Nurses’ Views on the Use of Physical Restraints in Intensive Care: A Qualitative Study

Despite the worldwide promotion of a “restraint-free” model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses’ feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient’s bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person.

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Eliciting critical care nurses’ beliefs regarding physical restraint use

Nursing Ethics ◽

10.1177/0969733017752547 ◽

2018 ◽

Vol 26 (5) ◽

pp. 1458-1472 ◽

Cited By ~ 11

Author(s):

Gemma Via-Clavero ◽

Marta Sanjuán-Naváis ◽

Marta Romero-García ◽

Laura de la Cueva-Ariza ◽

Gemma Martínez-Estalella ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Theory Of Planned Behaviour ◽

Physical Restraint ◽

Critical Care Nurses ◽

Control Beliefs ◽

Physical Restraints ◽

Planned Behaviour ◽

Restraint Use ◽

And Control

Background: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice. Aim: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. Research design: A belief elicitation study was conducted. Participants and research context: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. Ethical considerations: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. Findings: Nurses framed the use of restraints as a way of prioritising patients’ physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients’ relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients’ medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. Discussion: Safety arguments based on the surrounding work environment were discussed. Conclusion: Nurses’ behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives’ involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

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The challenges of using physical restraint in intensive care units in Iran: A qualitative study

Journal of the Intensive Care Society ◽

10.1177/1751143719892785 ◽

2020 ◽

pp. 175114371989278

Author(s):

Zahra Salehi ◽

Soodabeh Joolaee ◽

Fatemeh Hajibabaee ◽

Tahereh Najafi Ghezeljeh

Keyword(s):

Critical Care ◽

Intensive Care ◽

Qualitative Study ◽

Intensive Care Units ◽

Physical Restraint ◽

Critical Care Nurses ◽

Structured Interviews ◽

Standard Equipment ◽

Restraint Use ◽

Ensure Patient Safety

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

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Physical restraints in intensive care units: a national questionnaire survey of physical restraint use for critically ill patients undergoing invasive mechanical ventilation in Japan

Acute Medicine & Surgery ◽

10.1002/ams2.380 ◽

2018 ◽

Vol 6 (1) ◽

pp. 68-72 ◽

Cited By ~ 5

Author(s):

Takeshi Unoki ◽

Hideaki Sakuramoto ◽

Akira Ouchi ◽

Shigeki Fujitani ◽

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Intensive Care Units ◽

Critically Ill ◽

Critically Ill Patients ◽

Questionnaire Survey ◽

Invasive Mechanical Ventilation ◽

Physical Restraint ◽

Physical Restraints ◽

Restraint Use

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Variation of the Occurrence of Physical Restraint Use in the Long-Term Care: A Scoping Review

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182211918 ◽

2021 ◽

Vol 18 (22) ◽

pp. 11918

Author(s):

Elisa Ambrosi ◽

Martina Debiasi ◽

Jessica Longhini ◽

Lorenzo Giori ◽

Luisa Saiani ◽

...

Keyword(s):

Scoping Review ◽

Care Setting ◽

Long Term Care ◽

Physical Restraint ◽

Data Sources ◽

Physical Restraints ◽

Design Data ◽

Term Care ◽

Restraint Use

Physical restraints in the long-term care setting are still commonly used in several countries with a prevalence ranging from 6% to 85%. Trying to have a broad and extensive overlook on the physical restraints use in long-term care is important to design interventions to prevent and/or reduce their use. Therefore, the aim of this scoping review was to analyze the range of occurrence of physical restraint in nursing homes, long-term care facilities, and psychogeriatric units. Pubmed, CINAHL, Ovid PsycINFO- databases were searched for studies with concepts about physical restraint use in the European long-term care setting published between 2009 and 2019, along with a hand search of the bibliographies of the included studies. Data on study design, data sources, clinical setting and sample characteristics were extracted. A total of 24 studies were included. The median occurrence of physical restraint in the European long-term care setting was still high (26.5%; IQR 16.5% to 38.5%) with a significant variability across the studies. The heterogeneity of data varied according to study design, data sources, clinical setting, physical restraint’s definition, and patient characteristics, such as ADLs dependence, presence of dementia and psychoactive drugs prescription.

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Nursing professionals’ attitudes toward use of physical restraints in Styrian nursing homes Austria

Pflege ◽

10.1024/1012-5302/a000649 ◽

2019 ◽

Vol 32 (1) ◽

pp. 57-63

Author(s):

Hannes Mayerl ◽

Tanja Trummer ◽

Erwin Stolz ◽

Éva Rásky ◽

Wolfgang Freidl

Keyword(s):

Nursing Homes ◽

Large Scale ◽

Critical Role ◽

Physical Restraint ◽

Care Practice ◽

Physical Restraints ◽

Convenience Sample ◽

Restraint Use ◽

Positive Attitudes ◽

Nursing Professionals

Abstract. Background: Given that nursing staff play a critical role in the decision regarding use of physical restraints, research has examined nursing professionals’ attitudes toward this practice. Aim: Since nursing professionals’ views on physical restraint use have not yet been examined in Austria to date, we aimed to explore nursing professionals’ attitudes concerning use of physical restraints in nursing homes of Styria (Austria). Method: Data were collected from a convenience sample of nursing professionals (N = 355) within 19 Styrian nursing homes, based on a cross-sectional study design. Attitudes toward the practice of restraint use were assessed by means of the Maastricht Attitude Questionnaire in the German version. Results: The overall results showed rather positive attitudes toward the use of physical restraints, yet the findings regarding the sub-dimensions of the questionnaire were mixed. Although nursing professionals tended to deny “good reasons” for using physical restraints, they evaluated the consequences of physical restraint use rather positive and considered restraint use as an appropriate health care practice. Nursing professionals’ views regarding the consequences of using specific physical restraints further showed that belts were considered as the most restricting and discomforting devices. Conclusions: Overall, Austrian nursing professionals seemed to hold more positive attitudes toward the use of physical restraints than counterparts in other Western European countries. Future nationwide large-scale surveys will be needed to confirm our findings.

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