الفهرس 
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Abstract
Summary
Physical restraint is the procedure that restricting patient’s freedom of movement, physical activity, or normal access to his/her body by the use of any physical or mechanical tools and devices attached to the patient’s body. It is commonly used in hospitals especially in ICU settings when patients’ are confused, physically harmful to themselves and others, and when the alternative methods are inadequate or contraindicated (Kavumpurath et al., 2023).
However, the use of PR has been clearly associated with physical and mental complications for patient as edema, bruising, pressure ulcer, and death. Emotional complications include fear, depression, and loss of dignity. Besides patients, nurses may also experience emotional, ethical, and mental problems and face negative feelings such as sadness, guilt, and pity due to PR use (Salehi et al., 2021).
Aim of the study:
This study aimed to assess the relationship between physical restraints and physiological parameters among critically ill patients, through:
1. Assessment of nurse’s knowledge regarding physical restraint.
2. Assessment of patient’s physiological parameters related to physical restraint.
Research Question:
Is there a relationship between physical restraints and physiological parameters among critically ill patients?
Research design:
A descriptive design will be used to conduct this study.
Setting:
The study was conducted in four ICUs (neurological, anesthesia, medical and respiratory) affiliated to Tanta University Hospitals.
Subject:
1. A convenience sample of all available nurses (50 nurses) working in ICUs at Tanta University Hospital.
2. A purposive sample of 100 patients underwent physical restraint in ICUs at Tanta University Hospital.
Inclusion criteria:
• Criteria for inclusion included:
1. All adult patients with agitation, disturbed conscious level (GCS 8-12) and connected to mechanical ventilation from both genders.
2. Patients need physical restraint for the first time.
Tools for data collection:
The data was collected through the following tools:
І: Nurse’s self- administered questionnaire:
This tool aimed to assess nurse’s personal data and knowledge related to physical restrain. It was developed by the researcher in Arabic language after reviewing the most relevant and recent literature (Woldekirkos et al., 2021; Salehi et al., 2021). This tool was divided into two parts:
Part І: Nurse’s personal characteristics as age, sex, educational level, years of experience and previous training courses.
Part П: Nurses’ knowledge regarding physical restraint as definition of physical restraint, indication for use of physical restraint, types of physical restraint, standards of use of physical restraint, alternatives to physical restraint, complications of physical restraint, precautions and nursing care needed for patient with physical restraint.
П: Patient’s clinical data:
This tool aimed to assess patient’s clinical data. It was developed by the researcher in English language after reviewing most the relevant and recent literatures (Anderson & Bladerston, 2017). This tool was divided into four parts:
Part І: Patient’s characteristics form, as age, sex, diagnosis, past medical history, allergy history, indication for physical restraints, types and time of Physical restraint released, duration of physical restraint, types of material used for physical restraint.
Part П: Patient’s physiological parameters as vital signs, capillary refill, ABG, hydration, skin condition and elimination.
Part Ш: Critical Care Pain Observation Tool (CPOT): This standardized tool adopted from (Nazari et al., 2022) to assess patient’s pain response.
Ш: Sedation - Agitation Scale (SAS) standardized adopted scale contained 7 items to assess anxiety and agitation level among patients undergoing physical restraint (Urden et al., 2019).
Results:
The main results of the study revealed that:
1- More than half (54%) of studied nurses their age ranged between (30-<40) years and were male. Concerning level of education 46% had bachelor’s degree of nursing. About workplace, 30% of studied nurses worked at chest ICU. Also, none of nurses had previous training regarding physical restraint. 40% of studied nurses had (5-<10) years’ experience in ICU.
2- Less than two fifths (34%) of studied nurses had a satisfactory knowledge level regarding physical restraint and (66%) of them had unsatisfactory knowledge.
3- There were a statistically significant relation between studied nurses’ knowledge and their age, gender and years of experience in ICU (P<0.05).
4- There were no statistically significant relation between nurses’ knowledge and their level of education and workplace (P>0.05).
5- More than two fifths (42%) of studied patient were less than 60 years age and 54% of them were male. About 30% of patients admitted at neurological ICU and medical ICU. Also, 51% of them stay at ICU less than one month.
6- Less than half (48%) of patients were unconscious and used wrist restraint type. About 40%, 74% and 63% respectively their physical restraint is released every 2hrs, duration of physical restraint depend on patient’s condition and Gauze and dressing were used for physical restraint.
7- There was a highly statistically significant difference regarding patients’ vital signs and circulation between, before, during and after physical restraint with (p=<0.01).
8- There was a highly statistically significant difference regarding patients’ ABG and hydration between, before, during and after physical restraint with (p=<0.01).
9- There was a highly statistically significant difference between before, during and after physical restraint regarding skin parameter an elimination with (p<0.01).
10- There was a statistically significant difference regarding facial expression and muscle tension with p-value <0.05, and there was no statistically significant difference concerning body movement and compliance with ventilator with p-value >0.05 between before, during, and after PR.
11- There was a statistically significant difference between before, during, and after regarding agitation with (p= <0.01).
12- There was a positive correlation between the total scores of the patient’s physiological parameters and total score of physical restraint (before, during and after).
Conclusion:
Based on the results of the present study and research question, the study concluded that:
Two thirds of the studied nurses had unsatisfactory knowledge regarding physical restraint. Concerning physiological parameters related to physical restraint, the result of the current study revealed that there was a highly statistically significant difference regarding patients’ vital signs, circulation, ABG, hydration, skin and elimination between before, during and after physical restraint.
Also there was a statistically significant difference regarding pain before, during and after physical restraint. Regarding agitation level before, during and after physical restraint the present study result displayed that there were a statistically significant difference before, during, and after physical restraint. Furthermore, there was a positive correlation between total scores of the patient’s physiological parameters and total score of physical restraint (before, during and after).
Recommendations
Based on the results of the present study the following recommendations are suggested:
• Reduce the use of physical restraint as the latest possible solution to control restless patient and create an environment free from physical restraints.
• Proper planning is conducted for reducing the use of physical restraints and its complications through increasing the knowledge and attitude of nurses in the area of physical restraint of patients and related affective factors.
• In-service training programs based on best practice guidelines for nurses working in ICU to improve nurses’ practice regarding use of physical restraint and emphasizing the importance of procedure.
• Develop appropriate protocols and instruments based on the best scientific evidence to assist the multidisciplinary team in evaluating the patient regarding the use of physical restraint.
• Replicate the study by increasing the size of the sample