[article] | Title : | Psychiatric nurses's attitude and practice toweard physical restraint | | Material Type: | printed text | | Authors: | Mahmoud, Amal Sobhy, Author | | Publication Date: | 2017 | | Article on page: | p.8-12 | | Languages : | English (eng) Original Language : English (eng) |
in Archives of Psychiatric Nursing > Vol.31 No.1 (Feb) 2017 [07/20/2017] . - p.8-12| Keywords: | Psychiatric nurses.Nurses's attitude.Physical restraint. | | Abstract: | Aim
This study was to assess psychiatric nurses' attitude and practice toward physical restraint among mentally ill patients.
Methods
A descriptive research design was used to achieve the study objective. The present study was carried out in three specialized governmental mental hospitals and two psychiatric wards in general hospital. A convenient purposive sample of 96 nurses who were working in the previously mentioned setting was included. The tool used for data collection was the Self-Administered Structured Questionnaire; it included three parts: The first comprised items concerned with demographic characteristics of the nurses, the second comprised 10 item measuring nurses' attitudes toward physical restraint, and the third was used to assess nurses' practices regarding use of physical restraint.
Results
There were insignificant differences between attitudes and practices in relation to nurses' sex, level of education, years of experience and work place. Moreover, a positive significant correlation was found between nurses' total attitude scores, and practices regarding use of physical restraint.
Conclusion
Psychiatric nurses have positive attitude and adequate practice toward using physical restraints as an alternative management for psychiatric patients. It is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. The study recommended that it is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort.
In psychiatric hospitals, patients' violence and threats of violence constitute serious emergencies that may be difficult to handle by staff. Physical restraints (PRs) refer to any physical methods of restricting a person's freedom of movement, physical activity or normal access to his or her body (Martin, 2002). Moreover it is used in psychiatric health care settings as one of the psychiatric managements to reduce the risk of harm among psychiatric patients whether it is directed toward self or toward others (Gelkopt Roffe, Behrbak, Melamed, Werbloff et al., 2009). The use of PR as an intervention in the care of psychiatric patients goes back to the beginning of the science of psychiatry. However, it is still one of the challenging questions in the psychiatric services and has always been considered as a moral argument (Iversen, 2009, Steinert et al., 2010). Physical restraint includes devices designed to limit a patient's physical movements such as limb holders, safety vests and bandages. It is used to handle violent and maladaptive behaviors, manage patients with severe mental disorders, prevent injury and reduce agitation and aggression (Akansel, 2007, Capezuti, 2004, Chien et al., 2005).
Nurses are closely involved in caring for restrained patients. The common absence of medical orders for starting or removing physical restraints indicates that the nurses mostly make these decisions. Their roles start with the selection of the least restricting arm restraint device available, followed by ones responsible and ending with modifying the patient care plan based on an hourly assessment of the patient's response and physical condition (De Jonghe et al., 2013).
Several attempts have been made to reduce the integration of restraints in the clinical practice, as most studies used educational approaches in order to encourage nurses to use alternative measures instead of physical restraint. All studies delivered intensive training sessions and introduced a nurse specialist as a consultant; however, the success rate of these interventions in different countries has been variable; for example a successful educational intervention applied on nurses working in the USA proved to be ineffective in The Netherlands (Becker et al., 2007, Capezuti et al., 2007, Huizing et al., 2006).
In general, research findings revealed that patients as a result of being restrained reported that they felt angry, helpless, sad, and powerless, punished, embarrassed, and that their right to autonomy and privacy has been violated, in addition to a feeling of loss of self worth, degradation, demoralization and humiliation while they are restrained (Elgamal, 2006, The American Psychiatric Nurses Association, 2001, The JOANNA Briggs Institute, 2002). Most of the patients' subjective experiences highlight the negative impact of physical restraint on the patients. These experiences were summarized in two themes: restriction and discomfort. Restriction relates to loss of freedom and control over what is happening during hospitalization, while discomfort is caused by enforced immobility, i.e. from patient narrative comment:“I felt like a dog and cried all night, it hurts me to have to be tied up, and I'm in a jail stuck, I couldn't even bring my hands together” (Sailas and Wahlbeck, 2005;;Suen et al., 2006).
A study about psychiatric staff's thoughts and feelings about restraint use, found that the risk of harm and the use of restraint conflicted with nurses' role to protect. Nurses did not want to use restraints as a first option (Aschen, 1995, Hantikainen and Ka¨ppeli, 2000, Hennessy et al., 1997, Karlsson, 2000). In most of the studies the nursing staff reported a range of emotional reaction felt while doing restraint procedure, including anxiety, anger, feeling bored or distressed, crying, inadequacy, hopelessness, frustration, fear, guilt, dissatisfaction, isolation, being overwhelmed, feeling drained, vengeance and repugnance (Kamel, Maximos, & Gaafar, 2007).
In another study the nursing staff described how they had come hardened to the experience of restraint. Some of them reported that they had no emotional reaction and many reported automatic responding during restraint event in which they did not feel any emotion. This lack of feeling among nurses might be due to the fact that the practice had become so ritualized that it does not provoke any reaction (Sequeira & Halstead, 2004). Nurses' attitudes toward physical restraints described as ambivalent, characterized by respect for a person's dignity and by anxiety and the responsibility for the resident's safety. Nurses described feelings of frustration and guilt when they used physical restraints against the will of a resident (Hantikainen and Ka¨ppeli, 2000, Karlsson, 2000).
Attitudes toward physical restraint can affect on nurses' performance and behavior, especially psychiatric patients who already confronting and discrimination, which may express also by professionals and the general public (Emrich, Thomson, & Moore, 2003). Getting in touch with psychiatric patients and getting knowledge can help in replacing the myths with facts, decreasing stigma and affecting attitudes positively (Halters, 2004).
Physical restraints are a common practice in psychiatric hospitals, with prevalence rates ranging between 33% and 68% in hospital settings (Hamers & Huizing, 2005). Since nurses' attitude and practice play an important role in psychiatric health care setting, it was deemed important to develop a restraint policy and educate nurses how to implement it because hospitals in Sudan do not have policies and there are illegal uses of restraint recorded. | | Link for e-copy: | http://www.psychiatricnursing.org/ | | Record link: | http://libsearch.siu.ac.th/siu/opac_css/index.php?lvl=notice_display&id=27070 |
[article] Psychiatric nurses's attitude and practice toweard physical restraint [printed text] / Mahmoud, Amal Sobhy, Author . - 2017 . - p.8-12. Languages : English ( eng) Original Language : English ( eng)
in Archives of Psychiatric Nursing > Vol.31 No.1 (Feb) 2017 [07/20/2017] . - p.8-12| Keywords: | Psychiatric nurses.Nurses's attitude.Physical restraint. | | Abstract: | Aim
This study was to assess psychiatric nurses' attitude and practice toward physical restraint among mentally ill patients.
Methods
A descriptive research design was used to achieve the study objective. The present study was carried out in three specialized governmental mental hospitals and two psychiatric wards in general hospital. A convenient purposive sample of 96 nurses who were working in the previously mentioned setting was included. The tool used for data collection was the Self-Administered Structured Questionnaire; it included three parts: The first comprised items concerned with demographic characteristics of the nurses, the second comprised 10 item measuring nurses' attitudes toward physical restraint, and the third was used to assess nurses' practices regarding use of physical restraint.
Results
There were insignificant differences between attitudes and practices in relation to nurses' sex, level of education, years of experience and work place. Moreover, a positive significant correlation was found between nurses' total attitude scores, and practices regarding use of physical restraint.
Conclusion
Psychiatric nurses have positive attitude and adequate practice toward using physical restraints as an alternative management for psychiatric patients. It is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. The study recommended that it is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort.
In psychiatric hospitals, patients' violence and threats of violence constitute serious emergencies that may be difficult to handle by staff. Physical restraints (PRs) refer to any physical methods of restricting a person's freedom of movement, physical activity or normal access to his or her body (Martin, 2002). Moreover it is used in psychiatric health care settings as one of the psychiatric managements to reduce the risk of harm among psychiatric patients whether it is directed toward self or toward others (Gelkopt Roffe, Behrbak, Melamed, Werbloff et al., 2009). The use of PR as an intervention in the care of psychiatric patients goes back to the beginning of the science of psychiatry. However, it is still one of the challenging questions in the psychiatric services and has always been considered as a moral argument (Iversen, 2009, Steinert et al., 2010). Physical restraint includes devices designed to limit a patient's physical movements such as limb holders, safety vests and bandages. It is used to handle violent and maladaptive behaviors, manage patients with severe mental disorders, prevent injury and reduce agitation and aggression (Akansel, 2007, Capezuti, 2004, Chien et al., 2005).
Nurses are closely involved in caring for restrained patients. The common absence of medical orders for starting or removing physical restraints indicates that the nurses mostly make these decisions. Their roles start with the selection of the least restricting arm restraint device available, followed by ones responsible and ending with modifying the patient care plan based on an hourly assessment of the patient's response and physical condition (De Jonghe et al., 2013).
Several attempts have been made to reduce the integration of restraints in the clinical practice, as most studies used educational approaches in order to encourage nurses to use alternative measures instead of physical restraint. All studies delivered intensive training sessions and introduced a nurse specialist as a consultant; however, the success rate of these interventions in different countries has been variable; for example a successful educational intervention applied on nurses working in the USA proved to be ineffective in The Netherlands (Becker et al., 2007, Capezuti et al., 2007, Huizing et al., 2006).
In general, research findings revealed that patients as a result of being restrained reported that they felt angry, helpless, sad, and powerless, punished, embarrassed, and that their right to autonomy and privacy has been violated, in addition to a feeling of loss of self worth, degradation, demoralization and humiliation while they are restrained (Elgamal, 2006, The American Psychiatric Nurses Association, 2001, The JOANNA Briggs Institute, 2002). Most of the patients' subjective experiences highlight the negative impact of physical restraint on the patients. These experiences were summarized in two themes: restriction and discomfort. Restriction relates to loss of freedom and control over what is happening during hospitalization, while discomfort is caused by enforced immobility, i.e. from patient narrative comment:“I felt like a dog and cried all night, it hurts me to have to be tied up, and I'm in a jail stuck, I couldn't even bring my hands together” (Sailas and Wahlbeck, 2005;;Suen et al., 2006).
A study about psychiatric staff's thoughts and feelings about restraint use, found that the risk of harm and the use of restraint conflicted with nurses' role to protect. Nurses did not want to use restraints as a first option (Aschen, 1995, Hantikainen and Ka¨ppeli, 2000, Hennessy et al., 1997, Karlsson, 2000). In most of the studies the nursing staff reported a range of emotional reaction felt while doing restraint procedure, including anxiety, anger, feeling bored or distressed, crying, inadequacy, hopelessness, frustration, fear, guilt, dissatisfaction, isolation, being overwhelmed, feeling drained, vengeance and repugnance (Kamel, Maximos, & Gaafar, 2007).
In another study the nursing staff described how they had come hardened to the experience of restraint. Some of them reported that they had no emotional reaction and many reported automatic responding during restraint event in which they did not feel any emotion. This lack of feeling among nurses might be due to the fact that the practice had become so ritualized that it does not provoke any reaction (Sequeira & Halstead, 2004). Nurses' attitudes toward physical restraints described as ambivalent, characterized by respect for a person's dignity and by anxiety and the responsibility for the resident's safety. Nurses described feelings of frustration and guilt when they used physical restraints against the will of a resident (Hantikainen and Ka¨ppeli, 2000, Karlsson, 2000).
Attitudes toward physical restraint can affect on nurses' performance and behavior, especially psychiatric patients who already confronting and discrimination, which may express also by professionals and the general public (Emrich, Thomson, & Moore, 2003). Getting in touch with psychiatric patients and getting knowledge can help in replacing the myths with facts, decreasing stigma and affecting attitudes positively (Halters, 2004).
Physical restraints are a common practice in psychiatric hospitals, with prevalence rates ranging between 33% and 68% in hospital settings (Hamers & Huizing, 2005). Since nurses' attitude and practice play an important role in psychiatric health care setting, it was deemed important to develop a restraint policy and educate nurses how to implement it because hospitals in Sudan do not have policies and there are illegal uses of restraint recorded. | | Link for e-copy: | http://www.psychiatricnursing.org/ | | Record link: | http://libsearch.siu.ac.th/siu/opac_css/index.php?lvl=notice_display&id=27070 |
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