Study on continuous improvement of clinical application of evidence-based practice program of physical restraint in ICU patients / 中国实用护理杂志

Objective:To understand the current status of the evidence-based practice program of physical restraint in ICU patients and analyze its influencing factors, formulate and implement an action plan for continuous application of the program, so as to improve the knowledge level and evidence-based nursing ability of nurses, promote the improvement of patient outcomes, and strengthen the organization′s evidence-based cultural atmosphere.Methods:This study selected the program application departments of China Japan Friendship Hospital Surgical ICU as the research object, including all nurses, patients, nursing process, department standard system, etc. To understand the status and influencing factors of the project through observation and interview methods. The "Optimized Version of Evidence-based Practice Program of Physical Restraint in ICU Patients" was formulated and implemented, and a before-and-after comparative study method was used to comprehensively evaluate the implementation effect from the level of patients, nurses and organization.Results:The implementation rate of the 7 review standards of the program application department showed a downward trend; the patient restraint rate and restraint duration increased compared with the previous period; after the implementation of the optimized version program, the implementation of each item had been improved; the physical restraint rate decreased from 34.91% (37/106) before optimization to 28.57% (8/28) ( χ 2 value was 0.40, P>0.05), and the time of physical restraint decreased from 60.93 hours before optimization to 48.09 hours after optimization ( Z value was -0.19, P>0.05). Conclusions:The continuous application of the evidence-based practice project of physical restraint in ICU patients was not very optimistic. The continuity of implementation was affected by many factors. The continuous quality improvement of this evidence-based practice project can promote the improvement of the standard of physical restraint of patients, improve the quality of life of patients, promote the improvement of nurses' knowledge level and the improvement of evidence-based nursing ability; at the same time, it created a better organization′s evidence-based cultural atmosphere.

Evidence-based Clinical Practice Protocol of Physical Restraints by Adaptation Process for Patients in a Geriatric Hospital / 재활간호학회지

PURPOSE: This study was to develop an evidence-based clinical practice protocol of physical restraints by adaptation process for patients with a geriatric hospital. METHODS: Protocol adaptation process was conducted in accordance with manual for guideline adaptation version 1.0 by ADAPTE collaboration. RESULTS: The adapted physical restraint protocol was consisted of 3 domains and 37 recommendations. The number of recommendations in each domain were: 7 nursing assessment, 19 nursing intervention, and 11 nursing evaluation. More than half (56.8%) of the recommendations were rated as grade B, 37.8% as grade C, and 5.4% were rated as grade D. CONCLUSION: The adapted physical restraint protocol is expected to contribute as an evidence-based clinical practice protocol for healthcare workers in geriatric hospitals for reducing and improving efficiency of appropriate physical restraints use.

Effects of an Educational Program for the Reduction of Physical Restraint Use by Caregivers in Geriatric Hospitals

PURPOSE: The purposes of this study were to develop an educational program to reduce the use of physical restraints for caregivers in geriatric hospitals and to evaluate the effects of the program on cargivers' knowledge, attitude and nursing practice related to the use of physical restraints. METHODS: A quasi experimental study with a non-equivalent control group pretest-posttest design was used. Participants were recruited from two geriatric hospitals. Eighteen caregivers were assigned to the experimental group and 20 to the control group. The data were collected prior to the intervention and at 6 weeks after the intervention through the use of self-administered questionnaires. Descriptive statistics, chi-square test, Fisher's exact probability test, and Mann-Whitney U test were used to analyze the data. RESULTS: After the intervention, knowledge about physical restraints increased significantly in experimental group compared to the control group. However, there were no statistically significant differences between the groups for attitude and nursing practice involving physical restraints. CONCLUSION: Findings indicate that it is necessary to apply knowledge acquired through educational programs to nursing practice to reduce the use of physical restraints. User friendly guidelines for physical restraints, administrative support of institutions, and multidisciplinary approaches are required to achieve this goal.

Development and Testing of an Instrument to Measure Family's Emotional Response toward Physically Restrained Patients / 간호학회지

PURPOSE: This was a methodological research to develop an instrument to assess the emotional response of family members of physically restrained patients. METHODS: A primary instrument with 68 questions was developed based on literature review and semi-structured interviews with family members. A group of experts revised individual questions and removed 4 irrelevant questions. This secondary instrument, then, was tested with 199 family members of physically restrained patients in intensive care units of a university hospital. The validity and reliability of the instrument were tested by factor analysis. RESULTS: After item analysis, 3 questions with a correlation coefficient under .30 were discarded and the questions with a factor loading under .45 on Varimax Rotation were also removed. After factor analysis on the final 37 questions, 7 factors were identified; avoidance, shock, helplessness, grudge, depression, anxiousness, and acceptance. The total variance explained was 55.63%. The reliability of this instrument was 0.93 of Cronbach's alpha. CONCLUSION: This instrument was statistically reliable and valid to measure family's emotional response to physical restraints of the patients. This instrument can be useful in assessing the effects of nursing interventions for family members of restrained patients.

ICU Patients' Experience Process of Physical Restraint / 성인간호학회지

PURPOSE: The purposes of this study were to explore and describe the use of restraint on patients and to generate a grounded theory of how the use of restraint affects patients who have been restrained. METHODS: Interview data from seven patients with physical restraint was analyzed using the Strauss and Corbin's grounded theory method. Data were collected and analyzed simultaneously. Unstructured and in-depth interviews were conducted retrospectively with patients recalling their memories of ICU following their transfer to general unit. RESULTS: 'Safety belt' was emerged as a core category and it reflected that physical restraint provided a sense of security to patients. On the basis of core category, a model of the experience process of restrained patients in ICU was developed. The experience process were categorized into four stages: resistance, fear, resignation, and agreement. Stages of these proceeds appeared to have been influenced by the nurses' attitude and caring behavior such as the frequency of nurse-patient interaction, repetition of explanation, and empathetic understanding. CONCLUSION: These findings indicate that patients have mixed feelings towards restraint use, although negative feelings were stronger than positive ones. The result of this study will help nurses make effective nursing intervention.

Troubles during Dementia Management : Geropsychiatric Restraints

OBJECTIVES: The use of physical restraints for the geropsychiatric patients has been underreported to decrease in recent years. The aims of this study were to investigate frequency of restraints, to identify predictors and reasons for restraint use with geropsychiatric patients, to evaluate restraint related risks, and to suggest care alternatives used in restraint reduction. METHODS: English literatures published during 1990 thru 2005 were searched using internet and were reviewed. RESULTS: 1) Prevalence of restraint use in nursing homes was 25-85%. Incidence rate of restraints in geriatric ward of psychiatric hospital was 27.1%, which was 10.6 times more for the dementia patients. 2) Predictors of restraint use with geropsychiatric patients were older age, cognitive impairment, disruptive behaviors, impaired mobility and history of falls. Two variables most likely to affect fall and safety risk were cognitive function and ambulatory status. 3) Restrained patients were significantly more demented, show more safety judgement problems, and have a much higher overall risk for injury. 4) Five care alternatives to replace restraints are environmental care alternatives, alterations in nursing care, activities, physiological alternatives, and psychosocial alternatives. CONCLUSION: Physical restraints cannot just be removed. Care alternatives should be implemented to protect patient's safety. This is the beginning for the provision of safe care in a dignified and less restrictive environment that will promote or maintain patient's abilities.