在職教育對於加護病房護理人員執行身體約束之相關成效探討

The Effects of the ICU Nurses' Execution of Physical Restraints In-Service Education Program

賴美玉(Mei -Yu Lai)

指導教授 ： 蔡秀婷

中山醫學大學/醫學院/護理研究所/碩士(2013年)

https://doi.org/10.6834/CSMU.2013.00165

摘要

身體約束是醫護人員為了方便照顧病人常使用的方法之一，但執行約束過程卻經常忽略病人內心的感受，也可能造成相關的合併症，故護理人員擁有正確的身體約束知識、態度、行為對病人是非常重要的。
研究目的：本研究為介入性研究，藉由介入性在職教育，探討加護病房護理人員接受在職教育前、後，對於身體約束知識、態度、行為之改變及其相關性，並探討護理人員對病人約束行為之改變，及是否會影響留置氣管內管病人發生自拔管。
研究對象：以中部某醫學中心成人加護病房，包括：內科加護病房、心臟內科加護病房、外科加護病房、神經外科加護病房、呼吸照護中心之護理人員為研究對象，以立意取樣方式收集215位成人加護單位護理人員進行研究分析，研究中，分別藉由護理師親自上在職教育、及使用事先由護理師錄製好的教學光碟，教導護理人員如何正確執行身體約束之相關知識，並以物理性(身體)約束量表(包含約束知識問卷、約束態度問卷、約束行為問卷)為測量工具，分別於在職教育前、及在職教育後、在職教育後兩週、在職教育後一個月、在職教育後三個月進行問卷測量，總共進行5次問卷調查。在職教育前測、在職教育後測、後測兩週、及後測一個月，共收集215份有效問卷，在後測三個月時因有10位護理人員離職，所以在接受在職教育後測三個月共收205份有效問卷。
研究結果：由護理師親自上在職教育及使用事先由護理師錄製好的教學光碟進行在職教育，兩組護理人員之基本屬性無顯著差異，且兩組護理人員約束知識、態度、及行為量表之得分在接受在職教育後皆有顯著的增加，且其得分數在在職教育後三個月仍有顯著的增加。其得分數分別為：觀看教學光碟組在職教育前知識之平均得分為20.1±2.9，在職教育後平均得分25.2±1.0，p＜0.001；現場在職教育組在職教育前知識之平均得分19.6±2.9、在職教育後平均得分25.1±1.1，p＜0.001。態度量表方面，觀看教學光碟組在職教育前平均得分36.7±3.0，在職教育後平均得分41.8±1.8，p＜0.001；現場在職教育組在職教育前態度量表平均得分37.3±2.9，在職教育後平均得分42.3±1.7，
p＜0.001；行為量表得分，觀看教學光碟組在職教育前平均得分36.9±4.1，在職教育後平均得分42.7±2.2，p＜0.001；現場在職教育組在職教育前平均得分37.2±4.9，在職教育後平均得分42.6±2.4，p＜0.001。且觀看教學光碟組與現場在職教育組二組間在接受在職教育後，其知識、態度、及行為量表之得分在兩組間並無顯著差異。我們認為，觀看教學光碟與現場在職教育，此二者在護理人員對病人約束行為之知識、態度、與行為量表得分之提升具有相同之效益。在相關性檢測方面，護理人員在接受在職教育前知識、態度、行為量表之得分三者間無顯著的相關，但是在接受在職教育後，知識、態度、行為量表之得分，三者間呈現顯著正相關(知識與態度r=0.805、p=0.0001；態度與行為r=0.677、p=0.0001；行為與知識r=0.773、p=0.0001)。另外，護理人員接受在職教育後，病人氣管內管自拔發生率雖然無顯著差異，但是病人約束比例及約束時數卻是有下降趨勢。
結論：藉由護理師親自上在職教育或是使用事先由護理師錄製好的教學光碟，教導護理人員如何正確執行身體約束之相關知識，不但能顯著提升護理人員執行病人身體約束之專業知識，亦能藉由專業知識的提升，使護理人員對病人身體約束具正確之態度與行為，進而減少不必要的約束行為。此外，在職教育對於護理人員執行病人身體約束之專業知識的提升，於在職教育後三個月內仍然維持其效果。因此建議，醫院能定時給予護理人員有關正確執行身體約束的在職教育，使臨床護理人員能夠有正確知識評估病人約束的必要性，以減少病人約束造成的傷害。

關鍵字

身體約束 ； 約束知識 ； 約束態度 ； 約束行為

並列摘要

The use of physical restraints is one of common approaches in the context of providing patient care by medical staff. However, the complex emotional feelings of patients are easily ignored during the implementation process and may cause related complications. Nurses’ accurate knowledge, attitudes, behaviors toward the use of physical restraints for patients are very important.
Objectives: The purpose of this study was to investigate the differences in knowledge, attitudes, and behaviors before and after intensive care unit (ICU) nurses received an interventional on-the-job education. In addition, we explored the effects of theses changes on nurses’ decisions when applying physical restraints on patients, and to examine the consequent impacts on self-extubation rates among patients intubated with endotracheal tubes (ETT).
Methods and subjects: The adult ICU nurses of medical ICU, cardiac ICU, surgical ICU, neurosurgical ICU, and respiratory care center of a medical center located in central Taiwan were enrolled in this study. A purposive sampling method was conducted to collect 215 adult ICU nurses. On-the-job education was provided by nurse practitioners or with the use of pre-recorded teaching materials on CDs. The nurses were taught about the knowledge of correct or adequate implementation of physical restraints, and were evaluated by the instruments related to physical restraints (including questionnaires to measure knowledge, attitudes, and behaviors of restrain use) before the on-the-job training started and after it’s completed. The survey was repeated at two weeks, one month, and three months after the training, giving a total of 5 times and 215 valid questionnaires were obtained. However, because 10 nurses left their jobs within three months after the training, a total of 205 valid questionnaires were used for analysis.
Results: No significant difference in the basic characteristics was found between the two groups of nurses receiving the on-the-job education provided by nurse practitioners, or using pre-recorded teaching materials on CDs. There were significant increases in the scores of knowledge, attitudes, and behaviors of restrain use in both groups of nurses. The increases in scores remained significant three months after the training. For the nurses receiving on-the-job training by using CDs, the means scores were 20.1 ± 2.9 and 25.2 ± 1.0 (p < 0.001) before and after the training. For those having training provided by nurse practitioners, the mean scores were 19.6 ± 2.9 and 25.1 ± 1.1 (p <0.001), respectively. Regarding the attitudes toward restrain use, the scores were 36.7 ± 3.0 and 41.8 ± 1.8 (p <0.001) before and after training among the nurses received CDs, and were 37.3 ± 2.9 and 42.3 ± 1.7 (p < 0.001) among those received training provided by nurse practitioners. The average scores for behaviors were 36.9 ± 4.1 and 42.7 ± 2.2 (p < 0.001) before and after training for the nurses receiving CDs, and were 37.2 ± 4.9 and 42.6 ± 2.4 (p < 0.001) for those having training provided by nurse practitioners. However, no significant difference in knowledge, attitudes, and behaviors was detected after training between the two groups. The results suggest that the on-the-job training provided by nurse practitioners and training CDs resulted in the same effects and increases in knowledge, attitudes, and behaviors of restrain use for these nurses. There was no significant correlation among the scores of knowledge, attitudes, and behaviors before the nurses receiving on-the-job training. However, significantly positive correlations were observed between the scores of knowledge, attitudes, and behaviors after the training (knowledge/attitude, r = 0.805, p = 0.0001; attitude/behavior, r = 0.677, p = 0.0001; behavior/knowledge, r = 0.773, p = 0.0001). In addition, Despite the incidence patient’s self-extubation of the endotracheal tube did not show significant difference after our nursing staff have received on job education, but the trend of patient’s physical restraint rate and timing is decreasing.
Conclusions: On-the-job training provided by nurse practitioners or pre-recorded teaching materials on CDs to educate the nurses for knowledge about correct implementation of physical restraints on patients could result in significantly enhanced professional knowledge on applying physical restraints. Consequently, the nurses were enabled to have correct attitudes and behaviors; thereby unnecessary constraint behaviors were reduced. Furthermore, the effectiveness of promoted knowledge about the proper applications of physical restraints on patients remained significant up to three months after the on-the-job training. Therefore, it is recommended that on-the-job training for proper implementation of physical restraints should be provided to nurses by hospitals from time to time, and thereby the clinical nurses were enabled to have correct knowledge for assessing the necessity of patient restraints in order to reduce the potential damage related to patient restraints.

並列關鍵字

Physical Restraints ； Knowledge Towaed Physical Restraints ； Attitudes Towaed

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