Page 110 - Reduction of coercive measures

Chapter 5
Coercive measures
Recorded coercive measures in the mandatory registration system of the care organization were used to test program effects. The system is part of the residents’ electronic personal file. The registration includes a broad range of coercive measures, which are recorded irrespective of whether residents resist the coercive measure or not. The registration system included a list of 57 coercive measures which was developed for a reliability study (Schippers et al., 2018) prior to the current study. The list was compiled on the basis of three types of sources. The first source were studies on coercive measures (Dörenberg et al., 2018; Matson & Boisjoli, 2009; Williams, 2010), the source were informational resources of the Dutch Health Care and Youth Inspectorate (2007, 2008, and 2012) and, the third source were coercive measure committees of the care organization. These coercive measure committees supervise and support the implementation and enforcement of the organisational policy concerning the use of coercive measures. Reliability was tested (Schippers et al., 2018; Chapter 2 this dissertation) and at least 25 coercive measures were found to be adequately consistent across informants, either colleague caregiver or trained observer. Further resident file studies revealed 21 additional coercive measures which were added to the list. Medication used to regulate behavior or medication which restricts residents in their functioning are not recorded in the registration system by physicians. Given the lack of consensus on which medication belongs to these categories, these two measures were not included in the registration. However, administering medication under coercion or without informing the client was included. This yielded a total available set of 76 coercive measures.
Four a priori defined subsets of coercive measures were distinguished. The first subset consists of 14 measures applied to protect from direct and mostly unforeseen danger. This can be a danger that arises from physical aggression by a resident. The danger is then averted, for example, by the application of physical restraint or seclusion. The second subset contains 46 measures preventing from indirect danger or disadvantage. These are measures such as having to follow a very strict daily program, being obliged to follow a diet,
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