Cerrahi Yoğun Bakım Ünitelerinde Çalışan Hemşirelerin Fiziksel Tespit Kullanımına İlişkin Bilgi, Tutum ve Uygulamalarının Belirlenmesi: Çok Merkezli Kesitsel Bir Çalışma

Year 2024, Volume: 17 Issue: 4, 560 - 54, 15.10.2024

Aynur Koyuncu , Gülay Akbay Kaya , Ayla Yava

https://doi.org/10.46483/jnef.1332508

Abstract

Giriş: Cerrahi yoğun bakım ünitelerinde çalışan hemşirelerin fiziksel tespit kullanımına ilişkin bilgi, tutum ve uygulamalarını belirleyen araştırmalar sınırlıdır.

Amaç: Bu çalışma, cerrahi yoğun bakım ünitelerinde (C-YBÜ) çalışan hemşirelerin fiziksel tespit kullanımına ilişkin bilgi, tutum ve uygulamalarını belirlemek amacıyla yapıldı.

Yöntem: Araştırma, tanımlayıcı kesitsel bir çalışma olup, 15 Mart 2022 ile 15 Haziran 2022 tarihleri arasında üç hastanenin cerrahi yoğun bakım ünitelerinde görev yapan toplam 73 gönüllü hemşire (n=73) ile yürütüldü. Veriler, Fiziksel Kısıtlama Bilgi, Tutum ve Uygulama Ölçeği kullanılarak yüz yüze anketler aracılığıyla toplandı. Verilerin analizinde bağımsız gruplarda t testi ve tek yönlü ANOVA kullanıldı. Farklılıklara katkıda bulunan değişkenleri belirlemek için post hoc Tukey HSD testi kullanıldı. p-değeri <0.05 olan sonuçlar istatistiksel olarak anlamlı kabul edildi ve çalışmanın raporlaması STROBE kontrol listesine uygun olarak yapıldı.

Bulgular: Çalışmaya katılan hemşirelerin yaş ortalaması 32.08±6.91, %61.6’sı kadın, %68.5’i lisans mezunudur. Ölçeğin toplam puanı 76.86±6.58, bilgi, tutum ve uygulama alt boyut puanları (sırasıyla; 7.09±1.49, 32.52±4.5, 37.24±3.30) bulundu. Haftalık çalışma süresi ≤61 saat olan hemşirelerin fiziksel tespit tutum ve uygulama puan ortalamaları daha düşüktü (sırasıyla p=.001, p= .001, p=.001) (p<.05). Hemşirelerin haftalık çalışma saatleri ile fiziksel kısıtlama tutum ve uygulama puanları arasında negatif yönde yüksek bir korelasyon vardı (sırasıyla, r=.746 ve r=.734) (p<.05).

Sonuç: Hemşirelerin fiziksel tespit bilgi, tutum ve uygulamalarında eksikler olduğu belirlendi. Hemşirelerin fiziksel tespit uygulamasını her zaman kayıt etmediği, hekim direktifi ile uygulamadığı, alternatif yöntemlere başvurmadığı belirlendi. Bilgi puanları C-YBÜ çalışma deneyimlerinden, tutum ve uygulama puanları ise haftalık çalışma sürelerinden etkilenmektedir.

Keywords

Yoğun Bakım Ünitesi, Fiziksel Tespit, Cerrahi, Hemşirelik

Determination of Knowledge, Attitudes and Practices of Nurses Working in Surgical Intensive Care Units on the Use of Physical Restraint: A Multicenter Cross-Sectional Study

Abstract

Background: Research on the knowledge, attitudes, and practices of nurses working in surgical intensive care units regarding the use of physical restraints is limited.

Objective: This study aimed to assess nurses’ knowledge, attitudes, and practices regarding physical restraint use in surgical intensive care units (S-ICUs).

Method: The research, a descriptive cross-sectional study, involved nurses from three hospitals’ surgical intensive care units between March 15th and June 15th, 2022, with a total of 73 voluntarily participating nurses (n=73). Data were gathered using the Physical Restraint Knowledge, Attitude, and Practice Scale via face-to-face surveys. In the analysis of the data, independent t tests and one-way ANOVA were used. The post hoc Tukey HSD test was utilized to determine the variables contributing to the differences. A p-value of <0.05 was considered statistically significant, and the study’s reporting adhered to the STROBE checklist.

Results: The participating nurses had a mean age of 32.08±6.91 years, with 61.6% being female and 68.5% having undergraduate degrees. The total scale score was 76.86±6.58, with subdimension scores for knowledge, attitude, and practice at 7.09±1.49, 32.52±4.5, and 37.24±3.30, respectively. Nurses working ≤61 hours per week had lower scores in physical restraint attitude and practice (p=.001 for both), and there was a significant negative correlation between nurses’ weekly working hours and their physical restraint attitude and practice scores (r=.746 and r=.734, respectively) (p<.05).

Conclusion: Nurses displayed shortcomings in knowledge, attitudes, and practices related to physical restraint use. It has been determined that nurses do not consistently document the physical restraint, do not always implement it solely based on physician directives, and do not always resort to alternative methods. Knowledge scores were linked to S-ICU work experience, while attitude and practice scores were influenced by weekly working hours.

Keywords

Intensive Care Unit, Physical Restraint, Surgical, Nursing

References

• Akansel, N. (2007). Physical restraint practices among ICU nurses in one university hospital in Western Tur-key. Health Science Journal, 1(1), 51-57.
• American Nurses Association. (2024). Reduction of patient restraint and seclusion in healthcare settings. Available at: https://www.nursingworld.org/~4af287/globalassets/docs/ana/ethics/ps_reduction-of-patient-restraint-and-seclusion-in-health-care-settings.pdf (accessed April 16, 2024).
• Bilge, E. Ü., Kaya, M., Şenel, G. Ö., & Ünver, S. (2015). The incidence of delirium at the postoperative intensi-ve care unit in adult patients. Turkish Journal of Anaesthesiology and Reanimation, 43(4), 232-239. doi: 10.5152/TJAR.2015.61570.
• Bray, K., Hill, K., Robson, W., Leaver, G., Walker, N., O’Leary, M., Delaney, T., Walsh, D., Gager, M., Waterhou-se, C., & British Association of Critical Care Nurses. (2004). British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units. Nursing in Critical Care, 9(5), 199-212.doi: 10.1111/j.1362-1017.2004.00074.x.
• Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum Associa-tes. https://doi.org/10.4324/9780203771587
• Cui, N., Qiu, R., Zhang, Y., et al. (2021). Why are physical restraints still in use? A qualitative descriptive study from Chinese critical care clinicians’ perspectives. BMJ Open, 11(11), e055073.doi:10.1136/bmjopen-2021-055073.
• Cui, N., Yan, X., Zhang, Y., Chen, D., Zhang, H., Zheng, Q., & Jin, J. (2022). Non-pharmacological interventions for minimizing physical restraints use in intensive care units: An umbrella review. Frontiers in Medicine (Lau-sanne), 9, 806945.doi:10.3389/fmed.2022.806945.
• da Silva, P. S., & Fonseca, M. C. (2012). Unplanned endotracheal extubations in the intensive care unit: Sys-tematic review, critical appraisal, and evidence-based recommendations. Anesthesia & Analgesia, 114(5), 1003-1014. doi:10.1213/ANE.0b013e31824c0b6d.
• de Casterlé, B. D., Goethals, S., & Gastmans, C. (2015). Contextual influences on nurses’ decision-making in cases of physical restraint. Nursing Ethics, 22(6), 642-651.doi:10.1177/0969733014557114.
• Devlin, J. W., Skrobik, Y., Gélinas, C., Needham, D. M., Slooter, A. J. C., Pandharipande, P. P., et al. (2018). Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immo-bility, and sleep disruption in adult patients in the ICU. Critical Care Medicine, 46(9), e825-e873.
• Dolan, J., & Dolan Looby, S. E. (2017). Determinants of nurses’ use of physical restraints in surgical intensive care unit patients. American Journal of Critical Care, 26(5), 373-379.doi:10.1097/CCM.0000000000003299.
• Emanuel, E. J., Wendler, D., Killen, J., & Grady, C. (2004). What makes clinical research in developing count-ries ethical? The benchmarks of ethical research. Journal of Infectious Diseases, 189(5), 930-937.
• Ertuğrul, B., & Özden, D. (2020). The effect of physical restraint on neurovascular complications in intensive care units. Australian Critical Care, 33(1), 30-38.doi:10.1016/j.aucc.2018.10.067.
• Gürlek Kısacık, Ö., & Coşğun, T. (2019). Investigation of restriction applications and neurovascular effects in intensive care patients. Journal of Intensive Care, 10(2), 53-62.
• Karaca, T., & Aydın Özkan, S. (2018). Investigation of responsible nurses’ knowledge on detection practices by qualitative research method. Journal of Health and Nursing Management, 5(3), 172-178.
• Kavak, F., Yılmaz, E., Okanlı, A., & Aslanoğlu, E. (2019). The effect of psychoeducation given to psychiatry nur-ses on level of knowledge, attitudes, and practices regarding physical restraint: A randomized controlled study. Perspectives in Psychiatric Care, 55(4), 743-751.doi:10.1111/ppc.12411.
• Kaya, H., Aştı, T., Acaroğlu, R., Erol, S., & Savcı, C. (2008). Nurses’ knowledge, attitudes and practices towards detective use. Maltepe University Journal of Nursing Science and Art, 1(2), 21-29.
• Kılıç, G., Kutlutürkan, S., Çevik, B., & Erdoğan, B. (2018). Evaluation of nurses working in intensive care units on physical detection practice. Van Medical Journal, 25(1), 11-16.
• Kirk, A. P., McGlinsey, A., Beckett, A., Rudd, P., & Arbour, R. (2015). Restraint reduction, restraint elimination, and best practice. Clinical Nurse Specialist, 29(6), 321-328.doi:10.1097/NUR.0000000000000157.
• Lach, H. W., Leach, K. M., & Butcher, H. K. (2016). Evidence-based practice guideline: Changing the practice of physical restraint use in acute care. Journal of Gerontological Nursing, 42(2), 17-26.doi:10.3928/00989134-20160111-05.
• Lan, S. H., Lu, L. C., Lan, S. J., Chen, J. C., Wu, W. J., Chang, S. P., & Lin, L. Y. (2017). Educational intervention on physical restraint use in long-term care facilities - Systematic review and meta-analysis. Kaohsiung Jour-nal of Medical Sciences, 33(8), 411-421.doi:10.1016/j.kjms.2017.05.019.
• Paslı Gürdoğan, E., Uğur, E., Kinici, E., & Aksoy, B. (2016). Knowledge, attitudes and practices of intensive ca-re nurses on physical detection and affecting factors. Journal of Internal and Surgical Sciences Intensive Care, 7(3), 83-88.
• Rose, L., Burry, L., Mallick, R., Luk, E., Cook, D., Fergusson, D., Dodek, P., Burns, K., Granton, J., Ferguson, N., Devlin, J. W., Steinberg, M., Keenan, S., Reynolds, S., Tanios, M., Fowler, R. A., Jacka, M., Olafson, K., Skrobik, Y., & Mehta, S. (2016). Prevalence, risk factors, and outcomes associated with physical restraint use in mec-hanically ventilated adults. Journal of Critical Care, 31(1), 31-35.
• Salehi, Z., Najafi Ghezeljeh, T., Hajibabaee, F., & Joolaee, S. (2020). Factors behind ethical dilemmas regar-ding physical restraint for critical care nurses. Nursing Ethics, 27(2), 598-608.
• Suen, L. K. P. (1999). Knowledge, attitude and practice of nursing home staff towards physical restraints in Hong Kong nursing homes. Asian Journal of Nursing Studies, 5(2), 73-86.
• Suliman, M., Aloush, S., & Al-Awamreh, K. (2017). Knowledge, attitude and practice of intensive care unit nurses about physical restraint. Nursing in Critical Care, 22(5), 264-269.doi: 10.1111/nicc.12303
• Turgay, A. S., Sari, D., & Genc, R. E. (2009). Physical restraint use in Turkish intensive care units. Clinical Nurse Specialist, 23(2), 68-72.
• Unoki, T., Hamamoto, M., Sakuramoto, H., et al. (2019). Influence of mutual support and a culture of blame among staff in acute care units on the frequency of physical restraint use in patients undergoing mechanical ventilation. Acute Medicine & Surgery, 7(1), e479.
• Unoki, T., Sakuramoto, H., Ouchi, A., & Fujitani, S. (2018). Physical restraints in intensive care units: A natio-nal questionnaire survey of physical restraint use for critically ill patients undergoing invasive mechanical ventilation in Japan. Acute Medicine & Surgery, 6(1), 68-72.
• Via-Clavero, G., Sanjuán-Naváis, M., Romero-García, M., et al. (2019). Eliciting critical care nurses’ beliefs regarding physical restraint use. Nursing Ethics, 26(5), 1458-1472.
• World Medical Association. (2008). Declaration of Helsinki – Ethical principles for medical research involving human subjects. Available at: https://www.wma.net/what-we-do/medical-ethics/declaration-of-helsinki/doh-oct2008/ (accessed July 13, 2022).