The Attitudes Of Family Caregivers Of People With Dementia On Physical Restraints: A Qualitative Study

Objective:This study aims to explore the attitude of family caregivers towards the use of physical restraints in the home environment of patients with dementia,understand the influencing factors of the use of physical restraints by family caregivers,and analyze the decision-making process of the use of physical restraints by family caregivers,so as to provide a basis for reducing physical restraints in home care and improving the quality of life of patients with dementia.Methods:A descriptive qualitative study was employed.We selected the participants based on the largest difference sampling method.A total of 25 semi-structured individual interviews were conducted with family caregivers recruited from a memory clinic of a large general hospital in Changchun from July 2020 to September 2020.The interviews were transcribed and analysed using thematic analysis with the help of qualitative analysis software NVivo.Results:Through the in-depth interview and comprehensive analysis of 25 family caregivers of patients with dementia at home,it was found that the attitudes of family caregivers are different,and the decision-making of physical restraints was influenced by many factors.Through indepth analysis and refinement of the interview data,four core themes were formed,including "cognition of physical restraints","approach-avoidance conflict of physical restraints","support for reducing physical restraints" and "social and cultural environment",and a decision-making framework for the physical restraints of family caregivers was formed.1." Cognition of physical restraints" included five sub-themes:(1)Many family caregivers failed to correctly describe the concept of physical restraints;(2)Many family caregivers recognized the negative consequences of physical restraints;(3)Some family caregivers still had misconceptions about physical restraints;(4)Family members are the main participants in decision-making of physical restraints;(5)Plans for physical restraints vary from person to person.2."Approach-avoidance conflict of physical restraints" included two sub-themes:(1)Approach conflicts included caring for stress,lack of knowledge and ensuring safety;(2)Avoidance Conflicts included injury to patients,cherishing family’s affection and loss of dignity and autonomy.3."Support for reducing physical restraints" included four sub-themes:(1)caregiver replacement measures included: 24 h companionship,use of smart devices,antipsychotics and other methods;(2)hiring a nanny;(3)the help of professional health care staffs;(4)Community support;4."Social and cultural environment" included two sub-themes:(1)Legal and policy environment;(2)Cultural environment includes "filial piety" culture and institutionalization.Based on family caregivers’ attitudes and various factors,the decision-making framework of physical restraints for family caregivers of patients with dementia at home was initially formed: family caregivers’ cognition,avoidance conflict,social support and socio-cultural environment interacted and influenced each other,and eventually led to the decision of whether to use physical restraints for family caregivers.Conclusions:The attitudes of family caregivers to physical restraints of patients with dementia at home were multi-faceted,and there were many wrong understandings of the cognition of physical restraints.Many factors affected the use of physical restraints by family caregivers.Family caregivers had a poor understanding of physical restraints and adverse consequences.Family caregivers were the main participants in the decision-making of physical restraints;affecting factors the use of physical restraints included approach factors and avoidance factors.Reducing the use of physical restraints required support from all sides;social and cultural environments that reduced physical restraints were not ripe for soil.1.Health care personnel should strengthen the popularization of physical restraints knowledge among family caregivers and fully realize the adverse consequences of physical restraints;2.Solve the avoidance conflict of family caregivers,strengthen the avoidance conflict,weaken the approach conflict,and avoid the dilemma faced by family caregivers when making decisions;3.Strengthen all aspects of support to reduce physical restraints,popularize alternative measures to physical restraints,provide formal caregiver assistance,give play to community functions,and reduce caregiver stress for family caregivers;4.Policymakers should improve relevant policies and laws to limit physical restraints in home care and create a favorable social environment for reducing the use of physical restraints;at the same time,it is necessary to further understand the complex effects of traditional Chinese culture on the home care of dementia patients in future studies.5.The decision-making of physical restraints is influenced by multi-level factors.In the future,the framework of decision-making of physical restraint should be further improved to build a systematic theoretical model of decision-making of physical restraints at home.