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Namdar Areshtanab H, Vahidi M, Ehsani A, Ebrahimi H. Knowledge, Attitude and Practice Regarding the Use of Physical Restraints Among Nurses Working in Razi Psychiatric Hospital, Tabriz, Iran. IJN 2025; 38 (S1 ) : 889.1
URL: http://ijn.iums.ac.ir/article-1-3847-en.html
Knowledge, Attitude and Practice Regarding the Use of Physical Restraints Among Nurses Working in Razi Psychiatric Hospital, Tabriz, Iran
Hossein Namdar Areshtanab1 , Maryam Vahidi2 , Asma Ehsani2 , Hossein Ebrahimi2
1- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran. , hna442000@yahoo.com
2- Department of Psychiatric Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
Keywords: Attitude, knowledge, Performance, Psychiatric nursing, Restraint
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Introduction
Patient safety is a core component of healthcare quality. Ensuring patient safety is one of the fundamental rights of patients and one of the main goals of nursing care. Restraining the patient with restraints is one of the ways to ensure patient safety. The nurses in the psychiatric wards usually face unreasonable expectations and aggressive behaviors of psychiatric patients in these wards. One of the recommended ways to control the psychiatric patients’ restlessness and aggressive behaviors and ensure patient safety is the use of restraints. The nurses should select the appropriate type of restraints based on standards, apply them safely to patients, and provide care based on frequent assessment of the patients’ conditions. The factors affecting the use of physical restraints include the nurse’s knowledge, attitude, and practice, cultural factors and regulations in the field of physical restraining. This study aims to determine the knowledge, attitude and practice of psychiatric nurses working in a hospital in Tabriz, Iran, regarding the use of physical restraints in psychiatric wards.

Methods
This cross-sectional descriptive study was conducted on 200 psychiatric nurses selected using a convenience sampling method from Razi Hospital in Tabriz, Northwest Iran, in 2022. The data collection tools were a demographic form surveying age, sex, education level and work experience in the psychiatric ward and a questionnaire surveying the knowledge, attitude and practice regarding the use of physical restraints. The knowledge subscale had 23 items answered as correct (1 point) or wrong (0 points). Therefore, the total score for this section ranges from 0 to 23. The attitude subscale had 12 items rated on a five-point Likert scale from 5 (strongly agree) to 1 (strongly disagree). The total score of this section ranges from 12 to 60. A score >28 indicates a positive attitude and a score <28 indicates a negative attitude. The practice subscale had 15 items rated on a five-point Likert scale from 5 (always) to 1 (never). The total score of this section ranges from 15 to 75. A score >55 indicates good practice. The tools had good validity and reliability. The data was analyzed using SPSS software version 18 using descriptive statistics (Mean±SD, frequency and percentage) and inferential statistics (independent t-test, analysis of variance and Pearson correlation test).

Results
The mean scores of knowledge, attitude and practice were 19.36±1.73 (out of 23), 36.51±4.65 (out of 60) and 65.19±3.39 (out of 75), respectively.
In the field of knowledge, the highest mean score was for the item “during restraining, the health and safety of medical staff is also a priority” and the lowest score was for the item “Continuous monitoring of patients after physical restraining is necessary”.
In the field of attitude, the highest mean score was for the item “I believe that restraints should not be used only for the convenience of medical staff” and the lowest score was for the item “I feel guilty when using physical restraints”. 
In the field of practice, the highest mean score was for the item “I restrain the patient only on the physician’s order” and the lowest score was for the item “After finishing the restraining, I usually assess and record the effect of physical restraints on the patient”.
The practice of using physical restraints had a statistically significant correlation with work experience in psychiatric wards (P=0.048) and knowledge of physical restraints (P=0.016).

Conclusion
According to the results of the study, it is better to provide in-service training programs for psychiatric nurses to improve their knowledge, attitude and practice regarding the use of physical restraints. Nursing managers can plan to reform the structure of psychiatric wards and increase the motivation of psychiatric nurses to improve their attitudes towards physical restraints.

Ethical Considerations

Compliance with ethical guidelines
This study was approved by the Ethics Committee of Tabriz University of Medical Sciences (code: IR.TBZMED.REC.1400.489). All participants read a short introduction and informed consent information. First, the objectives of the study, the anonymity of the participants, voluntary participation, and study information were explained verbally. Informed consent was obtained from all subjects and the research method was carried out in accordance with the Declaration of Helsinki.

Funding
This study was conducted with financial support from the Vice Chancellor for Research of Tabriz University of Medical Sciences as a master's thesis by Asma Ehsani, a student in the field of psychiatry at the Faculty of Nursing and Midwifery of Tabriz University of Medical Sciences.

Authors' contributions
Conceptualization and supervision: Hossein Namdar Arshtanab; writing original draft, review & editing, and data collection: Esma Ehsani and Hossein Ebrahimi; data analysis: Maryam Vahidi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the Vice-Chancellor for Research of Tabriz University of Medical Sciences, and the nurses working in the Razi Hospital for their participation in the study.




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Type of Study: Research | Subject: nursing
Received: 2024/10/20 | Accepted: 2025/03/21 | Published: 2025/03/21
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