Quali alternative alle contenzioni fisiche sono applicate nella pratica quotidiana? Risultati di uno studio multi-metodo multicentrico

Introduction: Physical restraint is still very widespread and debated due to its implications; however, available literature focuses on prevention, neglecting recommendations on possible alternatives. Objective: To explore whether and which alternatives nurses apply before deciding to restrain patients. Method: A two-phase multi-centre multi-method study was performed. In the first, a prevalence survey on restraints was conducted; in the second, a short interview was carried out with the nurses responsible for the care of restrained individuals to identify the alternatives implemented before deciding to restrain. Results: 37 facilities in Friuli-Venezia Giulia region were included, 17 Nursing Homes (NHs), 10 Intermediate Units (IUs) and 10 Medical/Surgical wards. On the index day 1818 (78.2%) patients were present in the NHs, 157 in the IUs (6.8%) and 308 in the hospital wards (13.3%) (= 2283). A total of 28.9% (659/2283) patients were restrained (31.3% in NHs; 26.8% in IUs; 15.6% in hospitals). Only for 81 (12.3%) of them the restraints had been preceded by the application of an alternative (e.g., involving family members, lowering the bed, or using pillows). Discussion: In the physical restrain decision-making process, nurses consider few alternatives, approximately one in every eight restraints, more frequently in IUs, less in NHs and never in hospital wards. Those used are simple, and depend on the context and the resources available.