Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology

Eun Ja Yeun; Jeong Hwa An; Jung A Kim; Mi Soon Jeon

doi:10.7475/KJAN.2013.25.3.344

Journal List > Korean J Adult Nurs > v.25(3) > 1076196

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Yeun, An, Kim, and Jeon: Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology

Original Research

Korean J Adult Nurs 2013;25(3):344-355.

Published online: 18 June 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.3.344

Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology

Eun Ja Yeun¹, Jeong Hwa An², Jung A Kim³, Mi Soon Jeon^4,

^¹Department of Nursing, Konkuk University, Chungju

^²Konkuk University Hospital, Chungju

^³Department of Nursing, Hanyang University, Seoul

^⁴Department of Nursing, Baekseok University, Cheonan, Korea

Corresponding author: Jeon, Mi Soon Department of Nursing, Baekseok University, 115 Anseo-dong, Cheonan 330-704, Korea. Tel: +82-10-9882-6520, Fax: +82-41-550-2829, E-mail: jms@bu.ac.kr

Received 18 February 201319 June 2013 Accepted 24 June 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify on the perceptions of family care-givers toward use of physical restraints according to their values, beliefs, and perceptions using Q methodology.

Methods

Thirty-three family care-givers classified 41 selected Q-statements into 9 points standard. The obtained data were analyzed by using a pc QUANL program.

Results

Principal component analysis identified 4types of the perceptions of family care-givers toward the use of physical restraints. Type I is ‘Rational accepted’, which means that they perceived the restraints are essential therapeutic devices and had cooperative attitude to use of medical staffs' restraints. Type II is ‘Sardonic sensibility’, which means that they have a negative and a cynical attitude to use of physical restraints. Type III is ‘Ambivalent', which means that they have conflicts between rationality and emotion, and type IV is ‘Practical claim of a right', which means they insist that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.

Conclusion

The findings of this study suggest that perceptions toward the use of physical restraints among family care-givers should be understood for patients' safety and dignity in medical circumstance. Based on the results, this study will be useful in developing the customized nursing intervention for supporting family care-givers’ subjectivity considering the Korean context.

Keywords: Intensive care units, Family, Perception, Physical restraint, Q-methodology

REFERENCES

Bigwood S.., Crowe M.2008. It's part of the job, but it spoils the job: A phenomenological study of physical restraint. International Journal of Mental Health Nursing. 17:215–222.

Cho K. J.., Jun E. M.2007. Effect of an information protocol on anxiety and nursing satisfaction for family care-givers of cerebrovascular accident patient in the ICU. Journal of Korean Academy Fundamental Nursing. 14(1):53–61.

Cho Y. A.., Kim J. S.., Kim N. R.., Choi H. J.., Cho J. G.., Lee H. J., et al. 2006. A study on the use of physical restraint in ICUs. Journal of Korean Academy of Adult Nursing. 18:543–552.

Evan D.., Fitzerald M.2002. Reason for physically restraining patients and residents: A systematic review and content analysis. International Journal of Nursing studies. 39(7):735–743.

Hardin S. B.., Magee R.., Vinson M. H.., Owen M.., Hyatt E.., Stratmann D.1993. Patient and family perceptions. Journal of Holistic Nursing. 11:383–397.

Kang S. H.2003. A study on nurses' knowledge and perception toward the use of physical restraints. Unpublished master's thesis, Chonnam National University of Korea, Gwangju.

Kanski G. W.., Janelli L. M.., Jones H. M.., Kennedy M. C.1996. Family reaction to restraints in an acute care setting. Journal of Gerontological Nursing. 22(6):17–22.

Kim H. G.2008. Q-methodology. Seoul: Communication Books.

Kim K. S.2002. Patterns of impatient's families in the intensive care units. Journal of Korea Community Health Nursing Academic Society. 16(1):1–12.

Kim M. Y.., Park J. S.2010. A study on the application of physical restraints in intensive care units. Journal of Korean Academy of Fundamentals of Nursing. 17:177–186.

Kim Y. H.., Jeong Y. S.., Park J. H.., Yoon S. H.2008. The effects of nurse education on physical restraint use in the ICU. Korean Journal of Anesthesiology. 55(5):590–595.

Kwon S. B.., Lee M.1987. Factor analysis of the seriously ill patient's family needs. Journal of Korean Academy of Nursing. 17(2):122–136.

Lee E. N.., Ha S. J.., Kang J. Y.2008. Development and testing of instrument to measure family's emotional response toward physically restrained patients. Journal of Korean Academy of Nursing. 38(4):629–638.

Lee M. M.., Kim K. S.2012. Comparison of physical injury, emotional response and unplanned self-removal of medical devices according to use of physical restraint in intensive care unit patients. Journal of Korean Clinical Nursing Research. 18(2):296–306.

Lee Y. G.., Cho E. H.., Kim S. A.., Kim J. K.., Kim H. M.., Kim H. E., et al. 2003. The study on physical restraint use in intensitive care unit. Journal of Korean Clinical Nursing Reserch. 8(2):117–130.

Macpherson D. S.., Lofgren R. P.., Granieri R.., Myllenback S.1990. Deciding to restrain medical patients. Journal of American Geriatrics Society. 38:516–520.

Martin B.., Mathisen L.2005. Use of physical restraints in adult critical care: A bicultural study. American Journal of Critical Care. 14(2):133–142.

Minnick A. F.., Leipzig R.., Johnson M. E.2001. Elderly patients' reports of physical restraints experiences in intensive care units. American Journal of Critical Care. 10(3):168–171.

Minnick A. F.., Mion L. C.., Johnson M. E.., Catrambone C.., Leipzig R.2007. Prevalence and variation of physical restraint use in acute care settings in the USA. Journal of Nursing Scholarship. 39(1):30–37.

Mion L. C.2008. Physical restraint in critical care settings: Will they go away? Geriatric Nursing. 29:421–423.

Park J. H.2003. Psychiatric nurse's perception in ethical situation. Unpublished master's thesis, Yonsei University, Seoul.

Wynn R.2004. Psychiatric inpatients' experiences with restraint. Journal of Psychiatry & Psychology. 15:124–144.

Yang S. E.2007. A critical science research on the families of critically ill patients. Journal of the Korean Home Economics Association. 45(3):1–10.

Yeo J. M.., Park M. H.2006. Effect of an education program for nurses on the use of restraints. Journal of Korean Academy of Nursing. 36(3):532–541.

Youn H. W.2006. . A study on burden, stress and social support in family members of intensive care unit patient. Unpublished master's thesis, Konyang University, Daejeon.

Figure 1.

Distribution of items and scoring.

Table 1.

Q- samples on Physical Restraint

Q-	statement
Q1.	I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff.
Q2.	Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint.
Q3.	Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems).
Q4.	The physical restraint is a therapeutic method needed to provide patients with better treatment; in this way, it is similar to patient stabilization or injections.
Q5.	I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint.
Q6.	I think that the physical restraint must be used only with patients on life-support systems whose consciousness is unclear.
Q7.	The senior medical staff has an important role in learning about the application of, or perceptions regarding, the physical restraint.
Q8.	I think that patients must bear the discomfort associated with wearing physical restraints.
Q9.	I think that very few measures exist that can be used to reduce the side effects of physical restraint use.
Q10.	I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances.
Q11.	It is absurd to apply the physical restraint as a result of violation of ward rules.
Q12.	I trust the judgment of (fellow) medical staff regarding the application of physical restraints.
Q13.	I feel a sense of guilt and pity for patients under physical restraint.
Q14.	I think that patients under physical restraint must feel very uncomfortable and confined.
Q15.	I think that patients who wear physical restraints must feel disgraced and embarrassed.
Q16.	I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.
Q17.	I think that it is absolutely necessary to record when and why a physical restraint is applied or removed, as well as the type of physical restraint that is applied or removed.
Q18.	I think that physical restraint use can be reduced when the patient is with a caregiver.
Q19.	I think that using a physical restraint is preferable to using drugs to stabilize patients.
Q20.	The medical staff uses the physical restraint whenever they think it is necessary.
Q21.	The medical staff does not seem to feel any particular emotion when applying physical restraints on patients.
Q22.	There is no need to use the restraint on unconscious patients.
Q23.	I think that patients or family members have the right to refuse use of the physical restraint.
Q24.	If I were a patient, I would refuse or resist wearing a physical restraint.
Q25.	I think that wearing the physical restraint is a kind of punishment for patients.
Q26.	I think that the main reason for using the physical restraint is related to a lack of hospital manpower.
Q27.	The medical staff often becomes flustered when the family of a restrained patient enters the patient's room.
Q28.	It is important that the medical staff inform restrained patients that they are being taken care of.
Q29.	The physical restraint must be used when the patient cannot be observed from a close distance.
Q30.	The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.
Q31.	The medical staff can legally be sued if the physical restraint was used unnecessarily in a situation that did not require it.
Q32.	In emergency situations, the nurse can legitimately use the physical restraint without a doctor's orders.
Q33.	Application of the physical restraint makes patients more anxious, leading to a loss of orientation.
Q34.	The physical restraint is used when the patient is semiconscious and at risk of falling.
Q35.	The physical restraint is used to control the behavior of mentally unstable patients.
Q36.	The physical restraint must be used for patients that need total rest.
Q37.	The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective.
Q38.	It is important to provide the medical staff with education and guidance for dealing with situations in which they might lose control of their emotions due to violent patient behavior.
Q39.	It is difficult to apply the physical restraint by predicting patient behavior in advance through careful observation.
Q40.	It is important to prevent patients from causing accidents by removing physical restraints themselves.
Q41.	The medical staff must monitor changes in the patient's condition and remove the physical restraint at a planned time.

Table 2.

Demographic Characteristics and Factor Analysis of P-sample (N=33)

No.	ID	Demographic characteristics					Factor weight	Factor 1	Factor 2	Factor 3	COM.	PURE
No.	ID	Gender	yr	Religion	Marital status	Use of restraints	Factor weight	Type 1	Type 2	Type 3, 4	COM.	PURE
Type 1 (n=15)
1	30	F	32	Other	Unmarried	No	0.55	0.44	.07	0.05	0.20	0.97
2	29	M	39	Buddhism	Unmarried	No	0.55	0.44	.05	-0.10	0.20	0.96
3	12	F	54	Other	Married	Yes (Family)	1.08	0.64	-.17	0.05	0.44	0.93
4	4	F	25	Buddhism	Unmarried	No	0.56	0.45	-.10	-0.09	0.22	0.92
5	11	F	18	Buddhism	Unmarried	Yes (Family)	0.70	0.52	-.17	0.07	0.30	0.89
6	3	M	49	Buddhism	Unmarried	No	0.86	0.58	-.17	0.23	0.41	0.81
7	23	M	48	Protestant	Married	Yes (Family)	0.85	0.57	-.26	-0.12	0.41	0.79
8	13	M	50	Protestant	Married	No	0.93	0.60	-.19	0.26	0.46	0.78
9	15	F	18	Buddhism	Unmarried	No	0.91	0.59	-.26	-0.26	0.49	0.72
10	22	M	36	None	Unmarried	No	0.19	0.18	0.11	-0.04	0.05	0.71
11	8	F	55	Buddhism	Married	No	0.24	0.23	.09	-0.16	0.08	0.62
12	32	F	56	Buddhism	Married	Yes (Family)	0.27	0.26	0.10	0.19	0.11	0.59
13	33	M	30	Buddhism	Unmarried	Yes (Family)	0.31	0.28	.07	-0.24	0.14	0.55
14	2	F	51	Other	Married	Yes (Family)	0.34	0.31	.08	0.27	0.18	0.55
15	5	M	43	Catholic	Married	No	0.62	0.48	-.16	0.41	0.42	0.54
Type 2 (n=13)
16	28	F	30	None	Unmarried	No	0.43	0.05	0.37	-.03	0.14	0.98
17	9	F	29	None	Unmarried	No	0.61	-0.01	0.47	.09	0.23	0.96
18	25	M	46	Catholic	Married	No	0.56	-0.03	0.45	-.09	0.21	0.95
19	14	M	30	None	Unmarried	No	0.70	-0.14	0.52	0.12	0.29	0.89
20	19	F	43	None	Married	No	0.77	-0.19	0.54	.07	0.34	0.87
21	31	F	46	Catholic	Married	Yes (Family)	1.18	-0.39	0.66	0.11	0.60	0.73
22	20	M	35	None	Unmarried	No	0.29	0.07	0.27	-.16	0.10	0.72
23	17	M	51	None	Unmarried	No	0.19	0.08	0.19	-.09	0.05	0.71
24	21	F	26	None	Unmarried	No	0.72	-0.28	0.52	-.23	0.48	0.68
25	24	F	42	None	Married	No	1.93	-0.58	0.77	.01	0.93	0.64
26	18	M	48	None	Unmarried	Yes (Family)	0.40	-0.16	0.35	-.22	0.19	0.63
27	16	M	27	None	Unmarried	No	0.42	-0.23	0.37	0.22	0.24	0.57
28	7	F	46	Buddhism	Married	No	0.31	-0.12	0.28	0.27	0.17	0.49
Type 3 (n=2)
29	6	M	49	Buddhism	Married	No	0.83	0.09	0.18	0.57	0.36	0.88
30	27	F	45	None	Married	No	0.37	-0.07	0.21	0.33	0.16	0.70
Type 4 (n=3)
31	26	M	50	Catholic	Married	Yes (Family)	1.12	0.10	0.01	-0.65	0.43	0.98
32	1	M	60	None	Married	No	0.19	-0.09	0.02	-0.18	0.04	0.76
33	10	F	26	None	Unmarried	No	0.31	0.22	0.11	-0.28	0.14	0.58
Eigen value and variances for each factor					Eigen values			10.33	3.86	1.63
					Variance			0.31	0.12	0.05
					Cumulative			0.31	0.43	0.48
Correlation between types								Type 1	Type 2	Type 3	Type 4
					Type 1				0.32	0.32	0.23
					Type 2					0.12	0.42
					Type 3						-0.22

ID=identification; COM=communality.

Table 3.

Item Descriptions and Descending Array of Z-scores for Each Type

Types	Q- statement	Z-scores
Type 1	3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems).^†	2.22
	34. The physical restraint is used when the patient is semiconscious and at risk of falling.	1.44
	4. The physical restraint is a therapeutic method needed to provide patients with better treatment; in this way, it is similar to patient stabilization or injections.^†	1.38
	1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff.	1.26
	40. It is important to prevent patients from causing accidents by removing physical restraints themselves.	1.24
	28. It is important that the medical staff inform restrained patients that they are being taken care of.	1.21
	16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.	1.21
	24. If I were a patient, I would refuse or resist wearing a physical restraint.^†	-1.17
	31. The medical staff can legally be sued if the physical restraint was used unnecessarily in a situation that did not require it.^†	-1.19
	22. There is no need to use the restraint on unconscious patients.	-1.31
	10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances.^†	-1.82
	25. I think that wearing the physical restraint is a kind of punishment for patients.^†	-1.99
	30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.^†	-2.33
Type 2	37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective.^†	1.41
	16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.	1.38
	15. I think that patients who wear physical restraints must feel disgraced and embarrassed.^†	1.35
	17. I think that it is absolutely necessary to record when and why a physical restraint is applied or removed, as well as the type of physical restraint that is applied or removed.^†	1.30
	5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint.	1.27
	2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint.	1.19
	14. I think that patients under physical restraint must feel very uncomfortable and confined.	1.18
	38. It is important to provide the medical staff with education and guidance for dealing with situations in which they might lose control of their emotions due to violent patient behavior.	1.05
	10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances.	-1.09
	9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use.	-1.17
	20. The medical staff uses the physical restraint whenever they think it is necessary.^†	-1.23
	26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower.	-1.28
	8. I think that patients must bear the discomfort associated with wearing physical restraints.^†	-1.43
	19. I think that using a physical restraint is preferable to using drugs to stabilize patients.	-1.57
	30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.	-1.65

^† Difference of Z-score (greater and lesser±1) than all others.

Table 3.

Item Descriptions and Descending Array of Z-scores for Each Type (Continued)

Types	Q- statement	Z-scores
Type 3	25. I think that wearing the physical restraint is a kind of punishment for patients.	-1.84
	3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems).	1.75
	34. The physical restraint is used when the patient is semiconscious and at risk of falling.	1.66
	1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff.	1.51
	14. I think that patients under physical restraint must feel very uncomfortable and confined.	1.51
	22. There is no need to use the restraint on unconscious patients.^†	1.31
	13. I feel a sense of guilt and pity for patients under physical restraint.^†	1.27
	20. The medical staff uses the physical restraint whenever they think it is necessary.^†	1.27
	37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective.	1.22
	16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.^†	-1.07
	21. The medical staff does not seem to feel any particular emotion when applying physical restraints on patients.	-1.07
	27. The medical staff often becomes flustered when the family of a restrained patient enters the patient's room.	-1.12
	26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower.	-1.12
	18. I think that physical restraint use can be reduced when the patient is with a caregiver.^†	-1.31
	9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use.^†	-1.46
	23. I think that patients or family members have the right to refuse use of the physical restraint.^†	-1.55
	19. I think that using a physical restraint is preferable to using drugs to stabilize patients.	-1.55
	32. In emergency situations, the nurse can legitimately use the physical restraint without a doctor's orders.^†	-2.14
Type 4	11. It is absurd to apply the physical restraint as a result of violation of ward rules.^†	2.18
	28. It is important that the medical staff inform restrained patients that they are being taken care of.	1.62
	5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint.^†	1.50
	16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.	1.41
	2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint.	1.36
	40. It is important to prevent patients from causing accidents by removing physical restraints themselves.	1.31
	23. I think that patients or family members have the right to refuse use of the physical restraint.^†	1.01
	26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower.^†	1.01
	19. I think that using a physical restraint is preferable to using drugs to stabilize patients.	-1.08
	20. The medical staff uses the physical restraint whenever they think it is necessary.^†	-1.20
	12. I trust the judgment of (fellow) medical staff regarding the application of physical restraints.^†	-1.39
	30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.	-1.73
	22. There is no need to use the restraint on unconscious patients.^†	-1.85
	36. The physical restraint must be used for patients that need total rest.^†	-2.30

^† Difference of Z-score (greater and lesser±1) than all others.

TOOLS

Similar articles