Nurses' Attitudes Toward Restraint Use in Japanese Hospitals

Purpose: The use of restraints is a controversial issue that may present nurses with legal, ethical and practical dilemmas. Restraint use can result in numerous problems for the patients, including death by strangulation, falls injuries, deconditioning, skin breakdown, incontinence, constipation and psychological effects such as agitationand emotional distress. The aim of this study was to investigate nurses’ attitudes towards restraint use and related factors.

Methods: A descriptive study was conducted to measure nurses’ attitudes toward restraint use. Nurses employed in areas of internal, surgical, and sanatorium wards of three hospitals received the questionnaire. Japanese Version of Perceptions of Restraint Use Questionnaire (PRUQ), which is 17 item questionnaire measures nurses’ attitudes toward restraint use, was used. Each item is ranked on a 5-point Likerttype scale. A higher score indicates that the item is considered to be an important justification for the use of physical restraints. The instrument was judged to have face and content validity by a panel of gerontology nurse experts.

Results: The questionnaire was sent to a total of 227 nurses and was returned by 205, giving a response rate of 90.3%. The sample had a mean age of 35.8 years (range 20–62 years, SD 10.1) and had been nursing for an average of 7.6 years (range 0.4–34years, SD 7.4). As expected, the majority of respondents were women (94.6%). Nearly half of the respondents (45.1%) worked in internal wards, and surgical wards (24.4%) or sanatorium wards (25.4%). The mean score on the PRUQ was 2.897(possible range 1–5), indicating that respondents in this sample had a slightly negative attitude toward the use of restraints. Positive attitudes were shown about items such as preventing a patient from breaking open sutures and pulling out a catheter, feeding tube, and IV. Twelve of 17 items were significantly different due to type of ward, especially surgical wards indicated positive attitudes.

Conclusion: Nurses’ attitudes toward restraint use showed positive about preventing from pulling out catheter, feeding tube, and IV, moreover, different attitudes were observed among three wards.