RESEARCH doi: 10.1111/nicc.12303 Knowledge, attitude and practice of intensive care unit nurses about physical restraint Mohammad Suliman , Sami Aloush and Khitam Al-Awamreh ABSTRACT Background: Physical restraint is mainly used in intensive care units (ICUs) to prevent delirious or agitated patients from removing tubes and lines connected to them. However, inappropriate use of physical restraint could have many detrimental physical effects on the patient, such as nerve damage, asphyxiation or even death. Aim: The aim of the study is to investigate nurses’ knowledge, attitude and practice of physical restraint in ICUs in Jordanian hospitals, about which little is known. Design: A descriptive and cross-sectional design was used. Methods: A convenience sample of 400 nurses working in three public hospitals and one university-affiliated hospital from different geographical regions in Jordan was selected. An Arabic version of the Physical Restraint Questionnaire (PRQ) was used to collect the data. Results: A total of 300 completed questionnaires were returned, with a response rate of 75%. Of the total sample, 51% were males, 65.7% were from public hospitals and 80.3% held a bachelor’s degree. The mean score in the knowledge section was 9.7 (SD =1.7) out of 15; in the attitude section, it was 24.7 (SD = 4.8) out of 33; and in the practice section, it was 30.9 (SD = 3.5) out of 42. Nurses who reported previous related education scored higher on the knowledge section (mean = 10.7; SD = 1.4) than nurses who reported no previous related education (mean = 9.1; SD = 1.6; p < .001). However, no significant differences between these categories were found in relation to attitude and practice. Conclusions: The study demonstrated some lack of knowledge and unsafe practices regarding physical restraint in ICUs in Jordan. It suggests improving nurses’ knowledge, attitude and practices through in-service education on best practice for physical restraint, developing policies/guidelines and providing adequate staff and equipment to maintain patient safety and prevent complications. Relevance to clinical practice: Conducting education programmes on physical restraint for ICU nurses and providing other preventive strategies are important in improving nurses’ knowledge, attitude and practice. Key words: Critical care nursing • Education and training of ICU nurses • Physical restraint • Use of restraints in ICU INTRODUCTION Intensive care unit (ICU) patients are admit- ted with serious medical conditions and are under the effect of various types of sedation that can make them delirious and agitated (Langley et al., 2011). They are connected to equipment with many tubes and lines, mak- ing them prone to accidental self-removal of the medical devices (Nirmalan et al., 2004). Thus, nurses sometimes use phys- ical restraint to protect such patients from disrupting their treatment (Cohen et al., 2002). Physical restraint is routinely practiced in many ICUs worldwide, from 3.4% to 21% for 2.7–4.5 days (Evans et al., 2003). Physical restraint is defned as any action, method or procedure that restricts Authors: M Suliman, PhD, RN, Assistant Professor, Department of Community and Mental Health Nursing and Dean Assistant for training affairs/Al-alBayt University, Mafraq, Jordan; Sami Aloush, PhD, RN, Assistant Professor, Department of Adult Health Nursing/Al-alBayt University, Mafraq, Jordan; Khitam Al-Awamreh, PhD, RN, Assistant Professor, Department of Community and Mental Health Nursing/Al-alBayt University, Mafraq, Jordan Address for Correspondence: M Suliman, Al al-Bayt University, P.O. BOX 130040, Mafraq 25113, Jordan E-mail: mbarahemah@aabu.edu.jo the patient from moving freely or limits access to their own body (Bleijlevens et al., 2016). It helps nurses to control unexpected movement by patients, to keep them safe. However, from the patients’ or families’ perspective, physical restraint could be considered a form of assault or even false imprisonment. Physical restraint should be used only if other methods have failed, and then with caution and as a last option. Nurses should have good knowledge and follow safe practice to prevent adverse events from physical restraint (Martin and Mathisen, 2005). The literature indicates that physical restraint is associated with many direct adverse physical events, such as skin lac- eration, muscle wasting, nerve damage and bone destruction. Indirect adverse events include asphyxiation or even mor- tality (Evans et al., 2003). Physical restraint might also be associated with a number of psychological problems, such as feelings of anger, depression and social isolation (Bray et al., 2004). To prevent any of these compli- cations, nurses should use physical restraint only as the last resort after other alterna- tives have failed, following the prescribed standard of care. The American College of Critical Care Medicine Task Force recommended clinical practice guidelines to maintain the physical and psychological safety of ICU patients (Maccioli et al., 2003). For instance, physi- cal restraint should be the least restrictive option; alternatives to physical restraint © 2017 British Association of Critical Care Nurses 1