Restraint practice in the somatic acute care hospital: A participant observation study

Thomann, Silvia; Zwakhalen, Sandra; Siegrist-Dreier, Sandra; Hahn, Sabine (2022). Restraint practice in the somatic acute care hospital: A participant observation study Journal of Clinical Nursing, 32(11-12), pp. 2603-2615. Wiley-Blackwell - STM 10.1111/jocn.16322

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Aims and Objectives We aimed to describe daily restraint practices and the factors which influence their use, from an outsider's perspective. Background A reduction in restraint use is recommended in health care. However, somatic acute care hospital settings currently lack effective reduction strategies. Thus far, hospital restraint practice is described in terms of quantitative assessments and the ‘insider’ view of healthcare professionals. However, as factors such as routine or personal beliefs seem to play a relevant role in restraint use, these approaches might be incomplete and biased. Design A qualitative observation study design was employed. Methods Fieldwork with unstructured participant observation was conducted at a department of geriatrics and a department of intensive care in Switzerland between November 2019 and January 2020. Data were recorded as field notes. The analysis was conducted iteratively in two coding cycles using descriptive coding followed by pattern coding. We adhered to the Standards for Reporting Qualitative Research (SRQR). Results A total of 67 hours of observation were conducted. We found that daily restraint practice can be described in three categories: the context in which restraints are used, the decision-making process on the use and continued use of restraints, and the avoidance of restraint use. Most processes and decisions seem to take place unconsciously, and their standardisation is weak. Conclusions The lack of standardisation favours intuitive and unreflective action, which is prompted by what is also known as heuristic decision-making. To transform daily restraint practice, a technical solution that leads restraint management in line with ethical and legal requirements might be useful. Relevance to clinical practice The outsider perspective has allowed daily restraint practice to be described independently of existing routines, departmental cultures and personal attitudes. This is important to comprehensively describe restrictive practices, which is a prerequisite for the development of effective restraint reduction strategies.

Item Type:

Journal Article (Original Article)


School of Health Professions
School of Health Professions > Nursing
School of Health Professions > Academic-Practice-Partnership Insel Gruppe/BFH
School of Health Professions > Nursing > Innovation in the Field of Quality in the Health Sector


Thomann, Silvia0000-0002-9768-4845;
Zwakhalen, Sandra;
Siegrist-Dreier, Sandra and
Hahn, Sabine0000-0002-2697-2014




Wiley-Blackwell - STM


[UNSPECIFIED] 2019-068-175-208




Silvia Thomann

Date Deposited:

03 Aug 2022 10:43

Last Modified:

21 May 2023 01:36

Publisher DOI:


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Uncontrolled Keywords:

Decision-making Evidence-based practice Hospitals Qualitative research Restraint




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