The Effects of Continuing Education in Restraint Reduction on Novice Nurses in Intensive Care Units

Abstract

A decrease in the use of physical restraints in Intensive Care Units (ICUs) is an important indicator of quality of nursing care. This quasi-experimental study examined the effect on nurses of a session of continuing education aimed at reducing the use of restraints. At a medical center in southern Taiwan, 37 novice nurses were surveyed about their knowledge, perception, attitude and clinical practice of restraint use in 11 ICUs. Two instructors then taught a four-hour continuing education class on patient restraint standards, principles for reducing physical restraint use, and alternatives to restraining. Data were analyzed by paired t-test and the results of identical structured questionnaires which participants received before and after the lecture, showed that, afterwards, knowledge (t = -6.04, p < .01), perception (t = 4.76, p < .01), and attitude (t = 3.93, p < .01) toward restraint use had significantly improved . The continuing education improved the nurses' knowledge and attitude toward restraint use and may therefore enhance the quality of care provided to ICU patients.

Nurses’ Attitudes, Clinical Experience, and Practice Issues With Use of Physical Restraints in Critical Care Units

“…17,18 Although this instrument has not been widely used, it is the only instrument written in English currently available to assess attitudes and nursing practice issues related to physical restraint use. Suen 15,17,18 In this study, the reliability for the Nursing Practice Issues with Physical Restraint Use subscale was modest (Cronbach α = 0.56). The reliability for the Attitudes Toward Physical Restraint Use subscale was higher (Cronbach α = 0.78).…”

“…2,7,[11][12][13][14][15] The findings of this study show that continued research in this area is needed to explore possible relationships.…”

“…16 It has subsequently been administered to nurses working in other health care settings where physical restraints are used, including critical care units. 15,17 Although the entire instrument contains 4 subscales, 2 subscales of the Physical Restraint Questionnaire were used in the current study: Subscale 3, Nursing Practice Issues and Subscale 4, Attitudes Toward Physical Restraint Use. The Nursing Practice Issues subscale has 17 items, each with 3 answer choices-always, sometimes, and never.…”

“…14 In looking at various factors that can influence this decision, no consensus is apparent in the research findings to support a relationship between staffing, experience level, education level, nurses' attitudes toward use of physical restraints, and practice issues related to use of physical restraints (ie, nurses' actions while caring for patients who are restrained). 7,14,15 …”

Educational Strategies to Promote Use of Evidence-Based Practices

“…Active dissemination is needed [30]. Continuing education has been successful in increasing participant knowledge and attitude [42][43][44], but continuing education for health care practitioners has not always been effective at leading to changes in practice behaviors or improving patient outcomes [42,43,45,46]. Educational efforts to promote evidence-based practice changes must impact practitioner knowledge, attitude, and behavior to move them through the learning process toward adoption of the practice change and finally improving patient outcomes.…”