School of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Bern, Switzerland.
Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.
J Clin Nurs. 2023 Jun;32(11-12):2603-2615. doi: 10.1111/jocn.16322. Epub 2022 Apr 21.
We aimed to describe daily restraint practices and the factors which influence their use, from an outsider's perspective.
A reduction in restraint use is recommended in health care. However, somatic acute care hospital settings currently lack effective reduction strategies. Thus far, hospital restraint practice is described in terms of quantitative assessments and the 'insider' view of healthcare professionals. However, as factors such as routine or personal beliefs seem to play a relevant role in restraint use, these approaches might be incomplete and biased.
A qualitative observation study design was employed.
Fieldwork with unstructured participant observation was conducted at a department of geriatrics and a department of intensive care in Switzerland between November 2019 and January 2020. Data were recorded as field notes. The analysis was conducted iteratively in two coding cycles using descriptive coding followed by pattern coding. We adhered to the Standards for Reporting Qualitative Research (SRQR).
A total of 67 hours of observation were conducted. We found that daily restraint practice can be described in three categories: the context in which restraints are used, the decision-making process on the use and continued use of restraints, and the avoidance of restraint use. Most processes and decisions seem to take place unconsciously, and their standardisation is weak.
The lack of standardisation favours intuitive and unreflective action, which is prompted by what is also known as heuristic decision-making. To transform daily restraint practice, a technical solution that leads restraint management in line with ethical and legal requirements might be useful.
The outsider perspective has allowed daily restraint practice to be described independently of existing routines, departmental cultures and personal attitudes. This is important to comprehensively describe restrictive practices, which is a prerequisite for the development of effective restraint reduction strategies.
我们旨在从局外人的角度描述日常约束实践以及影响其使用的因素。
医疗保健建议减少约束的使用。然而，目前在躯体急症护理医院环境中缺乏有效的减少策略。迄今为止，医院约束实践是根据定量评估和医疗保健专业人员的“内部”观点来描述的。然而，由于常规或个人信念等因素似乎在约束使用中发挥了相关作用，因此这些方法可能不完整且存在偏见。
采用定性观察研究设计。
2019 年 11 月至 2020 年 1 月，在瑞士的老年科和重症监护科进行了无结构参与观察的实地工作。数据记录为实地笔记。分析在两个编码周期中使用描述性编码和模式编码进行迭代。我们遵守了定性研究报告标准 (SRQR)。
共进行了 67 小时的观察。我们发现，日常约束实践可以分为三个类别：使用约束的背景、使用和继续使用约束的决策过程以及避免使用约束。大多数过程和决策似乎都是无意识地进行的，其标准化程度较弱。
缺乏标准化有利于直觉和无意识的行动，这是启发式决策所提示的。为了改变日常约束实践，可以使用一种技术解决方案，根据伦理和法律要求来管理约束，这可能是有用的。
局外人的观点允许独立于现有常规、部门文化和个人态度来描述日常约束实践。这对于全面描述约束性实践很重要，这是制定有效的约束减少策略的前提。
