Psychiatric Nurses’ Knowledge, Attitudes, and Practice Regarding Physical Restraint in China: A Multicentre Cross-Sectional Study

Figures & data

Table 1 Basic Information of Participants (n=345)

Characteristics	n	Percentage
Hospital level
Secondary	304	88.12
Tertiary	41	11.88
Gender
Female	317	91.88
Male	28	8.12
Home location
Rural	61	17.68
Urban	284	82.32
Marital status
Unmarried	92	26.67
Married	242	70.14
Divorce	10	2.90
Other	1	0.29
Education Level
Below bachelor’s degree	93	26.96
Bachelor′s degree	245	71.01
Master′s degree	6	1.74
Doctor′s degree	1	0.29
Political status
The Masses	230	66.67
League Member	74	21.45
Communist party member	39	11.30
Other	2	0.58
Title
Junior nurse	78	22.61
Senior nurse	153	44.35
Charge nurse	110	31.88
Assistant chief senior nurse	3	0.87
Chief senior nurse	1	0.29
Position
Clinical frontline nurse	279	80.87
Nursing managers	45	13.04
Other	21	6.09
Ward management model
Open	37	10.72
Semi-open	53	15.36
Enclosed	255	73.91
National Counselor/Certificate
Yes	25	7.25
No	320	92.75
Physical restraint knowledge training
Yes	234	67.83
No	111	32.17

Table 2 Current Status of Knowledge, Attitudes and Practices of Psychiatric Nurses Toward Physical Restraint (n=345)

Items	n	Percentage
Family informed consent
Yes	315	91.30
No	30	8.70
Patient informed consent
Yes	319	92.46
No	26	7.54
Introduce the patient to the purpose/role of restraint
Yes	332	96.23
No	13	3.77
Know the laws and regulations related to restraint
Yes	335	97.10
No	10	2.90
Reasons for imposing constraints (multiple choice)
Not listening to nurses	14	4.06
Tendency to be impulsive	259	75.07
Cursing, yelling and screaming	64	18.55
Suicidal tendencies	284	82.32
Threatening the personal safety of staff	255	73.91
Disruption of medical order	120	34.78
Preventing patient falls/falling out of bed	168	48.70
After Modified Electroconvulsive Therapy (MECT)	39	11.30
Wandering around the ward	11	3.19
Tension xerosis	32	9.28
Threatening the personal safety of other patients	233	67.54
Uncooperative treatment	80	23.19
Behavior Disorders	102	29.57
Other	2	0.58
Whether the constraint has been overused
Yes	82	23.77
No	263	76.23
Whether the constraint is replaceable
Yes	298	86.38
No	47	13.62
Need for alternative measures
Psychological reassurance (“cooling down”)	92	26.67
Meeting reasonable patient requests	32	9.28
Contacting doctors several times to check on patients	40	11.59
Drug treatment	119	34.49
Participating in behavior modification training	20	5.80
Notifying family members to accompany the patient	5	1.45
Diverting the patient’s attention	29	8.41
Accompanying patients (doctors/nurses)	8	2.32
Correct use of restraint techniques
Yes	334	96.81
No	11	3.19
Whether improper restraint techniques have been used
Yes	85	24.64
No	260	75.36
Whether the restraint will cause the patient to feel humiliated or develop other negative emotions
Yes	214	62.03
No	131	37.97
Concern about what potential risks of somatic problems when the patient is restrained (multiple choice)
Skin Injury	279	80.87
Agitation leading to torso bumping	247	71.59
Sudden death	142	41.16
Venous thrombosis	161	46.67
Dehydration	37	10.72
Malnutrition	2	0.58
Whether measures have been taken to prevent deep vein thrombosis after constraint
Yes	268	77.68
No	77	22.32
Difficulties encountered in the implementation of restraints (multiple choice)
Inadequate staffing	255	73.91
Hospitals have no human support mechanism	101	29.28
Fear of being harmed	210	60.87
Provoking patient retaliation	131	37.97
Resulting in disputes or adverse events	204	59.13
The doctor could not arrive in time	123	35.65
Hospital restraint system needs improvement	56	16.23
Concerning about inconsistency with physician assessment	71	20.58
Injured during restraint (multiple choice)
No	102	29.57
Injury by scratching or clawing	210	60.87
Bites	66	19.13
Kick Injury	160	46.38
Bruise	73	21.16
Constraining the psychological needs after being hurt
Colleagues comfort	14	4.06
Head nurse comfort	9	2.61
Nursing Department Comfort	17	4.93
Leaving the environment	48	13.91
Can be handled in a timely manner	255	73.91
Other	2	0.58
Somatic response after restraint (multiple choice)
None	124	35.94
Palpitation	88	25.51
Asthma	161	46.67
Stomach discomfort	17	4.93
Hand shaking	103	29.86
Back discomfort	123	35.65
Other	21	6.09
Psychological response after restraint (multiple choice)
None	175	50.72
Calm	54	15.65
Fear	51	14.78
Reluctance to work	26	7.54
Repeatedly calling for support in case of emergencies	85	24.64
Crying	11	3.19
Anxiety	80	23.19
Tension	91	26.38
Other	1	0.29
Consider patient restraint release
Patient is emotionally stable	154	44.64
Patients can communicate effectively	14	4.06
Patients have a correct understanding of the reasons for their restraint	62	17.97
The patient is better than before and the nurse feels in control of the situation with the staff on her shift	87	25.22
Patients say they “listened”	3	0.87
Patients feel they can control their words and actions	25	7.25

Table 3 Factors Affecting Psychiatric Nurses’ Knowledge, Attitudes and Practices Toward Use of Physical Restraint (n=345)

Variable	Mean±SD	95% CI	p-values
Education Level
Below bachelor’s degree	8.13±0.17	7.79–8.47	0.049
Bachelor′s degree	8.68±0.08	8.53–8.83
Master′s degree	7.83±0.65	6.15–9.51
Position
Clinical frontline nurse	8.65±0.08	8.49–8.80	<0.001
Nursing managers	8.24±0.19	7.85–8.63
Other	7.38±0.37	6.61–8.15
Physical restraint knowledge training
Yes	8.13±0.14	7.84–8.41	<0.001
No	8.70±0.08	8.54–8.86

Notes: When the education level is Doctor′s degree, the score is a constant and has been omitted.

Table 4 Multiple Linear Stepwise Regression Analysis of Psychiatric Nurses’ Knowledge, Attitudes and Practices Toward Use of Physical Restraint (n=345)

Variable	B	S.E.	β	t	p-values
Constants	7.573	0.394		19.212	<0.001
Education Level	0.458	0.141	0.166	3.245	<0.001
Position	−0.537	0.125	−0.223	−4.300	0.001
Physical restraint knowledge training	0.484	0.148	0.169	3.267	0.001

Data Sharing Statement

The data are not available due to privacy or ethical restrictions.