Effectiveness of An Educational program on Critical Care Nurses` Performance and Patients Outcomes Regarding Physical Restraint

Background: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice. Aim: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. Research design: A belief elicitation study was conducted. Participants and research context: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. Ethical considerations: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. Findings: Nurses framed the use of restraints as a way of prioritising patients’ physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients’ relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients’ medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. Discussion: Safety arguments based on the surrounding work environment were discussed. Conclusion: Nurses’ behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives’ involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

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The challenges of using physical restraint in intensive care units in Iran: A qualitative study

Journal of the Intensive Care Society ◽

10.1177/1751143719892785 ◽

2020 ◽

pp. 175114371989278

Author(s):

Zahra Salehi ◽

Soodabeh Joolaee ◽

Fatemeh Hajibabaee ◽

Tahereh Najafi Ghezeljeh

Keyword(s):

Critical Care ◽

Intensive Care ◽

Qualitative Study ◽

Intensive Care Units ◽

Physical Restraint ◽

Critical Care Nurses ◽

Structured Interviews ◽

Standard Equipment ◽

Restraint Use ◽

Ensure Patient Safety

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

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Factors behind ethical dilemmas regarding physical restraint for critical care nurses

Nursing Ethics ◽

10.1177/0969733019858711 ◽

2019 ◽

Vol 27 (2) ◽

pp. 598-608 ◽

Cited By ~ 2

Author(s):

Zahra Salehi ◽

Tahereh Najafi Ghezeljeh ◽

Fatemeh Hajibabaee ◽

Soodabeh Joolaee

Keyword(s):

Critical Care ◽

Patient Safety ◽

Content Analysis ◽

Intensive Care ◽

Ethical Dilemmas ◽

Physical Restraint ◽

Critical Care Nurses ◽

Legal Problems ◽

Restraint Use ◽

Conventional Content Analysis

Background: Physical restraint is among the commonly used methods for ensuring patient safety in intensive care units. However, nurses usually experience ethical dilemmas over using physical restraint because they need to weigh patient autonomy against patient safety. Aim: The aim of this study was to explore factors behind ethical dilemmas for critical care nurses over using physical restraint for patients. Design: This is a qualitative study using conventional content analysis approach, as suggested by Graneheim and Lundman, to analyze the data. Methods: Seventeen critical care nurses were purposefully recruited from the four intensive care units in Tehran, Iran. Data were collected through in-depth semi-structured interviews and were concurrently analyzed through conventional content analysis as suggested by Graneheim and Lundman. Ethical consideration: This study was approved by the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran with the code: IR.IUMS.REC.1397.795. Before interviews, participants were provided with explanations about the aim of the study, the confidentiality of the data, their freedom to participate, and the right to withdraw the study, and their free access to the study findings. Finally, their consents were obtained, and interviews were started. Results: Factors behind ethical dilemmas for critical care nurses over using physical restraint were categorized into three main categories, namely the outcomes of using physical restraint, the outcomes of not using physical restraint, and emotional distress for nurses. The outcomes of using physical restraint were categorized into the three subcategories of ensuring patient safety, physical damage to patients, and mental damage to the patient. The outcomes of not using physical restraint fell into two subcategories, namely the risks associated with not using physical restraint and legal problems for nurses. Finally, the two subcategories of the emotional distress for nurses main category were nurses’ negative feelings about restraint use and uncertainty over the decision on physical restraint use. Conclusion: Decision-making for restraint use is often associated with ethical dilemmas, because nurses need to weight the outcomes of its use against the outcomes of not using it and also consider patient safety and autonomy. Health authorities are recommended to develop clear evidence-based guidelines for restraint use and develop and implement educational and counseling programs for nurses on the principles of ethical nursing practice, patient rights, physical restraint guidelines and protocols, and management of emotional, ethical, and legal problems associated with physical restraint use.

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Effectiveness of an Educational Program on Critical Care Nurses’ Practices Regarding Endotracheal Suctioning of Adult Patients Who are Mechanically Ventilated in Hospitals at AL-Najaf, Iraq

Indian Journal of Forensic Medicine & Toxicology ◽

10.37506/ijfmt.v14i4.12777 ◽

2020 ◽

Keyword(s):

Critical Care ◽

Educational Program ◽

Critical Care Nurses ◽

Adult Patients ◽

Endotracheal Suctioning ◽

Mechanically Ventilated

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EFFECTIVENESS OF AN EDUCATIONAL PROGRAM ABOUT BIOLOGICAL HAZARD SAFETY MEASURES KNOWLEDGE AMONG CRITICAL CARE NURSES

10.36106/gjra/0410816 ◽

2021 ◽

pp. 98-100

Author(s):

Yasmin Abdalla

Keyword(s):

Critical Care ◽

Personal Protective Equipment ◽

Educational Program ◽

Critical Care Nurses ◽

Public Hospitals ◽

Work Place ◽

Protective Equipment ◽

Safety Measures ◽

Biological Hazard ◽

Nurses Knowledge

Background: communicable and contagious diseases and exposure to blood-borne pathogens make critical care nurses expose to biological work place hazard. The aim of the study was to assess the effectiveness of an educational program on critical care nurses' knowledge about safety measures of biological hazard. Methodology: It was a pre/post interventional, hospital-based study, study subjects were 200 intensive care nurses (34 males 17% and 166 females 83%) working for one year or more in critical care settings (8 units) in ve public hospitals, Khartoum state, Sudan. A structured face to face questionnaire was used pre and posttest. A program done by lectures about biological hazard, causes, and safety measures, sitting group's discussion and direct individual educational sessions, interview was carried with each hospital's matron. Results: Knowledge about biological hazard as work place hazards was 100% in both pre and post results. Regarding preventive measures of biological hazard, participants showed different values in answer like uses of personal protective equipment (PPE) mentioned by 99% in preprogram test while hand washing was mentioned by 49.5% in pretest evaluation, Personal protective equipment was poorly provided. Conclusion: The educational program for critical care nurses had efcient results, as the noticeable improvement of results of critical care nurses' knowledge about universal precautions.

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