Physical Restraint Practices Research Articles

Family perspectives on physical restraint practices and minimization in an adult intensive care unit: A qualitative descriptive study

ObjectiveTo explore family perspectives on physical restraint practices and their minimization in an adult intensive care unit. Design & MethodsA qualitative descriptive study with one-on-one semi-structured interviews. A deductive content analysis approach was undertaken using the Theoretical Domains Framework. SettingA 20-bed medical, surgical, trauma ICU in Toronto, Canada. FindingsFifteen family members were interviewed. Three themes emerged: (i) barriers and facilitators to restraint minimization. Barriers noted by families included patient agitation posing risks of losing endotracheal tubes, nurse reluctance to remove restraints, lack of family involvement, limited knowledge of alternatives, and a noisy environment. Facilitators included family involvement in decision-making, timely extubation, use of less restrictive alternatives such as mittens, mandating shorter periods of restraints application, and environmental modifications; (ii) unilateral decision-making regarding physical restraint use, where clinicians made decisions with inadequate communication with families nor obtaining consent; and (iii) the emotional impact of physical restraint use, with families experiencing sadness and shock and believing the patient would feel similarly. ConclusionThis qualitative study highlights significant issues surrounding the use of physical restraints, particularly the lack of family involvement in decision-making, the emotional toll on families, and various barriers and facilitators to minimizing restraint use. Effective communication and collaboration between clinicians and families are crucial to addressing these issues. Implications for Clinical PracticeOur findings underscore the critical need to enhance communication between clinicians and families, alongside consent processes. Identifying barriers and facilitators at various levels can inform individualized strategies to reduce restraint use, including integrating alternatives like mittens and involving families in care. Timely introduction of alternatives and family involvement are vital to prevent further emotional distress for families. Prioritizing the reduction of restraint duration is crucial, particularly in settings emphasizing harm minimization.

An integrative review on physical restraint in adult critical care unit.

Physical restraints (PRs) are frequently used in adult critical care units to protect staff and prevent self-harm, despite the fact that they represent significant safety risks. Restraint complications may have an impact on the patient's long- and short-term outcomes. This integrative review aimed to meticulously evaluate existing evidence pertaining to physical restraint practices in adult critical care settings. The review was specifically geared towards examining the prevalence of PR, identifying influential factors, elucidating the role of nurses in PR implementation, exploring nurses' experiences in caring for patients under restraint, and scrutinizing the complications associated with PR application. This integrative review included the studies published between January 2009 and December 2019 and the literature search was conducted in July 2020. The databases searched included EBSCOhost, Ovid, ProQuest, PubMed, Wiley Online Library, SCOPUS, and ScienceDirect. The keywords included in the search were restraint, critical care, intensive care, ICU, mechanical ventilation, intubation, nursing, and experience. A checklist based on the CASP checklist and the JBI Critical Appraisal Tool was used to assess the methodological quality. The findings were evaluated and summarized into seven key topics after twenty-one publications were found to be evaluated. i) High prevalence of PR application in adult critical care unit; ii) determinants of PR applications; iii) types of PR in adult critical care units; iv) decision maker of PR; v) moral and ethical dilemma in PR application; vi) awareness and guidelines for PR applications; vii) common complications and use of sedation, analgesics, antipsychotic drugs in PR application. The number of days PR is used is related to the risk of an adverse event. In order to standardize nursing practice, ICU nurses require greater training on the ideas of PR use. Evidence-based recommendations will assist critical care nurses in making the best judgments possible concerning the use of PR.

Physical Restraint Practices at the Emergency Department of a Mental Health Hospital.

Coercive treatments can lead to ethical, legal, and clinical concerns, especially in emergency settings. The indications and characteristics of patients for whom physical restraint is indicated should be well-evaluated in order to prevent unnecessary practices. The aim of this study was to comprehensively assess the physical restraint practices in psychiatric emergencies and clinical characteristics related to their use. All patients admitted to the emergency unit of a tertiary mental health hospital between June 1 and June 30, 2022, were included in the sample. Data were retrieved from the manual and electronic medical records. Age, gender, clinical settings, diagnosis, substance use, and other factors were categorized and analyzed, comparing physically restrained and not-restrained patients. Totally, 2051 patients were included in the study (1022 female and 1029 male). The mean age of the participants was 39.5 ± 14.8 years (female: 40.3 ± 14.8 male: 38.4 ± 14.7, P = .004). Seventy-two (3.51%) of the admitted patients were exposed to physical restraint and those had significantly lower number of applications in the past year (P = .020). The median restraint duration was 90 (60-150) minutes. Fifty-four (75.00%) of the physically restrained patients were male (P < .001), and they were significantly younger (mean age 34.5 ± 12.1 vs. 39.5 ± 14.9, P = .005). Clinical diagnoses of restrained patients were significantly different, in favor of psychosis. While 42 (58.33%) of the restrained patients were substance-negative, 15 (20.83%) were screened as positive for at least 1 substance (P < .001). Physically restrained patients differ from others with regard to age, gender, and number of previous applications. Fewer hospital applications in the past year were related to higher incidence of physical restraints.

The use of physical restraints and PRN medications in adolescent psychiatric inpatient units.

Although physical restraint practices and psychotropic/sedative pro re neta (PRN, as needed) medications have been commonly used for managing inpatient aggression, little is known about the characteristics of adolescents who receive them in psychiatric adolescent inpatient units. We aimed to determine the relationship between the use of physical restraints and psychotropic/sedative PRN medications, and to characterize individual attributes, substance use, clinical factors, and time of the first restraint episodes of the use of physical restraints and psychotropic/sedative PRN medications. A retrospective case-control study approach was used with the data from electronic health records at a pediatric psychiatric hospital in the United States. Descriptive statistics, χ2 , multivariate logistic regression, and Cox proportional hazard model were used. Participants of younger age and participants with a longer length of stay were significantly associated with the use of physical restraints and psychotropic/sedative PRN medications, although the substance-related risks were not significantly associated with the use of restraints. Physical restraints were more likely to have occurred soon after the admission and tapered off as the length of stay increased. This study provides important information in understanding the risk factors of the use of restraints and psychotropic/sedative PRN medications in psychiatric adolescent inpatient units.

Physical Restraints in a Mental Hospital Emergency Unit: Facts vs Perceptions of Healthcare Workers

IntroductionCoercion is a general term used to refer to a series of actions, ranging from involuntary treatments to forced interventions, which can be ethically, legally and clinically challenging for both professionals and service-users. Perception of healthcare professionals on restraint practices is in important factor determining the clinical outcomes.ObjectivesThe aim of this study was to determine i) the differences between the estimates of healthcare professionals working in the Emergency Unit of Erenköy Psychiatric and Neurological Training and Research Hospital (Erenköy RSHEAH) regarding physical restraint practices and the real use and outcome values ii) the knowledge, attitudes and opinions of healthcare professionals on such procedures.MethodsThe study was designed as a descriptive cross-sectional online survey. All healthcare professionals working in the Emergency Unit of Erenköy RSHEAH (with a catchment area of 5 million people) who agreed to participate in the study and who were not part of the research team were included. Sociodemographic information, information about working experience, and estimates of physical restraint practices in the last month were questioned. Attitudes and opinions towards these practices were evaluated with 5-point Likert-type questions. Ethical approval was obtained from Erenköy RSHEAH Clinical Ethics Committee (Decision No: 40, 18.07.2022).ResultsA total of 55 healthcare workers (31 trainees, 10 specialist psychiatrists, 6 nurses, 8 security personnel) participated in the study. The mean age of the participants was 32±6.4 years (24-50, min-max) and 52.7% were female. The mean duration of employment in the health sector and current institution were 6.6±5.7 (1-22, min-max), and 4.1±4.1 (1-17, min-max) years, respectively. The estimated mean rate of physical restriction was 13.5±13% (2-60, min-max). However, the actual median rate was 4% (0 - 8.8% min-max) in the same month. The estimated mean duration of physical restraint was reported as 87.8±54.1 (20-300, min-max) minutes, whereas the median actual duration of physical restraint was 60 minutes. No significant relationship was found between the estimates of duration, rates and complication rates of of physical restraint and the duration of professional experience (p&gt;0.05). A significant difference was found between professional groups in terms of restraint duration and complication rate (p&lt;0.05), as well as their opinions regarding the appropriateness of restraint practices with the legal framework (Table 1).Image:ConclusionsIt was observed that healthcare workers had a misperception regarding the rate and duration of physical restraints, which were perceived as higher than the actual values. Thus, the restraint interventions were perceived to be more negative than they actually are. Correction of such misperceptions should become part of the continous educational processes of all professional groups.Disclosure of InterestNone Declared

Nurses' knowledge, attitudes and practices related to physical restraint: the case from Turkey

BackgroundNurses are primarily for the care of patients and should ensure that physical restraint, which has many negative consequences, be applied according to standard practice. Therefore, they should have knowledge about physical restraint and apply physical restraint by observing existing laws and ethical principles. This study aimed to determine the knowledge level, attitude and practices of pediatric nurses on physical restraint and identify the factors influencing physical restraint use. MethodsA cross-sectional study was conducted involving 150 pediatric nurses working in the pediatric clinic of a training and research hospital. The data were collected with an information form containing the introductory characteristics of the nurses and the Level of Knowledge, Attitudes and Practices of Staff Regarding Physical Restraints Questionnaire. Data were analyzed using the Mann-Whitney U test and the Kruskal-Wallis test. ResultsOverall, nurses had good restraint-related knowledge with positive attitudes, although the physical restraint practices of nurses were not the best and there were some deficiencies. A statistically non-significant difference was found between age, gender, education status, nurses' work unit, and training status regarding physical restraint on the one hand and knowledge, attitude and practice scores relating to the use of physical restraints on the other (p&gt;0.05). ConclusionsPediatric nurses' level of knowledge about physical restraint was quite good and their attitudes were positive. However, there were some deficiencies in their practices. Future training should therefore be emphasized to enhance nurses' ethical and sensitive thinking, increase their competence in applying physical restraint and working with patients.

Evaluation of physical restraint practices in the emergency department of a mental health hospital

Evaluation of physical restraint practices in the emergency department of a mental health hospital

Interprofessional intensive care unit (ICU) team perspectives on physical restraint practices and minimization strategies in an adult ICU: A qualitative study of contextual influences.

Guidelines advocate for minimization of physical restraint (PR) use in intensive care units (ICU). Interprofessional team perspectives on PR practices can inform the design and implementation of successful PR minimization interventions. To identify ICU staff perspectives of contextual influences on PR practices and minimization strategies. A qualitative descriptive study in a single ICU in Toronto, Canada. One-on-one semi-structured interviews were conducted with 14 ICU staff. A deductive content analysis of interviews was undertaken using the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Five themes were developed: risk-averse culture, leadership, practice monitoring and feedback processes, environmental factors, and facilitation. Participants described a risk-averse culture where prophylactic application of PR for intubated patients was used to prevent unplanned extubation thereby avoiding blame from colleagues. Perceived absence of leadership and interprofessional team involvement situated nurses as the primary decision-maker for restraint application and removal. Insufficient monitoring of restraint practices, lack of access to restraint alternatives, and inability to control environmental contributors to delirium and agitation further increased PR use. Recommendations as to how to minimize restraint use included a nurse facilitator to advance leadership-team collaboration, availability of restraints alternatives, and guidance on situations for applying and removing restraints. This analysis of contextual influences on PR practices and minimization using the i-PARIHS framework revealed potentially modifiable barriers to successful PR minimization, including a lack of leadership involvement, gaps in practice monitoring, and collaborative decision-making processes. A team approach to changing behaviour and culture should be considered for successful implementation and sustainability of PR minimization. The establishment of an interprofessional facilitation team that addresses risk-averse culture and promotes collaboration among ICU stakeholders will be crucial to the success of any approach to restraint minimization.

Pasung: A qualitative study of shackling family members with mental illness in Indonesia.

Use of coercion on people with mental illness is a deeply embedded practice around the world. Not only does the practice raise human rights issues, it also leads to further mental, physical, and emotional harms. In Indonesia, 'pasung' is a common practice of physical restraint, which involves lay people using a variety of illegal methods to tie a person. In this article, we explore the meanings families attach to their actions when using pasung by asking the question: to what extent does the use of pasung by families emerge from socioculturally prescribed norms and conventions? To explore this question, we conducted and analysed eight interviews with family members from Nias Island, Indonesia using Giorgi's descriptive phenomenological method. Our findings reveal that pasung emerges in the disjunction between sociocultural demands and the family's capacity to meet these demands. Struggling to understand the behaviour of a family member with mental illness, the family tries to cope with neighbourhood reactions to ever more visible behavioural signs alongside managing their everyday life. These struggles, in turn, make their social situation increasingly stressful, which initiates a process of depersonalization as a response. Moreover, the prevailing sociocultural values convey a need to act according to expected norms. As such, pasung materializes as a socioculturally accepted practice that allows families to take back control in stressful social situations. In sum, when families feel overwhelming emotional stress and a sense of powerlessness, they try to resolve their situation by using pasung to regain control and thus manage their lives.

Yoğun Bakım Hemşirelerinin Yaşlılara Yönelik Tutumları ile Fiziksel Tespit Edici Kullanımları Arasındaki İlişki

AbstractObjective: This study aimed to investigate the relationship between the attitudes among intensive care nurses towards older people and the use of physical restraints.Material and Methods: This cross-sectional study was performed between February-April 2016. The study designed in survey method was conducted on 107 nurses working in intensive care units of three hospitals. In the study, data were collected by using the “Survey Form”, “ The Scale for Measuring Nurses’ Knowledge Level, Attitudes and Practices regarding the Use of Physical Restraints” and Ageism Attitude Scale (AAS).Results: The average scores of intensive care nurses regarding the use of physical restraints were found to be 7.22±1.59 for their knowledge, 31.60±5.80 for their attitudes and 37.64±2.99 with respect to the practice of restraining devices. Their average score regarding the Ageism Attitude Scale, on the other hand, was 86.13±9.44. There was no correlation between the level of knowledge, attitudes and practices of the nurses about the use of physical restraint and their attitudes towards the elderly.Conclusion: It was found that the knowledge level of the nurses about the use of physical restraints wkaas good, their attitudes were positive and their practices were sufficient, and their attitudes towards the elderly were positive. It is thought that intensive care nurses consider physical restraint practice as a part of the care to ensure the safety of the elderly patient.

Factors Influencing Nursing Practice for Physical Restraints among Nurses in the Intensive Care Unit

Purpose : This study aimed to identify the factors influencing physical restraint-related practice among nurses working in the intensive care unit (ICU).Methods : The participants consisted of 169 ICU nurses in three general hospitals in B and U cities. Data were collected from December 2021 to January 2022 through a structured selfadministered questionnaire. Demographic characteristics, physical restraint-related practice, Person-centered Critical Care Nursing (PCCN), work environment, and attitudes toward physical restraint use were measured. For data analyses, hierarchical multiple regressions were conducted using SPSS/WIN 25.0.Results : Clinical careers in the ICU, better work environments, higher PCCN levels, and more positive attitudes toward physical restraint use were associated with a better practice of physical restraints, which together explained 35.5% of the total variance of the outcome.Conclusion : Our findings suggest that to promote a safe physical restraintrelated practice among ICU nurses, it is important to improve the nursing environment, prepare guidelines for applying PCCN, and provide education for endorsing positive attitudes toward the use of physical restraints.

Nurses’ Knowledge, Attitudes, and Practices towards Using Physical Restraints in Intensive Care Units

Background: With the fact that physical restraints is widely used in intensive care units, further studies are needed to set a baseline for evidence-based practice and to develop regulations. Aim: To examine Jordanian ICU nurses' knowledge, attitudes, and practices of physical restraints. Methods: A descriptive cross-sectional design was applied using online survey. A convenience sample of 145 nurses filled out the questionnaire who were registered nurses with at least one year of experience in ICU. In addition to demographic data sheet, they completed a 3-domain questionnaire; levels of knowledge, attitudes, and practices regarding using physical restraints. Results: Participants’ scored relatively low on knowledge (M= 3.3/11, SD= 1.8), moderate on attitudes (M= 29.4/48, SD= 3.8), and moderate on practices regarding physical restraint (M=23.2/42, SD= 7). Results revealed that participants’ practice of physical restraint had a positive correlation with both their knowledge and attitudes. Many significant differences were noticed based on participants’ characteristics. Conclusion: Local guidelines should be legislated to regulate nurses’ and other care providers’ PR practices to maintain patient safety and avoid legal consequences. Also, educational programs are needed to promote nurses’ knowledge and attitudes and compliance toward the acceptable guidelines regarding PR.

Being tied down-The experience of being physically restrained while mechanically ventilated in ICU.

To explore the experience of physical restraints during mechanical ventilation in intensive care from the perspectives of patients and family members. This research was a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. In-depth, semi-structured conversations were conducted with five patients and six family members who had either personally experienced or witnessed their loved ones being physically restrained during mechanical ventilation in intensive care. Data collection occurred between March 2018 and June 2019. These conversations were audio-recorded and transcribed. Reflexive thematic analysis was used to analyse the data. Three major themes emerged from the data. These themes were: Being tied down; Feeling helpless; and Finding light in the darkness. The experience of physical restraints during mechanical ventilation in intensive care leads to traumatic experiences which can impact patients and families long after their ICU stay. Holistic care, which considers the physical, emotional and psychological needs of patients and families, should be more thoroughly explored when managing treatment interference to minimize harm. This study gained insight into the physical, emotional and psychological consequences of applying physical restraints to patients who are mechanically ventilated as an intervention for preventing treatment interference. The findings of this study have the potential to improve ICU patient and family outcomes by influencing current physical restraint practices. Recommendations from this research can contribute to practice change by informing policy, shifting workplace culture and norms about restraints, and encouraging education and training.

Involuntary Treatments in Italy: a Debated Issue

Involuntary treatments probably are the most critical issue for psychiatric practice all over the world, including Italy, where the public debate about involuntary admissions and related coercive measures has been constantly alive. In Italy involuntary treatments are justified on the basis of three criteria: the presence of a mental illness; the need for urgent hospital-based treatment, the patient refusal of treatment. Although only 10% of all hospitalizations in Italy occur on a involuntary basis, actually the lowest rate in Europe, proposals of modification of the current Law have been repeatedly presented, in terms of further restrictions of the conditions allowing involuntary hospitalization or even in terms of its abolition. The practice of physical restraint in particular, which has been reported as applied in approx. 85% of Psychiatric Wards, has been strongly criticized, although the effective dimension of its use in Italy is unknown due the lack of official data. In 2015 The National Council of Bioethics expressed a series of doubts and criticisms as well as the Special Commission for Human Rights of the Italian Senate in 2016. Moreover, the death of some patients submitted to physical restraint in the last years, gave repeteadly rise to a media hype, leading again very recently to claims for the abolition of any form of physical restraint during a National Conference on Mental Health, a proposal that the Minister of Health welcomed, committing himself to implement it through a agreement between the State and the Regions, officially devoted to health assistance in Italy.DisclosureNo significant relationships.

Enjeux de la contention mécanique dans les services d’urgence

IntroductionIn France, a new law now requires very strict supervision of seclusion and mechanical restraint measures for patients submitted to compulsory, unconsented psychiatric care. Many professionals perceive this law, along with other recent laws and rules, as reflecting defiance towards psychiatry professionals, and, above all, as utterly inapplicable except at the cost of medical and administrative chaos. This law has put in place a strict (overly strict?) framework for the use of seclusion and mechanical restraint in unconsented psychiatric care. No such legal framework is in place, however, for psychiatric or non-psychiatric emergency units. Yet, psychiatric emergency teams look after patients in crisis, agitated and potentially dangerous for others or for themselves. For them, alternative, non-coercive measures are not always appropriate or effective. More coercive measures, may, with demonstrated clinical evidence, be required. Objectives and methodsThe work presented here reviews the medical, legal and ethical considerations which need to be taken into consideration in light of the lack of a framework defined by the law. This work is based on interviews with different experts, and it also considers legal data. It was conducted before the recent law was passed, a law that does not cover medical practice prior to hospitalization in any event. ResultsIt appears that the practice of physical restraint in emergency departments is sometimes necessary. A study of the latest decisions in French case law shows that emergency services must, in certain situations, take necessary measures for patients “such as restraint, chemical treatment or [intensive] surveillance”. If not, they run the risk of being found legally at fault. Case law also teaches us that physical restraint in emergency services must be carried out in accordance with non specific recommendations of good practice. This legal framework is not well-known to all practitioners working in emergency units. It ought to circulate more, thanks perhaps to the release of a scientific article that can synthetize this information. In addition, in the absence of specific good practice recommendations for the implementation of physical restraint in emergency services, more work is needed, on standardization, on protocols for the implementation of physical restraint, and on monitoring trackers. Finally, this works endorses monitoring the use of such coercive measures, in order to plot out its extent, to analyze its evolution over time and ultimately to reduce recourse to it. This work submits a proposal to that end. ConclusionIronically, in emergency departments there may ultimately be less forensic risk in physically containing than in not containing - provided that it is done with appropriate supervision. Of course in emergency departments even more than elsewhere such measures are temporary and do not always result in admission to compulsory psychiatric care. Such measures must be proportionate with the perceived risk or danger. In our opinion, the present legal void, which permits all the flexibility that emergency care requires, must not be followed by the legal inflexibility currently applicable to coerced hospitalization. But it is necessary that every medical decision be justifiable, solidly argued and traced.

Nursing Students’ Perceptions and Practices of Physical Restraint in a Hospital Setting: A Qualitative Study

Physical restraint is generally used in the healthcare setting, implying that students were exposed toit during their clinical placement and may have participated in it, either actively or passively.Thisstudy explores the student nurses’ knowledge and practice of physical restraints in clinical practice.A descriptivequalitative design using one semi-structured individual interview and five focus groupdiscussions on nursing students (N=24) from two higher nursing institutions in Brunei Darussalam.The data were analysed using thematic analysis.We identified three meaningful themes focused on theuse of physical restraint in the hospital setting from the perspective of nursing students, namely, thedefinition of physical restraint, the uses of physical restraint and concerns towards its practice. Thestudent nurses reported that physical restraint was justified in providing safe and high-quality patientcare.However, they have concerns about its practice, both for themselves and the patients. The needfor theoretical and practical guidance onsafe and efficient use of physical restraint may further provideeducational supports to the students.

"Patient Comfort Can Be Sacrificed for Patient Safety"-Perception and Practice Reported by Critical Care Nurses Toward Physical Restraints: A Qualitative Descriptive Study.

Aim: The aim of the study was to explore the perception and practice of physical restraints used by critical care nurses.Design: A qualitative descriptive design was used.Method: From December 2019 to May 2020, a one-to-one, semi-structured in-depth interview with 10 critical care nurses from two intensive care units in a tertiary general hospital with 3,200 beds in China was conducted using the method of purposeful sampling. The data were analyzed using inductive thematic analysis.Findings: The perception of physical restraints among critical care nurses was that patient comfort can be sacrificed for patient safety. Physical restraints protected patient safety by preventing patients from unplanned extubation but influenced patient comfort. Physical restraints were common practice of critical care nurses. Relative physical restraints provided patients with more freedom of movement and rationalization of physical restraints which were the practical strategies.Conclusion: The study identified problems in critical care nurses' perception and practice on physical restraints. Critical care nurses are confident that physical restraints can protect patient safety, and the influence of physical restraints on patient comfort is just like the side effect. Although physical restraints were common practice, critical care nurses still faced dilemmas in the implementation of physical restraints. Relative physical restraints and rationalization of physical restraints help critical care nurses cope with the “bad feelings,” which may also be the cause of unplanned extubation. It is necessary for the adaptation of clinical practice guidelines about physical restraints for critically ill patients in the Chinese context, to change the perception and practice of critical care nurses and deliver safe and high-quality patient care.

Understanding nurses' perspectives of physical restraints during mechanical ventilation in intensive care: A qualitative study.

This study explored the experiences of nurses using physical restraints on mechanically ventilated patients in intensive care. Physical restraints are frequently used to prevent treatment interference and maintain patient safety in intensive care units worldwide. However, physical restraints are found to be ineffective in preventing treatment interference and cause negative outcomes for patients. The practices surrounding physical restraints are inconsistent due to a lack of education, training and protocols. This research was conducted as a qualitative study with a naturalistic inquiry framework adhering to the Consolidated Criteria for Reporting Qualitative Research guidelines. Twelve in-depth, semi-structured conversations were conducted with registered nurses who have experience working in intensive care and have cared for patients who were physically restrained and mechanically ventilated. These conversations were audio-recorded and transcribed. Thematic analysis was used to analyse the data. Three major themes emerged from the data. The themes were as follows: the ICU culture and its impacts on physical restraint practices; the consequences of physical restraints through a nursing lens; and understanding the ways of learning. The insights into the ICU culture, the nurses' understanding of the consequences of physical restraints and the ways in which nurses learn physical restraint practices have provided a greater depth of knowledge and understanding of the realities of current practice in ICU. This new information demonstrates nurses' understanding of the potential harm caused by physical restraints and the way in which current practices are guided more-so by workplace norms and expectations rather than on critical thinking and decision-making. These insights provide valuable information to intensive care clinicians, educators and policymakers to guide future practice and improve patient outcomes by highlighting the importance of education on physical restraint practices and informing the development of policies and guidelines.

An Application of the Theory of Planned Behavior to Predict the Intention and Practice of Nursing Staff Toward Physical Restraint Use in Long-Term Care Facilities: Structural Equation Modeling.

PurposeUnderstanding the factors that affect nursing staffs’ intention and practice of physical restraint (PR) on older adults help develop restraint-reduction programs. This study aimed to identify the relationship between the Theory of Planned Behavior (TPB) constructs and nursing staffs’ practice to use PR in long-term care (LTC) facilities.Patients and MethodsA cross-sectional survey was conducted via convenience sampling among 316 nursing staff in six Chinese LTC facilities. PR-TPB questionnaire and the practice subscale of the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR were used to collect the data. Structural equation modeling (SEM) was used to examine the relationship between variables.ResultsThe SEM fit well with the data (χ2/df =1.639, RMSEA = 0.045, CFI= 0.955, GFI=0.945). Attitude (β=0.536, P<0.001) and perceived behavioral control (PBC) (β=0.139, P<0.05) predicted intention (R2=0.359). PBC was a significant predictor of practice, with R2 accounting for 0.151.ConclusionTPB provided useful insight into better understanding nursing staffs’ PR practices, although it did not support all the TPB principles significantly. Prospective studies may be conducted to design and implement multi-component interventions based on TPB and explore the effectiveness of PR reduction in LTC facilities in-depth.

Attitude and practice toward physical restraint among psychiatric nurses in Guangdong, China: a cross-sectional survey†

Abstract Objective To explore the correlation between nurses’ attitude and practice toward physical restraint (PR) in psychiatric settings and identify the factors that influence the use of PR. Methods A cross-sectional survey was conducted. A self-designed questionnaire containing a PR scale was used to assess the attitude and practice of registered psychiatric nurses in Guangdong, China, from November 1, 2018 to December 31, 2018. Descriptive statistics, the Mann–Whitney U test, the Kruskal–Wallis test, and ordinal regression analysis were used to analyze the data. Results The response rate was 74.6%. The nurses’ responses showed neutral attitude and a moderate level of practice regarding the use of PR. Factors such as age, gender, marital status, professional position, nightshift, and the frequency of training programs on PR showed a significant association with nurses’ attitude and practice concerning PR (P &lt; 0.05). In addition to these factors, this study found that the practice of PR was associated with nurses’ attitude toward it (P &lt; 0.05). Our results showed that nurses with a largely negative attitude toward PR were more likely to use it (OR = 1.91, P &lt; 0.001). Conclusions Clinically, psychiatric nurses with negative attitude are more likely to practice PR. Training and education programs are highly recommended for nursing managers to change the nursing staff’s attitude, since their attitude may have an impact on the PR what they practice.