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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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Acevedo-Nuevo M, González-Gil MT, Martin-Arribas MC. Physical Restraint Use in Intensive Care Units: Exploring the Decision-Making Process and New Proposals. A Multimethod Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211826. [PMID: 34831583 PMCID: PMC8623552 DOI: 10.3390/ijerph182211826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022]
Abstract
Aim: The general aim of this study was to explore the decision-making process followed by Intensive Care Unit (ICU) health professionals with respect to physical restraint (PR) administration and management, along with the factors that influence it. Method: A qual-quant multimethod design was sequenced in two stages: an initial stage following a qualitative methodology; and second, quantitative with a predominant descriptive approach. The multicenter study was undertaken at 17 ICUs belonging to 11 public hospitals in the Madrid region (Spain) across the period 2015 through 2019. The qualitative stage was performed from an interpretative phenomenological perspective. A total of eight discussion groups (DG) were held, with the participation of 23 nurses, 12 patient care nursing assistants, and seven physicians. Intentional purposive sampling was carried out. DG were tape-recorded and transcribed. A thematic analysis of the latent content was performed. In the quantitative stage, we maintained a 96-h observation period at each ICU. Variables pertaining to general descriptive elements of each ICU, institutional pain-agitation/sedation-delirium (PAD) monitoring policies and elements linked to quality of PR use were recorded. A descriptive analysis was performed, and the relationship between the variables was analyzed. The level of significance was set at p ≤ 0.05. Findings: A total of 1070 patients were observed, amounting to a median prevalence of PR use of 19.11% (min: 0%–max: 44.44%). The differences observed between ICUs could be explained by a difference in restraint conceptualization. The various actors involved jointly build up a health care culture and a conceptualization of the terms “safety-risk”, which determine decision-making about the use of restraints at each ICU. These shared meanings are the germ of beliefs, values, and rituals which, in this case, determine the greater or lesser use of restraints. There were different profiles of PR use among the units studied: preventive restraints versus “Zero” restraints. The differences corresponded to aspects such as: systematic use of tools for assessment of PAD; interpretation of patient behavior; the decision-making process, the significance attributed to patient safety and restraints; and the feelings generated by PR use. The restraint–free model requires an approach to safety from a holistic perspective, with the involvement of all team members and the family.
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Affiliation(s)
- María Acevedo-Nuevo
- Transplant National Organization, Health Ministry, 28029 Madrid, Spain
- Correspondence:
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KILIÇ G, POLAT Ü. Yoğun Bakım Hemşirelerinin Yaşlılara Yönelik Tutumları ile Fiziksel Tespit Edici Kullanımları Arasındaki İlişki. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.953286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Yoğun bakım hemşirelerinin yaşlılara yönelik tutumları ile fiziksel tespit edici kullanımına ilişkin bilgi, tutum ve uygulamaları arasındaki ilişkiyi belirlemek.
Yöntem: Araştırma, kesitsel tipte olup, şubat-nisan 2016 tarihleri arasında iki üniversite hastanesi ve bir özel hastanenin yoğun bakım ünitelerinde çalışan 107 hemşire ile yapılmıştır. Araştırmada veriler, 'Anket Formu', ‘Hemşirelerin Fiziksel Tespit Edici Kullanımına İlişkin Bilgi Düzeyi, Tutum ve Uygulamaları Ölçeği’ ile 'Yaşlı Ayrımcılığı Tutum Ölçeği (YATÖ)' kullanılarak toplanmıştır.
Bulgular: Yoğun bakım hemşirelerin fiziksel tespit kullanımına ilişkin bilgi puan ortalaması 7.22±1.59, tutum puan ortalaması 31.60±5.80, uygulama puan ortalaması 37.64±2.99 olarak bulunmuştur. Yoğun bakım hemşirelerinin YATÖ toplam puan ortalaması 86.13±9.44 olarak bulundu. Hemşirelerin fiziksel tespit kullanımına ilişkin bilgi düzeyi, tutum ve uygulamaları ile yaşlılara yönelik tutumları arasında istatistiksel olarak anlamlı ilişki bulunmadı(p>0.05).
Tartışma ve Sonuç: Hemşirelerin fiziksel tespit edici kullanımına ilişkin bilgi düzeylerinin iyi, tutumlarının olumlu ve uygulamalarının yeterli düzeyde olduğu ve yaşlılara yönelik tutumlarının ise olumlu olduğu bulundu. Yoğun bakım hemşirelerinin fiziksel tespit uygulamasını, yaşlı hastanın güvenliğini sağlamada bakımın bir parçası olarak gördükleri düşünülmektedir.
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De La Cuesta-Benjumea C, Lidón-Cerezuela B, Abad-Corpa E, Meseguer-Liza C, Arredondo-González CP. Managing and keeping control: A qualitative synthesis of nursing and care staff strategies to prevent older people from falling. J Adv Nurs 2021; 77:3008-3019. [PMID: 33608944 DOI: 10.1111/jan.14794] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/14/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Abstract
AIM To better understand formal care providers' role in fall prevention. DESIGN Qualitative synthesis as part of an integrative review. DATA SOURCES Fifteen electronic databases were consulted with the time limit being December 2017. Studies included were qualitative primary studies on formal care providers and fall prevention of people over 65 years of age in health care facilities. 17 studies were included. REVIEW METHODS Qualitative researchers carried out a critical appraisal and abstraction of the studies retained. Primary studies were imported into Nvivo 12 software; grounded theory procedures of constant comparison, microanalysis, coding, development of memos and diagrams were completed concurrently in a continuous growing process of data conceptualization. Analysis was iterative; it started with open coding and ended with the development of an integrative memo. FINDINGS Primary studies were synthesized with the emerging core category of "Managing and keeping control" and described by the emerging strategies of risk management, risk control and articulation work. These three categories account for the formal care providers' role in fall prevention in health care facilities. CONCLUSION Fall prevention is not given by a series of means and instruments; it is rather built in the interactions between formal care providers and the material and social world. The interactive character of prevention implies that outcomes cannot always be anticipated. IMPACT Although falls are one of the most researched clinical problems in nursing, the role played by nursing and care staff is dispersed and scantily documented. Formal care providers alternate risk management with risk control strategies to prevent older people from falling in health care facilities, they also resort to the articulation of the health care team as a complementary strategy. This review shows the dynamic character of fall prevention, which is something that has tended to go unnoticed in the literature and in policy.
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Affiliation(s)
| | | | - Eva Abad-Corpa
- University of Murcia-Murcia Health Service (IMIB-Arrixaca), Murcia, Spain.,Nursing and Healthcare Research Unit (Investén-isciii), Biomedical Research Center for Fragility and Healthy Aging (CIBERFES), Madrid, Spain
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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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Walker H, Tulloch L. A "Necessary Evil": Staff Perspectives of Soft Restraint Kit Use in a High-Security Hospital. Front Psychiatry 2020; 11:357. [PMID: 32477174 PMCID: PMC7241439 DOI: 10.3389/fpsyt.2020.00357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Forensic mental health nurses working at the forefront of services can intermittently face enduring and somewhat harrowing or stressful situations. Enclosed is an example of the use of mechanical restraints (Soft Restraint Kit) for a two month period. Staff experience of working under such circumstances is an under reported area. METHODS The experience of nursing a patient under extreme conditions was captured through use of a qualitative study, using semi structured interviews with a purposive sample of (n = 10) staff nurses and nursing assistants in a high-security hospital. RESULTS Thematic analysis was undertaken generating four themes: sense of responsibility, aptitude, enablers/inhibitors, and consequence. Conclusions suggest that Soft Restraint Kits provide a useful method of containment, although prolonged use presents considerable challenges for staff. The importance of preparation and training cannot be underestimated and continued support and supervision are absolutely essential.
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Affiliation(s)
- Helen Walker
- Department of Health and Life Sciences, University of the West of Scotland, Paisley, United Kingdom
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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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The experience of restraint-use among patients with violent behaviors in mental health hospital. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30173-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Eskandari F, Abdullah KL, Zainal NZ, Wong LP. Use of physical restraint: Nurses' knowledge, attitude, intention and practice and influencing factors. J Clin Nurs 2017; 26:4479-4488. [PMID: 28233363 DOI: 10.1111/jocn.13778] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 10/20/2022]
Abstract
AIMS AND OBJECTIVES To investigate the knowledge, attitude, intention and practice of nurses towards physical restraint and factors influencing these variables. BACKGROUND A literature review showed a lack of studies focused on the intention of nurses regarding physical restraint throughout the world. Considering that very little research on physical restraint use has been carried out in Malaysia, assessment of nurses' knowledge, attitude, intention and practice is necessary before developing a minimising programme in hospitals. DESIGN A cross-sectional study was used. METHODS A questionnaire to assess the knowledge, attitude, intention and practice was completed by all nurses (n = 309) in twelve wards of a teaching hospital in Kuala Lumpur. RESULTS Moderate knowledge and attitude with strong intention to use physical restraint were found among the nurses. Less than half of nurses considered alternatives to physical restraint and most of them did not understand the reasons for the physical restraint. Nurses' academic qualification, read any information source during past year and nurses' work unit showed a significant association with nurses' knowledge. Multiple linear regression analysis found knowledge, attitude and intention were significantly associated with nurses' practice to use physical restraint. CONCLUSION This study showed some important misunderstandings of nurses about using physical restraint and strong intention regarding using physical restraint. Findings of this study serve as a supporting reason for importance of educating nurses about the use of physical restraint. RELEVANCE TO CLINICAL PRACTICE Exploring the knowledge, attitude, intention and current practice of nurses towards physical restraint is important so that an effective strategy can be formulated to minimise the use of physical restraints in hospitals.
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Affiliation(s)
- Fatemeh Eskandari
- Department of Nursing Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khatijah Lim Abdullah
- Head of Department of Nursing Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Nor Zuraida Zainal
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Head of Psychological Medicine Research Group of University of Malaya (PARADIGM), Kuala Lumpur, Malaysia.,Malaysian Psychiatric Association, Kuala Lumpur, Malaysia.,Malaysian J Psychiatry, Kuala Lumpur, Malaysia
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Staggs VS, Olds DM, Cramer E, Shorr RI. Nursing Skill Mix, Nurse Staffing Level, and Physical Restraint Use in US Hospitals: a Longitudinal Study. J Gen Intern Med 2017; 32:35-41. [PMID: 27553206 PMCID: PMC5215153 DOI: 10.1007/s11606-016-3830-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/21/2016] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units. OBJECTIVE To conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit's long-term average is associated with restraint use. DESIGN We analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to the unit's average staffing across study quarters. SUBJECTS 3101 medical, surgical, and medical-surgical units in US hospitals participating in the National Database of Nursing Quality Indicators during 2006-2010. Units had to report at least one quarter with restraint use and one quarter without. MAIN MEASURES We studied two nurse staffing variables: staffing level (total nursing hours per patient day) and nursing skill mix (proportion of nursing hours provided by RNs). Outcomes were any use of restraint, regardless of reason, and use of restraint for fall prevention. KEY RESULTS Nursing skill mix was inversely correlated with restraint use for fall prevention and for any reason. Compared to average quarters, odds of fall prevention restraint and of any restraint were respectively 16 % (95 % CI: 3-29 %) and 18 % (95 % CI: 8-29 %) higher for quarters with very low skill mix. CONCLUSIONS In this longitudinal study there was a strong negative correlation between nursing skill mix and physical restraint use. Ensuring that skill mix is consistently adequate should reduce use of restraint.
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Affiliation(s)
- Vincent S. Staggs
- Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, 64108 MO USA
- School of Medicine, University of Missouri-Kansas City, 2411 Holmes St, Kansas City, MO 64108 USA
| | - Danielle M. Olds
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Emily Cramer
- School of Nursing, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 USA
| | - Ronald I. Shorr
- Geriatric Research, Education and Clinical Center (GRECC), Malcom Randall Veterans Administration Medical Center, Gainesville, FL USA
- Department of Epidemiology, University of Florida, 2004 Mowry Road, PO Box 100231, Gainesville, FL 32610 USA
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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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Fereidooni Moghadam M, Fallahi Khoshknab M, Pazargadi M. Psychiatric Nurses' Perceptions about Physical Restraint; A Qualitative Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2014; 2:20-30. [PMID: 25349842 PMCID: PMC4201183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/08/2013] [Accepted: 10/10/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The use of physical restraint as an intervention in the care of psychiatric patients dates back to the beginning of psychiatry. Although it is a challenging question, it is still one of the common procedures in psychiatry. Considering that very little research has been done in Iran in relation to physical restraint, this qualitative study aimed to investigate the experiences of nurses working in psychiatric wards regarding physical restraint. METHODS This qualitative study was done on 14 nurses working in the psychiatric hospitals of Ahvaz city, southern Iran, during 2011-2012. The participants were selected by purposive sampling. Semi-structured interviews were used for data collection, which were continued until data saturation and emergence of themes. Inductive content analysis was used to analyze the data. RESULTS Four categories emerged: (1) Restraint as a multi-purpose procedure, (2) Processing of physical restraint, (3) Restraint as a challenging subject and (4) The effects of restraint on the spectrum. Each category has several different sub-categories. CONCLUSION The participants described using physical restraint as one of the main strategies to control psychiatric patients, and despite having negative consequences, it is extensively used. Given the risks and challenges of using physical restraint, nursing education should find alternative methods.
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Affiliation(s)
| | - Masoud Fallahi Khoshknab
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences (USWR), Tehran, Iran;
| | - Mehrnoosh Pazargadi
- Department of Nursing Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Möhler R, Meyer G. Attitudes of nurses towards the use of physical restraints in geriatric care: a systematic review of qualitative and quantitative studies. Int J Nurs Stud 2013; 51:274-88. [PMID: 24176718 DOI: 10.1016/j.ijnurstu.2013.10.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine nurses' attitudes towards the use of physical restraints in geriatric care. DESIGN Systematic review and synthesis of qualitative and quantitative studies. DATA SOURCES The following databases were searched: Medline, CINAHL, EMBASE, Psyndex, PsychInfo, Social SciSearch, SciSearch, Forum Qualitative Social Research (1/1990 to 8/2013). We performed backward and forward citation tracking to all of the included studies. REVIEW METHODS We included in the present review all qualitative and quantitative studies in English and German that investigated nurses' attitudes towards the use of physical restraints in geriatric care. Two independent reviewers selected the studies for inclusion and assessed the study quality. We performed a thematic synthesis for the qualitative studies and a content analysis of the questionnaires' items as well as a narrative synthesis for the quantitative surveys. RESULTS We included 31 publications in the review: 20 quantitative surveys, 10 qualitative and 1 mixed-method study. In the qualitative studies, nurses' attitudes towards the use of physical restraints in geriatric care were predominately characterised by negative feelings towards the use of restraints; however, the nurses also described a perceived need for using restraints in clinical practice. This discrepancy led to moral conflicts, and nurses described several strategies for coping with these conflicts when restraints were used. When nurses were in doubt regarding the use of restraints, they decided predominantly in favour of using restraints. The results of the quantitative surveys were inconsistent regarding nurses' feelings towards the use of restraints in geriatric care. Prevention of falls was identified as a primary reason for using restraints. However, the items of the questionnaires focussed primarily on the reasons for the use of restraints rather than on the attitudes of nurses. CONCLUSIONS Despite the lack of evidence regarding the benefits of restraints and the evidence on the adverse effects, nurses often decided in favour of using restraints when in doubt and they used strategies to cope with negative feelings when they used restraints. A clear policy change in geriatric care institutions towards restraint-free care seems to be warranted to change clinical practice. The results of this review should also be considered in the development of interventions aimed at reducing the use of restraints.
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Affiliation(s)
- Ralph Möhler
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany.
| | - Gabriele Meyer
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany; Institute of Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
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Kandeel NA, Attia AK. Physical restraints practice in adult intensive care units in Egypt. Nurs Health Sci 2013; 15:79-85. [PMID: 23302019 DOI: 10.1111/nhs.12000] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 08/04/2012] [Accepted: 08/13/2012] [Indexed: 11/26/2022]
Abstract
Physical restraints are commonly used in intensive care units to reduce the risk of injury and ensure patient safety. However, there is still controversy regarding the practice of physical restraints in such units. The purpose of this study was to investigate the practices of physical restraints among critical care nurses in El-Mansoura City, Egypt. The study involved a convenience sample of 275 critically ill adult patients, and 153 nurses. Data were collected from 11 intensive care units using a "physical restraint observation form" and a "structured questionnaire." The results revealed that physical restraint was commonly used to ensure patient safety. Assessment of physical restraint was mainly restricted to peripheral circulation. The most commonly reported physically restrained site complications included: redness, bruising, swelling, and edema. The results illustrated a lack of documentation on physical restraint and a lack of education of patients and their families about the rationale of physical restraint usage. The study shed light on the need for standard guidelines and policies for physical restraint practices in Egyptian intensive care units.
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Lane C, Harrington A. The factors that influence nurses' use of physical restraint: A thematic literature review. Int J Nurs Pract 2011. [DOI: 10.1111/j.1440-172x.2011.01925.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Falls and gait disorders in geriatric neurology. Clin Neurol Neurosurg 2010; 112:265-74. [DOI: 10.1016/j.clineuro.2009.12.015] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 08/17/2009] [Accepted: 12/27/2009] [Indexed: 11/23/2022]
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Johnson S, Ostaszkiewicz J, O'Connell B. Moving Beyond Resistance to Restraint Minimization: A Case Study of Change Management in Aged Care. Worldviews Evid Based Nurs 2009; 6:210-8. [DOI: 10.1111/j.1741-6787.2009.00162.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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