The association between the prevalence and attitude regarding physical restraint use in a Dutch acute hospital

Abstract

Title: The association between the prevalence and attitude regarding physical restraint use in a Dutch acute hospital. Background: Factors that influence physical restraint use need to be identified to reduce this questionable practice. However, due to limitations of previous studies, it is unknown whether an association exists between the prevalence and attitude regarding restraint use. Aim and research questions: To explore the association between the prevalence of physical restraint use and attitude of physicians and nurses towards restraint use in a Dutch acute hospital. The research questions were: what is the prevalence of restraint use, what is the attitude of physicians and nurses towards restraint use, and is there an association between the prevalence and attitude regarding restraint use? Method: A cross-sectional, correlational study was conducted. Unannounced, one researcher observed patients on 17 units on restraint use to determine the prevalence. Then, physicians and nurses working in these units were asked to complete the Maastricht Attitude Questionnaire (MAQ) to determine their attitude towards restraint use. Subsequently, the Spearman’s rank correlation coefficient was used to explore the association between the prevalence rates and mean MAQ scores at the unit level. Units with a response lower than 40% and/or a prevalence based on less than five patients were excluded from this analysis to increase the usability of the results. Results: A moderate to strong positive significant association (rs=0∙608, p=0∙027) was found, indicating that units with a positive attitude tended to use more restraint than units with a negative attitude. Physicians and nurses had a relatively neutral to slightly positive attitude regarding restraint use, but they considered the use of restraint as appropriate clinical practice. Physicians and nurses considered the mostly used restraint measure (bilateral bedrails) as moderately restrictive. Conclusion: Attitude may be an influencing factor of physical restraint use. Recommendations: Information programs for units with positive attitudes and high prevalence rates should be aimed at changing attitudes against restraint use in order to reduce the use of restraint.