Barriers to Minimising Restraint Implementation by ICU Nurses: A Qualitative Study

BACKGROUND: Enhancing the restraint decision-making capabilities of ICU nurses represents a core challenge, aimed at minimising restraints and enhancing patient experiences through assessment, tools and collaboration, thereby achieving humanistic nursing care. AIM: This research delves into the obstacles that ICU nurses face when implementing minimal restraint in their work, with the aim of offering insights for future nursing practice. STUDY DESIGN: Utilising purposeful sampling, semi-structured interviews were conducted with 16 ICU healthcare workers from a tertiary hospital in Southern China. The interview data were organised using NVivo 14 software. FINDINGS: The study has crystallised seven core themes, which are as follows: (1) Deficits in basic concepts and cognitive depth; (2) Lack of proactive assessment and supervision; (3) Relative shortage of human resources; (4) Ineffective collaboration between medical and nursing staff in pain management; (5) Need to strengthen professional awareness and humanistic care practices; (6) Impact of personal experiences and negative past encounters; (7) The demand for improved organisational strategies and a safe environment. CONCLUSION: The common factors affecting the implementation of minimising restraints by ICU nurses mainly involve hospital regulations, departmental management culture, professional roles within medical teams and individual nurse competencies. Based on these findings, the prerequisite for promoting minimal restraint is to comprehensively assess and identify barriers, while strengthening support for decisions regarding minimal restraint. Managers should establish a standardised assessment and decision-making process for minimal restraint, accompanied by corresponding training, to enhance the science of nurses' decision-making. Additionally, the spirit of teamwork should be advocated to foster a collaborative working environment between healthcare professionals. Through these measures, the aim is to bolster ICU nurses' confidence in implementing minimal restraint practices, ensuring that decisions regarding minimal restraint are effectively practised. RELEVANCE TO CLINICAL PRACTICE: These findings may contribute to improving ICU nurses' comprehension of minimising restraints and facilitate the promotion and application of this practice in clinical settings.