Highlights

• Nurses consider the physical restraint unpleasant, challenging, risky and conflicting.

• The majority of nursing staff suffered accidents related to restraint, most of them involving biological material exposure.

• Some nursing professionals considered physical restraint normal, therapeutic, punitive, or educational resource.

• The nursing assistants were more likely to use restraint, when compared to nurses.

• The nursing staff sought justifications for restraint to mitigate their negative feelings.

• A restricted repertoire of interventions to manage aggressive behavior reinforces the need for restraint.

Abstract
Background
Physical restraint in psychiatric units is a common practice but extremely controversial and poorly evaluated by methodologically appropriate investigations. The cultural issues and professionals’ perceptions and attitudes are substantial contributors to the frequency of restraint that tend to be elevated.

Aim

In this qualitative study, we aimed to understand the experiences and perceptions of nursing staff regarding physical restraint in psychiatric units.

Method
Through theoretical sampling, 29 nurses from two Brazilian psychiatric units participated in the study. Data were collected from 2014 to 2016 from individual interviews and analyzed through thematic analysis, employing theoretical presuppositions of symbolic interactionism.

Results
Physical restraint was considered unpleasant, challenging, risky, and associated with dilemmas and conflicts. The nursing staff was often exposed to the risks and injuries related to restraint. Professionals sought strategies to reduce restraint-related damages, but still considered it necessary due to the lack of effective options to control aggressive behavior.

Conclusions
This study provides additional perspectives about physical restraint and reveals the need for safer, humanized and appropriate methods for the care of aggressive patients that consider the real needs and rights of these patients.

Kelly Graziani Giacchero Vedana, Danielle Maria da Silva, Carla Aparecida Arena Ventura, Bianca Cristina Ciccone Giacon, Ana Carolina Guidorizzi Zanetti, Adriana Inocenti Miasso, Tatiana Longo Borges
Archives of Psychiatric Nursing, Volume 32, Issue 3, June 2018
https://doi.org/10.1016/j.apnu.2017.11.027
https://www.sciencedirect.com/science/article/pii/S0883941717302492

Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff – 2018