How Nurses Balance Risk with Patient Autonomy When Making Decisions about Physical Restraint Use with Older Patients in Acute Care

Abstract

The use of physical restraints to reduce falls within the older adult population in acute care hospital settings, are regarded as an integral part of risk management and prevention of patient harm (Bigwood & Crowe, 2008). Although literature indicates that nurses apply physical restraints to prevent injuries from a fall, there appears to be no robust evidence that links this intervention to injury prevention (Oliver, Healey, & Haines, 2010). Adding to this, decision-making around physical restraint use is a complex process and is influenced by different contextual factors (Dierckx de Casterle, Goethals, & Gastmans, 2015). The purpose of this interpretive descriptive study was to further understand how nurses balance risk with patient autonomy when making decisions about physical restraint use for falls prevention, and to provide a deeper understanding of risk and patient autonomy that are applicable and meaningful to everyday nursing practice. Perceptions related to nurses’ experience with balancing risk with patient autonomy were elicited through individual interviews with seven participants and one focus group session made up of five additional participants. The results of this research study provides insight into factors that influence the nurses’ decision-making process about whether or not to apply physical restraints.