Exploring the views of children's nurses and the public to the routine use of physical restraint in the care of hospitalised children

Project Description

Restraint involves using direct force to limit or restrict movement (Restraint Reduction Network 2019). Physical restraint in the care of vulnerable adults is seen as abuse, a breach of human rights e.g., DoH. (2012). Physical restraint has long been used in the care of hospitalised children but receives little nursing and public attention.
In Scotland 38,408 children are hospitalised annually (Public Health Scotland, 2021). Child patients are routinely exposed to restrictive physical interventions whilst receiving ‘compassionate care’ e.g., during medicines administration, taking blood samples and cannula insertion. Anecdotally, often this is done with little regard to the impact upon the child’s agency or rights despite the Children (Scotland Act (2020), and the United Nations Conventions on the Rights of the Child (1989) highlighting how physically restrictive interventions impact negatively on child health and wellbeing.
There has been some progress in raising nursing awareness about the harms of physically restraining children and the need to use less traumatic alternatives but, internationally, this topic is under-researched, and more action is needed. For example, the Royal College of Nursing (2019) states that physical restraint in children’s care should be used where these is no alternative and emergency/urgent intervention needs performed but, does not provide guidance on how children’s nurses can minimise the use of this at other times.
Project objectives are to better understand how children’s nurses and the public view the use of physical restraint in the care of hospitalised children and obtain feedback on a potential safe holding educational programme which could be used as an alternative. This project focuses on children in acute hospitals only e.g., receiving surgical care from children’s nurses.
Phase 1 is a systematic review of published papers reporting the views and experiences of children’s nurses and the public towards the use of physical restraint in the care of acute hospitalised children. Papers will be in nursing journals (any year) including primary research, narrative reports and editorials discussing the use of physical restraint in children’s hospital care. Phase 1 provides the historical context and identifies current guidance/good practice recommendations to minimise physical restraint use through using safer alternatives.
Phase 2 involves 8 focus groups (FGs) – maximum 15 participants per group. Five children’s nurse groups: qualified/practising nurses (2 groups), student nurses (2 groups) and non-practicing (1 group). Three public stakeholder groups – parents with experience of having a hospitalised restrained child (2 groups) and those representing children’s health/rights bodies/organisations (1 group). Parent, qualified/student nurse groups will be face-to-face in Edinburgh and Manchester – cities with children’s hospitals and training paediatric nurses. Groups for non-practising nurses and children’s organisations/bodies will be online to facilitate UK-wide recruitment. We will use various approaches including professional networks to recruit a range of participant views/experiences. FG will be audio-recorded, transcribed and thematically analysed.
Outputs: papers from Phases 1-2. Participants will be asked for their views of the practice-based safe holding educational programme developed by the lead applicant (Kennedy & Binns 2016). This feedback will be used to improve this programme ahead of a future trial.