Page 38 - Reduction of coercive measures

Chapter 2
leaving the degree of error unexplained. Hypothetical explanations varied widely from differences in intentions of staff and targeted behavior, knowledge and awareness of support staff on the value on self- determination, visibility of coercive measure, policy of the health care organization, and the degree to which application of coercive measures were a matter of normal routine. In fact, stakeholders considered it likely that measures with a low extent of agreement would be restrictive when above explanations were not applicable. A consequence of reducing the list to measures with at least a moderate extent of agreement would be the coverage of the registration of coercive measures would drop. The discussion revealed a number of elements that determine agreement on measures, including knowledge, skills, and awareness of caregivers, that can be improved by for example training and thus could lead to stronger agreement. As an implication of these reflections for the registration of coercive measures in the second part of the study the complete list of 57 coercive measures was retained and attention was paid on training on identification and registration of coercive measures.
Data collection was completed one year and seven months after the system was released and training and registration of coercive measures started. During training coercive measures were identified using the list of 57 coercive measures and registered in the registration system. However, when there was no consensus among the multidisciplinary team and researchers on whether a measure was restrictive or not, it was noted on a form with components of day to day care, which is part of the electronic personal file. Conform process and policy of the care organization it was assumed that all coercive measures were described and substantiated by professionals in written plans as part of the electronic personal file. Therefore, electronic files of 30 residents were checked for coercive measures. Content of these plans was considered as 100% of applied coercive measures. Compared to this number 46% of the coercive measures were registered in the registration system, 38% of the coercive measures were noted at the form which contained a set of components of daily care, and 16% of the coercive measures were noted in plans as part of the electronic personal file, although they were not identified
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