Development of an Evidence-Based Instrument to Justify the Use of Physical Restraint in General Adult Ward Settings: A Systematic Review.

Abstract

Background: Physical restraint is commonly applied in the clinical settings despite numerous studies presenting its paucity of efficacy and safety. Despite the various tangible and intangible factors associated with moral and safety issues, nurses must make decisions on restraint use in ethical dilemmas. Health care providers often find it challenging to make appropriate decisions regarding the use of physical restraint in demanding clinical environments without a standard and objective assessment tool.

Objectives: The objectives aimed to identify effective instrument to justify the decision-making regarding the use of physical restraint in general adult ward settings.

Methods: A literature search was conducted on several electronic databases, including Medline, PubMed, CINAHL Complete, Embase, and Cochrane Library, using subject MeSH headings and relevant keywords to identify any relevant studies pertaining to the research question. Only articles written in English from January 2014 to March 2024 were considered. The search was filtered by screening for articles with the full-text availability, cohort studies that are not considered an experimental studies, systematic reviews, or meta-analysis. The reference lists of literatures were also searched to identify any further relevant studies.

Results: Eight studies were included in this review, consisting of 6 cohort studies, 1 stepped-wedge randomized controlled trial, and 1 systematic review. The quality of the studies ranged from low to moderate, with the risk of bias being moderate to high. The interventions retrieved from the included studies can be categorized as restraint decision instruments, restraint preventive interventions and restraint preventive strategies. All included studies reported a significantly improved rate of restrained patients in the intervention group comparing to the control group. The rate of restrained patient days decreased significantly in the intervention group. There was no significant difference in the rate and number of accidental catheter removal, fall incident, and length of stay.

Conclusions: Implementing the evidence-based instrument can help improve patient outcomes, reduce inappropriate use of physical restraint, and provide a structured decision-making process for health care staff. An evidence-based assessment instrument is developed to assess patients who are necessary to be given physical restraint, and further stringent research is necessary to evaluate the effect of such instrument. Training on least restrictive techniques and effective strategies is crucial for nurses to ensure adherence of nurses and appropriate care for patients.