Staff members' intentions to physically restrain adolescent residential clients

Kristen Marie Helin (2007)

The Theory of Reasoned Action (TRA) was explored as a predictor of intentions of staff at adolescent residential placements, to implement physical restraint in response to various hypothetical scenarios. The TRA suggests the decision to follow through with a given behavior is highly determined by one's intentions to perform the behavior, while intention is informed by one's attitudes and perceived norms in relation to the behavior. A questionnaire was administered to 126 residential staff members of a medium-sized human service agency, presenting scenarios where physical restraint was considered a potential outcome, and asking respondents to indicate how likely they were to implement restraints under these conditions. To test the TRA, level of intention was regressed on staff members' attitudes and perceived norms, as determined through the questionnaire. Professional characteristics (including frequency of past restraints, sex of respondent, and length of employment) were also included among the predictors in a regression model. As predicted, the TRA variables of attitudes toward restraint and perceived norms surrounding use of restraint were significantly predictive of staff members' level of intention to physically restrain clients in scenarios. Professional characteristics were found to predict intent to restrain to a small yet statistically significant degree. In a hierarchical regression procedure, attitudes and perceived nouns added a significant and unique increment of prediction over professional characteristics alone. The results supported the hypotheses that the TRA is a useful theory in studying physical restraints in residential programs. Common themes in the qualitative results included the experiences of physically restraining clients, which did not typically go according to protocol. Also, anti-restraint attitudes are experienced as the majority opinion, while pro-restraint attitudes have diminished over the last few years. The discussion sections offer clinical implications including how to improve restraint-reduction strategies by beginning with the basic underpinnings of the TRA and integrating what is known about theories of social persuasion. Limitations and suggestions for future research are mentioned including studying the variance in how people perceive the imminent threat that justifies initiating physical restraints and developing physical interventions techniques that are more applicable to real-world restraint scenarios.