Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Families' Perspectives on the Use of Physical Restraints

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Families' Perspectives on the Use of Physical Restraints

Article excerpt

INTRODUCTION

The use of physical restraints is a complex issue in health care facilities. As a common practice in health care settings, the appropriateness of its use has been called into question. Not only does the application of physical restraints to a person bring about ill effects on their psychological wellbeing (Sullivan-Marx 199S), but it also results in a variety of untoward events, many of which are well documented (Evans, Wood & Lambert 2003). The importance of involving families in the process of removing physical restraints has been widely recognised (Werner et al. 1993). However, there is a dearth of literature on families' view of physical restraints. 'Family', 'perception or attitude', and 'physical restraint' were used as combined keywords to search in the CINAHL, MEDLINE, and PsycINFO databases for the last twenty years. Fifty-two articles were located after removing duplications. Only five articles were found to be specifically examining the topic under discussion.

Apparently, families have very different opinions with regard to physical restraints. Some families regard them as a means to ensure safety and prevent their loved ones from coming to harm (Hendel, Fradkin & Kidron 2004). Others were frustrated or hurt by the discomfort and loss of dignity of their relatives on being physically restrained (Hardin et al. 1993; Newbern & Lindsey 1994). Some thought physical restraints were used more often than necessary (Brennan et al. 1991), while others varied widely with regard to their acceptance of measures considered as physical restraints for the sake of preventing falls (Vassallo et al. 2004).

Hardin et al. (1993) examined the perceptions of 19 family members on the use of physical restraints upon their relatives. Twelve of them reported being upset at seeing their relatives restrained, yet 10 of them reasoned that it was for the sake of the patient that the restraint was applied. Werner et al. (1993) surveyed 137 family members of nursing home residents about the use of physical restraints. The results showed that the participants perceived the use of physical restraints as somewhat important. Using an open-ended questionnaire, Newbern and Lindsey (1994) studied the attitudes of wives towards having their husbands physically restrained. They found that it was the feeling of loss of hope for their husbands' condition and the disappearance of possible plans with their husbands that was upsetting to the participants, and not so much the actual use of the restraint.

Kanski et al. (1996) examined family reactions to restraint in an acute care setting. In their sample of 25 participants, the researchers found that families were often unaware of patients' right to refuse physical restraints and that families could have a voice in this matter. They noted that families were interested in this issue but were uninformed and lacking knowledge in this area. Evans and Fitzgerald (2002) conducted a systematic review of the qualitative literature on the topic of the experience of physical restraints. They found that the overall picture described patients and families' experience as gloomy. The majority of responses summarised by the authors related to negative experiences. Present-day health care services speak of the need to provide person-centred care. It is therefore important to further explicate the family's perspective on restraint use.

The reduction of restraint use is dependent upon the determination to address various factors that have contributed to this practice. This project team conducted a clinical trial of restraint reduction in two rehabilitation facilities in Hong Kong. Other than staff education and management input in the form of a restraint reduction committee, the team also tried to involve families as partners in restraint reduction. The team deemed that providing educational and sharing sessions with family members would help to facilitate families' understanding of what they could contribute toward the reduction of restraint use. …

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