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Critical Appraisal of Metasynthesis and Systematic Review Articles


CriticalAppraisal of Metasynthesis and Systematic Review Articles

CriticalAppraisal of Metasynthesis and Systematic Review Articles

Researchis an integral part of nursing. Nursing care is always experiencingchange and new problems arise on a regular basis. The importance ofresearch in nursing care is to produce new information and add to theexisting bodies of knowledge. Nursing care requires a propersynthesis of different research activities so as to create newinformation that can be used in patient care with improved results. Asynthesis of research information yields results that is useful inpatient care activities and gives nursing practitioners improvedchances of yielding good results. This discussion shall focus on thecritical appraisal of two articles ‘MechanicalRestraint—Which Interventions Prevent Episodes of MechanicalRestraint?—A Systematic Review’ and ‘Nurses’ decision-makingin cases of physical restraint: a synthesis of qualitative evidence’on physical restraint in nursing care.


Theapplication of mechanical restraint is based on personal choices byeither a nurse or the patient. Physical restraint is purely apersonal choice that has no scientific basis or importance (Goethals,Dierckx de Casterle´, B &amp Gastmans, 2011). The researchers usedboth qualitative and quantitative analyses so as to find the mostappropriate results for the literature review. The outcomes of thetwo studies show that the physical restraint does not yield muchresult primarily if the patient is not consulted in the decisionmaking process. According to Jesper et al., (2011) the cognitivemilieu therapy (CMT) was an effective method of reducing mechanicalrestraint by up to 87% as it involved a joint decision- makingprocess by both the nurse and the patient. The research used a totalof 385 papers to perform a study on ways of reducing mechanicalrestraint.

Sabine,de Casterle´ and Gastmans (2011) used a meta- synthetic method toresearch a total of 17 articles that had used a qualitative studymethod to find out how nurses made decisions regarding physicalrestraint. The researchers used six key words in their search forappropriate articles for the literature review. The research wasvalid as the study found nine key themes that influenced the decisionmaking process by nurses and they were safety, influences on thetrajectory, attitudes about physical restraint, the role of thecontext, principles and dilemmas, nurses’ thoughts and reasons,ethical issues, perception of restraint, decision-making as a complextrajectory and patient behavior (Goethals, Dierckx de Casterle´, B &ampGastmans, 2011). The study found that most of the decisions regardingphysical restraint are complex and are centered on the safety of thepatient and ethical principles of nursing care.


Jesperet al., (2011) found that the CMT method has not been widely studiedand utilized, but concluded that this may be because the method wasdiscovered recently (2008). The researchers also found there was nospecific method of mechanical restraint that reached the largestrecommendation degree. Only CMT was found to be the most effectivemethod although it did not involve physical restraint. The findingsalso noted that the use of mechanical restraint was an ineffectivemethod that must be avoided at all costs. The study found that thepatient ought to also be involved in decision- making.

Theresults were valid as they were synthesized following a rigorousanalysis of the research articles the results were based on specificcriteria. Additionally, the articles were picked on a random basis soas to ensure that the outcomes were not influenced by the personalpreferences of the researchers (Jesper et al., 2011). The researchersused approved methods of analysis and these were the methodologyoutlined by Sandelowski and Barroso (2007) on qualitative analysisand the quantitative analysis was based on the guidelines of DanishReference Programme Secretariat (Sekretariatet for Referenceprogrammer, 2004). The use of approved research methods shows thatthe studies used strict guidelines to select the articles for thestudies. Additionally,the articles chosen were selected from different countries and thestudies included the ethical recommendations of those countriesregarding nursing care (D’Orio et al., 2004).

Thestudy results can be applied in nursing care by using the CMT methodto reduce chances of mechanical restraint as CMT was found to have abigger impact in nursing care those individual decisions by nurses.Any care that may necessitate the use of physical restraint must beguided primarily by the safety of the patient and the ethicalprinciples that guide nursing care. It is also necessary to involvethe patient’s feelings about physical restraint and individualdecisions by nurses should only be used as a last resort method(D’Orio et al., 2004).

Theresults are informative for nurses in patient care. One of the keyoutcomes is that is important to involve patients in decision making.Nursing practitioners ought to involve patients in their decisions asthis results in less resistance and is likely to bring out betterresults from the restraint introduced. It was found that most nursesmade individual decisions regarding physical restraint. This oftenresulted in resistance from the patients and thus, the nurses ran therisk of unethical practice (Jesper et al., 2011). The patients oughtto be made to understand the reason for the physical restraint.

Itis also important to use physical restraint as a measure of lastresort. The studies found that most nurse use physical restraint forpersonal reasons. The nurses must avoid using physical restraint asit infringes on personal rights and is not allowed in most countries.This involves practicing patient- centered care, where the patient isplaced in the middle his own care (Jesper et al., 2011). The patientought to be invoolved of the decision process and the use ofmechanical restraint must be avoided at all costs. The nursingpractitioner uses mechanical restraint only where the safety of theepatient is of concern. The use of mechanical restraint must also beavoided as it is extremely intrusive and this adds to the reasons foravoidance.

Accordingto the research, a combination of interventions ought to be used innursing care. The combined interventions reduce the need for physicalrestraint and yield better results that physical restraint. Theinterventions include patient involvement in the nursing careschedule so that the patient knows what is expected of him (D’Orioet al., 2004). Physical restraint is only used if all other methodsfail. The use of Physical restraint was found to be ineffective. TheCMT method is the most recommended care for patients as it totallyeliminates the need for physical restraint. The CMT method is a newmethod in nursing care and has yet to be fully studied and utilized.However, the method is very promising and ought to be used in nursingcare.


Sabine,de Casterle´ and Gastmans (2011) found that the use of physicalrestraint was primarily a decision by nurses. The results werereported accurately as the methodology of choosing the articles to beinvolved used a stringent method of selection. The steps of choosingon whether to use physical restraint or not involves the nursesjudgment on the patient’s situation and issues that were affectedby the context. The results of the studies were reported accuratelyas they were grouped into five different categories that covered themajor reasons for using physical restraint in nursing care.

Thefindings indicated that the decision- making process is guided byethical values that guide the nursing practice. The decisions made bythe nurses are guided by the need to perform their professionalduties. The nurses are concerned with the need to act professionallywhile placing the safety of their patients in the middle of theirdecisions (Goethals, Dierckx de Casterle´, B &amp Gastmans, 2011).The preference for mechanical restraint is because nurses care aboutthe physical safety of their patients and all other factors areoutweighed by the need for safety. However, the use of safety as theguiding principle ignores the patient’s social, psychological,spiritual and moral health. The care thus, only focuses on thephysical health of the patient.

Thestudy also found that using mechanical restraint involves putting thenurse’s feeling aside, which can result in inner conflicts. The useof restraints o prevent patients from injury may seem like the nursesplace their own needs ahead of those of the patient. The nurses haveto put their feelings aside, which make them alienated from theirpatients. Additionally, the use of physical restraint is ofteninfluenced by the decisions of other people than the nurses and thishas an implication on the ethical values of the nurse (Goethals,Dierckx de Casterle´, B &amp Gastmans, 2011). The decisions reacheddue to the decisions by others indicate that the nurses make suchdecisions due to limited resources. This forces the nurse to makedecisions based on legal responsibilities. The results are valid asthey were synthesized using the guidelines of Sandelowski and Barroso(2007).

Thefindings can be used in patient care by encouraging nurses to useethical guidelines when taking care of their patients. The use ofethical guidelines offers the most suitable means of ensuring thatpatient care is maintained using the best practices. The use ofethical guidelines is reinforced using a supportive workingenvironment for the nurses and having an ethical leadership(Gastmans,2010).The leadership is the most influential force in ethical practices, innursing care. The leadership must use always apply ethical guidelinesto ensure that they the nurses also use ethical practices in theircare. The environment must be value- based as this provides anenvironment that allows nurses to discuss the best the concerns ofthe care with the patients and the leadership.

Thedecision making process ought to also be all- inclusive where thenurse and the patient are greatly involved so as to reach an amicabledecision. The decision- making process ought to involve the patientas this makes it possible for the patient’s feelings to be involvedin the whole process (Goethals, Dierckx de Casterle´, B &ampGastmans, 2011). The patient’s views are important as the careinvolves the patient’s physical, social, psychological, andemotional well- being (Gastmans,2010).The nurse and the patient must thus, make a joint decision.

Inconclusion, physical restraint is a method that has been in use toensure that the safety of the patient is well taken care of. However,the use of physical restraint has no positive results on the patientand it must thus be avoided whenever necessary. The use of physicalrestraint infringes on the patient’s privacy and psychologicalwell- being. The use of physical restraint has no value except theprotection of the patient’s safety. The use of physical restraintis often a unilateral decision by the nurse as a professionalresponsibility guided by ethical principles and guidelines. The useof CMT in nursing care instead of mechanical restraint is the mostsuitable instead of mechanical restraint.


D’Orio,B. M., Purselle,D., Stevens,D.,&amp Garlow, S. J. (2004). “Reductionof episodes of seclusion and restraint in a psychiatric emergencyservice.” PsychiatricServices,55(5),581–583.

GastmansC. (2010) Clinical-ethicalconsiderations on the use of physical restraint. In Rights, Risks andRestraint-Free Care of Older People(Hughes R., ed.), London: Jessica Kingsley Publishers.

Goethals,S., Dierckx de Casterle´, B &amp Gastmans, C. (12/11/2011). Nurses’decision-making in cases of physical restraint: a synthesis ofqualitative evidence. Belgium:Blackwell Publishing Ltd.

Jesperet al. (18/02/2011). MechanicalRestraint—Which Interventions Prevent Episodes of MechanicalRestraint?—A Systematic Review. NewYork: Willeys Periodicals, Inc.