title: Safety work: initiating, maintaining, and terminating restraints.
abstract: OBJECTIVE
  This study examines the variations and complexities in nurses' decision making about 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.
authors.affiliation: College of Nursing, Kent State University, Kent, OH 42242-0001, USA. rludwick@kent.edu
authors.forename: Ruth
authors.initials: R
authors.lastname: Ludwick
authors.forename: Anita
authors.initials: A
authors.lastname: Meehan
authors.forename: Richard
authors.initials: R
authors.lastname: Zeller
authors.forename: Richard
authors.initials: R
authors.lastname: O'Toole
mesh_terms: D015146:Midwestern United States; D009720:Nurse Clinicians; D012149:Restraint, Physical; D012449:Safety