The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol

Abstract

The use of physical restraints is a common practice in the care of hospitalised and institutionalised elderly people. This use is determined by factors related to the patients, their families, the healthcare professionals, the institution, and prevailing social values. Today, however, this practice is often questioned because of its physical, psychological, moral, ethical, and legal repercussions. The present study explores attitudes among healthcare professionals towards the physical restraint of geriatric patients in intermediate care hospitals in Majorca. This study is based on a qualitative design, combining an ethnomethodological approach with critical discourse analysis. The theoretical framework is drawn from Foucault’s work in this field and from Haslam’s theory of mechanisation. Individual interviews will be conducted with physicians, nurses, and nursing assistants at intermediate care hospitals in Majorca. The analysis will focus on these professionals’ knowledge, attitudes, and practices regarding the use of such measures, seeking to identify the factors, especially institutional factors, that determine the use of restraints. It is essential to determine the prevailing culture among healthcare professionals regarding the use of physical restraints on geriatric patients in order to design and propose a more dignified health care model in which such restraints are eliminated.

Physical restraints in nursing homes: A qualitative study with multiple stakeholders

“…The different views of the diverse stakeholders show the need for a joint approach to in‐depth knowledge of the needs and problems generated by restraints, as well as possible improvements in its use, organizational factors and regulation. The discourse is expected to vary according to the respondent's area of professional activity (Carrero‐Planells et al., 2021 ), yet, previous research has been conducted mainly among nurses, but none has been conducted with all the professional stakeholders involved in nursing home care.…”

“…In fact, there was no consensus regarding the restraint‐free model. This is particularly important because it has been stated that healthcare professionals who generally approve of the use of physical restraints may normalize the situation and make more extensive use of these measures, whilst professionals who reject physical restraints may perform actions of resistance to minimize their use (Carrero‐Planells et al., 2021 ). The concept of safety, in terms of the patient's physical safety, was frequently mentioned, with consensus on the justification of the measure in these cases.…”

“…Physical restraints are considered an accepted practice to ensure patient safety, however, their use has also been related to achieving organizational goals, alleviating problems caused by insufficient or inadequately trained care staff, or correcting physical spaces (Carrero‐Planells et al., 2021 ; Galán et al., 2008 ; Øye et al., 2017 ). This is particularly alarming not only because restraints risk physical and/or psychological complications, but also because of their potential impact on human rights (Gómez‐Durán et al., 2014 ; Robins et al., 2021 ).…”

“…Furthermore, improper use of restraints could be considered physical abuse and constitute a crime under our Criminal Code (Spanish Criminal Code, 1995 ). It has been described that the use of restraints is influenced by the knowledge, opinions and preferences of healthcare professionals, pressure from relatives, normal practices of the institution and social values (Carrero‐Planells et al., 2021 ). Therefore, a better understanding is needed of the different stakeholder's points of view surrounding restraints' use in nursing homes, to address the underlying factors and provide experience‐based information for future steps in the field.…”

Implementation of Step-Down Intermediate Care (IC) in Buckinghamshire, UK: A Qualitative Evaluation Study of Healthcare Professionals’ Experiences and Perspectives

“…A recently published review focused on the efectiveness of IC found that bedbased IC is linked with reduced readmission rates and length of hospital stay [14]. Furthermore, recent studies exploring experiences and perceptions of healthcare professionals from an IC setting focused on understanding patient's participation in IC [4,15] and the attitudes of healthcare professionals towards the physical restraints on patients in IC [16].…”