Dilemmas facing Japanese nurses regarding the physical restraint of elderly patients

Aim: The purpose of this study was to clarify the meaning of “dilemma” regarding the use of physical restraint on elderly persons as described by nurses in general wards at community hospitals. The questions asked included: to what extent has the dilemma of nurses regarding the restraint of elderly persons in the general ward been clarified?, which factor/s compose the dilemma?, what are the psychometric properties of the factors?, and how should nurses deal with the dilemma with regard to restraining elderly persons? Methods: The participants were 1477 nurses (12 male, 1463 female, and two: no answer) at 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units). The dilemma was measured by using a questionnaire consisting of 20 items previously developed by the author. Results: An explanatory factor analysis revealed four dilemma factors among 17 items investigated. These were “execution of treatment and security”, “characteristics in nursing of elderly patients”, “a cooperative relationship”, and “priorities in nursing”. The cumulative contribution ratio was 68.3%. In respect to the dilemma where nurses are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: “execution of treatment and security”, “characteristic features in nursing”, “a cooperative relationship in nursing”, and “priorities in nursing”. Conclusions: Based on the psychometric properties, the Dilemma scale is a valid and reliable tool. The construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to communicate with comedical workers in order to reach a consensus about the elderly’s care, avoid restraining the elderly by allocating care specialists to the elderly, establish institutional policies and safety standards that establish the nurses’ responsibilities for patients’ decision‐making, and receive continuous and timely ethical education.