The use of physical restraints on children: practices and attitudes of paediatric nurses in Turkey

Abstract

This study aimed to determine paediatric nurses' ideas and attitudes towards physical restraint in Turkey, the consent obtained, physical restraint types used in paediatric units and complications developing in children subjected to physical restraint. Physical restraint, although controversial, is still common in paediatric units in Turkey and creates complications, which were observed or investigated by researchers. The research used descriptive, analytical and cross-sectional methods with 121 paediatric nurses working in paediatric surgical-internal medicine services and paediatric intensive care units of four hospitals. The questionnaire consisted of open-ended questions and was applied via face-to-face interviews. 66.9% of nurses reported that nurse shortages were the main reason for increased physical restraint applications, 58.7% tried alternative methods, and 71.1% indicated no need of written orders for physical restraint use. Physical restraint decreased while the mother accompanied her child (P = 0.0001) and increased while inexperienced clinic nurses were in charge (P = 0.003). Wrist (96.7%), ankle (81.0%), and whole body (17.4%) restraints were all used. No nurse had received any verbal or written consent from children or surrogates and 96.7% used physical restraint without any verbal or written physician order. Thirty (24.8%) respondents reported that children under physical restraint had developed various complications, for example, oedema and cyanosis by arm and wrist restraint, food rejection and agitation. Physical restraint could be reduced by a wiser combination of education and expert consultation in paediatric units in Turkey, although further detailed research is needed.