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The Use of Physical Restraints in Clinical Practice

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 March 2022) | Viewed by 16044

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Dr. Elisa Ambrosi

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Guest Editor

Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy
Interests: nursing; caring; elderly; physical restraints; pressure injuries; nursing sensitive outcomes
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Dr. Federica Canzan

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Assistant Guest Editor

Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy
Interests: nursing education; qualitative research; nurse caring; nursing sensitive outcomes
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Special Issue Information

Dear Colleagues,

The use of physical restraints in healthcare settings has been heavily debated due to the questionable ethical and legal issues affecting the autonomy and dignity of patients and the many adverse physical and psychosocial effects of these devices. Nevertheless, despite clear evidence showing their lack of effectiveness and safety and the worldwide promotion of a “restraint-free” model of care, their use remains relatively high, especially in geriatric long-term care, mental health, and intensive care settings.

Much still needs to be learned about the use of physical restraints in healthcare settings, including the factors influencing their use and the multi-level and multicomponent interventions effective in reducing their prevalence.

This Special Issue welcomes research papers on various aspects of physical restraint use in different healthcare settings, including individual, staff, and organizational factors contributing to their use, the role of knowledge and attitude of healthcare professionals, the decision-making process, interventions supporting physical restraint reduction, alternative strategies, and the perspectives of patients, family, and/or informal caregivers. We especially encourage the submission of interdisciplinary work and multi-center research. We welcome original research papers using different study designs, both quantitative and qualitative, as well as systematic reviews and meta-analyses.

Dr. Elisa Ambrosi
Dr. Federica Canzan
Guest Editors

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Published Papers (4 papers)

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Research

14 pages, 778 KiB

Open AccessArticle

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

by Silvia Thomann, Gesche Gleichner, Sabine Hahn and Sandra Zwakhalen

Int. J. Environ. Res. Public Health 2022, 19(12), 7144; https://doi.org/10.3390/ijerph19127144 - 10 Jun 2022

Cited by 1 | Viewed by 2336

Abstract

The attitude of nursing staff towards restraint use can be decisive for whether restraints are used. So far, nursing staff’s attitudes have been studied primarily in long-term and mental health care settings, while findings from somatic acute care hospital settings are largely lacking. Therefore, we aimed to investigate (a) the attitudes of hospital nursing staff towards restraint use, and (b) the construct validity and reliability of a measurement instrument for use in hospital settings that was developed and validated in long-term care settings (Maastricht Attitude Questionnaire (MAQ)). Using a cross-sectional design, the attitudes of 180 nursing staff towards restraint use were assessed. The data were analysed descriptively and by means of regression analysis and factor analysis. We found that nursing staff in hospitals have a neutral attitude towards restraint use and that the MAQ, with minor adaptations, can be used in hospital settings, although further testing is recommended. Neutral attitudes of nursing staff have also been observed in long-term and mental health care settings, where changing attitudes were found to be challenging. Interventions at the national level (e.g., legal regulations) and management level (e.g., providing alternatives and changing institutional culture) are suggested. Full article

(This article belongs to the Special Issue The Use of Physical Restraints in Clinical Practice)

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14 pages, 665 KiB

Open AccessArticle

Between Restrictive and Supportive Devices in the Context of Physical Restraints: Findings from a Large Mixed-Method Study Design

by Alvisa Palese, Jessica Longhini, Angela Businarolo, Tiziana Piccin, Giuliana Pitacco and Livia Bicego

Int. J. Environ. Res. Public Health 2021, 18(23), 12764; https://doi.org/10.3390/ijerph182312764 - 03 Dec 2021

Cited by 7 | Viewed by 2406

Abstract

Physical restraints are still a common problem across healthcare settings: they are triggered by patient-related factors, nurses, and context-related factors. However, the role of some devices (e.g., bed rails), and those applied according to relatives’/patients’ requests have been little investigated to date. A mixed-method study in 2018, according to the Good Reporting of a Mixed Methods Study criteria was performed. In the quantitative phase, patients with one or more physical restraint(s) as detected through observation of a single index day in 37 Italian facilities (27 long-term, 10 hospital units, =4562 patients) were identified. Then, for each patient with one or more restraint(s), the nurse responsible was interviewed to gather purposes and reasons for physical restraints use. A thematic analysis of the narratives was conducted to (a) clarify the decision-making framework that had been used and (b) to assess the differences, if any, between hospital and long-term settings. The categories ‘Restrictive’ and ‘Supportive’ devices aimed at ‘Preventing risks’ and at ‘Promoting support’, respectively, have emerged. Reasons triggering ‘restrictive devices’ involved patients’ risks, the health professionals’ and/or the relatives’ concerns. In contrast, the ‘supportive’ ones were triggered by patients’ problems/needs. ‘Restrictive’ and ‘Supportive’ devices were applied based on the decision of the team or through a process of shared decision-making involving relatives and patients. According to the framework that emerged, long-term care patients are at increased risk of being treated with ‘restrictive devices’ (Odds Ratio 1.87, Confidence Interval 95% 1.44; 2.43; p < 0.001) as compared to those hospitalized. This study contributes to the improvement in knowledge of the definition, classification and measurement of physical devices across settings. Full article

(This article belongs to the Special Issue The Use of Physical Restraints in Clinical Practice)

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36 pages, 8308 KiB

Open AccessArticle

Physical Restraint Use in Intensive Care Units: Exploring the Decision-Making Process and New Proposals. A Multimethod Study

by María Acevedo-Nuevo, María Teresa González-Gil and María Concepción Martin-Arribas

Int. J. Environ. Res. Public Health 2021, 18(22), 11826; https://doi.org/10.3390/ijerph182211826 - 11 Nov 2021

Cited by 8 | Viewed by 5301

Abstract

Aim: The general aim of this study was to explore the decision-making process followed by Intensive Care Unit (ICU) health professionals with respect to physical restraint (PR) administration and management, along with the factors that influence it. Method: A qual-quant multimethod design was sequenced in two stages: an initial stage following a qualitative methodology; and second, quantitative with a predominant descriptive approach. The multicenter study was undertaken at 17 ICUs belonging to 11 public hospitals in the Madrid region (Spain) across the period 2015 through 2019. The qualitative stage was performed from an interpretative phenomenological perspective. A total of eight discussion groups (DG) were held, with the participation of 23 nurses, 12 patient care nursing assistants, and seven physicians. Intentional purposive sampling was carried out. DG were tape-recorded and transcribed. A thematic analysis of the latent content was performed. In the quantitative stage, we maintained a 96-h observation period at each ICU. Variables pertaining to general descriptive elements of each ICU, institutional pain-agitation/sedation-delirium (PAD) monitoring policies and elements linked to quality of PR use were recorded. A descriptive analysis was performed, and the relationship between the variables was analyzed. The level of significance was set at p ≤ 0.05. Findings: A total of 1070 patients were observed, amounting to a median prevalence of PR use of 19.11% (min: 0%–max: 44.44%). The differences observed between ICUs could be explained by a difference in restraint conceptualization. The various actors involved jointly build up a health care culture and a conceptualization of the terms “safety-risk”, which determine decision-making about the use of restraints at each ICU. These shared meanings are the germ of beliefs, values, and rituals which, in this case, determine the greater or lesser use of restraints. There were different profiles of PR use among the units studied: preventive restraints versus “Zero” restraints. The differences corresponded to aspects such as: systematic use of tools for assessment of PAD; interpretation of patient behavior; the decision-making process, the significance attributed to patient safety and restraints; and the feelings generated by PR use. The restraint–free model requires an approach to safety from a holistic perspective, with the involvement of all team members and the family. Full article

(This article belongs to the Special Issue The Use of Physical Restraints in Clinical Practice)

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12 pages, 370 KiB

Open AccessArticle

Nurses’ Views on the Use of Physical Restraints in Intensive Care: A Qualitative Study

by Federica Canzan, Elisabetta Mezzalira, Giorgio Solato, Luigina Mortari, Anna Brugnolli, Luisa Saiani, Martina Debiasi and Elisa Ambrosi

Int. J. Environ. Res. Public Health 2021, 18(18), 9646; https://doi.org/10.3390/ijerph18189646 - 13 Sep 2021

Cited by 9 | Viewed by 4796

Abstract

Despite the worldwide promotion of a “restraint-free” model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses’ feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient’s bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person. Full article

(This article belongs to the Special Issue The Use of Physical Restraints in Clinical Practice)

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