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Zhou J, Qin Q, Chen S, Zhang H. Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence and Justice in the Use of Physical Restraints. J Multidiscip Healthc 2024; 17:1619-1627. [PMID: 38628615 PMCID: PMC11020279 DOI: 10.2147/jmdh.s455910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
In intensive care units, patients are often restrained to ensure their safety, with physical restraints being the most commonly used method. However, physical restraints compromises the patient's freedom, health and comfort, and nurses often face moral dilemmas when deciding whether to use physical restraints. This article examines physical restraints through the four universal principles of autonomy, beneficence, non-maleficence and justice. Through these principles, the authors will critically explore whether the physical restraints of patients by nurses is ethical in practice and what moral issues exist. This paper also explores conflicts and moral dilemmas for nurses in this context. Finally, suggestions are made on changes to education and clinical practice.
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Affiliation(s)
- Junya Zhou
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Qingzhu Qin
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Songge Chen
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Hongmei Zhang
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
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Robinson AE, Driver BE, Cole JB, Miner JR, Dreyfuss AP, Strom AW, Brodt ER, Wyatt TE. Factors Associated With Physical Restraint in an Urban Emergency Department. Ann Emerg Med 2024; 83:91-99. [PMID: 37725022 DOI: 10.1016/j.annemergmed.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
STUDY OBJECTIVE To determine what patient characteristics were associated with the application of physical restraints in our emergency department (ED). METHODS This was a retrospective analysis of encounters in the ED of an urban, Level I academic trauma center. We included ED encounters of adult patients (aged ≥18 years) during a 5-year period starting in 2017. We evaluated the independent association of restraint application during an encounter using a generalized estimating equation model. RESULTS There were 464,031 ED encounters during the time period from 162,244 unique patients, including 34,798 (7.5%) with restraint application, comprising 18,166 unique patients. Several variables were associated with an increased likelihood of restraint use during an encounter. The variable with the highest odds ratio was intoxication with drugs or alcohol (adjusted odds ratio [aOR] 8.29; 95% confidence interval (CI) 7.94 to 8.65). American Indian race was associated with increased odds of restraint application (aOR 1.42; 95% CI 1.31 to 1.54) compared to the reference value of White race. Black race (aOR 0.58; 95% CI 0.55 to 0.61) and Hispanic ethnicity (aOR 0.42; 95% CI 0.37 to 0.48) were associated with lower odds of restraint application. CONCLUSIONS Drug and alcohol intoxication were most closely associated with restraint. Encounters in which the patient was American Indian had higher odds of restraint, but this study does not replicate prior findings regarding other racial disparities in restraint.
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Affiliation(s)
- Aaron E Robinson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Menominee Indian Tribe of Wisconsin, Keshena, WI, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jon B Cole
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - James R Miner
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Andrea P Dreyfuss
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Aida W Strom
- Department of Health Equity, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Erik R Brodt
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Thomas E Wyatt
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA; Loyal Shawnee Tribe and Quapaw Nation, OK, USA
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3
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Cortinhal VSJ, Correia ASC, Deodato Fernandes SJ. Nursing Ethical Decision Making on Adult Physical Restraint: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:75. [PMID: 38248539 PMCID: PMC10815796 DOI: 10.3390/ijerph21010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE to map the existing knowledge on nursing ethical decision making in the physical restraint of hospitalised adults. (1) Background: physical restraint is a technique that conditions the free movement of the body, with risks and benefits. The prevalence of physical restraint in healthcare suffers a wide variation, considering the environment or pathology, and it raises ethical issues that hinders decision making. This article intends to analyse and discuss this problem, starting from a literature review that will provoke a grounded discussion on the ethical and legal aspects. Inclusion criteria are: studies on physical restraint (C) and ethical nursing decision making (C) in hospitalized adults (P); (2) methods: a three-step search strategy was used according to the JBI. The databases consulted were CINAHL Plus with Full Text (EBSCOhost), MEDLINE Full Text (EBSCOhost), Nursing and Allied Health Collection: Comprehensive and Cochrane Database of Systematic Reviews (by Cochrane Library, RCAAP and Google Scholar. All articles were analysed by two independent reviewers; (3) results: according to the inclusion criteria, 18 articles were included. The categories that influence ethical decision in nursing are: consequence of the decision, the context, the nature of the decision in terms of its complexity, the principles of the ethical decision in nursing, ethical issues and universal values; (4) conclusions: the findings of this review provide evidence that there is extensive knowledge regarding nursing ethical decision making in adult physical restriction, also, it is considered an ethical issue with many associated assumptions. In this article we aim to confront all these issues from a legal perspective.
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Affiliation(s)
- Vanessa Sofia Jorge Cortinhal
- Centro Hospitalar Barreiro Montijo, EPE, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Ana Sofia Castro Correia
- Centro Hospitalar de Lisboa Ocidental, EPE, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Sérgio Joaquim Deodato Fernandes
- School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa,1649-023 Lisbon, Portugal
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
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Joebges S, Mouton-Dorey C, Ricou B, Biller-Andorno N. Coercion in intensive care, an insufficiently explored issue-a scoping review of qualitative narratives of patient's experiences. J Intensive Care Soc 2023; 24:96-103. [PMID: 36874283 PMCID: PMC9975803 DOI: 10.1177/17511437221091051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The use of coercion, in a clinical context as imposing a measure against a patient's opposition or declared will, can occur in various forms in intensive care units (ICU). One prime example of a formal coercive measure in the ICU is the use of restraints, which are applied for patients' own safety. Through a database search, we sought to evaluate patient experiences related to coercive measures. Results For this scoping review, clinical databases were searched for qualitative studies. A total of nine were identified that fulfilled the inclusion and the CASP criteria. Common themes emerging from the studies on patient experiences included communication issues, delirium, and emotional reactions. Statements from patients revealed feelings of compromised autonomy and dignity that came with a loss of control. Physical restraints were only one concrete manifestation of formal coercion as perceived by patients in the ICU setting. Conclusion There are few qualitative studies focusing on patient experiences of formal coercive measures in the ICU. In addition to the experience of restricted physical movement, the perception of loss of control, loss of dignity, and loss of autonomy suggests that restraining measures are just one element in a setting that may be perceived as informal coercion.
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Affiliation(s)
- Susanne Joebges
- Clinic for Anesthesiology, Surgical Intensive Care Medicine and Postoperative Pain Therapy, Dortmund, Germany.,Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
| | - Corine Mouton-Dorey
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
| | - Bara Ricou
- Department of Anaesthesiology, Pharmacology and Surgery Intensive Care, University of Geneva, Geneva, Switzerland
| | - Nikola Biller-Andorno
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zürich, Switzerland
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Kuppili PP, Vengadavaradan A, Bharadwaj B. A Cross-Sectional Study to Assess the Frequency of Restraint, and Knowledge and Attitudes of the Caregivers of Patients Toward Restraint in a General Hospital Psychiatry Setting from South India. Indian J Psychol Med 2022; 44:359-365. [PMID: 35949638 PMCID: PMC9301748 DOI: 10.1177/02537176211061304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is limited Indian data on the epidemiology of hospital-based restraint practices and the knowledge and attitude of caregivers toward restraint. Therefore, this study aimed to report the frequency and pattern of restraints in a general hospital psychiatry setting and assess the knowledge and attitude about restraint practices among caregivers of patients. METHODS We calculated the frequency of restraints (physical and chemical) over one year. The knowledge and attitude toward restraint were assessed in 75 caregivers each of patients from inpatient and outpatient settings, using a questionnaire designed by the authors and pretested in a pilot study. RESULTS The frequency of any form of restraint was 19%. The frequency of chemical and physical restraints was 19% and 0.5%, respectively. Less than 20% of caregivers in both groups reported that restraint was either stigmatizing (5.33% inpatient caregivers vs. 12% outpatient caregivers), cruel (8% inpatient caregivers vs. 15.33% outpatient caregivers), or a measure of punishment (9% inpatient caregivers vs. 16% outpatient caregivers). No significant difference was found between knowledge and attitude about restraint between caregivers of outpatients and inpatients, except for a significantly greater number of caregivers of outpatients reporting that the restraint practices in the hospital were similar to those adopted by faith healers or religious/spiritual centers. CONCLUSION The frequency of either physical or chemical restraint was less compared to the existing international and Indian data. In addition, most caregivers of patients of both outpatients and inpatients did not report a negative attitude toward restraints.
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Affiliation(s)
| | - Ashvini Vengadavaradan
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvanthri Nagar, Puducherry, India
| | - Balaji Bharadwaj
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvanthri Nagar, Puducherry, India
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Guenna Holmgren A, Juth N, Lindblad A, von Vogelsang AC. Nurses' experiences of using restraint in neurosurgical care - A qualitative interview study. J Clin Nurs 2021; 31:2259-2270. [PMID: 34514650 DOI: 10.1111/jocn.16044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To describe nurses' experiences of using restraint in neurosurgical care. BACKGROUND Despite reports of negative consequences, and conflicts with key values in healthcare, restraint measures are still practised in somatic healthcare worldwide. When using restraint, basic principles of nursing collide, creating dilemmas known to be perceived as difficult for many nurses. Patients in neurosurgical care are at high risk of being subjected to restraint, but research on nurses' experiences of using restraint in neurosurgical care are scarce. DESIGN A qualitative, descriptive design guided by a naturalistic inquiry was used. METHODS Semi-structured interviews with 15 nurses working in three neurosurgical departments in Sweden were analysed with inductive qualitative content analysis. COREQ reporting guidelines were used as reporting checklist. RESULTS The analysis resulted in one overarching theme, The struggling professional, and two categories. The category Internal struggle describes nurses' conflicting emotions and internal struggle when engaging in restraint. The category The struggle in clinical practice, describes how nurses struggle with handling restraint in clinical practice, and how the use of restraint is based on individual assessment rather than guidelines. CONCLUSION Nurses' experience restraint in neurosurgical care as a multi-layered struggle, ranging from inner doubts to practical issues. In order to enhance patient safety, there is a need for policies and guidelines regarding the use of restraint, as well as structured discussions and reflections for nurses engaged in the practice. RELEVANCE TO CLINICAL PRACTICE The results highlight the importance of clear guidelines, openness, support and teamwork for nurses working with patients at risk to be subjected to restraint, in order to create a safer care for patients as well as healthcare personnel. When developing guidelines and policies concerning restraint in somatic care, both practical issues such as the decision-making process, and the emotional effect on nurses should be considered.
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Affiliation(s)
- Amina Guenna Holmgren
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Department of Neurosurgery, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Hall H, Smithard DG. A Principlist Justification of Physical Restraint in the Emergency Department. New Bioeth 2021; 27:176-184. [PMID: 33818319 DOI: 10.1080/20502877.2021.1903152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The ethics of physical restraint in the Emergency Department (and elsewhere) has always been an emotive and controversial issue. Recently a vanguard of advocacy groups and regulatory agencies have been aiming to reduce and optimize its use, resulting in new guidance around physical restraint. This article considers prevailing opinions surrounding physical restraint in the Emergency Department using a Principlist model of medical ethics (specifically that of Beauchamp and Childress' four pillars). It also examines the ethical underpinning of the new guidance on the usage of restraint. Ultimately, examination from a Principlist perspective suggests the use of physical restraint in the Emergency Department is justified, as long as it is used carefully. Despite this, physical restraint can have severe physical and psychological consequences for patients, and work needs to be continued into its reduction and optimization.
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Affiliation(s)
| | - David G Smithard
- University of Greenwich, London, UK.,Queen Elizabeth Hospital, Woolwich, UK
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Almomani MH, Khater WA, Qasem BAA, Joseph RA. Nurses' knowledge and practices of physical restraints in intensive care units: An observational study. Nurs Open 2021; 8:262-272. [PMID: 33318834 PMCID: PMC7729655 DOI: 10.1002/nop2.625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/27/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022] Open
Abstract
Aim To investigate the knowledge and practice of physical restraints (PR) among Jordanian intensive care unit (ICU) nurses. Design A descriptive, observational design was used. Methods A convenience sampling was used to recruit participants. We examined the knowledge of PR in 301 nurses (knowledge check) and the real-time practice of PR in 81 nurses (direct observation) in ICU. A knowledge questionnaire was used to collect data on knowledge about PR use, and data on their practice of PR were observed and documented using an observation checklist. Results The mean scores of nurses' knowledge and practices were 61.5 (SD = 12.1) and 57.4 (SD = 9.7), respectively. More than half of nurses had poor knowledge of PR use and incorrect practice of implementing PR (51.5% and 60.5%, respectively). Results indicated a positive correlation between nurses' knowledge and their use of PR.
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Affiliation(s)
- Maysa H. Almomani
- Department of Adult Health NursingFaculty of NursingJordan University of Science and TechnologyIrbidJordan
| | - Wejdan A. Khater
- Department of Adult Health NursingFaculty of NursingJordan University of Science and TechnologyIrbidJordan
| | | | - Rachel A. Joseph
- Department of NursingCollege of Health SciencesWest Chester University of PennsylvaniaWest ChesterPAUSA
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9
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Podgorica N, Flatscher-Thöni M, Deufert D, Siebert U, Ganner M. A systematic review of ethical and legal issues in elder care. Nurs Ethics 2020; 28:895-910. [PMID: 32468910 DOI: 10.1177/0969733020921488] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ethical and legal issues are increasingly being reported by health caregivers; however, little is known about the nature of these issues in geriatric care. These issues can improve work and care conditions in healthcare, and consequently, the health and welfare of older people. AIM This literature review aims to identify research focusing on ethical and legal issues in geriatric care, in order to give nurses and other health care workers an overview of existing grievances and possible solutions to take care of old patients in a both ethical and legally correct way. METHODS Using a systematic approach based on Aveyard, a search of the PubMed, CINAHL, and Ethicshare databases was conducted to find out the articles published on ethical and legal issues in geriatric care. ETHICAL CONSIDERATIONS The approval for the study was obtained from UMIT-The Health and Life Sciences University, Austria. RESULTS Only 50 articles were included for systematic analysis reporting ethical and legal issues in the geriatric care. The results presented in this article showed that the main ethical issues were related to the older people's autonomy, respect for their needs, wishes and values, and respect for their decision-making. The main legal issues were related to patients' rights, advance directives, elderly rights, treatment nutrition dilemma, and autonomy. CONCLUSION Further education for professional caregivers, elderly people, and their families is needed on following topics: care planning, directive and living wills, and caregiver-family member relationships to guide and support the elderly people within their decision-making processes and during the end-of-life care.
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Affiliation(s)
- Nertila Podgorica
- UMIT-University for Health Sciences, Austria; 307399FH Gesundheit-Health University of Applied Sciences Tyrol, Austria
| | | | | | - Uwe Siebert
- 31510UMIT-University for Health Sciences, Austria
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Ye J, Wang C, Xiao A, Xia Z, Yu L, Lin J, Liao Y, Xu Y, Zhang Y. Physical restraint in mental health nursing: A concept analysis. Int J Nurs Sci 2019; 6:343-348. [PMID: 31508457 PMCID: PMC6722410 DOI: 10.1016/j.ijnss.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/04/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Physical restraint is frequently used in medical services, such as in mental health settings, intensive care units and nursing homes, but its nature varies in different institutions. By reviewing related literature, this study aims to clarify the concept of physical restraint in mental health nursing. METHOD Three databases (PubMed, PsycINFO and CINAHL) were retrieved, and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing. RESULTS Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement. It should be the last option used by qualified personnel. Antecedents of physical restraint are improper behavior (violence and disturbance) of patients, medical assessment prior to implementation and legislation governing clinical usage. Consequences of physical restraint are alleviation of conflict, physical injury, mental trauma and invisible impact on the institution. DISCUSSION This study defined the characteristics of physical restraint in mental health nursing. The proposed concept analysis provided theoretical foundation for future studies.
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Affiliation(s)
- Junrong Ye
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Chen Wang
- Early Intervention Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Aixiang Xiao
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Zhichun Xia
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Lin Yu
- Traditional Chinese Medicine Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Jiankui Lin
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Yao Liao
- Cardiovascular Surgery Department, Jingzhou Central Hospital, China
| | - Yu Xu
- Intensive Care Unit Department, West China Hospital of Sichuan University, China
| | - Yunlei Zhang
- Cardiovascular Surgery Department, Jingzhou Central Hospital, China
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Ahmadi M, Bagheri-Saweh MI, Nouri B, Mohamadamini O, Valiee S. Effect of Interventional Educational Programs on Intensive Care Nurses' Perception, Knowledge, Attitude, and Practice About Physical Restraints: A Pre-/Postclinical Trial. Crit Care Nurs Q 2019; 42:106-116. [PMID: 30507671 DOI: 10.1097/cnq.0000000000000244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The article reports results of an educational program designed to modify negative attitudes of intensive care nurses regarding the use of physical restraints. Findings revealed that increased knowledge about appropriate utilization of various types of restraints positively impacted perceptions, attitudes, and patient care practices. Authors also explore restraint use in several countries and identify variations in use of restraining methods.
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Affiliation(s)
- Mohamad Ahmadi
- Student Research Committee (Mr Ahmadi), Clinical Care Research Center (Mr Bagheri-Saweh and Dr Valiee), Social Determinants of Health Research Center, Research Institute for Health Development (Dr Nouri), and Salahuddin Ayyubi Hospital (Mr Mohamadamini), Kurdistan University of Medical Sciences, Sanandaj, Iran
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12
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Kor PPK, Kwan RYC, Liu JYW, Lai C. Knowledge, Practice, and Attitude of Nursing Home Staff Toward the Use of Physical Restraint: Have They Changed Over Time? J Nurs Scholarsh 2018; 50:502-512. [PMID: 30058199 DOI: 10.1111/jnu.12415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Use of physical restraints is common in nursing homes, although empirical evidence has shown it to be a hazardous measure. This article aims to understand whether there were any changes in nursing home staff's knowledge, attitudes, and practices of using physical restraints in Hong Kong, after years of deliberation on this topic. METHODS A questionnaire about the knowledge, attitude, and practice of using physical restraint was sent to all 298 staff members in four nursing homes in Hong Kong run by a nongovernmental organization. The results were compared with previous findings from 1999 using the same questionnaire. RESULTS Overall, the staff had satisfactory knowledge of the daily application of physical restraints, such as the operational procedure and daily assessment. Concerning the conceptual knowledge of minimizing physical restraint use, their performance in the survey was less satisfactory. For example, only 6.6% of respondents were aware that residents had a right to reject the use of physical restraints, and 70% believed that there were no good alternatives to restraints. They showed appropriate attitudes in their practice of daily use of physical restraints. Compared with the previous study in 1999, a significant improvement was found in the attitudes (p = .0014) and practice (p = .0002) of using restraints, but there was no difference in their knowledge test results (p = .29). CONCLUSIONS The results of this study show a significant improvement among the nursing home staff in terms of their attitudes and practice of using restraints. In-service training for nursing staff should focus more on their knowledge of ethical considerations and the hands-on practice of using alternative devices (e.g., motion detectors or anti-slip pads). CLINICAL RELEVANCE The findings of this study suggest that in-service training for nursing staff should focus more on their knowledge of ethical considerations, the principles of using physical restraint, and the alternatives to restraint in order to fill the knowledge gaps of staff and improve the quality of care in nursing homes.
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Affiliation(s)
| | - Rick Yiu Cho Kwan
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Justina Yat-Wa Liu
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Claudia Lai
- School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China
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13
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Balci H, Arslan S. Nurses' Information, Attıtude and Practices towards Use of Physical Restraint in Intensive Care Units. J Caring Sci 2018; 7:75-81. [PMID: 29977877 PMCID: PMC6029653 DOI: 10.15171/jcs.2018.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 04/03/2018] [Indexed: 11/09/2022] Open
Abstract
Introduction: Physical restraint may seem to be a useful and simple procedure to help the treatment but is a complex practice including physical, psychological, judicial, ethical and moral issues. Research was made on description basis in order to determine the knowledge, attitude and application levels of nurses working in critical care units about physical restraint applied on patients. Methods: The study was performed as a descriptive and correlation study. Working in ICUs, 158 nurses constituted the sampling. "Levels of Knowledge, Attitudes and Practices of Staff Regarding Physical Restraints Questionnaire" was used to collect data. Results: For information, attitude and practice scores, participants' scores were 7.1(1.7), 31.8 (4.6) and 36.6 (3.2), respectively. No association was found between information subscale, and age, professional years, working time in ICUs and weekly working hours. However, for attitude subscale, a negative and weak association was found between age (r=-0.229) and professional years (r=-0.174), and increasing these variables decreased attitude score. No association was found between attitude score, and working time in ICUs and weekly working hours. While there was no association between practice score, and age, professional years and working time in ICUs, the increase in weekly working hours (r=-0.243) was found to decrease practice score, and this association was found weak. Conclusion: In conclusion, we consider nurses' level of information is sufficient, but attitudes and practice were not at a positive level. It is recommendable that out of such conditions, novel approaches should be developed to decrease the use of physical restraint.
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Affiliation(s)
- Hatice Balci
- Department of Medical Services and Techniques, Vocational High School of Health Services, KTO Karatay University, Konya, Turkey
| | - Selda Arslan
- Department of Nursing, Healthy Science Faculty, Selcuk University, Konya, Turkey
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14
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Lam K, Kwan JS, Wai Kwan C, Chong AM, Lai CK, Lou VW, Leung AY, Liu JY, Bai X, Chi I. Factors Associated With the Trend of Physical and Chemical Restraint Use Among Long-Term Care Facility Residents in Hong Kong: Data From an 11-Year Observational Study. J Am Med Dir Assoc 2017; 18:1043-1048. [DOI: 10.1016/j.jamda.2017.06.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022]
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Acevedo-Nuevo M, González-Gil MT, Solís-Muñoz M, Láiz-Díez N, Toraño-Olivera MJ, Carrasco-Rodríguez-Rey LF, García-González S, Velasco-Sanz TR, Martínez-Álvarez A, Martin-Rivera BE. [Therapeutic restraint management in Intensive Care Units: Phenomenological approach to nursing reality]. ENFERMERIA INTENSIVA 2016; 27:62-74. [PMID: 26805701 DOI: 10.1016/j.enfi.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/06/2015] [Accepted: 11/26/2015] [Indexed: 11/30/2022]
Abstract
AIMS To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. METHOD A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. FINDINGS Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. CONCLUSIONS In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint.
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Affiliation(s)
- M Acevedo-Nuevo
- UCI Médica, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda (Madrid), España; Máster en Cuidados Críticos, Universidad Camilo José Cela, Madrid, España.
| | - M T González-Gil
- Sección Departamental de Enfermería, Universidad Autónoma de Madrid, Madrid, España
| | - M Solís-Muñoz
- Departamento de Investigación, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda (Madrid), España
| | - N Láiz-Díez
- UCI Médica, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda (Madrid), España
| | - M J Toraño-Olivera
- Unidad de Cuidados Cardiacos Postoperatorios, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | | | | | - B E Martin-Rivera
- Unidad de Críticos Quirúrgicos, Hospital Universitario Ramón y Cajal, Madrid, España
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16
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Abstract
BACKGROUND There is controversy concerning the use of physical restraint. Despite this controversy, some nurses still consider the application of physical restraint unavoidable for some of their clients. AIM Identify the perceptions and practice of physical restraint in China. RESEARCH DESIGN This was a descriptive study that combined qualitative interviews with a quantitative cross-sectional survey. PARTICIPANTS A total of 18 nurses were interviewed and 330 nurses were surveyed. ETHICAL CONSIDERATIONS Approval of the study was obtained from the hospital ethics committee. Permission to conduct the study was obtained from the director of nursing. Participants were assured that their participation is voluntary. RESULTS Physical restraint was commonly used to protect patients' safety. Naturally, intensive care unit nurses used physical restraint much more frequently than general medical/surgical ward nurses (p < 0.01). In addition, night shift nurses tended to use physical restraint more frequently. CONCLUSION Nursing managers should be aware of the role nurses play in the use of physical restraint. In-service training regarding the proper use of physical restraint should be strengthened and nurse staffing levels should be improved in order to minimize the use of physical restraint in China.
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Affiliation(s)
- Hui Jiang
- Tongji University School of Medicine, China
| | | | - Yan Gu
- Tongji University School of Medicine, China
| | - Yanan He
- Tongji University School of Medicine, China
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17
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Examination of ethical dilemmas experienced by adult intensive care unit nurses in physical restraint practices. Holist Nurs Pract 2014; 28:85-90. [PMID: 24503745 DOI: 10.1097/hnp.0000000000000013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.
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18
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Knowledge, attitudes, and practices of Turkish intern nurses regarding physical restraints. CLIN NURSE SPEC 2014; 27:262-71. [PMID: 23942106 DOI: 10.1097/nur.0b013e3182a0baec] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study was carried out to determine knowledge, attitudes, and practices of intern nurses who completed the nursing internship program on the use of physical restraints. DESIGN This research was conducted using descriptive and cross-sectional research design. METHODS The study sample comprises 91 fourth-grade students who took an integrated curriculum and completed the nursing internship program. The data were collected with the Demographic Characteristics Questionnaire and the Levels of Knowledge, Attitudes and Practices of Staff Regarding Physical Restraints Questionnaire. For the assessment of the data, percentages, the arithmetic mean, and t test were used. RESULTS The findings indicated that, of the intern nurses, 95.6% observed the use of physical restraints during their education, and 69.2% applied physical restraints. The mean knowledge, attitude, and practice scores of the nurses for physical restraint were 9.38 ± 1.19 (0-11 points), 34.70 ± 5.62 (12-48 points), and 37.95 ± 2.32 (14-42 points), respectively. CONCLUSIONS Intern nurses' knowledge about how to use physical restraints was at a very good level; they displayed positive attitudes, and they used their knowledge and attitudes in their practices to a great extent. IMPLICATIONS Although there are studies on the knowledge, attitudes, and practices of nurses working in the fields of elderly care, rehabilitation, and psychiatry in acute care units, there are no studies investigating intern nurses and other nursing students. However, intern nurses about to begin their careers should make accurate decisions regarding the use of physical restrains if they are to ensure patient safety and to fulfill this application effectively in their professional lives.
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Iecovich E, Rabin B. Practices used in Israel by nurses who care during hospitalization for older patients with dementia or who are bedridden. Am J Alzheimers Dis Other Demen 2014; 29:166-76. [PMID: 24211869 PMCID: PMC10852597 DOI: 10.1177/1533317513511287] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
The study's purpose was to examine (a) bedside nurses' care practices when providing care to patients with dementia or those who are physically disabled and (b) the extent to which these actions vary by type of hospital, type of ward, and nurse's characteristics. The sample included 265 nurses in internal medicine and geriatric wards in 2 general hospitals in Israel. The results showed that the most prevalent practices were giving greater attention to these patients, locating them in a room near the nurses' station and asking family members to stay with the patient or to hire paid carers. Use of restraints was more prevalent in patients with dementia than those who were physically disabled. Use of specific practices significantly varied by type of ward and hospital, suggesting that nurses' care practices are more connected with organizational characteristics than other factors.
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Affiliation(s)
- Esther Iecovich
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, BeerSheva, Israel
| | - Barbara Rabin
- Social Services, Meir Medical Center, Kfar Saba, Israel
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20
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Bersot HY, Arrigo BA. The Ethics of Mechanical Restraints in Prisons and Jails: A Preliminary Inquiry from Psychological Jurisprudence. JOURNAL OF FORENSIC PSYCHOLOGY PRACTICE 2011. [DOI: 10.1080/15228932.2011.537585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Ludwick R, O’Toole R, Meehan A. Restraints or alternatives: safety work in care of older persons. Int J Older People Nurs 2010; 7:11-9. [DOI: 10.1111/j.1748-3743.2010.00244.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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22
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Mechanische freiheitsentziehende Maßnahmen im Krankenhaus. Z Gerontol Geriatr 2010; 43:291-6. [DOI: 10.1007/s00391-010-0111-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
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Restraints and the code of ethics: An uneasy fit. Arch Psychiatr Nurs 2010; 24:3-14. [PMID: 20117684 DOI: 10.1016/j.apnu.2009.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2008] [Revised: 02/15/2009] [Accepted: 03/24/2009] [Indexed: 11/21/2022]
Abstract
This article examines the use of physical restraints through the four broad principles of ethics common to all helping professions. It asks whether the continued use of physical restraints is consistent with ethical practice through the lens of those principles. It also examines where the necessity to use restraints in the absence of empirically supported alternatives leaves professionals in terms of conflicts between ethical principles and makes recommendations for changes in education and clinical practice. It concludes that an analysis through a bioethics lens demonstrates that the use of restraints as a tool in psychiatric settings is a complex and multifaceted problem. Principles of ethics may often be in conflict with each other in instances where patients must be physically restrained.
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Kim SM, Lee YJ, Kim DH, Kim SY, Ahn HY, Yu SJ. Perception, Attitude, and Knowledge about Physical Restraints among Nursing Personnel in Long Term Care Facilities. ACTA ACUST UNITED AC 2009. [DOI: 10.5977/jkasne.2009.15.1.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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