The safety of nurses during the restraining of aggressive patients in an acute psychiatric unit

Abstract

Objective: The aim of the study was to describe patterns of injuries sustained by nurses during the restraining of aggressive patients and to identify factors in the restraining process that can be modified to improve the safety of nurses during restraining. Design: Within‑method triangulation was used in this study and involved two quantitative data collection methods. Setting: An adult acute psychiatric unit in Victoria, Australia. Subjects: Seven male and twenty‑six female nurses. Main outcome measures: The outcome measures are patterns of injuries and ways of reducing injuries. Results: Incident reports showed more than half of all injuries occurred in the afternoon shift and during the holding stage of restraining. Eighty percent of the injured nurses sustained multiple injuries. Questionnaire results showed that restraining was associated with an estimated increased risk of being injured of 25% (RR = 1.25, 95% CI= 0.97 to 1.61, p > 0.05). The proportion of injuries was higher among female nurses (52.38%) compared with male nurses (28.57%), (RR=0.51, 95% CI = 0.15 to 1.74, p > 0.05). Lack of group co‑ordination was perceived as the main contributor to injury. Introducing easier restraining techniques and increasing the training period were identified as ways that might improve the safety of nurses. Conclusion: Most injuries occurred at the holding stage of restraining and in the afternoon shift. Many participants sustained multiple injuries and most of the injuries were caused by physical assaults. There is need for improving group coordination during restraining to increase the safety of nurses.