RESEARCH PROPOSAL
Title:
Nurse’s Perception on the Use of Physical Restraint
Abstract
Nurses perception on the use of physical restraints have a lot of issues and arguments to deal with and that several literature points on utilizing physical restraints from nurses thinking have lots of assumptions to consider and factors to identify and understand. The need to conduct a meta-analysis in adhering to emerging situations pointing to using physical restraints and how nurses perceived the matter, health professional viewpoints. For methodology, the use of survey strategy and structured interview method has to be applied into the realization of the project plan. The need to have detailed research investigation on nurses’ views on the use of physical restraints from with elderly patients, there will be comprising of twenty five nurses (25 nurse respondents), these will be nurses from Hong Kong hospital as being part of simple sampling process. The one projected conclusion can be that, it might be that majority of these nurses are not aware of options deemed for physical restraints and may have no ample knowledge on restraint usage and not consider restraints to be useful. The methods and research evidence may indicate the need for more nursing education based on nursing practice and professionalism values as well as the participative mode of these nurses towards health care decision making concerning the perceived ways on the use of physical restraints concerning elderly patients.
Aims and Objectives
The research aims and objectives for this study is basically to determine such nurses’ perceptions/views towards the use of physical restraints, in particular there will be the need to recognize and at the same time understand the ongoing healthcare practices regarding physical restraints matter among Hong Kong hospital nurses assigned in the operating room units. To be able to discover, execute and apply effective physical restraints process determining points of ideas formation imposed by these nurses. Also, to come up best recommendations, conclusion and future research assimilation of the topic in focus for spontaneity and preciseness of supporting information weighted by ideal literature review and methodology organization from within good resource avenue for literature. To simplify, it can be that the core research aim for this nursing research is to ideally recognize physical restraints within the nurses’ perceptions as found into ample research vigour in lieu to both primary and secondary research assumptions, as well as to understand in brief about Hong Kong nurses respondents to surveys and interviews. Thus, there will be the need to review domains of literature from within peer reviewed journals and or articles as the process relates to nurses’ perception towards physical restraints usage and other underlying factors to be known thus, there needs to better imply general points regarding the central topic concern and the need to come up with useful yet effective nursing context recommendation towards nurses’ perception on physical restraints in such usage and other ways.
Research Questions
Nurses’ perception on the use of physical restraints could assume and display constant care and attention to the situation from within better research approaches that will have ample means for Hong Kong hospital nurses to be more focused and advanced into their mindset mostly, with regards to comprehensive assessment of reviewed academic studies manifesting literature effectiveness that can be supported by research articles/journals pointing to physical restraints issues and possible arguments there is.
For this research project, the following will be the research questions, guiding organized flow of the project at hand:
How will the Hong Kong nurses’ achieve proper perception stance regarding the use of physical restraints towards elder patients? Explain briefly
What are some of the studies being documented proving that the use of physical restraints is a common practice done in nursing health care? Give example studies to be put into the literature review
What are some of the useful ways for the Hong Kong nurses in order to recognize as well as realize any positive function of physical restraints to elderly patients? Discuss
How can adverse outcomes to physical restraints be prevented? Does nurses’ roles are enough to make restraint work effectively on elder patients?
Introduction
The physical restraint were being under intense scrutiny during the late 1980s, when there began public outcry in developed countries arising out of concern with regard to the standard of care in long-term care settings. Thus for ‘Britain, the use of physical restraints on older people is often regarded as abuse’ (Gallinagh, Nevin, McIlroy, Mitchell, Campbell, Ludwick and McKenna, 2002 p. 149). The ‘researchers’ still find nurses resistant to the notion of removing patients’ restraints. Protecting patients from injuries such as falls and preventing treatment disruption are the most important reasons given for the use of physical restraints by all professional groups’ (Minnick, Mion, Leipzig, Lamb and Palmer, 1998 p. 20; Werner, 2002 p. 62) It can be noted that, some of the nurses are often the care staff who initiate restraint usage and some of the study involving physical restraints and restraint use in elder patients have amiably focused on nurses’ inadequate as well as some inaccurate knowledge about use of restraints and adverse effects. These studies, however, fail to note that nurses can also be victims of the system. Restraint use is a complex issue that needs to be understood in relation to the dynamics within an environment. The project will be ideal upon strengthening nursing research and practice with ample basis towards application of primary and secondary approach to meta-analysis relating to nurses’ perception on physical restraints. Perceptions and knowledge of nurses play an important role on understanding physical restraint usability and that, for better nursing care it is duly important to develop and execute restraint policy, and train HK hospital nurses in order for them to provide awareness of the highly elaborated practice into the nursing care settings.
Literature review
Literature review provides comprehensive account of research done in support to the peer reviewed journals and articles, as there imperative to integrate in-depth reviews of ample amount entailing the topic relevance that links to use of physical restraints and nurses’ perceptions on it. There utilization of research methods in form of qualitative and quantitative resources, there is sort of descriptive research and process along with the inclusion of survey interviews as well as case study for extensive analysis and conforms to the high end primary research. It maybe recommended that methods must facilitate the discovery of quantifiable information as in methods triangulation, as argued that if nursing scholars limit themselves to one method of enquiry, possible restrictions will be placed on the development of nursing knowledge from the composed studies about shift work and its related domains. For nursing practice manifested, the arguments into nature of knowledge recognized by applied methods and how such nursing related articles/journals should be critiqued in whole sense as it is not possible to judge qualitative research by using conventional criteria through reliability-validity and conclusion and agreeing that, there needs to be in operational stature to take account effective research form.
Lee and Tam (1999, p. 1365), asserted that, there was “use of physical restraints on elderly patients, exploring study of the perceptions of nurses in Hong Kong, as qualitative study were being designed to explore nurses’ perceptions of the use of physical restraints on elderly patients in Hong Kong. There was significant process on using content analysis of semi-structured interviews with 20 registered nurses working in medical and geriatric settings of two regional hospitals revealed that although nurses generally had mixed feelings about the use of physical restraints on elderly patients, they did not question this ‘routine’ practice and their knowledge about the consequences and alternatives to the use of restraint was limited. It was found that nurses had an overriding concern in ensuring elderly patients’ physical safety and using restraints therefore provided them with a sense of security. The deleterious impact of restraint on the care received by elderly patients was largely unrecognized. Implications for practice and future studies are discussed in the light of these findings”. Furthermore, Karlsson, Bucht, Eriksson and Sandman (2001 p. 1722) reported that, “physical restraints are commonly used on older persons living in geriatric care settings, with the aim of investigating influence of environmental and organizational variations and resident and staff characteristics on restraint prevalence”. Further, the proponents have “presented cross-sectional study within 33 nursing home wards and 12 group living units for old persons with dementia”. (Karlsson, Bucht, Eriksson and Sandman, 2001 p. 1722) Then, further noted that proportion of residents with impaired mobility function, the number of behavioral disturbances, and nursing staff’s attitudes towards use of restraints were the strongest discriminators between restraint-free wards and wards that used restraints. Karlsson, Bucht, Eriksson and Sandman (2001 p. 1722), their study showed that the use of physical restraints is strongly connected with residents’ functional status and nursing staffs’ attitudes toward their use.
The underlying perceptions of nurses in the use of restraints could be: - Staff nurses continue to use physical restraints in well-intended efforts to protect patients from potential harm - The use of physical restraints remains an unresolved clinical practice issue. - There demonstrates that nurses are aware of many alternatives to restraint use. The authors suggest that alternatives may not be widely used because the measures are often not considered practical
Patients’ safety was the most important reason for using physical restraints for both groups. Increased attention should be given to the role of social workers as team members in the process of decision-making regarding the use or removal of physical restraints, especially as mediators between the elderly person, family members and staff members.
Despite reported cognitive impairments, patients vividly described anger, discomfort, resistance and fear in response to the experience of physical restraint. The decision to restrain posed a conflict between protection of the patient and beliefs about professional behavior for the nursing staff. Lack of interdisciplinary collaboration in decisions to use a physical restraint was also apparent. The findings suggest that the use of physical restraint is not a benign practice and support the need for developing alternatives more consistent with professional practice and quality care. According to Arja Liukkonen (1994, in Blackwell Science), “reasons cited most often for restraint use were reduced physical and cognitive capacity of demented patients. The most common alternative was to try to understand the reasons for the elderly patient’s disruptive behaviour, one major challenge for future research and for field experiments is to provide new alternatives to the use of physical restraint in the nursing practice”.
Meanwhile, in Hong Kong, “Chien explored the factors that determine nurses’ decisions to apply physical restraints on hospitalized elderly psychiatric patients” (Chien, 1999, p. 249) It can be true that, patient safety was a crucial factor accounting for the use of physical restraints in Chien’s sample. Staff mostly justified their use of restraints by saying that it was because of the shortage of nurses and facilities, meaning that they could not provide a safe environment for their patients without using restraints. Chien concluded that nurses’ attitudes contributed to inappropriate decision-making with regard to restraint use (Chien, 1999, p. 249).The types of physical restraints used in Hong Kong include trunk restraints, limb holders, mitts, lap tables and bedrails nursing staff choose to use physical restraints (Wynn, 2003 p. 452), the decision itself is often to be called a dilemma (Marangos-Frost and Wells, 2000 p. 365), frequently accompanied by feelings of frustration and less power (Hantikainen, 1998 p. 334) as the feelings could arise from pressure in care management and or patients as there exploring of nurses’ views on the use of physical restraints.
The HK hospital nurses as respondents in research can be more interested in discussing their views and experiences in the use of restraints than the restraint reduction project conducted in their hospital, highly likely related to the strong sentiments they felt toward restraint use. They expressed dissatisfaction with management with regard to the pressure they felt was placed on them to reduce fall rates and restraint use. Most participants thought that they had already done their best, and emphasized that better communication among all stake holders was significant in resolving the use of restraints. Aside, HK hospital nurses should not be regarded as the main source of the problem but a potential solution. In fact, the phenomenon of restraint reduction should be viewed from a more macroscopic perspective.
Methodology
Survey interviews are to be based on literature studies known in this research as well as the researchers’ perceptions or observations on the restraining practice.
Design
A total of fifteen survey interview questions have to be administered during months of March to May of 2009. The survey interviews will take place during daytime in between breaks of the HK nurses having day shifts. The structured interview has to consist of detailed literature assumption and its discussion. The research will be open to HK hospital nurses with a voluntary participation style. The nurses will need to be assured that although taking interviews are being taped, it is of confidential manner that no names will be on the record to conform into nursing ethics and protocol. The analysis and research procedures have to be in adaptation sense from Colaizzi’s method such as the reading and rereading of interview transcripts to gain good shots of impression of research vigour as the process of immersion, does enable researcher to develop good sense of the whole of the interview as to be part of the successful context. To ensure trustworthiness of research to happen, first, some theme clusters are to be reliably validated by the researcher by looking into original transcript again detecting direct responses made by the interviewees. Second, there will be identification of validated research by the supervisor of the research project.
Methods and Analysis
Amiably, the good process of literature has provided an abundance of evidence on the adverse outcomes of restraint use on elder patients. Moreover, it can be that some of the nurses are often the personnel who initiate restraint use and attribute its use to ensuring the safety of the restrained and the others. The need to conduct clinical trial through education and administrative input, one component of restraint reduction program, subsequent to implementation of intervention program, survey interviews have to be conducted to determine the perspective of the nursing staff on the use of restraints and their opinions of appropriate means to reduce their use. Hong Kong nurses that are involved in the study have to be invited to participate in the surveys and interviews on voluntary basis. There will be 25 HK registered nurses to attend the research sessions. The interviews to partake will be recorded as material for proof, as it will need to be taped and analyzed accordingly. Thus aside from the researcher, the supervisor staff will need to seek validity of the findings imposed. It can be that HK nurses are experiencing conflicts when applying physical restraints and have been ambivalent about their use preventing falls and injuries to elder patients. To feel that HK nurse staffing are inadequate in some ways and not doing their best for proper management and care. Thus, it can be that communication among various health care and nursing team might be a serious problem to tackle as every HK nurse can have a diverse perception regarding what assumes physical restraint and how safe the device upon use manifested by the nursing staff.
The need to emphasize one good research study, as there was high time there investigation of complexity issues surrounding restraint use from qualitative perspective and identified solutions that would address the total situation. Many large scale empirical studies have adopted quantitative approach to investigating the phenomenon. For instance, there will have to be in-depth studies to understand dynamics of restraint use within the health care system as required and that non-participatory observational studies may help to shed light on the contexts in which restraints are applied. The kinds and level of perceived stress of nurses associated with the application or removal of restraints will help researchers to better understand the perspective of nurses, why and how they use restraints on patients. The use of the case study method in studying restraint use can in fact provide insights into the dynamics between different parties involved in the process of deciding to restrain the patient, and the nurses’ role in it. It is also important to examine nurses’ attitude and behaviour when they feel that they are not empowered, because nursing actions impact on patient outcomes.
Ethical Consideration
Indeed, ethics approval has to be granted by Ethics Review Board of the institution which the researcher is a student member as well as the Ethics Review Board of the health care institution wherein the research project will take its place. Thus, oral/written information about the project has to be provided with at least 2-3 weeks prior to the surveys and interviews and also, informed consent are to obtain from the nurse respondents, starting each of research session.
Timeline
TASK
Month
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
Select topic
Undertake preliminary literature search
Define research questions
Write-up aims and objectives
Select appropriate methodology and locate sources of information. Confirm access.
Write-up Dissertation Plan
Undertake and write-up draft critical literature review.
Secondary and Primary Data Detailed
Sources
Consulted
Research Findings:
Analysed
Evaluated
Written-up
Discussion:
Research findings evaluated and discussed in relation to the literature review
Methodology written-up
(including limitations and constraints)
Main body of the report written-up and checked for logical structure
Conclusions drawn
Recommendations made
Introduction and Executive Summary written-up
Final format and indexing
Budget
Breakdown Costing
Internet usage and website surfing used in gathering relevant literature studies and other essential information
Ranging from 15-30 dollars
Research methods – its materials such as software packages used for interpretations or evaluation
Ranging from 50-75 dollars
Writing up the Overall Dissertation Plan, materials used such as pads, papers and pens
Ranging from 20-40 dollars
Access of secondary data, journals and articles on purchase or with reading fees
Ranging from 40-90 dollars
Final Presentation, formatting and Indexing
Ranging from 15-25 dollars
Printing
Ranging from 10-20 dollars
References
Chien, W. (1999), The use of physical restraint of hospitalized elderly patients. J Psychiatr Ment Health Nurs 1999, 6:249-250.
Colaizzi, P. (1978), Psychological research as the phenomenologist views it. In Existential-phenomenological Alternatives for Psychology. Edited by: Valle NS, King M. New York: Oxford University Press; 1978:48-71.
Gallinagh R, Nevin R, McIlroy D, Mitchell F, Campbell L, Ludwick R, McKenna H (2002), The use of physical restraints as a safety measure in the care of older people in four rehabilitation wards: findings from an exploratory study. Int J Nurs Stud 2002, 39:147-156.
Hantikainen, V. (1998), Physical restraint: a descriptive study in Swiss nursing homes. Nurs Ethics 1998, 5:330-346
Karlsson, S. Bucht, G. Eriksson, S. and Sandman, P. (2001), Factors Relating to the Use of Physical Restraints in Geriatric Care Settings. American Geriatrics Society, J Am Geriatr Soc 49:1722–1728. 10.1046/j.1532-5415.2001.49286.
Lee, D. and Tam, E. (1999), Use of physical restraints on elderly patients: an exploratory study of the perceptions of nurses in Hong Kong, Hospital Authority of Hong Kong 10.1046/j.1365-2648.1999.00880
Marangos-Frost S, Wells, D. (2000), Psychiatric nurses’ thoughts and feelings about restraint use: a decision dilemma. J Adv Nurs 2000, 31:362-369
Minnick AF, Mion LC, Leipzig R, Lamb K, Palmer RM (1998), Prevalence and patterns of physical restraint use in the acute care setting. J Nurs Adm 1998, 28:19-24.
Werner, P. (2002), Perceptions regarding the use of physical restraints with elderly persons: comparison of Israeli health care nurses and social workers. J Interprof Care 2002, 16:59-68.
Wynn, R. (2003), Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nord J Psychiatry 2003, 57:453-459.
Credit:ivythesis.typepad.com
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