102 Journal of Meiho University, Vol. 32 No.2, pp. 13-28

13

168SPSS 17.0

t90%

102

14

(restraint)

( 2006)( 2002)

( 2004)/

( 2006 Benbenbishty, Adam, Endacott, 2010; Lane & Harrington, 2011)

(2004 2004 2006 Agens, 2010; Kandeel,

2013; Sokol, 2010)

(Krüger, Mayer, Haastert, Meyer, 2013)79.2% 74.7%( 2004)

Minnick(2001) 13-43%(2010)

78% 10% 9 1611

(2006)65

(2008)41.7%

60.575% Ortiz-Pruitt(1995) 188

(2005)

(2003)

15

62.3%

Koczy (2005) Hurlock-Chorostecki Kielb(2006)(2011)

89.4%

Huizing Hamers Gulpers Berger (2009)(2004)

(Liukkonen & Laitinen, 1994)Hantikainen Kappeli(2000) 323-6 20

1. 32.

3. 4.

102

16

0.96 Cronbach 0.86-0.91

( )

( )

13(1 )

(5 )0.98

( )

( ) Strumpf Evans(1988)(perceptions of restraint use questionnaire; PRUQ)

150.94 Likert 5 5

1

( )15

1 00.91

(IRB No: 098-10) (pilot study)

0.97

15-20

17

SPSS 17.0

t

180 16893% 168

31 64.3%

35.7% 3 74.4%N2 44.6.%

(79.8%)1

( 92.9%)(41.7%) (36.3%) 38.1% 24

29.3% 3

2 3

4

15 11.45+1.488

7 15

5

102

18

1 (N=168)

+

168 100

31.41+ 6.30

102 60.7 66 39.3

82 48.8 86 51.2

57 33.9 111 66.1

8 4.8 160 95.2

108 64.3 60 35.7

3 43 25.6 3+-5 28 16.7 5+-10 51 30.3 10+ 46 27.4

N- N1 49 29.2 N2 75 44.6 N3-N4 44 26.2

93 55.4 75 44.6

134 79.8 34 20.2

6

t

19

2 (N=168)

3.40 + 0.783 (65 ) 3.47 + 0.811

(ADL 60) 3.43 + 0.989 (MMSE 10 ) 3.53 + 0.960

3.05 + 1.126 3.46 + 1.002

3.52 + 0.985 2.98 + 1.161

/ 3.07 + 1.171 4.42 + 0.696 1

4.09 + 0.895 2 4.00 + 0.954 3

3.64 + 1.090

3 (N=168)

156 92.9 12 7.1

70 41.7 37 22.0 61 36.3

<8 69 41.1 9-24 35 20.8 >24 64 38.1

1 0.6

159 94.7 8 4.7

3 1.8

143 85.1 22 13.1

7

( / )

102

20

4 (N=168) +

3.57 + 0.543 58.9 2 3.56 + 0.555 58.9 2

3.57 + 0.564 60.7 1 2.76 + 0.776 13.7

3.20 + 0.595 29.2 2.45 + 0.787 9.5

2.40 + 0.891 10.1 3.17 + 0.701 32.1

2.39 + 0.895 11.3 1.98 + 0.844 4.8

2.15 + 0.852 6.0 2.59 + 0.821 10.7

3.30 + 0.617 37.5 2.56 + 0.772 7.1

( ) 2.44 + 0.764 5.4

5 (N=168)

1 161 95.8 3

2 160 95.2

3 162 96.4 2 4

91 59.2 13

5

131 78.0

6 4~5 125 74.4 7 167 99.4 1

8 40 23.8 15

9

152 91.5

10 2 125 74.4

11 1 111 66.1

12 2 30~40 150 89.3 13 48

136 81.0

14 57 33.9 14 15

157 93.5

+ ( ) 11.45+1.488 (7-15)

21

6 (N=168)

+ Fa/ tb + Fa/ tb

-.725b 1.531 b

92.9 42.19+6.37 11.40+1.49 7.1 40.83+4.15 12.08+1.31

.223a .438a 41.7 42.01+5.94 11.57+1.31 22.0 41.62+4.91 11.43+1.70

36.3 42.48+7.28 11.33+1.54

3.459a* 2.190a

<8 41.1 41.67+5.34 11.71+ 1.43 9-24 20.8 40.29+5.76 11.09+1.40 >24 38.1 43.55+7.10 11.23+1.95

Fa= tb = t *p< .05

7 (N=168)

+ Fa/tb/rC + Fa/tb/rC (M+SD) 31.39+6.28 42.10+6024 -.189C* 11.40+1.65 .164C* .816b 3.16b

60.7 42.41+5.40 11.43+1.73 39.3 41.61+7.38 11.35+1.54

-1.559b 1.619b 48.8 41.33+6.34 11.61+1.698 51.2 42.83+6.09 11.20+ 1.60 -.011b -.464b

33.9 42.09+5.66 11.32+1.89 66.1 42.10+6.55 11.44+1.53

.014b .395b 4.8 42.13+6.53 11.63+1.50 95.2 42.09+6.25 11.39+1.60

.423b -.284b 35.7 42.35+ 5.23 11.35+1.59 64.3 41.95+ 6.76 11.43+1.69

1.638a 1.366a 3 25.6 42.86+4.95 11.70+1.28 3+-5 16.7 42.68+6.90 10.96+ 1.91 5+-10 30.3 42.69+6.41 11.53+1.44 10+ 27.4 40.37+6.58 11.24+1.96

1.321a .310a N- N1 29.2 43.08+4.94 11.55+ 1.22 N2 44.6 42.11+ 7.37 11.36+1.73 N3-N4 26.2 40.98+5.31 11.30+1.93

1.424b -.1.039b 55.4 42.71+ 6.42 11.28+1.44 44.6 41.33+ 5.97 11.55+1.88

.991b .065b 79.8 42.34+6.20 11.40+1.76 20.2 41.15+6.39 11.38+1.15

102

22

: Fa= tb = t rC= *p< .05

8

8 (N=168)

2 p 2 p 2 p

1.966 .220 4.492 .106 .117 .943 9.500* .002 5.645 .059 12.618* .002 1.489 .225 .197 .906 1.578 .454

.646 1.000 .470 .791 4.901 .086 .199 .757 7.584* .023 9.941* .007

2.661 .447 17.594* .007 5.602 .469 11.042* .004 7.391 .117 3.600 .463 11.892* .003 8.604 .072 17.612* .001 1.135 .463 5.155 .076 11.965* .003

2: *p< .05

Evans FitzGerald(2002) 13

(2010)(2006) Hofso Coyer(2007)

23

Minnick(2001) 12-43%(2006)

13-24% (2004) 70-80%Ortiz-Pruitt(1995)Koczy (2005) Hurlock-Chorostecki

Kielb(2006)

3 N2N2

Krüger Mayer Haastert Meyer(2013)

(2001)

( 58.3%)Kandeel(2013)

3

8

3

102

24

25

(2004) ICU1-19

(2005)

(2002)1(2) 24-30

(2010)27(2) 161-170

(2011)5(5) 44-53

(2006)23(3) 319-328

(2006)8 1-11

(2004)7(4) 399-408

(2006) 17(4) 399-407

(2004)5(2) 48-54

(2006) 1(1) 63-68 (2003)

2(2) 32-41 (2001)

9(2) 183-193 (2009) 8(6)

77-86 (2004)

15(3) 248-257 (2006) 10(1) 105-114

Agens, J. E. (2010). Chemical and physical restraint use in older person. British Journal for Medical Practitioners, 3(1), 302.

Benbenbishty, J., Adam, S., Endacott, R. (2010). Physical restraint use in intensive care units across Europe: The PRICE study. Intensive and critical Care Nursing, 26(5), 241-245.

102

26

Hantikainen, V.,& Käppeli, S. (2000). Using restraint with nursing home residents: A qualitative study of nursing staff perceptions and decision-making. Journal of Advanced Nursing, 32, 1196-1205.

Hofso, K., & Coyer, F. M. (2007). Part 1. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: Contributing factors. Intensive and Critical Care Nursing, 23(5), 249-255.

Huizing,A.R., Hamers, J.P.,Gulpers, M.J., & Berger, M.P., (2009). A cluster-randomized trial of an educational intervention to reduce the use of physical restraints with psychogeriatric nursing home residents. Journal of the American Geriatric Society, 57(7), 1139-1148.

Hurlock-Chorostecki, C., & Kielb, C. (2006). Knot-So-Fast: A learning plan to minimize patient restraint in critical care. Dynamics, 17(3), 12-18.

Kandeel, N. A. (2013). Physical restraints practice in adult intensive care units in Egypt. Nursing and Health Sciences, 15, 79-85.

Koczy, P., Klie, T., Kron, M., Bredthauer, D., Rissmann, U., Branitzki, S., et al. (2005). Effectiveness of a multi-factorial intervention to reduce physicalrestraints in nursing home resident s with dement ia . Zeitschriftfur Gerontologie und Geriatrie, 38(1), 33-39.

Krüger, C., Mayer, H., Haastert, B., & Meyer, G. (2013). Use of physical restraints in acute hospitals in Germany: A multi-center cross-sectional study. International Journal of Nursing Studies, 50, 8-17

Lane, C., & Harrington, A. (2011). The factors that influence nurses’ use of physical restraints: a thematic literature review. International Journal of Nursing Practice, 17(2), 195-204.

Liukkonen, A., & Laitinen, P. (1994). Reasons for uses of physical restraint and alternatives to them in geriatric nursing: A questionnaire study among nursing staff. Journal of Advanced Nursing,19(6), 1082-1087.

Minnick, A., Leipzig, R.M. & Johnson M.E. (2001). Elderly patients' reports of physical restraint experiences in intensive care units. American Journal of Critical Care, 10(3), 168-171.

Minnick, A. F., Mion, L. C., Johnson, M. E., Catrambone, C., & Leipzig, R. (2007). Prevalence and variation of physical restraint use in acute care settings in the US. Journal of Nursing Scholarship, 39(1), 30-37.

Oriez-Pruitt, J. (1995). Physical restraint of critically ill patients. Critical Care Nursing Clinics of North America, 7(2), 363-373.

Sokol, D. F. (010). When is restraint appropriate? British Medical Journal, 341, c4147.

Strumpt, N.E., & Evans, L.K. (1998). Physical restraint of the hospitalized elderly:

27

Perceptions of patients and nurses. Nursing Research, 37(3), 132-137. Watson, B., & Mibiol, C.(2001). Restraint: its use and misuse in the care of older

people. Nursing Older People, 13(3), 21-25.

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28

Nurses’ Use of Physical Restraints on Patients

in Medical and Surgical Units

Chieh-Chun Kao , Pei-Chi Hsieh , Hsiao-Chun Yeh , Yueh-Pei Tseng

Abstract

This study examined the reasons of nurses’ using physical restraints on patients in medical and surgical units and the factors influencing such use. A cross-sectional design was employed. Purposive sampling was used to determine potential subjects. One hundred and sixty-eight registered nurses from the medical-surgical wards and intensive care units of four teaching hospitals in the metropolitan Taipei area participated in the study. Data was collected by well-trained research assistants, and the research tools included the nurse and patient demographic data, a survey of restraint use, perceptions regarding restraints, and knowledge of restraints. Descriptive statistics, the chi-square test, the independent t-test, the Pearson correlation test, and the one-way ANOVA were used to analyze all the obtained data. The data indicated that over 90% of nurses have used restraints on patients within the past two years. To prevent or minimize harm was the main reason for using physical restraints. Wrist and glove restraints were the preferred choices of nurses, and restraints were the most frequently used during the daytime, with less usage at night. The lengths of time for which nurses restrained their patients and nurses’ perceptions of the need for restraints showed significant differences. Findings can not only be viewed as data to assist in shaping educational training programs for patient safety, but can also serve as references for nursing professionals in providing “restraint-free” interventions in medical and surgical care settings in the future. Key words: medical and surgical ward, intensive care unit, physical restraint, patient

safety.

Instructor, Department of Nursing, Ching Kuo Institute of Management and Health

RN, MSN, Doctoral Candidate, School of Nursing, Yang-Ming University Instructor, Dept. Nursing,, Meiho University.

Supervisor, Department of Nursing, Keelung Hospital, Ministry of Health and Welfare