Nurses' use of physical restraints in four Turkish hospitals

Purpose: (a) Determine the frequency and types of physical restraints used by nurses in intensive care units, emergency departments, and neurosurgery wards; (b) understand nurses' attitudes toward physical restraint, and (c) identify complications in physically restrained patients. Design and Methods: This descriptive, cross-sectional study was carried out on 254 nurses working in intensive care units, emergency departments, and neurosurgery wards in four Turkish hospitals where physical restraints were used. The whole population was studied without any sampling, and data were collected via semistructured interviews from July 20 to September 6, 2005. Findings: Nurses used either wrist, ankle, or whole body restraints at various levels. Those nurses who worked in surgical intensive care units and emergency departments and bad in-service training used more physical restraint than did others. Only a third of nurses decided on physical restraint together with physicians and three-fourths tried alternative methods. Nurses reported edema and cyanosis on wrist and arm regions, pressure ulcers on various regions, and aspiration and breathing difficulties in relation to physical restraint. Moreover, they reported 9 deaths of patients in chest restraints. Reduction in the frequency of caregiving was related to complications. Conclusions: Actions to reduce use of and complications from physical restraints should include attention to nurse staffing and education about use of restraints.