Between Restrictive and Supportive Devices in the Context of Physical Restraints: Findings from a Large Mixed-Method Study Design

Abstract

Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives’/patients’ requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories ‘Restrictive’ and ‘Supportive’ devices aimed at ‘Preventing risks’ and at ‘Promoting support’, respectively, have emerged. Reasons triggering ‘restrictive devices’ involved patients’ risks, the health professionals’ and/or the relatives’ concerns. In contrast, the ‘supportive’ ones were triggered by patients’ problems/needs. ‘Restrictive’ and ‘Supportive’ devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with ‘restrictive devices’ (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings.

Physical Restraint Use in Nursing Homes—Regional Variances and Ethical Considerations: A Scoping Review of Empirical Studies

“…The second most common rationale for using physical restraints was patient-related factors such as wandering, agitation, and cognitive impairment. Similar results were seen in previous studies [14,42,49]. While the behaviors of the elderly may be a factor, studies have also shown that using physical restraint triggers aggressive behaviors in older people [82,83].…”

Coming to Grips—How Nurses Deal With Restlessness, Confusion, and Physical Restraints on a Neurological/Neurosurgical Ward

“…In the literature, some comparable insights have been found. A recent study by Palese et al (2021) in over 37 care settings found that a wide range of arguments exist for applying restraints, but that indeed in some instances this is argued for the comfort and independence of the patient. Antonelli (2008) successfully trained nurses in the use of diversion tactics before applying restraints.…”

Nursing Ethical Decision Making on Adult Physical Restraint: A Scoping Review

“…Consequences of the decision on the person Physical: Increased blood pressure, heart rate, and temperature; changes in skin (bruising, oedema) and circulation can lead to limb ischemia; pressure ulcers; aspiration; pain; fractures; bladder, and faecal incontinence; death; dehydration; urinary tract, and respiratory infections [33,38,39]; Psychological: Depression, anger, loss of autonomy, dignity violated, decreased self-confidence, altered body image, fear, anxiety, aggression, delirium, agitation, risk of post-traumatic disorder, confusion, and distress [7,[39][40][41][42]; Social: Social isolation [39,40,43]; and sense of abandonment [44]. 13 42…”

“…Consequences of the decision on the nurse Frustration, ambivalence, guilt, anxiety, physical problems (headache, fatigue, and gastrointestinal changes), insomnia, sadness, emotional instability, fear, anger, pity, absenteeism from work, anguish, compassion, burnout, emotional, and moral distress [7,39,40,[45][46][47]. 12 40…”