Published in

Wiley, Journal of Psychiatric and Mental Health Nursing, 5(29), p. 659-675, 2022

DOI: 10.1111/jpm.12838

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Nurses' attitudes towards the use of physical restraint in psychiatric care: A systematic review of qualitative and quantitative studies

Journal article published in 2022 by Wai Kit Wong ORCID, Daniel Thomas Bressington ORCID
This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

Accessible SummaryWhat is known on the subject? Application of physical restraint is a common practice to protect service users and staff in psychiatric care. Nurses' attitudes towards physical restraint and its influencing factors in psychiatric settings in different countries are variable. Previous reviews include studies on different coercive methods, making it difficult to differentiate attitudes specific to physical restraint. What this paper adds to existing knowledge? Nurses' attitudes were marked by negative feelings and moral conflict towards the use of physical restraint and consider it a necessary nursing intervention and a last resort. The barriers for restraint‐free environment practice included contextual demand, lack of knowledge on restraint and lack of alternatives to restraint. What are the implications for practice? Nurse educators should develop and evaluate related educational training programmes to promote the development of alternative effective skills in handling violence instead of physical restraint. Policy makers should develop strategies to remove the barriers to a restraint‐free environments. AbstractIntroductionPhysical restraint is common in psychiatric care; nurses' attitudes are crucial as nurses often implement the procedure. Previous reviews include studies exploring coercive methods but do not specifically focus on physical restraint.AimsThis integrated mixed‐method systematic review aimed to examine nurses' attitudes towards the use of physical restraint in psychiatric care and the factors influencing these attitudes.MethodsSix databases were searched from 2000 to 2021. Thematic integrative analysis was used to synthesize the data.ResultsTen studies were included. Five themes encapsulate nurses' attitudes towards physical restraint: “emotional responses,” “moral conflicts,” “ensuring safety for all,” “a necessary nursing intervention” and “a last resort.” Three themes were identified for factors influencing attitudes: “contextual demands,” “level of knowledge” and “alternatives to restraint.”DiscussionNurses' attitudes were marked by negative feelings and moral conflict towards the use of physical restraint. However, nurses applied physical restraint as an ordinary nursing intervention. Educational interventions and the leadership role may facilitate the change of current practice to a restraint‐free environment.Implications for PracticeMental health nurses should work to remove the barriers to restraint‐free environment and develop effective skills that can be used as alternatives to physical restraint.