Nurses using physical restraints: Are the accused also the victims? – A study using focus group interviews

Registered nurses working in units involved in the study were invited to participate in focus group interviews on a voluntary basis. Twenty-two registered nurses (three males [13.6%] and nineteen females [86.4%]) attended the four sessions. All interviews were audio taped and transcribed verbatim. Other than the author, another member of the project team validated the findings from the data analysis.Four themes were identified. Participants experienced internal conflicts when applying physical restraints and were ambivalent about their use, but they would use restraints nonetheless, mainly to prevent falls and injuries to patients. They felt that nurse staffing was inadequate and that they were doing the best they could. They experienced pressure from the management level and would have liked better support. Communication among the various stakeholders was a problem. Each party may have a different notion about what constitutes a restraint and how it can be safely used, adding further weight to the burden shouldered by staff.Studies about restraints and restraint use have mostly focused on nurses' inadequate and often inaccurate knowledge about the use of restraints and its associated adverse effects. These studies, however, fail to note that nurses can also be victims of the system. Restraint use is a complex issue that needs to be understood in relation to the dynamics within an environment.The topic of restraint reduction has been under intense scrutiny since the late 1980s, when it began with a public outcry in developed countries arising out of concern with regard to the standard of care in long-term care settings. In Britain, the use of physical restraints on older people is often regarded as abuse [1]. In the United States, a nursing home reform law was enacted in 1987, resulting in an increasing number of studies on restraint use from then onwards. Almost two decades later, however, researchers still find nurses resistant to the notion of removing patients'