The Knowledge, Practice and Attitudes of Nurses Regarding Physical Restraint: Survey Results from Psychiatric Inpatient Settings

Abstract

There is a considerable amount of literature describing how nurses’ knowledge contributes to their attitudes and practices related to patient physical restraint. However, whether or not there have been any improvements in nurses’ knowledge levels, attitudes or practices regarding physical restraint during the past few years is unknown. A survey was conducted on nurses (n = 133) in one psychiatric hospital in Hong Kong (n = 98, response rate = 74%). The data were analyzed using independent t-tests, ANOVA, a Mann–Whitney U test, a Kruskal–Wallis test and Spearman’s rho. In general, nurses had good restraint-related knowledge with satisfactory attitudes and practices, although their knowledge levels, attitudes, and practices regarding restraint varied. Having a higher age, seniority, and education level contributed to a higher restraint-related knowledge level. Male nurses demonstrated more desirable practices (i.e., care of restrained patients), while nurses with a higher education level were more likely to avoid restraint. Nurses’ restraint-related knowledge positively correlated with restraint practices. Although nurses’ knowledge levels, attitudes, and practices regarding restraint were found to be satisfactory, more training efforts should focus on young nurses working in psychiatric settings with less work experience and lower education levels. As some nurses seem to favor the use of restraint with limited reflection, more studies are needed to verify nurses’ emotions and how their emotions influence the use of restrictive practices.

Assessment of Nurses’ Knowledge, Attitude and Practice Regarding Physical Restraint: A Scoping Review

“…A survey by Lee et al . (2021) [ 13 ] reported that nurses with master’s degrees had more desirable attitudes and significantly higher knowledge levels than those with diplomas or bachelor’s degrees. The study further showed nurses’ satisfactory attitudes toward using PR, and the authors recommended future training sessions to enhance nurses’ sensitive thinking and the following of ethics.…”

Effectivity of Restrain Management Training on Nurses at RSKD Dadi, South Sulawesi Province

“…Most of the nurses were aged 18-25 years (55.6%), nursing diploma education level was 82.1%, knowledge of physical restraint was obtained with a score of 52.1%, indicating above the median range (43), and skills in carrying out restraints 54 .7% adequate (mean 80.1 and SD 7.7) (Pradhan et al, 2019). Lee et al, (2021) that, in general, nurses have good control knowledge with good attitudes and practices, although their knowledge, attitudes, and practices regarding restraint vary.…”

Forensic mental health nurses' experiences of rebuilding the therapeutic relationship after an episode of physical restraint in forensic services in Ireland: A qualitative study

“…The use of physical restraint on people with mental health problems is one of the most controversial and criticized forms of restrictive practice. Studies indicate that the use of physical restraint has a negative impact on outcomes for people with mental health problems, and has traumatizing effects on patients, their careers and staff (Duxbury et al, 2019; Equality and Human Rights Commission, 2019; Goulet et al, 2017; Haines‐Delmont et al, 2022; Lee et al, 2021; Riahi et al, 2016; Rose et al, 2017). Despite the growing evidence and introduction of policies aimed at reducing the use of restraint, the use of physical restraint on people with mental health problems is still a common feature in inpatient mental health services (Maguire et al, 2020; Power et al, 2020; Riley, 2018; Thomann et al, 2021).…”

“…The relationship itself is based on the premise of engagement which can be more difficult to obtain in a forensic setting as opposed to a generic mental health facility, due to the high levels of security. The role of the FMHN has led to many debates due to the conflicts between the security and therapeutic aspects of their role (Lee et al, 2021; Ye et al, 2019). Physical restraint is an authoritarian, security‐focused element of the role of the FMHN which can negatively impact on their ability to work therapeutically with patients.…”

“…Although there have been national and international studies on therapeutic relationships from a mainstream mental health standpoint (Douglas et al, 2022; Lee et al, 2021; McAllister et al, 2021; Tomlin et al, 2020; Ye et al, 2019), there is a dearth of literature involving FMHNs perspectives on how therapeutic relationships can be rebuilt following an episode of physical restraint in an acute forensic setting. The continued high incidence of physical restraint used in these settings, along with the evidence that physical restraint is viewed as coercive by service users and seen to undermine the therapeutic relationship by FMHNs (Lawrence et al, 2022) makes the need for greater understanding of FMHNs therapeutic relationship building experience following physical restraint timely.…”