Safety work: initiating, maintaining, and terminating restraints.

PURPOSE

This study examines the variations and complexities in nurses' decision making about the initiation, maintenance, and termination of physical restraints.

METHODS

This qualitative research used a semistructured interview of registered nurses on medical-surgical units at a midsized hospital in the Midwest.

RESULTS

All the nurse respondents easily recalled caring for a patient in restraints and detailed in their accounts a complex trajectory of care that centered on safety. However, most nurses reported that the trajectory of restraint use was started by other departments, shifts, or nurses. The findings revealed a forceful interplay of patient, nurse, family, healthcare worker, and organizational factors that influence nurses' decision making about restraint use.

CONCLUSIONS

This article discusses how a deeper understanding of the intricacies of the decision-making processes related to restraints can help clinical nurse specialists tailor education, impact policy, and serve as role models to reduce the use of restraints in hospitals.