A Study to assess the Knowledge and Attitude regarding Restraints of Patients among Staff Nurses in Selected Psychiatric Hospitals in a View to Develop a Protocol

 

Ms. Nongmeikapam Memichand

Lecturer, AVK College of Nursing, 2^nd Stage Banashankari, Bangalore

 

ABSTRACT:

Introduction: Psychiatric facilities use medical interventions in the form of restraints to reduce safety risks posed by violent patients and to prevent patients from harming themselves and others.¹The objective of the study were 1)To assess the existing knowledge of staff nurses regarding restraints of patients.2)To assess the level of attitude of staff nurses regarding restraints of patients.3)To co-relate knowledge and attitude of staff nurses regarding restraints of patients.4)To associate knowledge and attitude of staff nurses regarding restraints of patients with their selected demographic variables.5)To develop a protocol. Methods: Non-Experimental Descriptive Correlation design was used. This study was conducted among 80 staff nurses. Result: The results revealed that majority 71(88.8%) of the staff nurses were having moderately adequate knowledge and 51 (63.8%) of them had moderately satisfactory attitude regarding restraints. The correlation between overall level of knowledge and attitude of staff nurses regarding restraints of patients revealed to be positive, that is r = 0.431 which is statistically highly significant at p<0.05and  significant association of overall level of knowledge with selected demographic variables of staff nurses such as marital status, total year of experience, year of working experience in psychiatric ward, income per month at p<0.05 and attitude with selected demographic variables of staff nurses such as gender and monthly income at  p <0.05. Conclusion: The Nurses have moderate adequate knowledge and attitude  so distributed the protocol regarding restraints of patients to improve the knowledge and attitude of nurses.

 

 

 

INTRODUCTION:

The term ‘restraint’ includes either a physical restraint or a drug that is being used as a restraint¹.Restraint should not be used for staff convenience or to overcome lack of adequate staff support and supervision². In August 2001: Twenty-five people were charred to death in Erwadi, India. A devastating fire broke out at 5 a.m. in the asylum. of the 46 with mental disorders, 40 had been chained to their beds.

 

Erwadi had long been considered a holy place, famous for its Dargah. During the course of the treatment, the persons with mental disorders were frequently caned, whipped and beaten up in the name of “driving away the evily, they were tied to trees with thick ropes. At night, they were tied to their beds with iron chains.³A descriptive study was conducted to assess the knowledge of staff of a Nigerian psychiatric hospital concerning the use of restraint by using questionnaire designed for the purpose of this study to 74 medical staff to record their socio-demographic characteristics and assess their knowledge about the use of restraint in a psychiatric setting and the results found are Fifty eight staff returned duly completed questionnaires (response rate, 78.4%). The mean age was 38.6 years, 69% were nurses and the mean year of practice was 11.9±9.0. Participants agreed that restraint was used to prevent patients from disturbing people 76%, to punish patients 14% use of restraint could not lead to patient’s death 47%. Thirty five percent had no training in the use of restraint and Concluded that respondents’ knowledge on some aspects of restraint was poor and this may be due to lack of training.⁴Managing aggressive and violent behaviours has become an essential skill important to all involved with psychiatric patients. Successful strategies such as clear guidelines and a comprehensive reporting requirement commitment by management; adequate staffing levels; and staff training in the safe use of, and alternatives to, restraints are keys to prevention.

 

OBJECTIVES:

1.        To assess the existing knowledge of staff nurses regarding restraints of patients.

2.        To assess the level of attitude of staff nurses regarding restraints of patients.

3.        To co-relate knowledge and attitude of staff nurses regarding restraints of patients.

4.         To associate knowledge and attitude of staff nurses regarding restraints of patients with their selected demographic variables.

5.        To develop a protocol

 

HYPOTHESIS:

H₁: There is a significant correlation between knowledge and attitude of staff nurses regarding restraints of patients.

H₂: There is a significant association between knowledge and attitude of staff nurses with their selected demographic variables

 

MATERIAL AND METHOD:

Non-Experimental Descriptive Correlation design was adopted for the study.80 staff nurses were selected by non probability convenience sampling technique. The data collected was analyzed by using descriptive and inferential statistics in terms of Frequency, percentage distribution, Mean, Range, mean percentage, standard deviation, correlation coefficient  and Chi-square test.

 

RESULT:

The first objective was to assess the existing knowledge of staff nurses regarding restraints of patients.

 

Table -1.Distribution of staff nurses according to their level of knowledge regarding restraints of patients in psychiatric ward n = 80

The second objective was to assess the level of attitude of staff nurse regarding restraints of patients

 

Table 2: Distribution of staff nurses according to their level of attitude regard in  restraints of patients in psychiatric ward. n=80

S. No	Level of attitude	No.	%
1	Unsatisfactory attitude (<50%)	26	32.5
2	Moderately satisfactory attitude (50-75%)	51	63.8
3	Satisfactory attitude (>75%)	3	3.8
4	Total	80	100

 

The third objective was to correlate knowledge and attitude of staff nurses regarding restraints of patients.

 

Table 3: Correlation between knowledge and attitude regarding restraints of patients in psychiatric ward among staff nurses n=80

Variables	Attitude
	r	p-value
Knowledge	0.431*	p<0.05

Note: *-Significant at 5% level (p<0.05).

 

Hence it shows that research Hypothesis H₁- “There is a significant correlation between knowledge and attitude of staff nurses regarding restraints of patients” is accepted.

 

Fig: Correlation between knowledge and attitude.

 

	Represent individual observation of the score of Knowledge and Attitude
	Represent regression line showing positive correlation   between Knowledge and Attitude.

 

The fourth objective was to associate the knowledge and attitude of staff nurses regarding restraints with their selected demographic variables.

 

Knowledge is having association with selected demographic variables such as marital status, total year of experience, year of working experience in psychiatric ward and monthly income at p<0.05 level. Hence there is a significant association of knowledge with the selected demographic variables; and attitude is also having association with the selected demographic variables such as gender and monthly income at 0.05 levels. Hence there is a significant association of attitude with the selected demographic variables. Hence research Hypothesis H₂ -“There is a significant association between knowledge and attitude of staff nurses with their selected demographic variables” is accepted.

 

The fifth objective was to develop a protocol.

The table 1and 2 depicts the level of knowledge and attitude of Staff Nurses regarding restraints of patients. About 71 (88.8%) of the staff nurses have moderately adequate knowledge 7(8.8%) of the staff nurses have inadequate knowledge,2(2.5%) have adequate knowledge . Among the total, 51 (63.8%) of them had moderately satisfactory attitude, 26 (32.5%) had unsatisfactory attitude and 2 (3.8%) of staff nurses had satisfactory attitude.

 

So the investigators develop a protocol regarding restraints to enhance the knowledge of the staff nurses regarding restraints.

 

 

CONCLUSION:

The most important role of the nurse is to impart awareness and education to their college and students nurses in order to reduce the risk of difficulty in managing the restraint patients. And nurses are playing an important role in health maintenance and health promotion too. In the present study, nurses have moderate adequate knowledge and satisfactory attitude and this should be improved by providing in service education, conducting workshops and conferences on this area and developing an Institutional protocol for the provision of awareness for a better future.

 

REFERENCE:

1.        Judy J. Regan et.al. The use of restraint in psychiatric settings. The Journal mental health series. Tennessee Medicine. 2006 March: 41-42.

2.        Restraints. Available from: http:// www.publicadvocate.wa.gov.au/.

3.        Chained And Burned Due To Accidental Fire. 2001 Aug. Available from: http://www.Indiatogether.Org.

4.        FT Nuhu, A J Yusuf, SB aremu. Use of restraint in the psychiatric setting: knowledge of medical staff in a Nigerian psychiatric hospital. Nigerian Journal of Psychiatry. 2010; 8(1).

 

 

 

 

 

Received on 22.07.2016          Modified on 29.08.2016

Accepted on 17.09.2016         © A&V Publications all right reserved