; Matson & Boisjoli, 2009; Williams, 2010), reports of the Dutch Health Care Inspectorate (2007, 2008, and 2012) and input of the coercive measure committees of the health care organization, who monitor and improve quality of care concerning the use of coercive measures. Coercive measure was defined as every measure that is restrictive in a specific situation, which was in accordance with the Dutch Healthcare Inspectorate and the Care and Coercion Act (Staatsblad, 2018, 36). The list of coercive measures is shown in Appendix A. Examples are ‘Physical restraints (parts of the body being held down)’, ‘Mechanical restraint of feet and legs’, ‘Camera/video surveillance (either within resident’s private room and/or in communal part(s) of the building)’ and an example of restrictions in movement of resident is ‘Locking the outer doors’. The list was administered electronically through the care organization’s intranet. Per coercive measure the options were ‘applied’ (coded 1) or ‘not applied’ (default; coded 0). Registration had to be done at the end
Measurement of coercive measures
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