Iranian nurses’ perceptions about using physical restraint for hospitalized elderly people: a cross-sectional descriptive-correlational study

Sharifi et al. BMC Geriatrics (2020) 20:233 https://doi.org/10.1186/s12877-020-01636-2 RESEARCH ARTICLE Open Access Iranian nurses’ perceptions about using physical restraint for hospitalized elderly people: a cross-sectional descriptivecorrelational study Azam Sharifi1, Narges Arsalani1*, Masoud Fallahi-Khoshknab1, Farahnaz Mohammadi-Shahbolaghi1 and Abbas Ebadi2,3 Abstract Background: Using physical restraint (PR) for hospitalized elderly people is a major nursing challenge. It is associated with different physical and mental complications and ethical dilemmas, though many nurses still use it to ensure patient safety. Nurses’ perceptions are one of the most important factors affecting PR use. This study aimed to evaluate Iranian nurses’ perceptions about PR use for hospitalized elderly people. Methods: This cross-sectional descriptive-correlational study was conducted from July to December 2019. Participants were 270 hospital nurses who were purposively recruited from intensive care units and medical and surgical wards of three teaching hospitals in Kermanshah, Iran. Data were collected using a demographic questionnaire and the Perceptions of Restraint Use Questionnaire (PRUQ). The SPSS software (v. 23.0) was used for data analysis through the independent-sample t test, the one-way analysis of variance, and the multiple regression analysis. Results: The total mean score of PRUQ was 4.08 ± 0.12 in the possible range of 1–5. The most important reasons for PR use were to prevent patients from falling out of bed and to prevent them from pulling out catheters. The total mean score of PRUQ had significant relationship with participants’ age, work experience, and history of receiving PR-related educations (P < 0.05), but had no significant relationship with their gender, educational degree, and affiliated hospital ward (P > 0.05). Conclusion: This study suggests that nurses attach high importance to PR use for hospitalized elderly people. Healthcare policy-makers at national and hospital levels are recommended to provide nurses with PR-related educations in order to reduce the rate of PR-related complications. Keywords: Physical restraint, Nurse, Elderly, Hospital * Correspondence: 1 Nursing Department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Sharifi et al. BMC Geriatrics (2020) 20:233 Background Patient safety is a main component of healthcare quality [1]. Ensuring patient safety is among the basic rights of patients and one of the main goals of nursing care [2, 3]. Restraint is one of the methods for ensuring patient safety [4–6]. Restraint refers to any medication or device used to restrict patients’ voluntary movements in order to prevent injuries to patients and others [7, 8]. There are two main types of restraint, namely chemical and physical. Chemical restraint is to calm patients, lower the level of their consciousness, and reduce their responsiveness to environmental stimuli through sedative agents. In chemical restraint, sedative agents (including opioids, benzodiazepines, and muscle relaxants) are used to induce tranquility and pain relief, reduce intracranial pressure, and prevent the accidental removal of catheters [8–10]. Physical restraint (PR) refers to “any action or procedure that prevents a person’s free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person’s body that he/she cannot control or remove easily” [11]. PR devices include wrist, ankle, chest, and waist restraints and bed rails [6, 11]. The prevalence of PR use among hospitalized patients is 10–75% [12–15]. This prevalence is three times greater among elderly people [16, 17]. This high prevalence may be related to the high hospitalization rate among elderly people secondary to their affliction by different chronic conditions [18, 19]. Hospitalization of elderly people is associated with different adverse events and safety issues because most of them have poor health status, use multiple medications, may suffer from cognitive or functional disorders, and hence, are at risk for fall and injury to self or others [17, 20–22]. Therefore, nurses often use PR to restrict their movements and ensure their safety [23, 24]. Nurses have many reasons for PR use. These reasons include ensuring patient safety, preventing treatment discontinuation, preventing patient fall, controlling agitated or restless patients, protecting patients and others against injuries, creating a safe environment, and overcoming the problems associated with staff shortage [3, 4, 6]. Although PR is used to ensure patient safety, there is limited evidence concerning its effectiveness [25]. Studies show that PR can endanger patient safety and cause different physical and mental complications. Physical complications include pressure ulcer, contracture, physical and cognitive dysfunction, prolonged hospital stay, increased likelihood of patient fall, asphyxia, and death due to strangulation [14, 26–28]. PR-associated mental complications include anger, frustration, aggression, fear, anxiety, depression, and reduced self-confidence [29– 32]. Besides, PR use is associated with ethical dilemmas because it contradicts patients’ right to have autonomy Page 2 of 7 and may negatively affect their dignity [33, 34]. PR use for hospitalized elderly people can also delay recovery [5, 19, 35]. Nurses have significant role in decision making about PR use [3, 4, 36–40]. One of the factors which may require nurses to use PR is their perceptions about PR use [2, 24, 41, 42]. Studies showed that nurses’ decision about PR use is greatly affected by their perceptions [3, 6, 41–43]. A mixed-method study also showed that a sense of security, heavy workload, and staff shortage can affect nurses’ perception (...truncated)