title: Contextual influences on nurses' decision-making in cases of physical restraint.
abstract: BACKGROUND
  In order to fully understand nurses' ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified.
  
  
  OBJECTIVE
  What is the influence of context on nurses' decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint?
  
  
  METHODS
  A qualitative descriptive study inspired by the Grounded Theory approach was carried out.
  
  
  METHODS
  In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium.
  
  
  METHODS
  The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven.
  
  
  RESULTS
  Relationships with nursing colleagues and the patient's family form an inter-personal network. Nurses also point to the importance of the procedural-legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses' decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint.
  
  
  CONCLUSIONS
  The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making.
  
  
  CONCLUSIONS
  An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions.
authors.affiliation: Catholic University of Leuven, Belgium.
authors.forename: Bernadette Dierckx
authors.initials: BD
authors.lastname: de Casterlé
authors.affiliation: APZ St. Lucia, Belgium sabine.goethals@scarlet.be.
authors.forename: Sabine
authors.initials: S
authors.lastname: Goethals
authors.affiliation: Catholic University of Leuven, Belgium.
authors.forename: Chris
authors.initials: C
authors.lastname: Gastmans
mesh_terms: D000328:Adult; D001530:Belgium; D003657:Decision Making; D004993:Ethics, Nursing; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009736:Nursing Process; D012149:Restraint, Physical / Q000941:ethics*; D055815:Young Adult
keywords: Context; decision-making; nursing; physical restraint; qualitative study