Psychiatric nurses' thoughts and feelings about, restraint use: a decisiondilemma

Patients continue to be physically restrained in psychiatric in-patient uni ts, Studies concerned with staff-related variables have suggested that the emotional reactions of professionals to violent or potentially violent pati ents may influence their use of restrictive measures. However, no research existed that described psychiatric nurses' thoughts and feelings while they were involved in restraint situations nor what effects their thoughts and feelings had on their decision to restrain. Therefore, an ethnographic qual itative study was conducted in order to describe systematically nurses' tho ughts and feelings toward restraint use in the in-patient psychiatric setti ng. The conceptual approach guiding the study was Etzioni's (1992) theoreti cal work on the role of normative-affective factors in decision making. Fol lowing ethical approval of the study, ethnographic interviews were conducte d with six nurses from an in-patient psychiatric unit who had participated in a situation involving the physical restraint of a patient. The analysis of the nurses' thoughts and feelings revealed that the restraint situation represented a decision dilemma for them. This overall finding was supported by four themes: (1) the framing of the situation: the potential for immine nt harm; (2) the unsuccessful search for alternatives to physical restraint s; (3) the conflicted nurse; and (4) the contextual conditions of restraint . The results indicated that restraint use is more complex than is currentl y conveyed in the literature in that normative-affective factors influenced nurses' restraint decisions. The findings advance our understanding of why restraints continue to be used in psychiatric units. Further research is n ecessary to examine the findings in other settings and with a larger and mo re diverse population in order to draw definitive conclusions about the con tinued use of physical restraints in the care of patients on psychiatric un its in hospitals.