title: Attitudes of nurses towards the use of physical restraints in geriatric care: a systematic review of qualitative and quantitative studies.
abstract: OBJECTIVE
  To examine nurses' attitudes towards the use of physical restraints in geriatric care.
  
  
  METHODS
  Systematic review and synthesis of qualitative and quantitative studies.
  
  
  METHODS
  The following databases were searched: Medline, CINAHL, EMBASE, Psyndex, PsychInfo, Social SciSearch, SciSearch, Forum Qualitative Social Research (1/1990 to 8/2013). We performed backward and forward citation tracking to all of the included studies.
  
  
  METHODS
  We included in the present review all qualitative and quantitative studies in English and German that investigated nurses' attitudes towards the use of physical restraints in geriatric care. Two independent reviewers selected the studies for inclusion and assessed the study quality. We performed a thematic synthesis for the qualitative studies and a content analysis of the questionnaires' items as well as a narrative synthesis for the quantitative surveys.
  
  
  RESULTS
  We included 31 publications in the review: 20 quantitative surveys, 10 qualitative and 1 mixed-method study. In the qualitative studies, nurses' attitudes towards the use of physical restraints in geriatric care were predominately characterised by negative feelings towards the use of restraints; however, the nurses also described a perceived need for using restraints in clinical practice. This discrepancy led to moral conflicts, and nurses described several strategies for coping with these conflicts when restraints were used. When nurses were in doubt regarding the use of restraints, they decided predominantly in favour of using restraints. The results of the quantitative surveys were inconsistent regarding nurses' feelings towards the use of restraints in geriatric care. Prevention of falls was identified as a primary reason for using restraints. However, the items of the questionnaires focussed primarily on the reasons for the use of restraints rather than on the attitudes of nurses.
  
  
  CONCLUSIONS
  Despite the lack of evidence regarding the benefits of restraints and the evidence on the adverse effects, nurses often decided in favour of using restraints when in doubt and they used strategies to cope with negative feelings when they used restraints. A clear policy change in geriatric care institutions towards restraint-free care seems to be warranted to change clinical practice. The results of this review should also be considered in the development of interventions aimed at reducing the use of restraints.
authors.affiliation: School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany. Electronic address: Ralph.Moehler@uni-wh.de.
authors.forename: Ralph
authors.initials: R
authors.lastname: Möhler
authors.affiliation: School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany; Institute of Health and Nursing Science, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Meyer
mesh_terms: D001291:Attitude of Health Personnel; D005853:Geriatrics; D006801:Humans; D009740:Nursing Staff / Q000523:psychology*; D036301:Qualitative Research; D012149:Restraint, Physical
keywords: Geriatric nursing; Meta-synthesis; Physical restraints; Qualitative research; Surveys; Systematic review