Use of physical restraint in hospital patients: A descriptive study in a tertiary hospital in South Africa

Sabela George Petros,Sebastiana Zimba Kalula

doi:10.4102/cur.v39i1.1605

Sabela George Petros, Sebastiana Zimba Kalula

Open Access

https://doi.org/10.4102/cur.v39i1.1605

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Abstract

Background: The use of physical restraint in patient management is a common and emotive issue, and has legal and ethical dimensions. Objective: To document the prevalence of physical restraint use, patient characteristics associated with physical restraint use, and nurses’ and doctors’ knowledge and perceptions towards the practice. Methods: A cross-sectional study of 572 patients, of whom 132 were physically restrained, was conducted in acute wards of a tertiary hospital. Data were collected on the 132 physically restrained patients. Fifty-nine doctors and 159 nurses completed a specially constructed questionnaire. Descriptive statistics were derived and expressed as numbers and percentages. Results: Prevalence of restraint use was 23% (132/572). The distribution in acute wards was: medical 54.5%; surgical 44.7%; maternity 0.8%; psychiatry none. Mean age (SD) of the restrained patients was 49 years (20.5); 53.8% were male. The commonest types of restraints used were bed rails 93% and wrist belts 12%. Restraints were used largely to protect medical devices and as protection from harm. Less than 15% of the nurses reported having received training and 36% of the doctors reported having received some guidance on the use of restraints. Only a minority of nurses and doctors knew of a hospital policy on restraint use. Documentation on the prescription and indication for the use of restraint was poor. Conclusion: Prevalence of restraint use is high and poorly coordinated. A policy on the use of restraint and comprehensive guidelines should be developed to guide health care practitioners in the management of patients where restraint cannot be avoided.

Highlights

The use of physical restraint in hospital patients has been extensively investigated in so-called developed countries (Cotter 2005; Evans & Strumpf 1989; Heinze, Dassen & Grittner 2012; Krüger et al 2013; Martin & Mathisen 2005), but less commonly in the developing world
In the former case it is argued that the practice is purely to ensure patient safety as well as the safety of other patients and health care practitioners (Demir 2007; Heinze et al 2012; Martin & Mathisen 2005; Minnick et al 2007)
The practice is justified by hospital staff as being in the patient’s interest, as he or she may be at risk of harming him or herself, but pose a danger to other patients and health care practitioners (Demir 2007; Heinze et al 2012; Martin & Mathisen 2005; Minnick et al 2007)

Summary

Introduction

The use of physical restraint in hospital patients has been extensively investigated in so-called developed countries (Cotter 2005; Evans & Strumpf 1989; Heinze, Dassen & Grittner 2012; Krüger et al 2013; Martin & Mathisen 2005), but less commonly in the developing world. Arguments are proffered to both support (Demir 2007; Heinze et al 2012; Martin & Mathisen 2005; Minnick et al 2007), and question, discourage and reject (Agens 2010; Watson 2001) the practice In the former case it is argued that the practice is purely to ensure patient safety as well as the safety of other patients and health care practitioners (Demir 2007; Heinze et al 2012; Martin & Mathisen 2005; Minnick et al 2007). The use of physical restraint in patient management is a common and emotive issue, and has legal and ethical dimensions

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