No abstract available.
Restraint, Physical*

PURPOSE: The purpose of this study was to identify the patterns of physical restraint experience in mentally ill persons. METHODS: Q-methodology, an approach designed to discover patterns in various subjective experiences, was used. Twenty-two participants classified 36 selected Q-statements on a nine-point scale to create a normal distribution. The collected data were analyzed using the PC Quanl Program. RESULTS: Five types of physical restraint experience in mentally ill persons were identified by the participants. Type I Emotional reaction-explosive anger, Type II Emotional reaction-internalized anger, Type III Rational reaction-rejection, Type IV Rational reaction-acceptance, Type V Rational reaction-trust. CONCLUSION: The results of this study provide an understanding that different types of reactions to physical restraint experience exist and that each type has certain characteristics, which suggest a need to develop interventions specifically designed for each type of physical restraint experience.
Anger ; Humans ; Mentally Ill Persons ; Restraint, Physical

PURPOSE: The purposes of this study were to explore and describe the use of restraint on patients and to generate a grounded theory of how the use of restraint affects patients who have been restrained. METHODS: Interview data from seven patients with physical restraint was analyzed using the Strauss and Corbin's grounded theory method. Data were collected and analyzed simultaneously. Unstructured and in-depth interviews were conducted retrospectively with patients recalling their memories of ICU following their transfer to general unit. RESULTS: 'Safety belt' was emerged as a core category and it reflected that physical restraint provided a sense of security to patients. On the basis of core category, a model of the experience process of restrained patients in ICU was developed. The experience process were categorized into four stages: resistance, fear, resignation, and agreement. Stages of these proceeds appeared to have been influenced by the nurses' attitude and caring behavior such as the frequency of nurse-patient interaction, repetition of explanation, and empathetic understanding. CONCLUSION: These findings indicate that patients have mixed feelings towards restraint use, although negative feelings were stronger than positive ones. The result of this study will help nurses make effective nursing intervention.
Humans ; Intensive Care Units ; Nursing ; Restraint, Physical* ; Retrospective Studies

BACKGROUND: Physical restraint is widely used to prevent self-harm and treatment interference in the intensive care unit (ICU)s, but it can cause adverse effects such as physical, psychological, and ethical problems. We examined the effect of nurse education on physical restraint use in the ICU. METHODS: For 3 months before an ICU patient restraining program (IPRP), we investigated the application ratio of physical restraint, the incidence of complications and self-medical device breakage (self-extubation, self removal of intravenous line, etc.) Then we educated the 49 ICU nurses with an IPRP. The same data was collected again for 3 months after IPRP, and we also collected data from ICU nurses on their knowledge, attitude, and intention when applying physical restraint using questionnaires before and after IPRP education. RESULTS: After IPRP education, the nurses' knowledge about physical restraint use improved significantly and their intension for restraint decreased. The physical restraint application ratio did not change significantly in the period before IPRP (146/475, 30.7%) compared to the period after IPRP (110/399, 27.6%). Significant decreases were shown in the incidence of physical injury and self-medical device breakage after restraint removal. There were no significant differences on the site, duration, or cause of physical restraints. CONCLUSIONS: Although the IPRP education did not decrease the restraint application ratio, there were significant decreases on patient physical injuries and medical device breakage after restraint removal. We suggest that education should be performed continuously to both nurses and doctors to decrease the application of physical restraints.
Humans ; Incidence ; Intensive Care Units ; Intention ; Restraint, Physical

BACKGROUND: Physical restraint is widely used to prevent self-harm and treatment interference in the intensive care unit (ICU)s, but it can cause adverse effects such as physical, psychological, and ethical problems. We examined the effect of nurse education on physical restraint use in the ICU. METHODS: For 3 months before an ICU patient restraining program (IPRP), we investigated the application ratio of physical restraint, the incidence of complications and self-medical device breakage (self-extubation, self removal of intravenous line, etc.) Then we educated the 49 ICU nurses with an IPRP. The same data was collected again for 3 months after IPRP, and we also collected data from ICU nurses on their knowledge, attitude, and intention when applying physical restraint using questionnaires before and after IPRP education. RESULTS: After IPRP education, the nurses' knowledge about physical restraint use improved significantly and their intension for restraint decreased. The physical restraint application ratio did not change significantly in the period before IPRP (146/475, 30.7%) compared to the period after IPRP (110/399, 27.6%). Significant decreases were shown in the incidence of physical injury and self-medical device breakage after restraint removal. There were no significant differences on the site, duration, or cause of physical restraints. CONCLUSIONS: Although the IPRP education did not decrease the restraint application ratio, there were significant decreases on patient physical injuries and medical device breakage after restraint removal. We suggest that education should be performed continuously to both nurses and doctors to decrease the application of physical restraints.
Humans ; Incidence ; Intensive Care Units ; Intention ; Restraint, Physical

The brachial plexus may be visualized simply as beginning with five nerves and terminating in five nerves. It begins with the anterior rami of C5, C6, C7, C8, and the first thoracic nerve. It terminates with the formation of the musculocutaneous, median, ulnar, axillary, and radial nerves. The anatomy of the brachial plexus can be confusing, especially because of frequent variations in the length and the caliber of each of its components. The most common type of injury is one involving a motorcycle or bicycle crash in which a forceful impact on the shoulder depresses the entire shoulder girdle and avules a portion of the plexus. The injuried area is usually the upper trunk althrough the lower trunk can be involved either in addition to or as the main site of injury. Our case involves brachial plexus injury due to physical restraint that had been used to avoid using a pharmachologic restraint.
Brachial Plexus* ; Motorcycles ; Radial Nerve ; Restraint, Physical* ; Shoulder ; Thoracic Nerves

Quality evaluation of Chinese medicinal decoction pieces is vital for the development of the downstream industries, and is an important channel for implementing the strategy of "higher quality, higher price, and priority for the high quality" for traditional Chinese medicine. At the moment, the quality of Chinese medicinal decoction pieces is mainly evaluated based on chemical component examination. Considering the weak preliminary research foundation and poor research conditions, traditional experience-based evaluation is undervalued in the quality rating of Chinese medicinal decoction pieces. However, traditional experience is a summary of the quality of Chinese medicinal materials based on clinical experience, which thus can be a potential basis for the quality evaluation of the decoction pieces. It is a challenge in the evaluation of Chinese medicinal decoction pieces to objectify the traditional experience-based evaluation from multiple aspects such as chemistry, effect, and characterization via modern techniques. Therefore, this study developed the "experience-ingredients-activity-electronic sensing" evaluation system for Chinese medicinal decoction pieces on the basis of experience-based assessment, chemical ingredients that can truly reflect the traditional experience, biological effect assessment, and electronic sensory evaluation, which is expected to quantify the traditional experience of quality evaluation of Chinese medicinal decoction pieces via chemistry, biology, and sensory simulation. The evaluation system can serve as a reference for clinical experience-based quality evaluation of Chinese medicinal decoction pieces.
China ; Drugs, Chinese Herbal ; Electronics ; Medicine, Chinese Traditional ; Restraint, Physical

PURPOSE: There are few studies globally regarding the barriers to restraint-reduction. The purpose of this study was to describe the views of nursing staff (both nurses and geriatric care assistants) regarding the barriers to reducing physical restraint use in Korean nursing homes. METHODS: Forty registered nurse and geriatric care assistant informants participated in the first round of interviews and 16 of them participated in second confirmatory interviews. All interviews were conducted on site, one-on-one and face-to-face, using semi-structured interview protocols. Qualitative descriptive method was used and qualitative content analysis was employed. RESULTS: Six themes were identified: (a) being too busy, (b) lack of resources, (c) beliefs and concerns, (d) lack of education, (e) differences and inconsistencies, and (f) relationship issues. CONCLUSION: The findings of this study provide a valuable basis for developing restraint reduction education programs. Korean national leaders and nursing homes should develop and employ practice guidelines regarding restraints, support nursing staff to follow the guidelines, provide more practical and professional education, employ alternative equipment, use a multidisciplinary team approach, and engage volunteers in care support as well as employ more nursing staff to achieve restraint-free care.
Education, Professional ; Humans ; Nursing Homes ; Nursing Staff ; Qualitative Research ; Restraint, Physical

PURPOSE: This study was conducted to explore the meanings of Korean patients' experiences of being restrained in psychiatric wards. METHODS: Data were collected through in-depth individual interviews (N=6) and analyzed based on Merleau-Ponty's phenomenology. RESULTS: Four bodily themes of being restrained were evident: wounded body after being shocked, dented body with scarred dignity, powerless body, and reflexive body dealing with the chaotic mind. Meaning dimensions such as time, space, language, emotions, and perception were also applied and explained by the bodily themes. CONCLUSION: Psychiatric patients' bodies, under physical restraint, were not silent and simply belonging to the situation, rather were embodied as a part of their existential worlds. Based on the findings of this study, nurses can better hear and understand the bodily voices of being restrained when caring for patients in mental health settings.
Cicatrix ; Humans ; Mental Health ; Psychiatric Nursing ; Qualitative Research ; Reflex ; Restraint, Physical ; Shock ; Voice ; Wounds and Injuries

OBJECTIVES: The use of physical restraints for the geropsychiatric patients has been underreported to decrease in recent years. The aims of this study were to investigate frequency of restraints, to identify predictors and reasons for restraint use with geropsychiatric patients, to evaluate restraint related risks, and to suggest care alternatives used in restraint reduction. METHODS: English literatures published during 1990 thru 2005 were searched using internet and were reviewed. RESULTS: 1) Prevalence of restraint use in nursing homes was 25-85%. Incidence rate of restraints in geriatric ward of psychiatric hospital was 27.1%, which was 10.6 times more for the dementia patients. 2) Predictors of restraint use with geropsychiatric patients were older age, cognitive impairment, disruptive behaviors, impaired mobility and history of falls. Two variables most likely to affect fall and safety risk were cognitive function and ambulatory status. 3) Restrained patients were significantly more demented, show more safety judgement problems, and have a much higher overall risk for injury. 4) Five care alternatives to replace restraints are environmental care alternatives, alterations in nursing care, activities, physiological alternatives, and psychosocial alternatives. CONCLUSION: Physical restraints cannot just be removed. Care alternatives should be implemented to protect patient's safety. This is the beginning for the provision of safe care in a dignified and less restrictive environment that will promote or maintain patient's abilities.
Dementia* ; Hospitals, Psychiatric ; Humans ; Incidence ; Internet ; Nursing Care ; Nursing Homes ; Prevalence ; Restraint, Physical