An Integrative Review to Understand and Identify Nurses’ Knowledge and Awareness in Reducing the Initiation of Physical Restraints on Patients With Dementia

Abstract

Aims: Admission of patients with dementia (PWD) in Singapore’s acute care is expected to increase. These patients are often cared using the same level of measure despite the differences of their stages of illness. Physical restraints (PR) are one such measures. PWD were more likely to be restrained than those without. Nurses are typically the first responder to initiate PR. This review aims to critically review the literature on PR practices and assess the needs to increase nurses’ knowledge and awareness about PR reduction as their awareness and knowledge were suggested to be important determinants of a PR reduction. Methodology: Six online databases (CINAHL, Web of Science, Medline, PsycINFO, Cocharane Library, ScienceDirect) were searched to source for full‐text English‐language articles published between 2006‐2016. Backward and forward citation tracking of references and hand searching of non‐electronic journals were also conducted. Methodological quality of the articles were then assessed. The findings were summarised through thematic analysis. Result: Fifteen studies were included (5 systematic, 7 quantitative, 2 qualitative, 1 Mixed methods). Several potential PR‐associated harms that patients and nurses are exposed to were identified. Nurses’ perception and experience towards PR were found to remain unchanged after PR reduction approaches. Structured educational programme was among the most effective approach to improve nurses awareness and knowledge on the importance of PR reduction. Conclusion: This review found that both patients and nurses are susceptible to PR‐associated harm when PR is initiated. Nurses’ perception and experience towards PR have also remained unchanged despite many PR reduction approaches. Nonetheless structured educational programme has consistently been identified as a key component in PR reduction initiatives. Therefore there is a paramount need to increase nurses’ knowledge and awareness. This review proposes the adoption of learning theories such as Bloom’s taxonomy of learning in the design of the educational programme.