The Effects of the ICU Nurses'' Execution of Physical Restraints In-Service Education Program

• Main Authors: Mei -Yu Lai, 賴美玉
• Other Authors: Hsiu-Ting Tsai
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/49284285139492773849

碩士 === 中山醫學大學 === 護理研究所 === 101 === The use of physical restraints is one of common approaches in the context of providing patient care by medical staff. However, the complex emotional feelings of patients are easily ignored during the implementation process and may cause related complications. Nurses’ accurate knowledge, attitudes, behaviors toward the use of physical restraints for patients are very important. Objectives: The purpose of this study was to investigate the differences in knowledge, attitudes, and behaviors before and after intensive care unit (ICU) nurses received an interventional on-the-job education. In addition, we explored the effects of theses changes on nurses’ decisions when applying physical restraints on patients, and to examine the consequent impacts on self-extubation rates among patients intubated with endotracheal tubes (ETT). Methods and subjects: The adult ICU nurses of medical ICU, cardiac ICU, surgical ICU, neurosurgical ICU, and respiratory care center of a medical center located in central Taiwan were enrolled in this study. A purposive sampling method was conducted to collect 215 adult ICU nurses. On-the-job education was provided by nurse practitioners or with the use of pre-recorded teaching materials on CDs. The nurses were taught about the knowledge of correct or adequate implementation of physical restraints, and were evaluated by the instruments related to physical restraints (including questionnaires to measure knowledge, attitudes, and behaviors of restrain use) before the on-the-job training started and after it’s completed. The survey was repeated at two weeks, one month, and three months after the training, giving a total of 5 times and 215 valid questionnaires were obtained. However, because 10 nurses left their jobs within three months after the training, a total of 205 valid questionnaires were used for analysis. Results: No significant difference in the basic characteristics was found between the two groups of nurses receiving the on-the-job education provided by nurse practitioners, or using pre-recorded teaching materials on CDs. There were significant increases in the scores of knowledge, attitudes, and behaviors of restrain use in both groups of nurses. The increases in scores remained significant three months after the training. For the nurses receiving on-the-job training by using CDs, the means scores were 20.1 ± 2.9 and 25.2 ± 1.0 (p < 0.001) before and after the training. For those having training provided by nurse practitioners, the mean scores were 19.6 ± 2.9 and 25.1 ± 1.1 (p <0.001), respectively. Regarding the attitudes toward restrain use, the scores were 36.7 ± 3.0 and 41.8 ± 1.8 (p <0.001) before and after training among the nurses received CDs, and were 37.3 ± 2.9 and 42.3 ± 1.7 (p < 0.001) among those received training provided by nurse practitioners. The average scores for behaviors were 36.9 ± 4.1 and 42.7 ± 2.2 (p < 0.001) before and after training for the nurses receiving CDs, and were 37.2 ± 4.9 and 42.6 ± 2.4 (p < 0.001) for those having training provided by nurse practitioners. However, no significant difference in knowledge, attitudes, and behaviors was detected after training between the two groups. The results suggest that the on-the-job training provided by nurse practitioners and training CDs resulted in the same effects and increases in knowledge, attitudes, and behaviors of restrain use for these nurses. There was no significant correlation among the scores of knowledge, attitudes, and behaviors before the nurses receiving on-the-job training. However, significantly positive correlations were observed between the scores of knowledge, attitudes, and behaviors after the training (knowledge/attitude, r = 0.805, p = 0.0001; attitude/behavior, r = 0.677, p = 0.0001; behavior/knowledge, r = 0.773, p = 0.0001). In addition, Despite the incidence patient’s self-extubation of the endotracheal tube did not show significant difference after our nursing staff have received on job education, but the trend of patient’s physical restraint rate and timing is decreasing. Conclusions: On-the-job training provided by nurse practitioners or pre-recorded teaching materials on CDs to educate the nurses for knowledge about correct implementation of physical restraints on patients could result in significantly enhanced professional knowledge on applying physical restraints. Consequently, the nurses were enabled to have correct attitudes and behaviors; thereby unnecessary constraint behaviors were reduced. Furthermore, the effectiveness of promoted knowledge about the proper applications of physical restraints on patients remained significant up to three months after the on-the-job training. Therefore, it is recommended that on-the-job training for proper implementation of physical restraints should be provided to nurses by hospitals from time to time, and thereby the clinical nurses were enabled to have correct knowledge for assessing the necessity of patient restraints in order to reduce the potential damage related to patient restraints.