Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants

Leahy‐Warren, Patricia; Varghese, V. J.; Day, Mary Rose; Curtin, Margaret

doi:10.1111/inr.12434

Cited by 14 publications

(24 citation statements)

References 41 publications

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“…Until then, life-saving therapies trump the reluctance which healthcare professionals may have to use restraints. The use of restraint is not favourable amongst healthcare staff for impairment management but a necessary evil for reducing falls and treatment interference [37,38]. Often, negative feelings are present towards the use of restraint, with a struggle between the duty of care and patient autonomy, which could sometimes foster feelings of guilt amongst healthcare staff [21].…”

Section: Attitudes Towards the Reasons Why Restraints Are Usedmentioning

confidence: 99%

The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

Gunawardena

Smithard

2019

Geriatrics

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Restraint in modern non-psychiatric-based healthcare is often regarded as a rare occurrence. It is deemed to be used as a last resort to prevent patients from directly harming themselves. However, techniques are used in modern day practice which are considered direct and indirect restraints with the justification of maintaining patient safety, but they are often not classified as “restraints”. Examples of these include the use of bed rails or tables to prevent patients from “wandering” and to reduce the risk of falls and injuries. More indirect techniques would involve passive interactions with patients or leaving mobility aids out of reach. Staff subconsciously restrain patients and reduce their liberties despite agreeing that patient autonomy should be upheld—a necessary evil to maintain a duty of care. Whilst the use of restraints is often justified to ensure patient care and prevent injury, it is not without consequence. There are physical and psychological health risks such as pressure sores from the inability to mobilise, or the brewing of anger and frustration when denied access to everyday actions. The reasons why restraints are used, whilst stemming from maintaining patient safety, are often due to low staffing levels and the inability to constantly watch at-risk patients due to a large workload. Inadequate training is another factor; by improving education in direct and indirect restraint and providing alternative methods, more ethical decisions and positive outcomes can be implemented. Healthcare professionals are reluctant to use restraint but often conduct it without realising it; assessing their understanding of restraint and providing education to raise awareness of the consequences of direct and indirect methods would result in positive steps toward reducing their use at the same time as looking to provide alternatives to uphold patient care whilst maintaining their dignity and liberty.

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Section: Attitudes Towards the Reasons Why Restraints Are Usedmentioning

confidence: 99%

The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

Gunawardena

Smithard

2019

Geriatrics

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“…Its physical consequences include pressure ulcer, fracture, cardiac dysrhythmia, neuromuscular injuries, urinary and fecal incontinence, asphyxia, and strangulation-induced death [7,8,[20][21][22]. The mental consequences of inappropriate PR use include anger, frustration, aggression, fear, humiliation, low self-confidence, delirium, depression, and anxiety [14,17,23]. Moreover, it is associated with ethical dilemmas and violates the autonomy and the respect for dignity principles of ethical practice [24,25].…”

Section: Introductionmentioning

confidence: 99%

“…Such lack of knowledge and skills not only causes serious problems for patients, but also causes professional, legal, and ethical challenges for healthcare providers. Therefore, clear guidelines are necessary for improving the quality of PR use and reducing its adverse consequences [23,25,34]. Several guidelines have so far been developed in this area.…”

Section: Introductionmentioning

confidence: 99%

The principles of physical restraint use for hospitalized elderly people: an integrated literature review

Sharifi¹,

Arsalani²,

Fallahi-Khoshknab³

et al. 2021

Syst Rev

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Background Physical restraint (PR) is a routine care measure in many hospital wards to ensure patient safety. However, it is associated with many different professional, legal, and ethical challenges. Some guidelines and principles have been developed in some countries for appropriate PR use. The present study aimed to explore the principles of PR use for hospitalized elderly people. Methods This was an integrative review. For data collection, a literature search was conducted in Persian and English databases, namely Magiran, Scientific Information Database (SID), Scopus, Google Scholar, Web of Science, and PubMed as well as the websites of healthcare organizations and associations. Eligibility criteria were publication in English or Persian between January 1, 2010, and January 1, 2021, and description of the principles of PR use for hospitalized elderly people. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for document screening and selection, while the critical appraisal tools of the Joanna Briggs Institute (JBI) and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument were used for quality appraisal. The data were analyzed through constant comparison. Results Primarily, 772 records were retrieved, while only twenty were eligible for the study. The principles of PR use for hospitalized elderly people were categorized into six main categories, namely principles of education for PR use, principles of decision making for PR use, principles of implementing the PR procedure, principles of monitoring patients with PR, principles of PR use documentation, and principles of PR management. Conclusion PR should be used only by trained healthcare providers, with the consent of patient or his/her family members, with standard devices and safe techniques, based on clear guidelines, and under close managerial supervision. Moreover, elderly people with PR should continuously be monitored for any PR-related complications. The findings of the present study can be used for developing clear PR-related guidelines.

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“…Decisions about physical restraint use among older adults in LTC facilities are complicated and are affected by various factors, such as characteristics of older adults, LTC facilities, and medical staff. For example, the knowledge and attitudes of nursing staff influenced their practice towards the use of physical restraint (Kor, Kwan, Liu, & Lai, 2018; Mayerl, Trummer, Stolz, Rásky, & Freidl, 2019), even they have negative feelings towards physical restraint, a need for use in specific circumstances is identified (Leahy‐Warren, Varghese, Day, & Curtin, 2018). The dependence of care, cognitive impairment, mobility restriction, or a history of falls was contributed to the use of physical restraint (Hofmann & Hahn, 2014; Hofmann, Schorro, Haastert, & Meyer, 2015).…”

Section: Introductionmentioning

confidence: 99%

The use of physical restraints in Chinese long‐term care facilities and its risk factors: An observational and cross‐sectional study

Wang

Liu

Peng³

et al. 2020

Journal of Advanced Nursing

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Aim To investigate the use of physical restraints among Chinese long‐term care facilities older adults and to identify its risk factors. Design Observational and cross‐sectional study. Methods A total of 1,026 older adults from six long‐term care facilities in Chongqing were recruited by cluster sampling method from July ‐ November 2019. Data on physical restraint use and older adults’ characteristics were collected using physical restraints observation forms and older adults’ records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi‐square test and binary logistic regression. Results The study found that the prevalence of physical restraints in six long‐term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. Conclusion The use of physical restraints among Chinese long‐term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. Impact This study will provide an effective reference for nursing staff in long‐term care facilities to assess high‐risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.

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Physical restraint: perceptions of nurse managers, registered nurses and healthcare assistants

Cited by 14 publications

References 41 publications

The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards—A Brief Literature Review

The principles of physical restraint use for hospitalized elderly people: an integrated literature review

The use of physical restraints in Chinese long‐term care facilities and its risk factors: An observational and cross‐sectional study

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