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The use and prevention of procedural restraint in children - A scoping review
Marthe Karolina Østberg1, Peter Forde Hougaard1, Nina Margrethe Kynø2
1Oslo University Hospital, Children's Surgical Department, Division of Surgery and Specialized Medicine, P. O Box 4950, Nydalen, 0424 Oslo, Norway; Oslo Metropolitan University, Department of Nursing and Health Promotion, Faculty of Health Sciences, P. O Box 4, St. Olavs Plass, 0130 Oslo, Norway.
Insights
Preventing child restraint during medical procedures is challenging. Research shows few effective strategies, highlighting a need for better definitions and approaches to reduce restraint use in healthcare settings.
Area of Science:
- Pediatric healthcare practices
- Patient safety in medical procedures
- Child psychology and behavior
Background:
- Restraint is used on children for medical procedures but can be harmful.
- Knowledge on preventing restraint use in pediatric care is limited.
- This review maps existing research and guidelines on restraint in children.
Purpose of the Study:
- To identify and map knowledge on the use and prevention of restraint in children.
- To explore available interventions and guidelines for preventing restraint use.
- To understand children's experiences with restraint during procedures.
Main Methods:
- Scoping review following Arksey and O'Malley, JBI, and PRISMA-ScR frameworks.
- Searched Medline, EMBASE, PsycINFO, Epistemonikos, CINAHL, Cochrane Library (Sept 2023).
- Included texts on children (1-18 years) in non-psychiatric healthcare facilities.
Main Results:
- 288 texts met inclusion criteria from 2943 initial texts; 188 were research.
- Research lacked clear definitions of restraint but noted observations and attitudes.
- No evidence found for prevention, only reduction strategies; 11 guidelines identified.
Conclusions:
- Few approaches exist to reduce or prevent pediatric restraint use.
- A lack of a clear, unified definition of restraint impedes effective research and guidelines.
- Future efforts should focus on developing strategies that enhance healthcare personnel competence, attitudes, and resources.
Problem:
In healthcare facilities, restraint may be used on children to perform treatments or procedures. Restraint can be harmful, and little is known about how to prevent the use of restraint during medical procedures. A scoping review was conducted to find and map knowledge about (1) the use and prevention of restraint and (2) approaches, such as interventions and guidelines, available to prevent the use of restraint.
Eligibility Criteria:
This review was conducted following Arksey and O'Malley's framework, the JBI framework for scoping reviews, and the PRISMA-ScR (Protocol registration number GN5R3). Medline, EMBASE, PsycINFO, Epistemonikos, CINAHL, Cochrane Library were searched sept 2023. The search encompassed texts about children 1-18 years of age undergoing procedures conducted in non-psychiatric health care facilities.
Sample:
The sample size was 2943 texts, and 288 texts met the inclusion criteria, of which 188 were considered research.
Results:
Non-research texts consisted of reviews, demonstrations, opinions, and guidelines. The research lacked definitions of restraint though they described observations and attitudes toward restraint. Eight studies reported children's experiences. No evidence of how to prevent restraint was found, only reduction. Eleven guidelines were identified.
Conclusions:
Few approaches have addressed how to reduce and prevent the use of restraints. Lack of a clear and united understanding and definition of restraint hinders the development of effective trials and guidelines.
Implications:
Going forward, it is important to develop and explore approaches that build upon existing knowledge concerning restraint and positive procedural practice, including healthcare personnels competence, attitudes, and resources.
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