Nursing and midwifery students are frequently exposed to physical restraint during clinical training, often presented as necessary for patient safety. However, growing evidence challenges this assumption, highlighting the risks associated with restraint and the limited implementation of effective alternatives in practice. Studies show that alternatives are considered in only a minority of cases, while organisational and educational factors contribute to the persistence and normalisation of restraint. Although professional codes define restraint as an exceptional, last-resort measure, this principle is not consistently reflected in practice or education. Students may experience moral distress and cognitive dissonance when witnessing practices that conflict with core values such as patient autonomy and dignity. At the same time, hierarchical dynamics, obedience to authority, and the influence of the hidden curriculum and professional socialisation may inhibit critical reflection, foster passive compliance, and contribute to the normalisation of ethically problematic care. Despite these implications, nursing and midwifery curricula often provide limited opportunities to explicitly address restraint, its ethical complexity, and the development of moral sensitivity. This discussion paper explores how educational strategies can support students to critically engage with restraint practices encountered during clinical placements and to develop both moral sensitivity and ethical agency. It highlights the importance of cultivating moral sensitivity through reflection, simulation, and experiential and digital learning, enabling students to recognise ethical dilemmas, question routine practices, and advocate for patients. Educational approaches should also promote the application of evidence-based alternatives to restraint, including person-centred interventions such as pain management, environmental adaptations, de-escalation strategies, and the involvement of family members or volunteers. Ultimately, nursing and midwifery education should prepare future professionals to recognise when routine clinical practices have been normalised despite being ethically problematic, to question their legitimacy critically, and to advocate for humane, dignified, restraint-free care.

Background: Pediatric ear, nose, and throat (ENT) surgery is common, but generates perioperative anxiety for caregivers and distress in children. Limited time for perioperative education and reliance on unverified online information can reduce family preparedness and increase stress. Few studies have evaluated co-designed mobile health (mHealth) apps to support and engage families in the perioperative ENT journey. Objective: This study aimed to compare caregiver anxiety between an mHealth app-supported care pathway and standard supportive and educational care alone in the perioperative ENT context. Secondary objectives explored between-group differences in caregiver anxiety at follow-up, family preparation, child distress, and social-impact indicators. Methods: A 2-arm, parallel-group, open-label randomized controlled trial (RCT) enrolled caregivers of children undergoing ENT surgery (tonsillectomy, adenoidectomy, tympanostomy tube insertion). The intervention was an mHealth app co-designed through a user-centered participatory approach and developed following Schnall and colleagues’ Information Systems Research Framework, with content based on caregivers’ informational needs. RCT participants were recruited at the hospital during their presurgery visit, when a health care provider introduced the study and provided instructions on how to use the app. No additional human support was scheduled thereafter. A sample size of 180 participants (90 per group) was estimated to detect the expected between-group difference in caregiver anxiety. Participants were randomly assigned in a 1:1 ratio to app use or standard care alone. The primary outcome was the between-group difference in caregiver state anxiety (State-Trait Anxiety Inventory [STAI-Y]). Secondary outcomes included between-group differences in child distress (modified version of the Yale Preoperative Anxiety Scale [mYPAS]), child preparation for surgery, family preparation for hospital admission and surgery, and social impact indicators. Outcomes were assessed online through questionnaires, which included both self-reported measures and evaluations completed by a nurse on the day of surgery. App engagement metrics were also collected. Reporting followed the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines. Results: The study enrolled 227 caregivers, with 111 allocated to the control group (CG) and 116 to the experimental group (EG), achieving the target sample size. No statistically significant differences were observed between the groups for the primary or secondary outcomes (all P >.05). In the EG, 75% (n=87) of the participants accessed at least 1 item of in-app content. Higher baseline anxiety was linked to lower app use (ρ=–0.22, 95% CI –0.39 to –0.04; P =.02), while greater use was linked to lower child distress (ρ=–0.23, 95% CI –0.40 to –0.04; P =.02). Conclusions: Although the hypotheses were not confirmed, these findings provide valuable insights for future perioperative mHealth research. The lack of effectiveness may reflect limited exposure to the intervention, outcome selection and timing, and contextual factors such as caregivers’ independent information-seeking. These findings support a greater focus on implementation processes and on identifying the caregivers most likely to benefit from mHealth-supported education.

Background/Objectives: Few studies focus on essential information and training for responsible caregivers in the operating theatre (OT). Our study explored challenges, opportunities and critical information for caregivers close to the child until induction, drawing on the experiences of nurses and caregivers. Methods: A mixed-method exploratory sequential design was adopted in the OT and surgery wards of a maternal and child health hospital in Italy (2021–2023). Results: Twelve nurses were involved in 2 focus groups. The content analysis yielded 3 themes and 6 subthemes. Two questionnaires were developed for nurses and caregivers based on qualitative findings. The quantitative phase included 25 nurses and 140 caregivers. Results from the quantitative strand confirm findings from the qualitative strand. However, discrepancies in information needs highlight gaps. Conclusions: Optimizing family comfort and workflows in the OT depends on caregivers’ awareness of their role near the child, emphasizing mindful presence and awareness of their body movements—watching, touching and fidgeting.