Difference of Physical Restraint Knowledge, Attitudes and Practice Between Nurses and Nursing Assistants in Long-Term Care Facilities: A Cross-Sectional Study

Abstract

Background: Physical restraint (PR) is widespread use among older adults in long-term care (LTC) facilities, which has negative effects on older adults' health and quality of care. Considering that research on PR use in Chinese LTC facilities is rare, assessment of nursing staff's knowledge, attitude, and practice (KAP) is a prerequisite before minimized PR program and staff training project development.Purpose: This study aimed at determining the differentiation of levels and factors of KAP toward PR use between nurses and nursing assistants in LTC facilities. Methods: A cross-sectional study was conducted in six Chinese LTC facilities from November to December in 2019 and May to June in 2020. A total of 316 nursing staff, comprising 69 nurses and 247 nursing assistants were investigated using the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR. One-way analysis of variance, chi-squared test, Welch test, the Mann-Whitney U-test, and multiple linear regression were performed for data analysis. Results: Mean scores of overall knowledge, attitude, and practice were 5.90±2.27, 31.97±3.01, 30.89±4.82, respectively. PR knowledge and practice of nurses were significantly higher than that of nursing assistants (all P<0.001), whereas PR attitude with no significant difference (P=0.084). In-school training, in-job training, and knowledge on PR significantly affected PR practice of nurses and nursing assistants. Further, nursing assistants' practice was also significantly predicted by education (β=0.131, P=0.019), age (β= −0.140, P=0.034), monthly income (β=−0.184, P=0.002), and attitude (β=0.130, P=0.030). In-job training (β=0.283, P<0.001), age (β= −0.164, P=0.021), and knowledge (β=0.292, P<0.001) significantly affected nursing assistants' attitude, while their knowledge was influenced by monthly income (β=0.153, P=0.019) and work years in LTC (β=0.343, P<0.001). Conclusion: Specific knowledge deficits, negative fields of attitude, and practice were dissimilar between nurses and nursing assistants. The targeted and stratified PR education approaches were suggested to prompt their KAP.

Effects and implementation of a minimized physical restraint program for older adults in nursing homes: A pilot study

“…Supplementary Appendix 5 presents the components of the intervention. A previous study reported that knowledge deficits and evidence-based education insufficiency were the main barriers to reducing PR use in this study's location (28). Thus, an educational program regarding the content of the minimized PR program was conducted for nursing assistants one-month period before the implementation of the…”

“…Due to these deficiencies, it remains unclear whether educational or multi-component interventions are effective and feasible for older adults in Chinese nursing homes. Previously, we have identified the incidence of and risk factors for PR ( 27 ), nursing staff's knowledge, attitudes, and practice (KAP) ( 28 ). Findings revealed the lack of practical norms of restraints in long-term care and staff's knowledge deficits and training needs.…”

Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study

“…Using qualitative approaches, negative feelings were expressed, while surveys with standardised questionnaires indicated a slightly favourable attitude of nursing staff towards restraint use. Furthermore, it was reported that attitudes have hardly changed in the past decades [ 17 , 18 , 19 ]. In the mental health care field, it was found that attitudes have tended to become slightly more critical over the past decades, although the change in attitude was not highly pronounced [ 9 ].…”