Staff perceptions of barriers to physical restraint-reduction in long-term care: a meta-synthesis.
OBJECTIVE
To critically review the existing qualitative studies to identify, from the perspective of staff, the barriers to physical restraint reduction in long-term geriatric care facilities.


BACKGROUND
Despite the adverse physical and psychosocial effects, physical restraints are still used frequently in many geriatric long-term care facilities around the world. There is, however, no study that synthesises the existing qualitative literature regarding the barriers to the restraint reduction from the perspective of facility staff.


METHODS
The metastudy research process guided this qualitative synthesis. Five electronic databases were searched, and ten studies were included in this metastudy.


RESULTS
Five themes were identified through metasynthesis of the findings: concern about and responsibility for safety, unclear and inconsistent definitions of restraint and restraint-free care, difficulties in the transition from acceptance to removal, noninvolvement in decision-making to remove restraint and insufficient resources and education.


CONCLUSIONS
A concept analysis of physical restraint is sorely needed, and future studies should explore the prevalence of restraint, the effects of education for staff and family on restraint reduction, and success stories related to restraint-free care. More research is needed regarding the restraint reduction effectiveness and cost issues.


CONCLUSIONS
Physical restraints, commonly used in many geriatric long-term care facilities, result in many negative effects and ethical issues. To achieve success in reducing physical restraint use, governmental policies and long-term care institutions should underpin staff efforts with legal, educational and practical support.
College of Nursing, Gachon University, Seongnam-si, Korea.
Eun-Hi
EH
Kong
College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Korea.
Heeseung
H
Choi
University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Lois K
LK
Evans
D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D009735:Nursing Homes; D036301:Qualitative Research; D012149:Restraint, Physical
barrier; long-term care; older adults; physical restraint; staff