Antoinette Barton-Gooden
University of the West Indies School of Nursing, Jamaica
Title: Physical restraint usage at a teaching hospital: A pilot study
Biography
Biography: Antoinette Barton-Gooden
Abstract
Statement of the Problem: Physical restraint usage is widespread in acute care settings and contributes to patient injuries and death. Nurses are ambivalent about the practice and face moral dilemma when it is used. However, little is known or documented about the use of physical restraints in Jamaica.
Aim: The purpose of the study is to examine the use of physical restraints among adult patients on the medical-surgical wards and one psychiatric unit at a teaching hospital in Jamaica.
Method: This mixed-methods study utilized a restraint prevalence tool to directly observe 172 patients and conduct 47 chart audits. Two focus group discussions with nurses and medical doctors working on the wards and unit were conducted. Qualitative data were audio taped, transcribed and thematically analyzed using a comparative matrix. Quantitative data was analyzed using SPSS® version 17.
Results: The prevalence of use of physical restraints was (75%) on the medical-surgical wards. Bedrails accounted for 70%, while limb and trunk restraints using stockinet and leather straps (5%). No restraint usage was observed on the psychiatric unit. Limb restraints were inappropriately applied (43%), and no doctors’ order or written consent was seen (90%). Focus group discussants were female ages 20-39 years, with 8-36 months experience in the area. They reported feelings of sadness, guilt and fear regarding the use of physical restraints. Also, restraints were necessary when the patient was at risk for harm to self and others. Majority reported being unaware of the policy (83%), not being formally trained in restraint application, but had learnt from peer observation.
Conclusion & Significance: High prevalence of bedrails was a standard procedural practice to prevent patient falls. Nurses and doctors experienced moral dilemma when restraints are used. Adequate institutional support and integration of evidence-based information is necessary to enhance patient safety.