Authors (including presenting author) :
TSANG LF(1), SO KF(1), NG CF(1), CHEUNG TP(1), TANG SK(1)
Affiliation :
(1) Nursing Services Division, United Christian Hospital
Introduction :
Physical restraints (PR) have been used in clinical settings, especially in mental health care, for centuries. PR is commonly applied in the clinical settings despite numerous studies presenting its paucity of efficacy and safety, as well as its potential to cause of adverse events or injuries. The prevalence rate of PR remains higher, reported as 10.19%, regardless of the hospital group, according to the Hong Kong Hospital Quality & Safety Annual report 2021-22. Healthcare providers often find it challenging to make appropriate decisions regarding the use of PR in demanding clinical environments without a standard and objective assessment tool. Currently, there is no effective tool based on guidelines to help nurses make appropriate decisions on the use of PR for patients in general wards
Objectives :
The objectives aimed to identify effective way to minimize the use of physical restraint in general adult ward settings and develop an evidence-based instrument to facilitate nurses in making decisions about the use of physical restraint.
Methodology :
A literature search was conducted on several electronic databases, including Medline, PubMed, CINAHL Complete, Embase and Cochrane Library, using subject MeSH headings and relevant keywords to identify any relevant studies pertaining to the research question. Only articles written in English from January 2014 to March 2024 were considered. The search was filtered by screening for articles with the full-text availability, experimental studies, systematic reviews, or meta-analysis. The reference lists of literatures were also searched to identify any further relevant studies.
Result & Outcome :
Eight studies were included in this review, consisting of 6 cohort studies, 1 stepped-wedge randomized controlled trial, and 1 systematic review. The quality of the studies ranged from low to moderate, with the risk of bias being moderate to high. The interventions retrieved from the included studies can be categorized as restraint decision instruments, restraint preventive interventions and restraint preventive strategies.
Implementing the evidence-based instrument can help improve patient outcomes, reduce inappropriate use of physical restraint, and provide a structured decision-making process for healthcare staff. An evidence-based assessment instrument is developed to assess patients who are necessary to be given physical restraint, and further stringent research is necessary to evaluate the effect of such instrument. Training on least restrictive techniques and effective strategies is crucial for nurses to ensure adherence of nurses and appropriate care for patients.
