Nurses using physical restraints: Are the accused also the victims? – A study using focus group interviews

Abstract

BackgroundTo date, the literature has provided an abundance of evidence on the adverse outcomes of restraint use on patients. Reportedly, nurses are often the personnel who initiate restraint use and attribute its use to ensuring the safety of the restrained and the others. A clinical trial using staff education and administrative input as the key components of a restraint reduction program was conducted in a rehabilitation setting to examine whether there were any significant differences in the prevalence of restraint use pre- and post-intervention. Subsequent to the implementation of the intervention program, focus group interviews were conducted to determine the perspective of the nursing staff on the use of restraints and their opinions of appropriate means to reduce their use.MethodRegistered nurses working in units involved in the study were invited to participate in focus group interviews on a voluntary basis. Twenty-two registered nurses (three males [13.6%] and nineteen females [86.4%]) attended the four sessions. All interviews were audio taped and transcribed verbatim. Other than the author, another member of the project team validated the findings from the data analysis.ResultsFour themes were identified. Participants experienced internal conflicts when applying physical restraints and were ambivalent about their use, but they would use restraints nonetheless, mainly to prevent falls and injuries to patients. They felt that nurse staffing was inadequate and that they were doing the best they could. They experienced pressure from the management level and would have liked better support. Communication among the various stakeholders was a problem. Each party may have a different notion about what constitutes a restraint and how it can be safely used, adding further weight to the burden shouldered by staff.ConclusionStudies about restraints and restraint use have mostly focused on nurses' inadequate and often inaccurate knowledge about the use of restraints and its associated adverse effects. These studies, however, fail to note that nurses can also be victims of the system. Restraint use is a complex issue that needs to be understood in relation to the dynamics within an environment.

Nursing practice with hospitalised older people: Safety and harm

“…The review yielded 23 articles that represented one mixed methods (Strumpf & Evans, ), seven quantitative (Farina‐Lopez, Estevez‐Guerra, Polo‐Luque, Pogranyiva, & Penelo, ; Janelli, Stamps, & Delles, ; Liukkonen & Laitinen, ; McCabe, Alvarez, McNulty, & Fitzpatrick, ; Myers, Nikoletti, & Hill, ; Suen et al, ; Werner, ) and 15 qualitative studies (Bok, Pierce, Gies, & Steiner, ; Boltz, Capezuti, & Shabbat, ; Brown, Williams, Woodby, Davis, & Allman, ; Chuang & Huang, ; Dahlke, Hall, & Baumbusch, ; Dahlke & Phinney, ; Goethals, Dierckx de Casterlé, & Gastmans, ; King, Pecanac, Krupp, Liebzeit, & Mahoney, ; Kneafsey, Clifford, & Greenfield, ; Lai, ; Lee, Chan, Tam, & Yeung, ; Ludwick, O'Toole, & Meehan, ; Nolan, ; Quinn, ; Schofield, Tolson, & Fleming, ). Nine were conducted in the United States, three in the United Kingdom, three in Hong Kong, two in Canada and one each in Spain, Taiwan, Belgium, Finland, Australia and Israel.…”

“…In 2 of the studies, nursing staff in the United States (US) (Janelli et al, ) and the United Kingdom (UK) (Schofield et al, ) discussed using chemical restraints to keep their older patients from harms that were defined as falling or removing medical equipment (e.g., catheters, intravenous lines). Studies from Taiwan (Chuang & Huang, ), Spain (Farina‐Lopez et al, ), the United States (King et al, ; Ludwick et al, ; McCabe et al, ; Quinn, ; Strumpf & Evans, ), Hong Kong (Lai, ; Lee et al, ; Suen et al, ), Finland (Liukkonen & Laitinen, ), Australia (Myers et al, ) and Israel (Werner, ) all reported nurses' use of physical restraints to keep their older patients safe. Four of the studies identified that once physical restraints had been applied to an older patient, nursing teams were reticent to remove them, even if the reason for using the restraint was no longer present (Chuang & Huang, ; Goethals et al, ; Ludwick et al, ; Suen et al, ).…”

“…Scholars, who have studied why nursing care processes contribute to functional decline (e.g., restraint use, limiting mobility) are employed, suggest that staffing resources being insufficient when nurses are dealing with sudden increases in numbers of patients or in patients' acuity and the lack of material resources (e.g., equipment, medications) contribute to nurses' decision‐making about care (Kalisch, Landstrom, & Williams, ). Ten of the studies in this review cited staffing resources as a factor in their decision to restrain older patients (Bok et al, ; Boltz et al, ; Brown et al, ; Dahlke et al, ; Dahlke & Phinney, ; Lai, ; Lee et al, ; Ludwick et al, ; Quinn, ; Suen et al, ). However, in our current economic climate, increasing staffing is unlikely and it is not necessarily going to improve care unless it is accompanied by a corresponding emphasis on viewing preventable functional losses as safety threats.…”

Use of physical restraint: Nurses’ knowledge, attitude, intention and practice and influencing factors

“…Although some organisational factors might influence the rate of physical restraint use, knowledge and attitude of nurses are ultimately the most powerful determinants of restraint use (Feng et al., ; Suen et al., ). Several studies demonstrated that nurses’ knowledge towards physical restraint was inadequate (Kandeel & Attia, ; Suen et al., ) and their attitudes were negative or they had ambivalent feelings regarding the physical restraints (Huang, Chuang, & Chiang, ; Lai, ; Mohler & Meyer, ). Thus, the study by Wynn () demonstrated that most nurses do not believe that more restlessness, aggression and injury could be a result of using physical restraints in hospitals.…”

Nurses' Physical Restraint Knowledge, Attitudes, and Practices

“…In terms of knowledge related to proper use, several studies have found that nurses' knowledge failed to attain a satisfactory level (Hsu, Huang, & Chen, 2006;Huang et al, 2003;Karlsson, Bucht, & Sandman, 1998;Suen et al, 2006;Swauger & Tomlin, 2001). In addition, it is evident that some nurses have ambivalent attitudes regarding physical restraint use (Chuang & Huang, 2007;Lai, 2007;Lee, Chan, Tam, & Yeung, 1999). Some nurses favored the use of physical restraints (Chang et al, 2006;Myers et al, 2001), whereas others held negative attitudes (Huang et al, 2003;Suen et al, 2006), and some had mixed feelings (Lee et al, 1999).…”