Attitudes of psychiatric nurses toward restraint interventions in Italian mental health care: Implications for clinical practice

Background and aim: The practice of restraint raises a wide range of issues, including technical, clinical, organizational, deontological, ethical, legal, and medico-legal concerns. Clinical practice and numerous studies on the subject suggest that, in general, physical restraint is not effective for the main reasons it is applied. This study aimed to assess nurses’ knowledge and training levels regarding the application of restraint tools. Methods: An observational, cross-sectional study was conducted among nurses working in mental health facilities using an online questionnaire. The questionnaire, specifically designed for this study, included five main sections: socio-demographic data, attitudes toward physical restraint, and de-escalation approaches among psychiatric nurses. Results: A total of 268 psychiatric nurses participated. Most had over six years of experience in mental health, and 80% had received training on physical restraint, primarily during their nursing degree and through post-graduate updates. Conflicting opinions emerged regarding physical restraints as safe tools for preventing skin injuries and the risks associated with their use. Nurses working in 24-hour facilities were more likely to disagree with restraint practices (36.9%), also advocating for constraints to ensure legal protection for both the nurse and the patient. Conclusions: Implementing educational programs for healthcare personnel is imperative. These programs should focus on equipping nurses with strategies to minimize the use of restraint and effectively adapt to the anticipated changes in contemporary psychiatry.