title: Australian nurses' perceptions of the use of manual restraint in the Emergency Department: a qualitative perspective.
abstract: OBJECTIVE
  To explore emergency nurses perceptions of the use of manual restraint.
  
  
  BACKGROUND
  Manual restraint of patients has historically been an accepted practice, though little is known about the use of manual restraint in general hospitals.
  
  
  METHODS
  A qualitative, descriptive, exploratory, study was undertaken.
  
  
  METHODS
  Fifteen semi-structured interviews with emergency nurses were completed. Data were analysed using qualitative thematic analysis procedures.
  
  
  RESULTS
  The following themes were identified: 'part of the job', 'reasons for manual restraint', 'restraint techniques', 'consequences' and 'lack of documentation'. Manual restraint occurred frequently each shift and most were not documented. This may be due to nurse's perceptions that manually restraining a patient did not comprise formal restraint and was the only option. Nurses used manual restraint to manage patients who were violent and aggressive or to perform procedures. However, they reported a lack of education and training in manual restraint. Nurses identified several consequences for the patient, staff and the organisation as a result of these events including psychological and physical injuries.
  
  
  CONCLUSIONS
  Empirical research of prevalence and issues surrounding manual restraint events is required to inform health care organisations and government to develop, implement and evaluate appropriate policies and strategies to ensure safety of patients and staff. The employment of peer support workers and professionals with expertise in mental health and dementia may aid in the reduction of manual restraint events and improve care of all patients within the Emergency Department. Research on manual restraint in health settings is also needed.
  
  
  CONCLUSIONS
  Nurses need to be aware that manual restraint is not just an accepted part of their work, but is a strategy of last resort that should be documented. Organisations must implement standardised educational programmes for nurses together with policies and processes to monitor and evaluate manual restraint events.
authors.affiliation: Australian Catholic University, Fitzroy, Vic., Australia.
authors.forename: Rose
authors.initials: R
authors.lastname: Chapman
authors.affiliation: Australian Catholic University, Fitzroy, Vic., Australia.
authors.forename: Kaye Robyn
authors.initials: KR
authors.lastname: Ogle
authors.affiliation: Australian Catholic University, Fitzroy, Vic., Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Martin
authors.affiliation: Australian Catholic University, Fitzroy, Vic., Australia.
authors.forename: Asheq
authors.initials: A
authors.lastname: Rahman
authors.affiliation: Australian Catholic University, Fitzroy, Vic., Australia.|North Western Mental Health, Melbourne Health, Parkville, Vic., Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: McKenna
authors.affiliation: Monash University Clayton, Vic., Australia.
authors.forename: Jakqui
authors.initials: J
authors.lastname: Barnfield
mesh_terms: D000328:Adult; D000374:Aggression; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D012149:Restraint, Physical; D055815:Young Adult
keywords: Emergency Department; manual restraint; nurses; perceptions; qualitative; violence and aggression