LAUSR

INTRODUCTION Physical restraint is common in psychiatric care; nurses' attitudes are crucial as nurses often implement the procedure. Previous reviews include studies exploring coercive methods but do not specifically focus on physical restraint. AIMS This integrated mixed method systematic review aimed to examine nurses' attitudes towards the use of physical restraint in psychiatric care and the factors influencing these attitudes. METHODS Six databases were searched from 2000 to 2021. Thematic integrative analysis was used to synthesise the data. RESULTS Ten studies were included. Five themes encapsulate nurses' attitudes towards physical restraint: 'emotional responses', 'moral conflicts', 'ensuring safety for all', 'a necessary nursing intervention', and 'a last resort'. Three themes were identified for factors influencing attitudes: 'contextual demands', 'level of knowledge' and 'alternatives to restraint'. DISCUSSION Nurses' attitudes were marked by negative feelings and moral conflict towards the use of physical restraint. However, nurses applied physical restraint as an ordinary nursing intervention. Educational interventions and the leadership role may facilitate the change of current practice to a restraint-free environment. IMPLICATIONS FOR PRACTICE Mental health nurses should work to remove the barriers to restraint-free environment and develop effective skills that can be used as alternatives to physical restraint.