Nurses' knowledge, attitude, and practice regarding the use of physical restraints in children in the intensive care setting in China: A cross-sectional multicentre study.

Objective: The objectives of this study were to investigate paediatric nurses' knowledge, attitude, and practice (KAP) regarding the use of physical restraints and to explore the factors related to the use of physical restraints. Findings will provide a reference to develop standard procedures and training.

Background: Nurses' KAP regarding the use of physical restraints affect the use of physical restraints in the paediatric intensive care unit and neonatal intensive care unit. Understanding nurses' decision-making processes should inform strategies and methods for effectively reducing and regulating the use of physical restraints in paediatric patients in the intensive care unit (ICU) in China.

Methods: We conducted a cross-sectional survey of 823 registered ICU nurses from 12 children's hospitals in China between April and June, 2020. ICU nurses' KAP regarding the use of physical restraints in children were evaluated using a structured self-administered questionnaire that was distributed through an online platform. Descriptive and multiple linear regression analyses were used to examine the factors that influenced ICU nurses' KAP regarding the use of physical restraints in children.

Results: Overall, 49.8% of respondents were paediatric intensive care unit nurses, 25.0% of respondents were neonatal intensive care unit nurses, and 25.2% of respondents were other ICU nurses; 58.44% of nurses had received some training on the use of physical restraints in children. Mean total scores on the items addressing ICU nurses' knowledge (range, 0 [lowest level of knowledge] -11 [highest level of knowledge]), attitude (range, 11 [least likely to use physical restraint] - 55 [most likely to use physical restraint]), and practice (range, 14 [few skills] - 42 [good skills]) regarding the use of physical restraints in children were 8.00 ± 1.46, 30.67 ± 5.31, and 37.61 ± 3.46, respectively. Multiple linear regression analysis showed a higher level of education and less work experience (years) were related to higher knowledge scores; prior training in the use of physical restraint was related to lower attitude scores; and female, prior training in the use of physical restraints, and a higher level of education were related to higher practice scores.

Conclusions: Nurses would like to use physical restraints without physician approval in an emergency or when they could not pay close attention to a child. There are a few standardised training and lack of clinical guidelines for paediatric nurses. We recommend establishing a standard of care for physical restraints in paediatric patients.