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How Often Are Hospitalised Children Physically Restrained During Painful and Stressful Procedures?
Danton Matheus de Souza1, Lucy Bray2, Vanderlei Amadeu Rocha1
1Department of Maternal, Child, and Psychiatric Nursing, School of Nursing, University of São Paulo. São Paulo, Sao Paulo, Brazil.
Insights
Physical restraint is frequently used during painful and stressful procedures in children, particularly younger ones and those with higher care dependency. This study highlights the need to reconsider restraint practices in pediatric care.
Area of Science:
- Pediatric healthcare research
- Clinical procedure safety
- Child psychology in medical settings
Background:
- Physical restraint is often employed during pediatric medical procedures.
- Understanding the incidence and associated factors of restraint use is crucial for improving patient care.
Purpose of the Study:
- To analyze the incidence of physical restraint use in hospitalized children during painful and stressful procedures.
- To identify factors associated with the use of physical restraint in pediatric clinical settings.
Main Methods:
- An observational, longitudinal, and prospective study was conducted.
- 1210 procedures were observed in 75 children (28 days to 10 years) in a Brazilian public hospital.
- Data included demographics, pain, stress behaviors, and physical restraint use, analyzed descriptively and inferentially.
Main Results:
- Physical restraint was used in 22.3% of observed procedures.
- Factors associated with restraint included younger age, higher pain scores, care dependency, and specific procedures (e.g., IV administration, airway suctioning).
- Stress behaviors preceded restraint use in stressful procedures; predictors included younger age, morning period, and ICU transfer.
Conclusions:
- A high incidence of physical restraint was observed during painful and stressful pediatric procedures.
- Child characteristics and procedural factors significantly influence the use of physical restraint.
- The findings call for a reevaluation of restraint practices to prioritize child well-being and rights.
Aim:
To analyse the incidence of physical restraint use during painful and stressful procedures in hospitalised children, as well as the factors associated with its use.
Design:
Observational, longitudinal and prospective study.
Methods:
Children aged between 28 days and 10 years in a public hospital in Brazil were each observed undergoing clinical procedures over a 6-h period. Data were collected on demographics, observed pain using validated measures, stress behaviours, and the use of physical restraint. Descriptive and inferential analyses were performed. National ethical guidelines were strictly followed.
Results:
1210 procedures were observed on 75 children, including 351 painful and 859 stressful procedures. Physical restraint was used in 270 (22.3%) procedures; of these, 131 (48.5%) were painful procedures and 139 (51.5%) were stressful procedures. In stressful procedures, at least one stress-related behaviour was observed before the initiation of physical restraint. Factors associated with increased use of physical restraint during painful procedures were younger children, with higher levels of care dependency, higher pain scores during procedures, and those who underwent intravenous medication administration, airway suctioning, tube insertion, and fixation changes. In stressful procedures, the factors associated with higher use of physical restraint were younger children, hospitalisation due to respiratory conditions, those who underwent physical examinations, inhaled medication, and nasal lavage; and the child's expression of stress behaviour before the procedure starts. Predictors of physical restraint included morning period, younger age group, male or female sex, and transfer from the Intensive Care Unit.
Conclusion:
A high incidence of physical restraints was observed across multiple painful and stressful procedures performed within a 6-h period, associated with variables related to both the child's characteristics and the procedures.
Implications For The Profession And/Or Patient Care:
This study aims to encourage reconsideration of the frequent use of physical restraint in paediatric procedures, calling for a reframing of its application as an unquestioned practice toward an approach that prioritises protecting and respecting a child as a subject with needs, rights, and desires.
Reporting Method:
Strengthening the Reporting of Observational studies in Epidemiology (STROBE).
