Factors influencing the use of physical restraints on elderly patients in acute care settings in St. John's, Newfoundland

Jacobs, Yvonne M. (1995) Factors influencing the use of physical restraints on elderly patients in acute care settings in St. John's, Newfoundland. Masters thesis, Memorial University of Newfoundland.

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Abstract

This exploratory study was an attempt to determine the prevalence of physical restraint use on elderly patients in acute care settings in St. John's, Newfoundland, and to determine factors that influence the use of physical restraints in those settings. The sample consisted of 242 registered nurses working on medical and surgical ward units. Each nurse anonymously completed an investigator devised questionnaire which consisted of: 1) demographic questions; 2) a 42 item Likert scale composed of positive and negative statements concerning nurses' knowledge about restraints, and their perceptions about the physical and organizational environment; and 3) nurses' self-report of the number of elderly patients restrained by different types of physical restraints on their ward unit at that time. Factor analysis was performed and factor scores were correlated with average restraint use per elderly patient. Correlations of four factors were statistically significant. These concerned the ward environment, including both the physical layout and staffing levels; lack of time to carry out nursing care; support of staff from both administration and coworkers for non-restraint decisions; and preference for working with the elderly. -- There were differences in types of restraints used by hospitals and by medical and surgical ward units. The most common types of restraints used were side rails, geriatric chairs, chest restraints, mitts, and chair belts. -- The reliability of the Likert scale was quite high (alpha = .8), but there were problems with verifying the accuracy of the measurement of restraint use, which was by self-report and may have been influenced by social desirability. In addition, the correlations between average restraint use and significant factors were low. However, the results indicate that these factors do have some influence on restraint use and need to be explored further. -- Three areas of considerable concern were revealed by the study. 1) Nurses' perception of the lack of support from administration and their fear of being blamed if they decide not to use restraints and a patient falls or wanders away. Thus, nurses felt pressured to use restraints when they were unable to observe patients closely due to the physical environment or to perceived shortage of staff or lack of time to carry out their tasks. 2) Due to time constraints, activities such as ambulation, position changing, and frequent observation of restrained patients may not be carried out. 3) Many nurses lacked knowledge about the danger of death resulting from restraint use and felt their patients were safe when restrained. -- Due to problems in measuring restraint use accurately and the low correlations, further research and instrument refinement are recommended. Other recommendations are made for nursing practice, education, and research.

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