NURSES' PERCEPTIONS OF FACTORS INVOLVED IN THE USE OF PHYSICAL RESTRAINTS WITH ELDERLY PATIENTS IN AN ACUTE CARE HOSPITAL.
Contributors: Indiana University School of Nursing.
Published: 1991
Number of pages: 199
Subjects: Health Sciences, Nursing.; Gerontology.
Description: The use of physical restraint is a relatively common intervention in the nursing management of elderly patients. Restraint situations present the nurse with a potential moral conflict between the nurse's commitment to act in the patient's best interest and the patient's right to self-determination. No research could be found that systematically examined the extent to which nurses attended to the values issues involved in the decision to restrain. The purpose of this study was to describe how nurses explained their use of physical restraints with elderly patients and to examine whether or not these nurses perceived the restraint decision to be a moral problem.

A Grounded Theory approach guided data collection and analysis. Verbatim transcripts of multiple in-depth interviews with 20 female registered nurses provided the major source of data. Four themes evolved from data analysis: goal orientation, multiple meanings of restraint, feelings of distress and redefinition. Redefinition was identified as a core variable.

The nurses in this study were committed to four overall nursing goals: prevention of patient harm, maintenance of the therapeutic regime, prevention of harm to others and fulfillment of other obligations. Two distinct meanings of restraint were expressed, a personal and a functional. Redefinition was the process by which participants cognitively restructured the meaning of restraint from the personal to the functional using five cognitive strategies: differentiating between a personal and a professional perspective, objectifying the patients, minimizing or denying the significance of restraint, focusing on intent rather than consequences and limiting personal responsibility. The amount of personal distress expressed by the participants was associated with the degree to which they had redefined what it was that they were doing in regard to restraint use.

Hypotheses for further study included: The level of distress expressed by the nurse is related to her recognition of a values conflict in restraint decisions, the extent to which she has redefined restraints and the degree of her commitment to the four nursing goals; the degree of the nurse's commitment to the four nursing goals is related to length of time in a given clinical setting; and, the nurse's past experiences with restraint use serve as prototypes for evaluating and managing subsequent situations.
Notes: Source: Dissertation Abstracts International, Volume: 52-08, Section: B, page: 4126.

Thesis (D.N.S.)--INDIANA UNIVERSITY SCHOOL OF NURSING, 1991.

School code: 0815.