{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:12:06Z","timestamp":1789042326384,"version":"build-2803163510"},"reference-count":39,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Clinical Nursing"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Physical restraint is still common in intensive care units (ICUs) despite well\u2010documented adverse effects. ICU nurses' knowledge, attitudes and practices (KAP) directly affect how restraints are used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To synthesize the evidence on physical restraint related KAP among ICU nurses in China and to identify gaps between knowledge and practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched 11 databases (CNKI, WanFang, CBM, VIP, Chaoxing, PubMed, Cochrane Library, Web of Science, MEDLINE via Ovid, CINAHL via EBSCO, Scopus) from inception to October 2025. The protocol was registered in PROSPERO (CRD420251154455). Methodological quality was assessed using Joanna Briggs Institute tools. We used a convergent segregated approach to integrate quantitative and qualitative findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty studies were included (13 quantitative, 6 qualitative, 1 mixed methods). Knowledge scores ranged from 50.43% to 93.73% (median 63.37%), attitude scores from 38.92% to 70.98% (median 64.28%), and practice scores from 50.51% to 94.36% (median 73.64%). Systematic training, years of ICU experience, and critical care certification were significant influencing factors. The qualitative synthesis produced three themes: a knowledge\u2010practice gap, attitudinal conflict between safety principles and emotional burden and a disconnect between standardized protocols and real\u2010world practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The linear KAP model does not fully explain restraint practices in Chinese ICUs. Environmental and systemic factors such as staffing levels, workflow design and safety metrics mediate the relationship between knowledge and practice. Improving practice calls for unit\u2010level interventions (a two\u2010tiered assessment process integrated into workflow, daily multidisciplinary review) and nurse\u2010level training (alternatives, ethical decision making). Future research should use validated instruments, include secondary hospitals and test interventions with controlled designs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>No Patient or Public Contribution<\/jats:title>\n                    <jats:p>This study is a systematic review of previously published literature and did not involve direct participation of patients, service users, caregivers or members of the public in its design, conduct, analysis, interpretation or manuscript preparation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jocn.70539","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:35:19Z","timestamp":1789040119000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Knowledge, Attitudes and Practices Regarding Physical Restraint Among\n                    <scp>ICU<\/scp>\n                    Nurses in China: A Mixed\u2010Methods Systematic Review"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2904-8408","authenticated-orcid":false,"given":"Zhenliang","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Intensive Care Unit (ICU) Zhejiang Hospital  Hangzhou China"},{"name":"School of Nursing Zhejiang Chinese Medical University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1005-8879","authenticated-orcid":false,"given":"Feng","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit (ICU) Zhejiang Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liling","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit (ICU) Zhejiang Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9776-4045","authenticated-orcid":false,"given":"Yuping","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit (ICU) Zhejiang Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5796-5987","authenticated-orcid":false,"given":"Wenchao","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit (ICU) Zhejiang Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit (ICU) Zhejiang Hospital  Hangzhou China"},{"name":"Nursing Department Zhejiang Hospital  Hangzhou 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Nurses","volume":"47","author":"Liu T.","year":"2025","journal-title":"Fujian Medical Journal"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010024\u201008864\u20103"},{"issue":"1","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"140","DOI":"10.55111\/j.issn2709-1961.20231005001","article-title":"Current Status and Influencing Factors of Knowledge, Attitude, and Practice Regarding Physical Restraint Among ICU Nurses in Guangxi Zhuang Autonomous Region","volume":"10","author":"Ma Q.","year":"2024","journal-title":"Chinese Journal of Integrative Nursing"},{"issue":"2","key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1097\/00044067-200205000-00013","article-title":"Restraint Use in Acute and Critical Care Settings: Changing Practice","volume":"13","author":"Martin B.","year":"2002","journal-title":"AACN Clinical Issues"},{"issue":"8","key":"e_1_2_9_23_1","first-page":"93","article-title":"Investigation and Analysis of Knowledge, Attitude, and Practice Regarding Physical Restraint Among Nurses in a Neurological Intensive Care Unit","volume":"29","author":"Nie D.","year":"2022","journal-title":"Capital Food Medicine"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n160"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003482"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13643\u2010016\u20100372\u20108"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/0969733019858711"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijn.12887"},{"issue":"4","key":"e_1_2_9_29_1","first-page":"42","article-title":"A Qualitative Study on the Decision\u2010Making Process of ICU Nurses in Implementing Physical Restraint on Patients","volume":"34","author":"Shen X.","year":"2019","journal-title":"Journal of Nursing 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Chongqing Medical University."},{"issue":"6","key":"e_1_2_9_33_1","first-page":"568","article-title":"Investigation and Analysis of ICU Nurses' Knowledge, Attitude, and Practice Regarding Physical Restraint","volume":"43","author":"Xia C.","year":"2008","journal-title":"Chinese Journal of Nursing"},{"issue":"12","key":"e_1_2_9_34_1","first-page":"872","article-title":"Investigation and Analysis of Intensive Care Unit Nurses' Knowledge, Attitude, and Practice Regarding Physical Restraint","volume":"16","author":"Xu P.","year":"2016","journal-title":"Journal of Nursing Administration"},{"issue":"1","key":"e_1_2_9_35_1","first-page":"19","article-title":"Evidence\u2010Based Nursing Practice for Reducing Physical Restraints in ICU Patients","volume":"54","author":"Xu Y.","year":"2019","journal-title":"Chinese Journal of Nursing"},{"issue":"4","key":"e_1_2_9_36_1","first-page":"371","article-title":"Survey and Analysis of Knowledge, Attitude, and Practice Towards Physical Restraint Implementation Among ICU Nurses","volume":"37","author":"Yang B.","year":"2018","journal-title":"Journal of Hubei University of Medicine"},{"issue":"9","key":"e_1_2_9_37_1","first-page":"46","article-title":"A Qualitative Study on the Physical and Psychological Experience of ICU Nurses Implementing Physical Restraint on Patients","volume":"23","author":"Yang C.","year":"2017","journal-title":"Journal of Qilu Nursing"},{"issue":"24","key":"e_1_2_9_38_1","first-page":"1894","article-title":"Survey on the Current Status of Knowledge, Attitude, and Practice Regarding Physical Restraint Among ICU Nurses in a Tertiary Hospital in Urumqi","volume":"33","author":"Yang C.","year":"2017","journal-title":"Chinese Journal of Practical Nursing"},{"issue":"20","key":"e_1_2_9_39_1","first-page":"3016","article-title":"Current Status and Influencing Factors of Knowledge, Attitude, and Practice Regarding Physical Restraint Among ICU Nurses in Gannan Region","volume":"18","author":"Zhang Y.","year":"2021","journal-title":"Nursing Practice and Research"},{"issue":"23","key":"e_1_2_9_40_1","first-page":"51","article-title":"Current Status and Influencing Factors of Knowledge, Attitude, and Practice Regarding Physical Restraint Among ICU Nurses in a Tertiary Hospital","volume":"38","author":"Zhu K.","year":"2023","journal-title":"Journal of Nursing Science"}],"container-title":["Journal of Clinical Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocn.70539","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jocn.70539","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocn.70539","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T11:35:26Z","timestamp":1789040126000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocn.70539"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":39,"alternative-id":["10.1111\/jocn.70539"],"URL":"https:\/\/doi.org\/10.1111\/jocn.70539","archive":["Portico"],"relation":{},"ISSN":["0962-1067","1365-2702"],"issn-type":[{"value":"0962-1067","type":"print"},{"value":"1365-2702","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"assertion":[{"value":"2025-12-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jocn.70539"}}