Nurses' knowledge and attitudes regarding physical restraint in Turkish intensive care units

Abstract

Background: Physical restraint is still widely used despite studies supporting a reduction in its use. The development of guidelines to reduce the use of PR first requires the identification of factors related to the use of alternative methods.Aim: This study aimed to determine factors associated with the use of alternatives to physical restraint (PR) in intensive care units.Design: This was a cross-sectional descriptive study.Methods: Data were collected from adult intensive care units of three hospitals in Turkey using the Physical Restraint Knowledge, Attitude and Practice Scale and a questionnaire including open-ended questions.Results: Overall, 202 nurses (80% response rate) completed the questionnaire.Nurses' knowledge, attitude, and practice scores regarding PR were 6.89 ± 1.79, 29.85 ± 4.93, and 36.76 ± 3.36, respectively. PR was reported to be necessary for patients at risk of self-harm, with dangerous behaviours, and who were trying to remove their catheters. Most nurses (64.9%) stated that they needed a written doctor's order. Analysis of free-text responses showed that patient disorientation (because of delirium, sedation, or agitation), nurses' workload, and lack of training regarding restraint were the primary reasons why nurses could not use alternatives.The main alternatives suggested by nurses were categorized as sedation, communication, and environmental regulation. Logistic regression analysis identified training (P = .009), working unit (P = .001), and nurses' practice score to use PR (P = .004) as independent risk factors for not using alternative methods of PR. Conclusions:The results of this study revealed a moderate level of knowledge, attitude, and practice among nurses regarding the use of PR. Thus, education of nurses about the prevention of delirium and alternatives to PR according to the characteristics of their units is required.

Restraining patients in acute care hospitals—A qualitative study on the experiences of healthcare staff

“…Studies have shown that, in addition to lack of knowledge, time pressure due to a heavy workload seems to prevent consideration of alternatives to restraint and preventive measures (Ertuğrul & Özden, 2020 ; Möhler & Meyer, 2014 ). This could be one reason why preventive measures were not mentioned more often in the interviews.…”

Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study

“…In the somatic acute care hospital (henceforth referred to as ‘hospital’) setting, little is known about the attitudes of the nursing staff. Some studies have been conducted in the intensive care area (e.g., [ 10 , 21 , 22 , 23 ]); however, these focused more on reasons for the use of restraints (e.g., using the Perception of Restraint Use Questionnaire), on knowledge and application practices (partly using questionnaires designed for the study), or on attitudes assessed only using qualitative methods. Therefore, the aim of the current study is to assess nursing staff’s attitudes in a hospital setting using a standardised questionnaire and to identify their associations with staff characteristics.…”

Development and implementation of a novel decision support tool on physical restraint use in critically ill adult patients

“…PR has been widely used among intensive care patients in many countries (Luke et al, 2014;Pan et al, 2018;van der Kooi et al, 2015). In the ICU, it is mainly used to restrict patient movement, reduce injuries from falling and prevent accidental catheter removals (Ertu grul & Özden, 2020;Leahy-Warren et al, 2018). However, evidence does not show that restraint can prevent accidental catheter removal (ACR) (Perren et al, 2015).…”