"We are not ready for restraint free.": Decision-making experiences of family members in physical restraint on older people in residential care homes

Abstract

Purpose Family members are involved in making decisions about physical restraint (PR), yet there is limited understanding of their experiences and attitudes regarding restraint practices for their older relatives living in residential care homes (RCHs). This study aims to explore family members’ decision-making experiences concerning the use of PR on their relatives in RCHs.

Methods A qualitative study with individual interviews was conducted. Purposive sampling was employed to recruit 27 family members of their older relatives in three RCHs in Hong Kong. Data was thematically analysed.

Results Two major themes were identified: “Experiencing the process of consenting to apply PR” and “Overcoming tension between physical safety and emotional wellbeing”. Participants’ decision-making process was rather quick, as they accepted the use of PR for maintaining their relatives’ physical safety. They often tended to agree with the staff to apply PR and had no idea about interventions that could serve as alternatives to PR. However, they mentioned that they lacked comprehensive information before consenting to the use of PR on their older relatives. Frequent visits to their older relatives and proactive communication between staff and family members were perceived by the participants as beneficial to manage their conflicting their emotions regarding PR decisions.

Conclusions This study provides increased awareness of family members’ views surrounding the use of PR, showing that they are not ready for restraint-free care. Continued research is needed to develop practical guidelines and policy implications for RCHs to support family members in making informed decisions about applying PR on their older relatives.