The Effects of a Physical Restraint Education Program on the Knowledge, Attitudes, and Behaviors of Nursing Staff

[[abstract]]背景：身體約束是醫院常見的措施之一，但卻會造成許多負面衝擊，同時護理人員也會感到罪惡感，或是過份高估好處。過去研究指出透過教育方式，可獲得維護病人安全的訊息，目前國內尚無以醫院為基礎的身體約束方案之介入研究。目的：執行教育介入課程後，探討護理人員於身體約束認知、態度與行為的改善成效。方法：採類實驗研究法，單組前、後測設計，為立意取樣方法。對象為某二家教學醫院之護理人員（380名）。使用身體約束介入照護手冊進行團體教育課程計8次，每次2小時。工具為「身體約束之認知、態度與行為量表」，測量時間為介入前（T1），課程結束（T2）及介入後第三個月（T3），以SPSS 20.0統計軟體，採重複測量分析方法。結果：研究對象在第一次前與後測（T2）身體約束認知得分率改變量（M=-7.13, p＜.01）、約束態度（M=-0.08, p＜.001）及約束行為改變量（M=-0.11, p＜.01）皆有顯著改善，同時後測（T3）測量值也具顯著成效，表示方案具有持續作用。研究對象無論工作年資、工作單位或年齡不同，方案介入皆可有效提升其身體約束的認知、態度和行為。結論／實務應用：本方案可提升護理人員身體約束認知，以及態度與約束行為的改變，故建議未來在職課程可持續導入此主題，以促進護理人員的知能，並提升態度與行為的正確性。 Background: Although the use of physical restraints (PR) is a very common strategy used in hospitals, this strategy poses significant psychological and emotional drawbacks. Moreover, nurses may feel guilt or overestimate the benefits of using PR. Previous studies have indicated that an education program may ameliorate patient safety and thus minimize the negative aspects of PR use. No hospital‐based intervention study on this topic has previously been conducted in Taiwan. Purpose: This study evaluates the effects of education programs on nursing staff in terms of improving PR‐use knowledge, attitudes, and behaviors. Methods: This quasi‐experimental study used a pre‐post testing research design and used purpose sampling to recruit nurses working at two teaching hospitals in northern Taiwan (N=380). We used PR guideline handbooks for eight sessions and conducted an education program and a group lesson for 2 hours during one session. We adopted the scale of knowledge, attitude, and behavior of PR to collect data at baseline (T1), at four‐week immediate post‐program (T2), and at three months follow‐up (T3). SPSS/PC 20.0 analyzed data using repeated measures ANCOVA. Results: The intervention significantly improved knowledge (M=‐7.13, p＜.01) and altered both the attitudes toward PR use (M=‐0.08, p＜.001) and the behaviors toward PR use (M=‐0.11, p＜.01) of the participants in the first pre‐post measurement. Additionally, the second pre‐post measurement realized similar and significant improvements. The results indicate that, despite differences in length of work, unit of work, and participant ages, the PR intervention program significantly improved scores in knowledge, attitudes, and behaviors toward PR use. Conclusions / Implications for Practice: A thorough education program may improve staff knowledge, attitudes and behaviors related to using PR. These findings may guide future hospital training by promoting knowledge on the use of PR in clinical settings