Physical Restraint Knowledge, Attitudes and Practices of Intensive Care Nurses in Turkey: The Effectiveness of an In-Service Training Program

Abstract

Background: Intensive care nurses use physical restraints (PRs) to prevent critically ill patients from disrupting invasive medical equipment, but they may not recognize the negative or positive consequences. Purpose: The study was conducted with a quasi-experimental, single-group pretest-posttest design to evaluate the impact of PRs training on the knowledge, attitudes, and practices of intensive care nurses. Materials and Methods: The sample of the study consisted of 81 nurses. The data were obtained using a " The Individual Data" and the "Levels of Knowledge, Attitudes and Practices of Staff Regarding Physical Restraints Questionnaire." Descriptive statistics analyzed sample characteristics and Friedman's multiple comparison test performed to compare the effectiveness of training. Results: It was determined that all nurses applied physical restraint, and the rate of application of these on agitated and restless patients was 100%. Sixty-nine-point nine percent of the nurses decided on the physical restraint together with physicians, and 70.4% of them wanted to receive training about physical restraint. The nurses' attitude, and practice scores about the use of physical restraint in the post-intervention period and retest after 1 and 3 months increased significantly compared to the pre-intervention period (p=.000). Conclusion: This study showed that the physical restraint training given to the nurses was effective. The findings recommended to carry out in-service training to increase the knowledge levels of nurses about physical restraint and its application, repeat this training periodically and evaluate its effectiveness.

Keywords

• Intensive care nursing
• physical restraint
• training
• knowledge
• attitudes

References

1. Referans1 Marshall JC, Bosco L, Adhikari NK, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care 2017;37:270-276.
2. Referans2 Perez D, Peters K, Wilkes L, Murphy G. Physical restraints in intensive care: an integrative review. Australian Critical Care 2019;32:165-174.
3. Referans3 Shdaifat SA, Al Qadire M. Anxiety and depression among patients admitted to intensive care. Nursing in Critical Care 2020;1-7.
4. Referans4 Burry L, Rose L, Ricou B. Physical restraint: time to let go. Intensive Care Med 2018;44:1296–1298.
5. Referans5 Kalula SZ, Petros SG. Use of physical restraint in hospital patients: a descriptive study in a tertiary hospital in South Africa. Curationis 2016;39(1):1-8.
6. Referans6 Hamilton D, Griesdale D, Mion Lorraine C. The prevalence and incidence of restraint use in a Canadian adult intensive care unit: A prospective cohort study. Canadian Journal of Critical Care Nursing 2017;28(3):25-33.
7. Referans7 Estévez-Guerra GJ, Fariña-López E, Núñez-González E, Gandoy-Crego, M, Calvo-Francés F, Capezuti EA. The use of physical restraints in long-term care in Spain: a multi-center cross-sectional study. BMC Geriatrics 2017;17(1): 29.
8. Referans8 Eskandari F, Abdullah KL, Zainal N, Wong LP. The effect of educational intervention on nurses' knowledge, attitude, intention, practice, and incidence rate of physical restraint use. Nurse Education in Practice 2018;32:52–57.

9. Referans9 Kılıç G, Kutlutürkan S, Çevik B, Erdoğan B. The evaluation of intensive care unit nurses' opinions on physical restraint application. Van Med J 2018;25(1):11-16.
10. Referans10 Gu T, Wang X, Deng N, Weng W. Investigating influencing factors of physical restraint use in China intensive care units: A prospective, cross-sectional, observational study. Australian Critical Care 2019;2(3):193-198.
11. Referans11 Kaya H, Dogu O Intensive care unit nurses' knowledge, attitudes, and practices related to using physical restraints. International Journal of Caring Science 2018;11(1): 61-70.
12. Referans12 Rose L, Dale C, Smith OM, et al. A mixed-methods systematic review protocol to examine the use of physical restraint with critically ill adults and strategies for minimizing their use. Systematic Reviews 2016; 5(1):194.
13. Referans13 Ye J, Xiao A, Yu L, Wei H, Wang C, Luo T. Physical restraints: an ethical dilemma in mental health services in China. International Journal of Nursing Sciences 2018;5(1):68-71.
14. Referans14 Fugger G, Gleiss A, Baldinger P, Strnad A, Kasper S, Frey R. Psychiatric patients' perception of physical restraint. Acta Psychiatrica Scandinavica 2016;133(3):221-231.
15. Referans15 Gnanapragasam A, Charles HS, Packirisamy T, Peravali V. Perception of physical restraints and its relationship to psychopathology. Indian J Cont Nsg Edn 2018;19:96-102.
16. Referans16 Crutchfield P, Gibb TS, Redinger MJ, Ferman D, Livingstone J. The conditions for ethical application of restraints. Medical Ethics 2019;155(3), 617-625.
17. Referans17 Mitchell DA, Panchisin T, Seckel MA. Reducing the use of restraints in intensive care units: a quality improvement project. Critical Care Nurse 2018;38(4):8-16.
18. Referans18 Birgili F, İzan F. The knowledge, attitudes, and practices of nurses about the use of physical restraints. International Journal of Health Sciences 2019;7(1):18-25.
19. Referans19 Dolan J, Looby SE. Determinants of nurses’ use of physical restraints in surgical intensive care unit patients. Am J Crit Care 2017;26(5):373-379.
20. Referans20 Nason R, Anderst P. Fit to be tied: restraint usage in adult intensive care unit (ICU). Canadian Journal of Critical Care Nursing 2018;29(2):58-59.
21. Referans21 Akbas M, Oztunc G, Torun S. Nurses' knowledge, attitudes, and practices towards the use of physical restraints and their affecting factors: A multi-center cross-sectional study. International Journal of Caring Sciences 2019;12(2):1-11.
22. Referans22 Balci H, Arslan S. Nurses' information, attitude, and practices towards the use of physical restraint in intensive care units. Journal of Caring Sciences 2018;7(2):75–81.
23. Referans23 Ertuğrul B, Özden D. The effect of physical restraint on neurovascular complications in intensive care units. Australian Critical Care Nurses 2020;33(1):30–38.
24. Referans24 Eskandari F, Abdullah K L, Zainal N Z, Wong L P. Use of physical restraint: Nurses' knowledge, attitude, intention and practice, and influencing factors. Journal of Clinical Nursing 2017;26(23-24): 4479–4488.
25. Referans25 Via-Clavero G, Claramunt-Domènech L, García-Lamigueiro A, et al. Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units. Enfermeria intensive 2019;30(2):47–58.
26. Referans26 Kassew T, Dejen Tilahun A, Liyew B. Nurses' knowledge, attitude, and influencing factors regarding physical restraint use in the intensive care unit: a multicenter cross-sectional study. Critical Care Research and Practice 2020;4235683.
27. Referans27 Ahmadi M, Bagheri-Saweh MI, Nouri B, Mohamadamini O, Valiee S. Effect of Interventional Educational Programs on Intensive Care Nurses' Perception, Knowledge, Attitude, and Practice About Physical Restraints: A Pre-/Postclinical Trial. Critical care nursing quarterly 2019;42(1):106–116.
28. Referans28 Nasrate H, Shamlawi A, Darawad MW. Improving ICU nurses’ practices of physical restraints in Jordan: effect of an educational program. Health 2017;9(12):1632.
29. Referans29 Suen LKP Knowledge, attitude, and practice of nursing home staff towards physical restraints in Hong Kong nursing homes. Asian Journal of Nursing Studies 1999;5(2):73-86.
30. Referans30 Kaya H, Aştı T, Acaroğlu R, Erol S, Savcı C. Hemşirelerin fiziksel tespit edici kullanımına ilişkin bilgi tutum ve uygulamaları (The knowledge, attitude, and practices of the nurses). Maltepe Üniversitesi Hemşirelik Bilim ve Sanatı Dergisi (Maltepe University J Nursing Science and Art) 2008;1(2): 21-29.
31. Referans31 Saglık Bakanligi yogun bakim uniteleri standartları genelgesi (2008/53). 2016. https://www,saglik,gov,tr/TR,10979/yogun-bakim-unitelerinin-standartlari-genelgesi-200853 (Accessed: 12.10.2019).
32. Referans32 Pradhan N, Lama S, Mandal G, Shrestha E. Physical restraining: Nurses knowledge and practice in Tertiary Care Hospital of Eastern Nepal. Nursing Open 2019;6(3):1029–1037.
33. Referans33 El-sol AESH, Mohmmed RGA. Assessment of nurses' knowledge, attitudes, and practice regarding physical restraints among critically ill patients National Journal of Advanced Research 2018; 4(1):15-22.
34. Referans34 T.C. Ministry of Health Saglikta Kalite Standartları Hastane 2020 Ankara https://kalite. saglik.gov.tr/TR,52460/guncel-standartlar.html.( Accessed December 2021)
35. Referans35 Ozden D, Karagozluoglu S, Vergi I. Effects of training on nurses' knowledge, attitudes and practices related to the use of physical restraint. Turkiye Klinikleri J Nurs Sci 2014;6(2):75-86.
36. Referans36 Taha NM, Ali ZH. Physical restraints in critical care units: impact of a training program on nurse’s knowledge and practice and on patient’s outcomes. J Nurs Care 2013;2(2):2167-68.
37. Referans37 Rentala S, Thimmajja SG, Nanjegowda RB. Nurses’ knowledge, attitude and practices on use of restraints at State Mental health care setting: An impact of in-servixe education programme. Invest Educ Enferm 2021;39 (1): e12.
38. Referans38 Ali FS, Mohamed AEA. Effect of scenario-based educational program on critical care nurses' knowledge, practice, and attitude regarding the use of physical restraints at a selected hospital in Cairo, Egypt. Journal of Health Sciences and Nursing 2019;4(4):21-37.
39. Referans39 Mehrok S, Belsiyal X, Kamboj P, Mery A. The use of physical restraints‑ knowledge and attitude of nurses of a tertiary care institute, Uttarakhand, India. J Edu Health Promot 2020;9:77.
40. Referans40 Younis GA, Ahmed SE. Physical restraint and maintenance of critically ill patient's safety in intensive care unit: effect of clinical practice guidelines on nurse's practice and attitude. IOSR Journal of Nursing and Health Science 2017;6(4): 6-21.