• Journal of Digital Convergence
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• v.15 no.12
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• pp.581-590
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• 2017

This study was conducted to investigate the perception of nurse's use of physical restraints. This study is a descriptive research study for 138 nurses who work at the small hospitals under 300 beds. Statistical analysis was performed using descriptive statistics, t-test, ANOVA, and factor analysis using the SPSS statistical program. The results of this study were as follows: The overall average of the nurses' perception of physical restraint was $3.91{\pm}0.54$, and the most important reason for using a physical restraint was to protect the patient from falling out of bed($4.37{\pm}0.68$). The factor analysis showed that 'behavior, psychological symptom management($3.81{\pm}0.67$)', 'maintain medical treatment($4.11{\pm}0.60$)' and 'patient safety($4.13{\pm}0.63$)'. It is necessary to understand the characteristics and factors of nurse's use of physical restraint in small and medium hospitals. Moreover, it is also required to use minimum physical restraints for patient's safeties and rights based on accurate understanding of physical restraint's use. Therefore, it is needed to provide job training for the physical restraint that is used in various situations and to develop education and intervention program to adjust in nurses' situation.

• Journal of Korean Clinical Nursing Research
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• v.18 no.2
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• pp.296-306
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• 2012

Purpose: This study was done to compare the physical injury, emotional response and unplanned self-removal of medical devices in patients with physical restraints and patients not restrained. Methods: Eighty patients admitted to the intensive care unit (ICU) of a university hospital in Seoul participated in this study. Forty patients made up each group and the group not restrained was matched with the restraint group for age and history of smoking and alcohol consumption. Data on occurrence of physical injury, intensity of anxiety, stage of agitation and unplanned self-removal of medical devices were collected by observation and medical chart review using a structured instrument. Statistical processing of collected data was done with the SPSS WIN 17.0 program. Results: The physically restrained group experienced more physical injuries and recorded significantly higher levels of anxiety and agitation than the unrestrained group. However, there were no significant differences between the groups in occurrence of unplanned self-removal of medical devices. Conclusion: Results indicate a need for critical care nurses to carefully monitor physical injuries and emotional responses of physically restrained patients and to develop nursing interventions to prevent adverse effects associated with restraint use. There is also a need to develop patient safety guidelines when using physical restraints.

• Journal of Korean Gerontological Nursing
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• v.21 no.2
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• pp.125-134
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• 2019

Purpose: The purpose of this study was to investigate factors related to use of restraints for older adults with dementia in long-term care settings. Methods: This study analyzed secondary data from the Nationwide Survey on Dementia Care in Korea (NaSDeCK). Demographic characteristics, disease characteristics, and functional characteristics were analyzed. Data were analyzed with χ² test, t-test, ANOVA, and logistic regression analysis. Results: Among participants, 8.2% experienced use of restraints. 'Strap' (78.3%) was the most commonly used restraint and 'Behavioral problem' (51.3%) was a major reason for the restraint. Persons who have low levels of daily activity and cognition deficits, higher levels of dependence, histories of falls within the past 3 months, and living in long-term hospitals have greater probability of restraint experience. Conclusion: Developing interventions for older adults who have a high risk of being restrained is essential to minimize unnecessary restraint use among older adults with dementia in long-term care settings. Further study exploring the interacting roles of organizational and staff factors related to use of physical restraints would provide more comprehensive perspectives in understanding this phenomenon.

• Journal of Korean Academy of Nursing
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• v.38 no.4
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• pp.629-638
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• 2008

Purpose: This was a methodological research to develop an instrument to assess the emotional response of family members of physically restrained patients. Methods: A primary instrument with 68 questions was developed based on literature review and semi-structured interviews with family members. A group of experts revised individual questions and removed 4 irrelevant questions. This secondary instrument, then, was tested with 199 family members of physically restrained patients in intensive care units of a university hospital. The validity and reliability of the instrument were tested by factor analysis. Results: After item analysis, 3 questions with a correlation coefficient under .30 were discarded and the questions with a factor loading under .45 on Varimax Rotation were also removed. After factor analysis on the final 37 questions, 7 factors were identified; avoidance, shock, helplessness, grudge, depression, anxiousness, and acceptance. The total variance explained was 55.63%. The reliability of this instrument was 0.93 of Cronbach's alpha. Conclusion: This instrument was statistically reliable and valid to measure family's emotional response to physical restraints of the patients. This instrument can be useful in assessing the effects of nursing interventions for family members of restrained patients.

• The Korean Journal of Emergency Medical Services
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• v.23 no.1
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• pp.35-48
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• 2019

Purpose: This study aimed to explore the rationality for and countermeasures against the use of prehospital patient restraint (PPR) techniques in efforts to limit violent behavior toward 119 emergency medical technicians (EMTs). Methods: Previous countermeasures to limit violent behavior toward 119 EMTs and medical personnel were focused on strict reactive and passive proactive responses. However, those in support of the countermeasures do not believe that violent and criminal behavior can be limited or extinguished by strengthening the punishment unconditionally. Results: When it comes to the far-reaching effects of stigmatization on people who engage in violent and criminal behavior, it is possible that unconditional punishment leads to more crime, increases the costs of imprisonment, and consequently, adds to the financial burden of the government. Conclusion: Thus, we are faced with an urgent need to prepare legal grounds for the use of PPR techniques by 119 EMTs for agitated or combative patients only, with direct medical oversight. Moreover, the legal foundation for the use of PPR techniques also needs to be established for emergency medical personnel. The use of PPR techniques not only ensures the safety of emergency medical services personnel, but also protects patients from injuring themselves and others.

• Journal of Korean Clinical Nursing Research
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• v.17 no.1
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• pp.90-100
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• 2011

Purpose: This paper was to develop an elbow restraint which can reduce the side effects of the wrist restraint which was frequently used in an intensive care unit and to evaluate its application. Methods: A nonequivalent control group non-synchronized design was used. Subjects were 38 patients (elbow restraint group: 18, wrist restraint group: 20) and 20 nurses who used both restraints in medical intensive care unit at G National University Hospital. Restraints were applied to subjects for 72 hours. Data were collected from December 1, 2009 through March 31, 2010. The data collected were analyzed using $x^2-test$, Fisher's exact test, t-test, and ANCOVA using SPSS 12.0 program. Results: Elbow restraint significantly decreased range of wrist motion reduction, swelling and significantly increased the convenience of wearing restraint compared to wrist restraint. Conclusion: The new elbow restraint are more efficient than the old wrist restraint, which have been used in an intensive care unit, in terms of convenience of restraint application, range of joint motion and prevention of swelling.

• Child Health Nursing Research
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• v.25 no.2
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• pp.103-111
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• 2019

Purpose: This study aimed to investigate incidence of delirium in the pediatric intensive care unit (PICU) and to analyze associated risk factors. Methods: The participants were 95 patients, newborn to 18 years, who were admitted to the PICU. The instruments used were the Richmond Agitation Sedation Scale (RASS), and the Cornell Assessment of Pediatric Delirium. Data analysis was performed using the descriptive, $x^2$ test, t-test, and logistic regression analyses. Results: The incidence of delirium in children admitted to the PICU was 42.1%. There were significant differences according to age ($x^2=14.10$, p=.007), admission type ($x^2=7.40$, p=.007), use of physical restraints ($x^2=26.11$, p<.001), RASS score ($x^2=14.80$, p=.001), need for oxygen ($x^2=5.31$, p=.021), use of a mechanical device ($x^2=9.97$, p=.041), feeding ($x^2=7.85$, p=.005), and the presence of familiar objects ($x^2=29.21$, p<.001). Factors associated with the diagnosis of delirium were the use of physical restraint (odds ratio [OR]=13.82, 95% confidence interval [CI]=4.16~45.95, p<.001) and the presence of familiar objects (OR=0.09, 95% CI=0.03~0.30, p=.002). Conclusion: Periodic delirium assessments and intervention should be actively performed. The use of restraints should be minimized if possible. The caregiver should surround the child with familiar objects and ensure a friendly hospital environment that is appropriate for the child.

• Journal of Korean Academy of Nursing
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• v.30 no.1
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• pp.60-71
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• 2000

This research is a field investigation to collect basic information about the safe and efficient use of physical restraint in hospitals and for the ultimate minimization of restraint use. The objects of this study were sixty-four patients. They were restrained physically. Add their 32 family members, 24 nurses of two university hospitals in Seoul were also involved in the study. From April 16, to May 27, 1999. Research data were collected throughout the observation and interview process. Also, the data was analyzed using frequencies and field study notes that were invented by researchers. Results of this study were as follows: 1. According to the sex and age distinction; male's restraint use was 75%, female's was 25% and pre-schoolage children 39.1%, middle age 26.5%, and senior citizens 20.3%. According to the disease distinction; neuro-system was 35.9%, respiratory system was 21.9%. In the Ward, 40.6% of ICU patients were restrained and 39.0% of pediatric ward children were also to restraint. 70.3% of patients were restrained under 5days, while 10.9% were restrained 10days. 2. Types of physical restraints were wrist restraint (45.21%), arm board (35.62%), leg restraint (8.22%), chest restraint (6.85%), elbow restraint (2.74%) and mitten restraint (1.37%). 3. The percentage was 3.5%, which was in 64 restrained out of 1828 hospitalized people. At 1st investigation, the ratio was 3.5%, the 2nd was 3.0% and the 3rd was 3.9%. 4. The reasons of using the physical restraint were 'to protect implements' (72.84%), 'to protect patients' (18.52%), 'to protect an operative site' (8.64%). 5. The result of the patients; family and nurses' response analysis was: 'It seems to be safe', 'It uses properly', 'It is convenient for relatives and nurses', 'It is helpful to treatment', 'Objective think it is not restraint' were 79.9%. 'It is discomfort and stuffy', 'The implement is ineffective' were 21.1%. However in interview of the patients who can do verbally communication, 6 of 7 was responded that 'It is stuffy and uncomfortable'. 6. When restraint is used, the main decision is usually made by the nurses 42.2% of the time. The statistics read as thus: nurses and the physician in charge 31.3%, nurses and family 12.5%, physician's order 7.8%, only family 6.2%. Although the record of restraint was only 15.6% so that only 10 cases out of all the 26 ICU patients restrained. This study shows that physical restraints which of infringe independent-right of patients, are used without using criterion, explaining the agreement. Also, subjective decision of physician, nurses, and family make the decision of using restraint. So development of practice manuals and rules for restraint implementation is urgent.

• Korean Journal of Adult Nursing
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• v.19 no.4
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• pp.583-592
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• 2007

Purpose: The purposes of this study were to explore and describe the use of restraint on patients and to generate a grounded theory of how the use of restraint affects patients who have been restrained. Methods: Interview data from seven patients with physical restraint was analyzed using the Strauss and Corbin's grounded theory method. Data were collected and analyzed simultaneously. Unstructured and in-depth interviews were conducted retrospectively with patients recalling their memories of ICU following their transfer to general unit. Results: 'Safety belt' was emerged as a core category and it reflected that physical restraint provided a sense of security to patients. On the basis of core category, a model of the experience process of restrained patients in ICU was developed. The experience process were categorized into four stages: resistance, fear, resignation, and agreement. Stages of these proceeds appeared to have been influenced by the nurses' attitude and caring behavior such as the frequency of nurse-patient interaction, repetition of explanation, and empathetic understanding. Conclusion: These findings indicate that patients have mixed feelings towards restraint use, although negative feelings were stronger than positive ones. The result of this study will help nurses make effective nursing intervention.

• Journal of Korean Clinical Nursing Research
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• v.19 no.3
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• pp.432-442
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• 2013

Purpose: The purpose of this study was to describe restraint use in care of patients with psychiatric disorders in an attempt to avoid unnecessary restraint use and provide information for developing standards regarding restraint use as a therapeutic maneuver. Methods: For this descriptive study, discharge records from N National Mental Hospital in the year 2009 were reviewed by trained nurses during Dec. 24, 2010 and Mar. 31, 2011. There were 596 restrains applied on 232 of 1,322 discharges. Data collected include general characteristic of patients, the frequency of restraint use, time since admission when restraint was applied, time of the day when restraint was applied, duration of restraint application, place of occurrence, reasons for restraint use, and degree of damage to the patent. Work experience of nurses who applied restraints, number of workforce at the time of restraint, and season of the year was also identified. Descriptive statistics, Chi-square test, t-test, ANOVA, $Scheff{\grave{e}}$ and Jonckheere-Terpstra were applied using SPSS 14.0 to analyze the data. Results: There were 596 restraint uses among 232 patients. Restraints were applied most frequently on males in their 40s, patients diagnosed with schizophrenia, and patients repeating admissions more than 6 times. Restraints were frequently applied within first week following admission, between 16:00 and 20:00, and the average duration of restraint was 5 hours. There were significant differences according to diagnoses of patients in the season restraint occured, time, place of occurrence, reason for restraint, and duration of restraint. Patients with alcoholism received longer restraint application. Conclusion: In order to avoid unnecessary restraint use in patients with psychiatric disorders, nurses and other health care team members need to acknowledge a group of patients such as patients with schizophrenia and alcoholism who relatively frequently restrained or receiving longer restraint. Reasonable and careful decision need to be made when applying restraint in the care of patients with alcohol problem.