The Efficacy of an In-Service Education Program Designed to Enhance the Effectiveness of Physical Restraints

身體約束在職教育之效果評價

10.1097/jnr.0000000000000092

張瑛瑛(Yin-Yin Chang)；尤琇慧(Hsiu-Hui Yu)；羅爾維(El-Wui Loh)；張麗銀(Li-Yin Chang)

身體約束 ； 在職教育 ； 加護病房 ； physical restraint ； in-service education ； intensive care unit (ICU)

The Journal of Nursing Research

24卷1期（2016 / 03 / 01）

79 - 86

英文

背景：身體約束旨在維持病人安全、預防受傷，但是如果使用不當、未密切監測病人，或護理人員執行身體約束的知能不足，則身體約束反而會造成病人的傷害。目的：主要在評價在職教育的介入對提升護理人員身體約束的知識、態度、行為及技術之效果。方法：採類實驗法之二組前後測研究設計，以評價在職教育之效果。研究對象為中部某醫學中心4個成人加護病房之護理人員，共136位，4個加護病房內外科各為二，以隨機分派內外科各一個加護病房為實驗組，另外則為對照組。先收集二組身體約束知識、態度、行為及技術之前測資料，然後予實驗組2小時以實證為基礎的身體約束臨床指引，及身體約束技術之在職教育為介入方案，在職教育介入後一個月，收集二組之後測資料。以SAS統計軟體之GEE進行重複測量分析。結果：護理人員身體約束之知識及技術在介入在職教育後有顯著的進步（p ＜ .0001）；但態度和行為則無顯著性改變。結論／實務應用：在職教育可以提升護理人員身體約束的知識及技術，而藉由正確身體約束方法的執行不僅可以促進加護病房病人照顧的品質，亦可減少身體約束所造成的合併症。

Background: Physical restraints are used to enhance the safety of patients and to avoid injury. However, physical restraints may cause injuries if improperly used or if they are used in the absence of continuous monitoring. Nursing staff who use physical restraints often lack sufficient related knowledge, which may increase the risk to patient safety. Purpose: This study investigates the impact of an in-service education program for nursing staff that is designed to improve physical-restraint-related knowledge, attitudes, behaviors, and techniques. Methods: A pretest-posttest design and a quasi-experimental method were employed to evaluate the effectiveness of the in-service education program. One hundred thirty-six nursing staff from four adult intensive care units (ICUs), including two medical ICUs and two surgical ICUs, in a medical center in central Taiwan were enrolled as participants. The experimental group (EG) and the control group (CG) were composed of patients from one randomly assigned medical ICU and one randomly assigned surgical ICU each. The pretest data on physical-restraint-related knowledge, attitudes, behaviors, and techniques were collected before the in-service education program. The EG received 2 hours of classroom education on guidelines and techniques related to physical restraints. The posttest data for the two groups were collected a month after implementation of the in-service education program. General Estimation Equation was used to measure and analyze the data repeatedly. Results: The posttest scores of the EG for knowledge and technique were significantly higher than the pretest scores (p G .0001). However, the posttest scores of the EG for attitudes and behaviors did not significantly differ from the pretest scores. Conclusions/Implications for Practice: In-service education for physical restraints enhances relevant knowledge and techniques but does not significantly affect attitudes or behaviors. Correct implementation of physical restraints not only promotes the quality of nursing care for patients in the ICU but also reduces the risk of physical-restraint-related complications. This study highlights the importance of changing the thoughts and concepts related to the use of physical restraints within the overall caring strategy of hospitals.

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