Physical restraint in mental health nursing: A concept analysis

Objective: Physical restraint is frequently used in medical services,such as in mental health settings,intensive care units and nursing homes,but its nature varies in different institutions.By reviewing related literature,this study aims to clarify the concept of physical restraint in mental health nursing.Method: Three databases (PubMed,PsyclNFO and CINAHL) were retrieved,and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.Results: Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement.It should be the last option used by qualified personnel.Antecedents of physical restraint are improper behavior (violence and disturbance) of patients,medical assessment prior to implementation and legislation governing clinical usage.Consequences of physical restraint are alleviation of conflict,physical injury,mental trauma and invisible impact on the institution.Discussion: This study defined the characteristics of physical restraint in mental health nursing.The proposed concept analysis provided theoretical foundation for future studies.

Clinical decision making on the use of physical restraint in intensive care units

Physical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients'safety and to prevent unexpected accidents.However,existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales,the negative physical and emotional effects on patients,but the lack of perceived alternatives.This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses.By reviewing the literature,intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases.However,it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint.Besides that,such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated.Therefore,despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint,it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary.

Attitude and practice toward physical restraint among psychiatric nurses in Guangdong,China:a cross-sectional survey

Objective:To explore the correlation between nurses’attitude and practice toward physical restraint(PR)in psychiatric settings and identify the factors that influence the use of PR.Methods:A cross-sectional survey was conducted.A self-designed questionnaire containing a PR scale was used to assess the attitude and practice of registered psychiatric nurses in Guangdong,China,from November 1,2018 to December 31,2018.Descriptive statistics,the Mann–Whitney U test,the Kruskal–Wallis test,and ordinal regression analysis were used to analyze the data.Results:The response rate was 74.6%.The nurses’responses showed neutral attitude and a moderate level of practice regarding the use of PR.Factors such as age,gender,marital status,professional position,nightshift,and the frequency of training programs on PR showed a significant association with nurses’attitude and practice concerning PR(P<0.05).In addition to these factors,this study found that the practice of PR was associated with nurses’attitude toward it(P<0.05).Our results showed that nurses with a largely negative attitude toward PR were more likely to use it(OR=1.91,P<0.001).Conclusions:Clinically,psychiatric nurses with negative attitude are more likely to practice PR.Training and education programs are highly recommended for nursing managers to change the nursing staff’s attitude,since their attitude may have an impact on the PR what they practice.

Evaluation and analysis of the effect of continuing education on nurses’physical restraint knowledge,attitude,and behavior

Objective:The objective of the study is to construct a training course for physical restraint(PR)evidence‑based practice project and apply it to verify its effect.Methods:A total of 162 nurses from five departments of a general hospital in Beijing were trained to compare the PR knowledge,attitudes,and behaviors of nurses before and after training.Results:The nurses were satisfied with the overall curriculum;the total scores of PR’knowledge,attitude and behavior of nurses after training were higher than before,and the difference was statistically significant(P<0.05);the total scores of nurses who received evidence‑related training before this training were higher than those of nurses who did not receive relevant training,and the difference was statistically significant(P<0.05).Conclusion:Continuing education can effectively improve nurses’knowledge,attitude,and behavior level of PR,ensure patient safety,and promote physical and psychological rehabilitation of patients.

Physical restraint using,autonomy,ethics among psychiatric patients in nursing practice in China

The application of physical restraint for patients represents ethical dilemmas for psychiatric nurses in terms of maintaining the safety of all(clients and staff)while at the same time curtailing the individual’s autonomy.This article aimed to provide a sound knowledge of ethical positions and strategies for psychiatric nurses to address ethical issues of physical restraint according to the ethical principles of autonomy,beneficence,nonmaleficence,and ethical theories.Given that nursing workforce was limited and workload among psychiatric nurses was heavy,physical restraint was one of the coercive interventions managing aggressive behavior.In relation to address ethical dilemmas,it was proposed to acquire informed consent of physical restraint from the individuals and provide person‑centered care.Effective communication and negotiation with patients could help to strike a balance between patients’autonomy and nurses’accountability when using physical restraint.In addition,guidelines and targeted intervention strategies need to be developed to regulate and reduce the implementation of restraint.Finally,a collaboration among nurses,psychiatrists,and families is essential to protect patients’autonomy concerning physical restraint use.