Knowledge
and Practice Regarding Physical Retraining among Nurses Working in Selected
Hospitals of Ludhiana, Punjab
Mrs. N. Sujata, Dr. Jasbir Kaur2
Dayanand Medical College & Hospital, College of Nursing,
Ludhiana, Punjab. Pin code:141001
Corresponding Author
Email: sujata.nong@gmail.com
ABSTRACT:
A descriptive study
on 60 nurses working in ICU’s, Emergency and Neuro-Surgery
ward of selected hospitals, Ludhiana was conducted. Convenience sampling
technique was used. The study was aimed to assess the knowledge and practice of
physical restraints among nurses working in various units of selected
Hospitals, Ludhiana. Data was collected by using following 3 tools a)
Socio-demographic profile of nurses b) Structured knowledge Questionnaire on
physical restraints and c) Observational checklist to assess the practice of
Physical Restraints. Majority (83.33%) of nurses belonged to ≤30 years,
91.66% were female, 83.33% of nurses were GNMs and only 16.67% were B.Sc.’s.
Majority (61.66%) of the nurses were working in ICU’s whereas only 38.3% were
working in Neuro-Surgery and Emergency ward. 63.3% of
nurses had work experience of >2 years and 36.7% of nurses had experience of
≤2 years. Mean knowledge score was found to be 14.2 ± 3.9. The result
showed that majority (76.66%) of nurses had average knowledge regarding
physical restraints. It was found that no physician written order were documented for all the patients,
written consent were not taken from 43.33% of patients prior to the procedure.
Clove hitch restraint with cotton and bandages were the most common type of
physical restraints used.
KEYWORDS: Knowledge, practice, physical restraints, ICUs, nurses.
INTRODUCTION:
Restraining is one of the common procedures
performing in various health care setting especially in ICU’s. Restraining
would be of various types like Verbal restraints, Chemical restraints and
Physical restraints. Physical restraints are commonly used in clinical settings
to control disruptive behavior, maintaining treatment plans and prevent fall. It shall not be employed for the purpose of
punishment, staff convenience or as a substitute for adequate staffing1.
Previous studies reveal that the prevalence of physical restraint used is only
three to four per cent and 21% in acute care settings. A study conducted in
Turkey on practice of physical restraints revealed that prevalence of physical
restraints is found to be used commonly in all ICU’s and gauze was most
commonly used but not a proper material for restraining patients in all ICU’s.2
Nurses also reported that
the reason for applying restraints were to prevent dislodgement of the medical
equipment, to keep patient safe and to control patient’s behavior. Majority of
nurses agreed on the fact that restraining reduces falls rate of patient from
hospital beds, also reduces injuries and allows health practitioners to work
safely.3 The overall
incidence of physical restraining have been reported to vary from 6%-13% in
various hospitals in India as well as worldwide. The level of
knowledge about restraints and the underlying attitudes of nurses toward the
use of restraints should be identified because knowledge and attitudes can
directly or indirectly affect practice.4 Recent anecdotal evidence
indicates that there are negative consequences such as limitation of movement
which can cause muscle wasting, weakness, bone resorption
due to demineralization, increased rates of infection and pressure ulcers that
are associated with the use of physical restraints due to knowledge deficit. In
addition, the psychological consequences include increased agitation confusion
and cognitive deterioration, fear and demoralization, and loss of dignity (Strumpf and Evans 1991, Scherer et al. 1993, Irving 2002).5
It is a common procedure so that there are
higher chances of common errors due to negligence, knowledge deficit and
working with busy schedule. Nurses play important role in the use of physical
restraints so they should have adequate knowledge of physical restraints and
incorporate in their practice to limit the negative consequences.
MATERIALS AND METHODS:
This was a descriptive study. Approval to conduct the
study was obtained from the institutional ethics committee. The study was
conducted in selected hospital of Ludhiana with the aim to assess the level of
knowledge and practices of Physical Restraints among nurses. Convenience
sampling technique was used. A total of 60 nurses working in ICU and emergency
unit were selected as sample. Brief information was given about the purpose of
the study and consent was taken from subjects before data collection. Data was
collected by using following 3 tools a) Socio-demographic profile of nurses b)
Structured knowledge Questionnaire on physical restraints and c) Observational
checklist to assess the practice of Physical Restraints. Descriptive statistics
and inferential statistics were used for analysis of data in SPSS 16 version.
RESULT:
Majority
(83.33%) of nurses belonged to age group ≤30years, 91.66% of the nurses
were female. Majority (66.6%) of the
nurses followed Sikhism, 26.6% followed Hinduism and 6.7% nurses followed
Christianity as religion. Most (61.67%) of the nurses were unmarried. Majority (83.33%) were GNM and only 16.67% nurses possessed
B. Sc. degree and there were no any post graduate nurse. Maximum (61.67%) of
nurses were working in ICU’s, 23.33% were working in Emergency and only 15%
were working in Neuro-Surgery ward. majority (81.67%)
of nurses had not attended any in-service educational programme
on physical restraining whereas only 18.33% had attended it. As shown in figure 1, it revealed that
majority (76.66%) nurses were found to have average level of knowledge,
(21.66%) were having poor knowledge and only 1.66% were
having good knowledge regarding Physical Restraints. The mean score of
knowledge was found to be 14.2 ± 3.9. So, maximum of the nurses were having
average level of knowledge regarding physical restraints.
Table
1 depicts that for all the 30 patients observed for physical restraints, there
were no physician written order to apply restraint. Informed written consent
was not taken prior to procedure and no documentation was done on any restraint
part.
As per the type of applied physical
restraints, clove hitch was commonest (100%). Maximum (76.7%) of patients were
not given chemical restraints prior to physical restraints. Majority (50%) of
patients were having adequate tying of knot. Most of the patients (56.7%) were
having one point restraint. Cotton and bandage was the most common material
used for restraints. Majority (93.3%) of the patients were applied appropriate
knot. Majority (73.3%) of the restraints were tied with side rails.
Figure 1: Percentage distribution of nurses as per the
level of their knowledge regarding Physical Restraints.
Table 1:
Observed practice of Physical Restraints for patients
|
Practice |
f (%) |
|
Ethico-
legal consideration |
|
|
No physician’s written order/ prescription
to apply physical restraint Informed written consent not obtained No documentation on restrained part Type
of physical restraint applied Clove Hitch Material
used Cotton
and bandage Body
part restrained One point Two point Three point Four point Restraints
tied with Side rails Bed frame Appropriate knot ** applied Yes No Tying of knot Loose Tight Adequate* Duration of physical restraining <24
hrs 24-72
hrs >72
hrs Physical restraint released q
4hrly q
6hrly q
8hrly Not
released Change of the site of physical restraining Yes No Time of physical restraint used the most Morning All
the time Chemical restraints used prior to physical
restraining Yes No |
30(100) 13(43.3) 30(100) 30(100) 30(100) 17(56.7) 08(26.7) 02(06.7) 03(10.0) 22(73.3) 08(26.7) 02(06.7) 28(93.3) 13(43.3) 02(06.7) 15(50.0) 08(26.7) 05(16.7) 17(56.7) 02(06.7) 01(03.3) 02(06.7) 25(83.3) 03(10.0) 27(90.0) 04(13.3) 26(86.7) 07(23.3) 23(76.7) |
**reef
knot *1cm
More than half (56.7%) of patients were
having duration of restraining for >72 hrs. For majority (83.3%) of the
patients, restraints were not released even once. There was no assessment done for any patient after the procedure. Majority (86.7%) of
patients were applied physical restraints all the time.
Other finding:
Table 2: Association of nurses’ knowledge on physical
restraints with professional qualification. N=60
|
Professional
qualification n |
Knowledge score Mean±
SD |
t test |
|
GNM 50 BSc 10 |
13.56 ± 0.57 15.4 ± 3.73 |
3.42* p=0.001 |
*= significant (p≤ 0.05), df =59
Table 8 depicts that
the mean difference score was higher among B.Sc. nurses (15.4±3.73) that GNM
nurses (13.56±0.57). This difference was tested and was found to be
statistically significant.
DISCUSSION:
Physical restraint
is any device, material or equipment attached to or near a person’s body which
deliberately prevents a person’s free body movement to a position of choice or
a person’s normal access to their body. Physical restraint is used as a mean of
protecting the patients from inflicting injury to self and others. A restraint
is any one the numerous devices used to immobilize a client or an extremity.6
A descriptive
research design was used for the study to assess the knowledge and practices
regarding physical restraints among nurses working in ICU’s, Neuro-Surgery ward and Emergency department of selected
Hospital, Ludhiana. The socio demographic characteristics of nurses revealed
that out of 60 nurses, majority (83.33%) belonged to ≤30 years and 16.7%
belonged to above >30 years. Majority (91.66%) were female and only 8.33%
were male. Majority (66.66%) of the nurses followed Sikhism, 26.66% Hinduism
and 6.67% of nurses followed Christianity as religion. Most (61.67%) of the
nurses were unmarried whereas only 38.33% nurses were married. Majority
(53.33%) of the nurses resided in urban area and only 46.67% of nurses lived in
rural area. Most (66.66%) of the nurses were having non medical and others
(arts and commerce) steam at their 10+2 level whereas only 33.33% opted medical
as their stream of education at 10+2 level. Majorities (83.33%) of nurses were
GNM and only 16.66% were B.Sc. Majority (61.7%) of the nurses were working in
ICU’s whereas only 38.3% of nurses were working in Emergency and Neuro-Surgery ward. It was also found that majority (63.3%)
of the nurses had >2 years of experience and only 36.7% had experience
≤2 year.
It revealed that the
mean knowledge score of nurses regarding physical restraints is found to be
14.2 ± 3.9. Majority of the nurses were having average level of knowledge
regarding physical restraining. Similar findings were reported by Lorna Suen (2006)1 among nurses working in
rehabilitation centre of Shatin, Hongkong.
Another similar finding was also reported by Janelli (1992)7. However
present study also revealed that 1.66% of nurses have poor knowledge regarding
physical restraining and similar findings were reported by Stig Karlsson
(1997).8
Present study also
revealed that physical restraining is not practiced ideally by the nurses as it
was found that they are not maintaining ethico-legal
considerations related to physical restraints. There was no physician’s written
order/prescription regarding physical restraining among 30 patients observed
who were being restrained. Informed written consent was not obtained from
43.33% patients who are restrained. No assessment of restrained part was
performed. Present findings were supported by the finding reported by Anke JE (2009)2.
The
knowledge of nurses were found to
be good among those who had attended an educational
programme related to physical restraining prior and
it was supported by the study findings reported by Janelli
MJ(2006)9, Huang H.(2009)10 and Lee YM(2007)11 on effectiveness of teaching program
on physical restraints.
CONCLUSION:
Majority of nurses had average knowledge regarding physical restraints and the practice was
found to be poor. Hands on skill training programme
can be conducted for the improvement in the practice of physical restraints
among nurses. It is also recommended that In-service education should be
planned to increase the knowledge and skills to incorporate in practice of
physical restraining among nurses to decrease the deleterious effects of
restraints on patients. Multicentre studies can be conducted involving more
number of subjects and institutions.
REFERENCES:
1.
Suen L, Lai C, Wong T, Chow S, Kong S, Kong T et al. Use of physical
restraints in rehabilitation settings. Journal of advanced nursing 2006 ;55(1):
20-28
2.
Akansel N. Physical restraint practices among ICU nurses in one university
hospital in Western Turkey. Health Science Journal 2007; I(4): 51-57
9.
Janelli LM. Nurse’s knowledge and attitudes toward the use of Physical
Restraint on older patients. International Journal of Nursing Research
approaches 2006; I (1):52
10. Huang H, Chuang Y, Chiang K. Nurses'
Physical Restraint Knowledge, Attitudes, and Practices: The Effectiveness
of an In-Service Education Program. Journal of Nursing research 2009;
17(4):241-48
11.
Lee YM Chien
W. Knowledge about physical restraints, Nursing practices and attitudes towards
the use of restraints. International Journal of nursing research approach 2007;
1(1):52-71
Received on 08.12.2014 Modified on 07.01.2015
Accepted on 18.02.2015 © A&V Publication all right reserved
Asian
J. Nur. Edu. and Research 5(2): April-June
2015; Page242-245
DOI: 10.5958/2349-2996.2015.00047.6