The use of physical restraint in acute medical setting : a case study on the perspectives and practices among health care professionals

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The use of physical restraint in acute medical setting : a case study on the perspectives and practices among health care professionals

 

Author: Li, Wing-on
Title: The use of physical restraint in acute medical setting : a case study on the perspectives and practices among health care professionals
Degree: M.Sc.
Year: 2009
Subject: Hong Kong Polytechnic University -- Dissertations.
Restraint of patients.
Medical personnel -- Violence against.
Department: School of Nursing
Pages: viii, 121 leaves ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2302286
URI: http://theses.lib.polyu.edu.hk/handle/200/4714
Abstract: Background: Physical restraint is commonly used in different clinical settings. Many studies have shown that the use of restraint causes harmful effects to patients instead of protecting them from injuries. Restraint reduction through a multidisciplinary approach is effective in reducing the use of physical restraint. The perception and attitudes of the staff affect their decision and participation in restraint use and restraint reduction. However, there are limited studies that explore different disciplines' perception about the use of physical restraint in the local setting. A comprehensive picture, which includes different disciplines' practice and perspectives in physical restraint, is thus needed. With this picture, the influencing factors affecting health professionals' collaboration in restraint use and restraint reduction can be identified. Method: A case study in an acute medical ward was conducted in order to explore different disciplines' perspectives and practice regarding the use of physical restraint. The data collection methods included a non-participant observation, a review of medical notes, and a face-to-face interview. Content analysis, pattern matching, and rival explanation were used to analyze the data. Results: In the non-participant observation, it was found that the ward routine was busy. Medical staff and allied health professionals were seldom actively involved in restraint use. Most of the restraint application, removal of restraint, restraint review, and care for restrained patients were performed by the nurses. The communication and collaboration between different disciplines in restraint use were also limited. In all of the restrained patients' notes, the medical staff and allied health professionals' documentation only focused on their work. Their documentation rarely mentioned the use of physical restraint among their patients. Most of the documentation related to restraint use such as restraint indication and restraint observation was made by the nurses. The interview results also showed that allied health professionals and medical staff seldom participated in the use of restraint. Allied health professionals did not recognize their role in restraint use. Both the nurses and the medical staff thought that the allied health professionals neither contributed greatly to the use of restraint nor regularly collaborated with them in this aspect. Allied health professionals and medical staff reported that they had limited time in the ward and that restraint use was not the major focus area in their practice. For the restraint use, the medical staff and allied health professionals mostly depended on the nurses' opinions. They thought the nurses stayed in the ward and thus understood the patients' restraint needs. Their communications and documentation on restraint use were also limited. Moreover, health professionals had a negative impression of restraint reduction. Therefore, the nurses had the major responsibility in this aspect. In pattern matching, the results from three data sources matched the predicted pattern. Allied health professionals and medical staff had limited participation in restraint use. The communication and collaboration between health professionals in restraint use were also limited. Moreover, health professionals' involvement in restraint reduction was limited. When rival explanations were examined, each disciplines' role in restraint use was not emphasized by the organization. Health professionals' perception of their role in restraint use affected their participation and collaboration with other disciplines in this aspect. The nature of an acute medical setting and a ward routine also affected the collaboration between different health professionals in restraint use. Factors such as the lack of multidisciplinary ward round, limited manpower and time, and the focus on disease management likewise affected health professionals' participation and collaboration in restraint use and reduction. Discussion: Allied health professionals and medical staff were not aware of their role in restraint use. They stated that restraint use was not their area of focus in their practice. Although the hospital guidelines mentioned their role in restraint use, they were not aware of it. Their limited awareness of their professional role in restraint, use led to their limited participation. These findings indicated that reinforcement in multidisciplinary restraint reduction and restraint assessment should be encouraged. This includes improving health professionals' awareness of different disciplines' role in restraint use and restraint reduction and emphasizing the application of physical restraint guidelines related to different disciplines. Health professionals focused on the patients' safety when deciding on restraint use. They also had limited ideas regarding restraint alternatives and restraint reduction. To improve the care given to patients and minimize restraint use, the staff's knowledge in restraint use, restraint complications, and restraint reduction should be promoted. Although health professionals believed there were no difficulties in communication and collaboration with other disciplines, their communication and collaboration were limited and were on a superficial level. They usually did not have extensive discussions about restraint use in patient care. To involve different disciplines in restraint use, a more comprehensive assessment of patients and more individualized restraint alternatives can be developed. Therefore, nurses' collaboration with different disciplines regarding restraint use should be encouraged, such as giving suggestions based on the referral of allied health professionals. Conclusion: As revealed in the literature, restraint reduction by a multidisciplinary approach is effective in reducing the use of physical restraint. In the current practice, allied health professionals and medical staff had limited involvement in restraint use. Their perception of restraint use and the acute care setting affected their involvement in this aspect. The staff's knowledge in restraint use also affected their practice. To improve the quality of patient care, involving different disciplines in restraint use is needed. Meanwhile, to facilitate their collaboration, it is also necessary to enhance their awareness of their role in restraint use and to improve their knowledge in restraint implications and reduction. In addition, nurses' collaboration with different disciplines in restraint use should be encouraged.

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