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Original Articles

Psychiatric nurses knowledge and attitudes

toward the use of physical restraint on
older patients in psychiatric wards
Wai-Tong Chien & Isabella Ym Lee
Pages 52-71 | Received 05 Feb 2007, Accepted 20 Sep 2007, Published online: 17 Dec 2014


Background: There is still an ongoing debate concerning whether or not to use physical
restraint with confused or frail older patients in various elderly care settings. Nurses views
and attitudes toward the use of physical restraints in controlling patients behavior and
ensuring patient safety may create conflicts with patients rights, including their autonomy in
making decisions for their own care.

Aims of the study: The purposes of this study were to identify registered psychiatric nurses
knowledge, attitudes and practice issues regarding the use of physical restraints in Hong
Kong, and to examine the factors influencing nurses decisions to use restraints on their
patients. The findings on the nurses knowledge, attitudes and practice issues were compared
with those found in the USA.

Methods: This descriptive exploratory study was conducted in two psycho-geriatric wards of
one of the two mental hospitals in Hong Kong, using a mixed research design. The study
consisted of two phases: first, 42 registered psychiatric nurses completed a self-administered
questionnaire to examine their practice, knowledge and attitudes towards restraint use; and
second, data were collected from semi-structured interviews of 15 of them, from observations
of their restraint practices, and from an examination of clinical records which were then
content analyzed to explore what determined nurses decisions to use restraints on the older

Results: Results from the questionnaires and semi-structured interviews indicated that about
two-thirds of nurses believed that patients should be restrained for their own safety and to
ensure treatment compliance, even if being restrained meant loss of dignity and was resisted
by patients and/or their family members. Overall, the nurses in this study demonstrated only
a modest level of knowledge of restraint use and slightly negative attitudes toward this

Four major themes relating to nurses decisions about restraint use were identified from the
qualitative data, showing considerable similarities and thus confirming the quantitative
These included attitudes towards the use of a safety measure and effective intervention for
patients, insufficient consideration of alternative measures and/or adverse consequences,
ethical dilemmas, and psychological reactions towards restraint use.

Conclusion: The mixed research methods and cross-cultural comparison of research findings
used in this study reveals apparent relationships between psychiatric nurses knowledge,
perceptions, attitudes, and practice issues concerning the application of physical restraints to
older hospitalized patients in psychiatric care. The findings demonstrate that continuing
education about restraint use is important for psychiatric nurses. Further research using an
action research method to evaluate the effectiveness of educational interventions on nurses
decisions regarding restraint use is recommended for improvement of nursing practice.

Keywords: physical restraint, knowledge, attitude, nursing practice, psychiatric

nursing, elderly patients