Safety Work Initiating, Maintaining, and Terminating Restraints

Purpose: This study examines the variations and complexities in nurses ’ decision makingabout the initiation, maintenance, and termination of physical restraints. Methods: This qualitative research used a semistructured interview of registered nurses on medical-surgical units at a midsized hospital in the Midwest. Results: All the nurse respondents easily recalled caring for a patient in restraints and detailed in their accounts a complex trajectory of care that centered on safety. However, most nurses reported that the trajectory of restraint use was started by other departments, shifts, or nurses. The findings revealed a forceful interplay of patient, nurse, family, healthcare worker, and organizational factors that influence nurses ’ decision making about restraint use. Conclusions: This article discusses how a deeper understanding of the intricacies of the decision-making processes related to restraints can help clinical nurse specialists tailor education, impact policy, and serve as role models to reduce the use of restraints in hospitals. KEY WORDS: clinical nurse specialist, physical restraint, qualitative, safety work The use of physical restraints continues to be a practice issue in healthcare settings.Although professional guidelines, directives, and researchers over the last 20 years have called for the discontinuance of the use of restraints, nurses continue to use them. In an online survey completed in November and December of 2002, 73 % (n = 1,400) of the nurse respondents said that they used restraints on patients in the year of the study.1 The use of physical restraints in hospitals continues to be a major practice problem. As clinical experts and clinical policy and education leaders, clinical nurse specialists (CNSs) are often asked to examine the issue of restraint use for a variety of reasons, for example, compliance purposes, cost questions, educational and orientation programs, and risk management. This article presents the findings from a qualitative study that was initiated by a CNS who had been asked to examine restraint use within the hospital where she wa