Factors influencing critical care nurses' intention to use physical restraints using the theory of planned behaviour: a cross-sectional multicentre study

Abstract

Background: Studies addressing critical care nurses' practices regarding physical restraints have focused on individual nurses' knowledge and attitudes but lack the understanding of other social influences that could affect nurses' intentions to use them. Objective: To determine critical care nurses' attitudes, subjective norms, perceived behavioural control, and intentions to use physical restraints in intubated patients and the relationship between them and socio-demographic, professional, and contextual factors. Methods: A cross-sectional, multicentre study was conducted in a convenience sample of 12 intensive care units from 8 hospitals in Spain (n=354). The data were obtained using the Physical Restraint Theory of Planned Behaviour questionnaire and a researcher-developed survey to collect structural and clinical data from each unit. Multilevel model analysis was used. Results: Critical care nurses showed a moderate level of intention to use physical restraints 12.52 (standard deviation=3.81) [3-21]. More than a half (52%) agreed restraints were safe. The highest perceived barrier against physical restraint use was patient cooperation. Although nurses did not feel that others expected them to use restraints, they did not perceive high levels of disapproval of such practice. Nurses who had received previous training on restraints and who worked in units with a flexible family visitation policy, an informed consent form for restraint use, analgo-sedation and restraint protocols, and nurse-driven analgo-sedation management reported lower levels of intention to use restraints. Working in smaller units (beta -1.81 [95%CI: -0.18; -3.44]) and in units with a consent form for restraint use (beta -4.82 [95%CI: -2.80; -6.85]) were the variables with the highest impact on nurses' intentions to use restraints. Conclusions: Critical care nurses' intentions to use physical restraints is moderate and is influenced by intrapersonal, patient and contextual factors. Nurses who work in units with organisational policies and alternatives to restraints demonstrated lower levels of intention to use them.