CHAPTER – I

INTRODUCTION

“Safety is the priority. Quality is the standard”

-Timothy Morphy
A hospital is a health care institution providing patient treatment with

specialized staff different departments with and specialized equipment patient centered

care is health care that is respectful of and responsive to, the preferences needs and

values of patients and consumers. The widely accepted dimensions of patient centered

care respect, physical comfort, information, emotional support and communication care

coordination and access to care are typically b ased on these domains. Health system

for the 21st century defined good-quality care in as safe, effective, patient centered

timely, efficient and equitable.6

Patient safety is the first thing that focused on health system. Patients who have

problems with memory, sleeping, incontinence, pain, uncontrolled body movement, or

who get out of bed and walk unsafely without assistance, must be carefully assessed for

the best ways to keep them from home, such as falling. Assessment by the patients

health care team will help to determine how best to keep the patients safe. Reasons for

using restraints include protecting clients from injury, maintaining treatment and

controlling disruptive behavior.2

Several studies have found that restraints actually increase the severity of falls

and can increase confusion, muscle atrophy, chronic constipation, incontinence, loss of

bone mass and decubitus ulcers. Restraint use is also linked to emotional distress

including loss of dignity and independence, dehumanization, increased agitation and

depression.4 Restraints are physical, chemical or environmental measures used to

1
control the physical or behavioral activity of a person or a portion of his/her body.

Medical restraints are physical restraints used during certain medical procedures.2

Medical restraints are designed to restraint patients with the minimum of

discomfort and pain to prevent patients injury themselves or others example bed rails,

mittens, wheel chair with belt5. Ethically and legally once a person is restrained the

safety and well being of restrained person falls upon the restrainer, appropriate to the

type and severity of the restraining method. The use of psychiatric restraints is no

longer viewed as a treatment, but can be used as behavioral intervention when an

individual is in imminent danger of serious harm to self or others.5

Adverse effects of physical restraints throughout the last decade or so there

have been an increasing amount of evidence of literature supporting the idea of restraint

free environment due to their contradictory and dangerous effects. This is due to the

adverse outcomes associated with restraint use, which include fall and injuries,

incontinence, circulation-impairment, agitation, social isolation and even death. 2 The

types of medical restraints such as four-point restraints fabric body holders, strait

jackets are typically only used temporarily during psychiatric emergencies, poesy vests

are commonly used with elderly risk who are at risk of serious injury from falling.1

Laws pertaining to medical restraints requires that most involuntary medical

(physical) restraints may only be used when ordered by a physician ordered which is

subject to renewal upon expiration if necessary is valid only for a maximum of 24 hrs.

Principle of physical restraining is to develop a good practice. The nurse should take

legal considerations in regard to the source of authority of applying the restraint and

observed the policies guidelines set by the institution which he/she is practicing before

any decision made on applying restraint.4

2
 The nurse should take ethical considerations by ensuring that there is a genuine

need to restraint and the safety, comfort, dignity and physical and psycho social needs

of a client on restraint are maintained. Restraint device should be used appropriately,

properly, correctly, reasonably and safely with reference to the circumstances of the

case. The client with restraint has to be put under close observation and scrutiny and

regular assessment. The use of restraint should be properly documented for record and

inspection purposes. The nurse should maintain updated knowledge and skills in

restraints.7

The responsibility of the nurse is to assess the need for restraint. Restraint is

applied only when the safety and well-being of the client or others is being threatened.

The nurse applies restraints as a last resort when less restrictive viable alternatives have

been considered, tried or proved to be insufficient, ineffective or inappropriative. The

nurse communicate with clients family members regarding the needs, benefits and risks

the nurse explains to the clients reason for the attempt of restraints to enlist the client

cooperation when restraint is applied.4

The nurse attends biological and psycho-social needs during restraint at regular

intervals. The nurse documents the use of restraints for record and inspection purposes.

The nurse should aware about the duration of the restraint period and renewal time and

date from the physician and the time of restraint attempt should be documented

properly. Should check and protect potential complication of restraining. 3 The policy is

determined by the comprehensive individual patient assessment which is performed by

a physician or lisenced independent practitioner.8

Restraint use must be limited to appropriate clinical situations and shall be

discontinued as soon possible. Restraints are utilized for behaviour management only in

3
;emergency situation in which there is an imminent risk of an individual harming him or

herself or others, including staff. Policy is to ensure the safety and general well being of

all patients whose condition necessitates the use of physical restraints paying particular

attention to the risk associated with vulnerable patient populations. 10Restraints may only

be imposed to ensure the immediate physical safety of the patient, staff or others and

must be discontinued as soon as safety possible, regardless of the scheduled expiration

of order.9

Restraint is only to be used when alternative or less restrictive interventions are

ineffective. Members of the multi disciplinary team serve as resources in development

of alternative measures. The staff uses the least restrictive form of restraint that protects

the physical safety of the patient, staff or others.6The policy does not permit restraint

use for any other purpose, such as coercion, discipline, convenience or retaliation by

staff. Restraint used on patients because of violent or self destructive behaviour is

limited to emergencies in which there is imminent risk of a patient physically harming

him, staff or others and non physical interventions would not be effective.4

The use of restraint is not based on a patients restraint history or solely on a

history of dangerous bahaviour. New registered nursing staff members who initiate or

terminate restraint will be specifically trained to do so during orientation and before

participating in the application of restraint. Only physicians who are privileged and

trained on the restraint use poley many order restraint interventions. Physicians receive

and acknowledge the medical staff’s policy on the use of restraint and sign the

attestation. Attestation will become a part of their credentials file and will be part of the

re-credentialising process.10

4
 Staff will implement restraint using safe technique as identified in restraint

application. All restraint use in accordance with a written modification to the patient’s

plan of care. Each patient care area as applicable, will participate in performance

improvement activities to develop alternatives to the use of restraint. Each area will

collect and assess aggregate data on all episodes of restraint with the goal of reducing

use.8 The restraints applied by the nurse should be soft and not injuring the part of the

patients.3

National Accreditation Board for Hospitals (NABH) and health care providers is

a constituent board of Quality Council of India (QCI) set up to establish and operate

accreditation programme for health care organizations. NABH has been established

with the objective of enhancing health system and promoting, continuous quality

improvement and patient safety. The board while being supported by all stakeholders,

including industry, consumers, government, has fully functional autonomy in its

operation.5

Need for the study

A restraint is a device that is used to restrict a patient’s voluntary movement.

Reported prevalence of physical restraints varies from 7.4% to 17% use in acute care

hospitals up to 37% in long-term care in the United States. Prevalence of 34%

psychotropic drug use in long term care facilities. Prevalence of physical restraints up to

17% in acute care settings. Prevalence of chemical restraints up to 34% psychotropic

drug use in long term care facilities. 6 A restraint is a device used to restrict a patients

movement for example, soft wrist restraints may be used to prevent a patient from

removing a precisely placed endotracheal tube.9

5
 Use of restraints should be the limited, and there should be frequent re-

evaluation of their indications, effectiveness, and side effects in each patient. 1 A

restraint is used as a medication which is used to restrict a patient’s movement.

Complication of restraints can be serious including death resulting from both

medications and devices. Use of restraints should be reserved for documented

indications, should be frequent re-evaluation of their analysis of environmental and

patient specific roof causes of potentially self-injurious behavior can lead to reduction

in the use of restraints. Education of the patients, families and the health care team can

increase the use of less restrictive alternatives.7

To critically review evidence on the safety and efficacy of physical restraints for

the elderly and to provide family physicians with guidelines for rational use of restraints

and current patterns of use, including prevalence, risk factors. In the qualitative studies

nurses attitudes towards the use of physical restraints in care, were predominantly

characterized by negative feelings towards the use of restraints however ,the nurses

also described a previewed need for using restraints in clinical practice. This

discrepancy led to moral conflicts, and nurses described several strategies for coping

with these conflicts when restraints used.3

Marjorie Bryan, et.al, (2009), conducted retrospective study on “Use of physical

restraints from a bedside practice perspective”. In this study the author viewed the

relationship between unplanned extubations and restraints and the contributing risk

factors. 37% to 57% 0f these patients must be reintubated within the first hour, and 37%

to 57% within 48 hours. Study concluded that nurses must be “develop effective

standards for use of physical restraints”, to prevent unplanned extubations. Intensive

care nurses must be vigilant in assessing their patient’s level of consciousness or

anxiety and in using methods other than physical restraints to prevent self-extubations.11

6
 Guttormson JL, (2010), conducted a study on “Factors influencing nurse

sedation practices with mechanically ventilated patients, Minnesota. Mechanically

ventilated patients commonly receive sedative medications. The author had taken 1,250

members of critical care nurses. Nurse attitude towards the efficacy of sedation for

mechanically ventilated patients was positively correlated with nurses report of their

sedation practice (r(s) =28, p<.001) and their intent to administer sedation (r(s) =58,

p<.001). Modifying nurses’ attitudes on sedation and the experience of mechanically

ventilation may be necessary to change sedation practices with mechanically ventilated

patients.2

Statement of the problem

Effectiveness of structured teaching programme on knowledge regarding

restraint policy of NABH among staff nurses working at Kamineni hospital, LB Nagar,

Hyderabad.

Objectives of the study

1. To assess the knowledge on restraint policy of NABH among staff nurses by pre
test scores.
2. To evaluate the effectiveness of structured teaching programme on knowledge
regarding restraint policy of NABH among staff nurses working at Kamineni
hospital, Hyderabad.
3. To find out the association between pre and post test knowledge scores of staff
nurse with selected demographic variables.

Operational Definition

1. Effectiveness: It refers to the capacity to produce strong change in

knowledge of staff nurses regarding restraint policy after administering structured
teaching programme.

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 2. Structured teaching programme: It refers to a systematically planned

teaching activity specially designed to provide information which improves

knowledge of staff nurses regarding restraint policy of NABH.

3. Restraint policy: It is a policy that refers to a device which limits or

prevents freedom of movement of a person developed by NABH.

4. NABH: National Accreditation Board of Hospitals

5. Staff nurses: Nurses who are registered and qualified in giving care to

the patients.

Assumptions:

1. Staff nurses may have some knowledge regarding restraints policy of

NABH.

2. Structured teaching programme improves knowledge and understanding of

staff nurses regarding restraint policy of NABH for patients and helps in

quality and efficient patient care.

3. Selected samples for the study will cooperate and respond honestly.

Hypothesis:

H1: Post test knowledge scores will be significantly higher than the pre test

knowledge scores after administration of structured teaching programme on knowledge

regarding Restraint policy of NABH among staff nurses as measured by structured

questionnaire at 0.05 level of significance.

Conceptual frame work:

Conceptual framework represent a less formal attempt at organizing phenomena,

with abstraction that are assembled by virtue of their relevance to common theme. A

8
conceptual model broadly represents an understanding of the phenomenon of interest

and reflects the assumptions and philosophic review of investigator.

Conceptual model broadly explains phenomena of interest expresses assumptions and

reflects a philosophical stance. As a body of knowledge related to phenomena on

increases, the development of a framework to express the knowledge become easier15.

The conceptual framework for this study was developed by applying “king’s

theory of goal attainment”. The purpose of nursing in this is to help individuals to

understand the restraint policy and process of interaction between nurse and patients

through communication.

The theory concepts are interaction, perception, communication, transaction,

self, role, stress, growth and development time and personal space. A process of

perception and communication between person and environment and between person

and person represented by verbal and nonverbal behaviors of the interaction.

According to king nursing it is viewed as interpersonal process of action,

reaction, interaction, transaction, where by the nurse and patient shares the information

about their perception in the nursing situation and as a process of human interaction.

The basic assumptions of the theory of goal attainment that nurses and clients

communicate information, set goals mutually and then act to attain their goals. The

three assumptions of the theory taken by researcher are: perception, interaction and

transaction.

Perception: perceptions are related to the past experience, concepts of self and

educational background. Perception influences all the behavior or to which all other

concepts are related15.

9
 In the present study, perception refers to the staff nurses demographic data (age,

gender, professional qualification, working area, work experience, previous

knowledge.) and assessment of knowledge regarding restraint policy.

Interaction: King defines the interaction as a process of perception and

communication between the person and person represented by verbal and nonverbal

behaviors that are goal directed. Interaction brings the different knowledge, needs,

goals, past experiences and perceptions which influences the interactions15.

Interaction is the active phase where structured teaching programme was

administered regarding the knowledge on restraint policy.

Transaction: Transaction is purposeful interactions that lead to goal attainment.

Transaction are observable behaviors of human beings interacting with the

environment, the valuation components of human beings communicated with the

environment to achieve goals that are valued, goal directed human behavior15.

Transaction is the adequate gain in the knowledge gained by the staff nurses

regarding restraint policy.

Freeman S, et.al, (2015), conducted a study on physical restraint experiences,

attitudes, and opinions of adult intensive care unit nurses, UK. Aimed to determine the

experiences, attitudes and opinions of adult intensive care nurses in relation to the

application of physical restraint. Questionnaire survey is used (n=192). Results shown

that nurses believed that physical restraint had a place to maintain patient safety. There

was a perceived need for training and support for nursing staff as well as the need for

medical staff to support the decision –making process. Conclude that nurses require

more guidance, support and evidence to base their decision making upon.18

10
Summary:

This chapter has dealt with the background of the study, need for the study, and

statement of the problem, objectives, operational definitions, assumptions, hypothesis,

delimitations, and conceptual frame work.

11
Model

12
 CHAPTER-II

REVIEW OF LITERATURE

The review of literature is an extensive, systematic selection of potential sources

of previous work, acquainted fact findings after securitization and location of references

to the problem under the study16

The review of literature is considered as essential step in research process. It

involves the systematic identification, Location, scrutiny and summary of written

material that contains information on research problem16.

Review of literature is an extensive, systematic selection of potential sources of

previous work acquainted with facts findings after securitization and location of

reference to the problem under study .It is helpful in understanding and developing

insight into the selected problems understanding and also asked to develop a conceptual

framework for the study. 13

The literature review is sectioned under the following headings:

1. Literature related to restraints.

2. Literature related to knowledge and attitude of staff nurses regarding the

restraints.

1) Literature related to restraints.

A Comparative study was conducted to assess physical restraint use among

nursing home resident seven care units in nursing homes and long term care units in a

hospital, from eight facilities which included 28 nurses and 377 residents by using

interview with one or several members of the regular nursing staff, and review of

13
 medical and nursing records and the result found was Compared to direct observation

(gold standard), reported restraint use by nursing staff yielded a sensitivity of 87.4%

at a specificity of 93.7% (phi = 0.84). When data was reviewed from subjects'

medical and nursing records, sensitivity was reduced to 74.8%, and specificity to

86.3% (phi = 0.54). Justifications for restraint use including risk for falls, agitation,

body alignment problems and aggressiveness were associated with the use of

physical.14

A Retrospective study was conducted to associate between patients’ gender, age

and immigrant background and use of restraint at a department of emergency psychiatry

among 960 admitted patients. Of 14% were exposed to the use of restraints. The rate

was significantly higher among patients with immigrant background, especially in the

younger age groups. Most commonly used were mechanical restraints alone for native-

born patients and a combination of mechanical and pharmacological restraints for

patients with immigrant background. The use of restraints decreased when patients

reached 60 years. Both patients’ age and immigrant background seem to have an impact

on the use of restraint.15

A Comparative study was conducted of restraint use in nursing homes in eight

countries Denmark, France, Iceland, Italy, Japan, Spain, Sweden and the USA using

data of the type of restraints used (trunk, limb or chair that prevents rising) and the

intensity of its use in eight and the result found was the total use of restraints in these

cross-sectional samples showed a very low prevalence in Denmark, Iceland and Japan

(less than 9%). Between 15 and 17% were seen in France, Italy, Sweden and the USA,

while Spain showed almost 40%. There are also differences in the types and intensity of

14
restraints used in different countries. In all countries, there is a constant increase in use

of restraints with increasing activities of daily living difficulties and cognitive

dysfunction.22

A descriptive cross-sectional study was conducted on the nurses’ use of physical

restraints in four Turkish hospitals was carried out on 254 nurses working in intensive

care units, emergency departments, and neurosurgery wards in four Turkish hospitals

where physical restraints were used and semi structured interviews and found that

nurses used either wrist, ankle, or whole body restraints at various levels. Nurses

reported edema and cyanosis on wrist and arm regions, pressure ulcers on various

regions, and aspiration and breathing difficulties in relation to physical restraint.

Moreover, they reported 9 deaths of patients in chest restraints and concluded Actions

to reduce use of and complications from physical restraints should include attention to

nurse staffing and education about use of restraints.18

A prospective study was conducted to assessed indications, incidence and

conditions of 148 restraints on the acute wards of a general hospital. Nursing and

medical staff were inquired according to a standardised procedure about ward

atmosphere, staffing, medication and other factors. 81% of restraints lasted up to 2

hours, danger of harm to others was found the principal indication criterion (70%). 41%

restraints occurred during the first 3 days after admission, mainly within the late shift

of nursing staff and outside the regular office hours of the doctors. Ward atmosphere

was rated rather relaxed, whereas nursing staff twice as often as doctors rated

medication as insufficient. Implications for indication on the use of restraints and for

future research are discussed.46

15
 A Cross-Sectional study and prospective cohort study was conducted to assess

Restraint use amongThirty nursing homes with 2367 residents in Hamburg, German by

direct observation on three occasions on one day, psychoactive drugs were extracted

from residents' records and prospective data were documented by nurses and the result

found Residents' mean age was 86 years, 81% were female. Prevalence of residents

with at least one physical restraint was 26.2%. Centre prevalence ranged from 4.4 to

58.9%. Bedrails were most often used (in 24.5% of residents), fixed tables, belts and

other restraints were rare. Prevalence of residents with at least one psychoactive drug

was 52.4% (95% CI 48.7-56.1). The proportion of residents with at least one

physical restraint after the first observation week of 26.3% (21.3-31.3) cumulated to

39.5% (33.3-45.7) at the end of follow-up (10.4 SD 3.3 months). The relative frequency

of observation days with at least one device ranged from 4.9-64.8% between centres.32

2)Literature related to knowledge and attitude of staff nurses regarding the

restraint of patients.

Goethals S, et.al (2011).conducted a study on "Nurses decision making in cases

of physical restraint: a synthesis of qualitative evidence” at Belgium. This study aimed

to synthesize the available qualitative evidence on nurse’s decision making in cases of

physical restraint. A systematic review was carried out to obtain a meta-synthesis of

qualitative evidence. The finding shown that thoughtful decision-making requires

nurses to carefully balance different options and associated ethical values. Review

provides a deeper understanding of nurse’s decision-making process obviously the use

of physical restraints. There is an urgent need to stimulate and educate nurses to

appropriate decision about the use of physical restraints.26

16
 Gastmans C, (2013), conducted a study on "Nurses ethical reasoning in cases of

physical restraint in acute elderly care: a qualitative study” in Belgium. A qualitative

interview design was carried out, interviewed 21 acute geriatric nurses from 12

hospitals from 2009-2011. Results shown that decision making is characterized as an

ethical deliberation process. Ethical decision-making in cases of physical restraint

implies that nurses have to choose which values receive priority and which not. Nurses

took into account the values of dignity and justice more implicitly endless dominantly.22

Fereidooni Might dam More, et.al (2014), conducted a study on "Psychiatric

nurses perceptions about physical restraint; A Qualitative study" at Southern Iron. This

study aimed to investigate the experience of nurses working in psychiatric wards

regarding physical restraint. This study was done on 14 nurses working in the

psychiatric hospitals by purposive sampling. Semi-structured interviews were used for

data collection. Inductive content analysis was used to analyze .Result shown that

restraints as a multipurpose procedure, challenging subject and effects of restraints on

the spectrum, nursing education should find alternative.41

Demir A, (2007), conducted a study on "Nurses use of physical restraint” in four

Turkey hospitals. The purpose of this study is determine the frequency and types of

physical restraints used by nurses, attitudes towards physical restraint and identifies

complications in physically restrained patients. The descriptive, cross-sectional study

was carried out on 254 nurses, and data were collected via semi structured interview.

Nurses used wrist, ankle, or whole body restraint at various levels. Nurses reported

edema and cyanosis, pressure ulcers on various regions due to application of restraints.

Study concluded that actions to reduce use of and complications from physical

17
restraints should include attention to nurse staffing and education about use of

restraints.15

Kangasniemi M, (2013), conducted a study on Nurses perceptions of the use of

restraint in pediatric somatic care at Finland. Aim of this study was to describe nurse’s

perceptions of the use of restraint in somatic pediatric care. The ultimate aim is to

deepen the understanding of the phenomenon of restraint; individual interviews were

selected among voluntary nurses. Inductive content analysis was used for aiming to

produce a synthesis of the research phenomenon. Restraint is part of somatic pediatric

nursing, described as the last, but in some cases, the only resort for carrying out care or

treatment. Restraint is not a goal in itself, but an instrumental tool and procedure in

carrying out care.16

Farina-Lopez E, et.al, (2014), conducted study on perception of Spanish nursing

staff on the use of physical restraints, Spain. The purpose of this study is to examine the

perception of registered nurses and nursing assistants regarding the use of physical

restraints with residents of nursing homes. Cross-sectional multi center and correlation

study, 785 nurses participated in the study. Results shown that score of 3.47, staff

respondents supported restraint use, nurses in this study still consider it necessary to

apply restraints in everyday practice. The education of nursing staff regarding Restraint

and knowledge of alternatives is needed; they should least be aware of international

standards of care regarding physical restraint use.17

Freeman S, et.al, (2015), conducted a study on physical restraint experiences,

attitudes, and opinions of adult intensive care unit nurses, UK. Aimed to determine the

experiences, attitudes and opinions of adult intensive care nurses in relation to the

application of physical restraint. Questionnaire survey is used (n=192). Results shown

18
that nurses believed that physical restraint had a place to maintain patient safety. There

was a perceived need for training and support for nursing staff as well as the need for

medical staff to support the decision –making process. Conclude that nurses require

more guidance, support and evidence to base their decision making upon.18

Huang HT, (2009), conducted study on Nurses physical restraint knowledge,

attitudes and practices, the effectiveness of an In-service education program at Taiwan.

Convenience sampling was used in this quasi experimental study. Result found a

significant improvement in the intervention group in terms of knowledge (p=.000),

attitudes (p=.0007), and self-reported practices (p=.048) related to physical restraint use

after program completion. Concluded that physical restraint knowledge and skills

improved after the 90-minutes in-service program. Findings highlight the need to

provide a hort-term In-service education program on physical restraint use in acute care

settings.19

Saarnio R, (2010), conducted a qualitative study on nursing staff perceptions of

the use of physical restraint in institutional care of older people, Finland. Study aimed

to describe the perceptions of nursing staff on the use of physical restraints in

institutional care of older people. In addition to traditional methods of restraint, such as

belts and locked doors, nursing staff also used indirect restraint by removing the patient

mobility aid. The use of restraints by nurses caused feelings of guilt among nursing

staff making older patient feel more secure. Alternative practices for physical restraint

can also directly applied to practical care of older people.20

Karagozoglu S, et .al, (2013), conducted study on Knowledge, attitudes, and

practices of intern nurses regarding physical restraints, Turkey. Research design

descriptive and cross-sectional used, sample comprises 91 fourth-grade students, 95.6%

19
observed the use of physical restraints during their education, and 69.2% applied

physical restraints. The mean knowledge, attitude, and practice scores of the nurses for

physical restraint were 9.38+-1.19 (0-11 points), 34.70+-5.62 (12-48 point). Intern

nurses knowledge about how to use physical restraints was at a very good level; they

displayed positive attitudes, and they used their knowledge and attitudes in their

practices to a great extent.2

An Explorative study was conducted to assess the relationship between nurses'

attitudes and decisions regarding physical restraint use among 30 registered nurses

working in two nursing home by using perceptions of Restraint Use Questionnaire

(PRUQ). A significant relationship between nurses' decisions and their attitudes toward

restraint use was also found. The results showed that, although nurses endeavour to

decide what they consider to be in the patient's best interests, this ambition is affected

by a variety of variables, especially in relation to the working conditions and the nurses'

willingness to take the risk when not restraining the patient.22

A Quasi Experimental study was conducted on Changes in attitudes toward

using physical restraints , were examined by interviewing 161 staff and 153 family

members of residents in four long-term care facilities before and after formal restraint

reduction programs were instituted. The four sites were divided into two groups: one

group was composed of two sites that had initiated restraint reduction prior to this

study, while the other group initiated restraint reduction as a result of this study. Both

groups experienced statistically significant declines in restraint prevalence rates from

pre- to post test. Although both staff and families cited fewer reasons for using

restraints from pre- to post test, staff along with families of previously restrained

20
residents, did not perceive increased benefits to residents or their relatives following

restraint reduction.25

A Descriptive Study was conducted to assess the experience and attitudes of

psychiatric hospital nurses among four hundred and twenty-five nurses working in a

420 bed metropolitan psychiatric hospital by using questionnaire about their experience

of physical assault by patients and their attitude toward the problem. 61% returned the

questionnaire. The overall mean annual rate of assault per nurse was 2.0, with student

psychiatric nurses (mean 6.7) significantly more at risk than any other group. Nurses

working in the psycho geriatric area reported more than double the rate of assaults

reported by nurses working in rehabilitation services. 60% of respondents were female;

there were very few sex differences

in attitudes to assault. Overall, nurses reported a high

tolerance for assault, although they recognised it as an experience that was often very

traumatic psychologically.32

A Cross Sectional study was conducted to investigate the attitudes of nursing

staff towards restraint measures and restraint use in nursing home residents, and to

investigate if these attitudes are influenced by country of residence and individual

characteristics of nursing staff among The Netherlands (n = 166), Germany (n = 258),

and Switzerland (n = 184)by using a questionnaire on attitudes regarding restraints

(subscales: reasons, consequences, and appropriateness of restraint use) and opinions

regarding the restrictiveness of restraint measures .The study concludedin general,

nursing staff held rather neutral opinions regarding the use of physical restraints.

Nursing staff from three European countries have different attitudes and opinions

regarding the use of physical restraints28.

21
 A study using focus group interviews on Nurses using physical restraints: Are

the accused also the victims? A clinical trial using staff education and administrative

input as the key components of a restraint reduction program was conducted in a

rehabilitation setting to examine whether there were any significant differences in the

prevalence of restraint use pre- and post-intervention.Twenty-two registered nurses

(three males [13.6%] and nineteen females [86.4%]) attended the four sessions. All

interviews were audio taped and transcribed verbatim. Other than the author, another

member of the project team validated the findings from the data analysis. It was

concluded that studies about restraints and restraint use have mostly focused on nurses'

inadequate and often inaccurate knowledge about the use of restraints and its associated

adverse effects.36

A Quasi Experimental study was conducted to examine the effectiveness of a

short-term in-service education program in improving nurses' knowledge, attitudes, and

self-reported practices related to physical restraint use. Convenience sampling was used

at two different branches of one hospital in southern Taiwan. Fifty-nine nurses at one

branch were assigned to the intervention group, and 70 nurses in the other branch were

assigned to the control group. The developed 90-minute in-service education program

was given to nurses in the intervention group. These scales were used to measure

critical study variables prior to and 2 weeks after the intervention. the result found was

a significant improvement in the intervention group in terms of knowledge (p = .000),

attitudes (p = .007), and self-reported practices (p = .048) related to physical

restraint use after program completion. Findings highlight the need to provide a short-

term in-service education program on physical restraint use in acute care settings.29

22
 A study on "Attitude, behavior, emotion of staff nurses towards patients

restraints in Israel. The study examined the attitude, environmental concern and

emotional response to physical restraints of psychiatic inpatients using

questionnaire were the nurses reported that the main criteria for restraints were

endangerment of patient's self. Emotional response to restraints as experienced by

staff and patients were negative. The study concluded that nurses should be trained

to deal with violent patients and recognize the therapeutic aspect of restraint in

order to response assertively. 9

A study on "Restraints practice in Australasian Emergency Department,

“Australia. The objective to estimate the use of restraint technique and evaluate the

restraints policy and training in australasian emergency department. The survey of

116 australasian emergency department was conducted ,the overall estimated rate

of patients restraint is 3.3 episode per 1000 presentation and department were

violence(52%),psychosis(32%),and acute brain syndrome (10%).The commonest

chemical restraints used were haloperidol(93%),midazolam(82%)and

diazepam(59%) at least one benzodiazepine and one major tranquilizer are used in

(97%) of emergency department. Manual restraints(87%)is frequently used as

prelude to chemical restraints, less frequently mechanical restraints(69%).The study

concluded that patients restraint is a common procedure in australasian emergency

department, there is little formal training in documentation, restraints practice in

australasian emergency department. 10

A study on "The physical restraints use among nursing home resident: A

comparison of two data collection method," were it determined the sensitivity and

specificity of physical restraint use -a) report by nursing staff and b)review from

23
medical and nursing record in nursing home settings. Sample of 8 care unit in

skilled nursing homes,7care unit in nursing homes. 1 long term care unit in hospital

which included 28 nurses and 377 residents, the difference between the method

were assessed using 'phi' coeffecient. The result showed that restraints used by

nursing staff yielded sensitivity of 87.4% and specificity of 93.7%(phi=0.84) and

data review from medical and nursing record sensitivity reduced74.8% and

specificity of 86.3% (phi=0.54).The study concluded that both interview of nursing

staff and review of medical and nursing record are valid and reliable technique,

higher sensitivity and specificity value were achieved when nursing staff was

interviewed as compared to reviewing medical records. 27

A study on "Nursing staff members intention to use physical restraints with

older patient: testing the theory of reasoned action," central Israel. The study aimed

to examine nursing staff members, attitude, subjective norms, moral obligation and

intention to use physical restraints using Theory of Reasoned Action (TRA) were

co-relation design was used with 303 nursing staff from elder care hospital. The

result analysis found attitude, subjective norms, moral consideration to be

significantly associated to intention to use physical restraints with older adults. The

TRA explained 48% of variance in nurses’ intention, the study concluded that TRA

is useful framework for examining nurses intention to use physical restraints. 33

A study on "Nurses and physician's educational need in seclusion and

physical restraints practices, "The purpose is to explore nurses (N=22)and

physician(N=5)educational need in the context of their perceived seclusion and

restraint-related mode of action and need for support. The data were collected by

focus group (N=4) interview and inductive analysis. The results showed that the

24
declared high ethical principle were not in accordance with participants, reliance of

manpower and high restrained rate. The study concluded that future educational

programme should bring written clinical guidelines on ethical issues and staff

support aspects. 16

A study on "Prospective, double blind, randomized trial of Midazolam v/s

haloperidol v/s lorazepam in chemical restraints of violent and severly agitated

patients," The sample were randomly selected from urban,with the participant of

111 violent and agitated patient and the result of the study were the mean age was

40.7(+/_13)yrs, the mean time of sedation was18.3(+/_14)mins for patient

receiving midazolom,28.3(+/_25)mins for haloperidol and 32.2(+/_20)mins for

lorazepam. Midazolam had significantly shorter time to sedation than haloperidal

and lorazepam(p<0.05),the mean difference between midazolam and lorazepam was

13.0 and between midazolam and haloperidol was 9.9 mins. The mean difference

time to awake between midazolam and haloperidol was 44.6min.The study

concluded that midazolam has significantly shorter time to onset of sedation and

more rapid time to arousal, the efficacies of all the three drug appears to be

similar. 41

A descriptive exploratory study was conducted to identify registered nurses'

knowledge, attitudes and practice issues regarding the use of physical restraints in Hong

Kong, and to examine the factors influencing nurses' decisions to use restraints on their

patients was conducted in two psycho-geriatric wards of one of the two mental hospitals

in Hong Kong, using a mixed research design. The study consisted of two phases: first,

42 registered psychiatric nurses completed a self-administered questionnaire to examine

their practice, knowledge and attitudes towards restraint use; and second, data were

25
collected from semi-structured interviews of 15 of them. Results from the

questionnaires and semi-structured interviews indicated that about two thirds of nurses

believed that patients should be restrained for their own safety and to ensure treatment

compliance. Overall, the nurses in this study demonstrated only a modest level of

knowledge of restraint use and slightly negative attitudes toward this practice dilemmas,

and psychological reactions towards restraint use. The findings demonstrate that

continuing education about restraint use is important for nurses.18

Summary:

This chapter has dealt with the review of research literature related to restraint

policy of NABH .And studies related to Effectiveness of structured teaching

programme.

26
 CHAPTER III

METHODOLOGY

Research methodology involves the systemic approach to techniques or

procedures related to the steps, procedures and strategies for gathering and analyzing

the data in a research investigation carried out by the research, from the time of initial

identification of problem to list final conclusion.

This study aims at assessing the effectiveness of structured teaching programme

on restraint policy of NABH among staff nurses at Kamineni hospital, lb nagar,

Hyderabad.

This chapter deals with the different steps which were undertaken by

investigation for gathering and organizing data. It describes the research approach,

research design, variables under study, settings of the study, populations, sample and

sampling techniques, selections and development of tool, pilot study, data collection

procedure and plan for data analysis.

Research approach:

27
 Research approach is the most significant part of research design. The selection

of research approach is basic procedure for the research enquiries; the research

approach helps the researcher to determine what data to collect and how to analyze it. It

also suggest possible conclusion to be drawn from the collected data. In view of

problem statement and based on objectives, evaluative research approach was

considered appropriate for the present study.

Research design:

Research design is a plan, structure and strategy of investigation of answering

the research question, is the overall plan or blue print the researcher select to carry out

the study. The selection of research design is an important and essential step in research

as it is concern with the overall frame work of conducting the study.

Group Pre test Intervention/treatment Post test

Experimental group O1 X O2

Pre experimental one group pre test post test research design was selected for

the present study. The pre experimental design is a design in which the pre test and post

test observation are made on different time with only one selected group i.e. with.

Table 1: schematic representation of research design

O1-Pre test – Administration of structured questionnaire for assessing knowledge on

restraint policy of NABH.

X –intervention/treatment- Administration of structured teaching programme on

restraint policy of NABH among staff nurses.

28
O2-Post test- Administration of questionnaire for assessing knowledge on restraint

policy of NABH .

Variables under study:

In the present study, the independent variable was structured teaching

programme, dependent variable was knowledge of staff nurses and the attribute

variables were age, educational qualification, and previous experience on restraint

policy of NABH and source of health education.

Setting of the study:

By considering the availability of sample, the present study was conducted

among staff nurses in Kamineni Hospital, L.B. Nagar, and Hyderabad.

Population:

The target population were staff nurses.

Sample and sampling technique:

In the present study, samples were staff nurses who are working in kamineni

hospital 30 staff nurses were selected using non probability convenient sampling

technique.

The following criteria were set by the investigator for the selection of sample.

The inclusion criteria were staff nurses who were willing to participate in the study and

who were available at the time of data collection. The exclusion criteria were staff

nurses who were newly joined staff nurses.

Development and description of the STP and tool:

29
 Structured teaching programme was developed based on the objectives of the

study, related research and opinion of experts. The STP was entitled as “restraint policy

of NABH.” STP consisted of the following sub headings: introduction, definition,

indication, purposes, types of restraints, types of physical restraints, physician orders,

device application and ongoing monitoring,chemical restraints and its guidelines,

advantages and disadvantages of chemical restraints and precautions of chemical

restraints and nurses responsibility of restraint policy of NABH.

A structured knowledge questionnaire was prepared to assess the knowledge

regarding restraint policy of NABH. Tool was organized under 2 parts. Part I consists of

demographic data of subject which includes age, educational qualifications, gender,

years of experience, previous knowledge on restraint policy of NABH. Part II is divided

into 3 sections. Sections I consists of 10 items related to meaning of restraints,

purpose,types and monitoring of restraints, section II consists of 10 items related to

physical restraints, benefits and its types of physical restraints, section III consists of 10

items related to chemical restraints agents advantages and disadvantages of chemical

restraints. Total items were 30 and each item carries ‘1’ mark for correct response and

‘0’ for wrong response. The knowledge scores were classified into 3 categories.

Content validity:

Content was validated by 8 experts comprising, 5 experts of medical surgical

nursing department, 1 physician from department of neuro surgery, 1 physician from

critical care medicine and physician from department of anaesthesiology. The experts

were requested to give their opinion and suggestions regarding the relevancy of the tool

modification. According to expert’s suggestions, 1 question was changed and where

30
100% acceptance was declared by the experts and ensured the clarity and validity of the

tool.

Reliability of the tool:

To establish reliability, test-retest method was used and ‘r’ value was calculated

by Karl Pearson’s correlations coefficient. Obtained ‘r’ value was 0.70, the tool was

found reliable for conducting the main study.

Pilot study:

Pilot study was conducted on 6-5-2017 to 9-5- 2017 at Ozone hospital, Kottha

pet, Hyderabad on one tenth of the samples of main study i.e. on 3 subjects. Results

showed that STP was effective and study was feasible and applicable.

Procedure for data collection:

Data collection was conducted at kamineni hospital, L. B Nagar, Hyderabad

10 samples were selected each day and purpose of the study was explained, informed

consent was taken. Pre-test was administered by structured knowledge questionnaire

followed by administration of structured teaching programme using power point

presentation and information handouts on indications of restraints and physical

restraints types. Post test was conducted on 7 th day using structured knowledge

questionnaire.

Plan for data collection:

The obtained data was analyzed using descriptive and inferential statistics. The

data analyses includes the organization of the data on computer sheet (master sheet),

31
demographic data was distributed in frequency and percentage distribution. Sample

characteristic were analysed in terms of percentages. The knowledge scores of subjects

were analysed using mean, standard deviation. Paired‘t’ test was used to find out the

effectiveness of structured teaching programme. Chi square test was used to determine

the association between post test knowledge scores of staff nurses with selected

demographic variables such as age, group chosen in intermediates.

Research Pre-experimental design

design

Setting Kamineni Hospitals, L.B Nagar, Hyderabad

Sampling & 30 samples were selected using convenient sampling technique

sampling
technique

Tool Structured questionnaire(Part A & part B)

Pilot study Pilot study was conducted on from 06-05-2017 to 08-05-2017 at

Ozone hospital, Kotthapet, Hyderabad

Tool was given to seven experts for content validity. The

Validity
reliability of the tool is established by test and re-test
Reliability

Data The data was collected from .pre-test was conducted 24-5-17 to32
26-05-
collection 2017 followed structured teaching programme was administered on
same day, after seven days post test was conducted
 Descriptive (percentage, frequency, mean, standard deviation)

Inferential statistics (chi-square test)

Publication
Communication of research findings

Summary:

This chapter has dealt with methodology adopted for the study, which includes

research approach, research design, population, sample, and sampling technique,

description and development of the tool, content validity, reliability of the tool, pilot

study, procedure of data collections, plan for data analysis for the undertaken by the

investigator.

33
 CHAPTER IV

ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of the data related to the

knowledge regarding restraint policy of NABH among staff nurses working at

Kamineni hospitals, at Hyderabad. Data was collected from 30 staff nurses and

interpretations were done with the help of descriptive and inferential statistics to meet

the objectives of the study.

Descriptive statistics such as Frequencies, Percentages, Mean and Standard deviation

were utilized for assessing the knowledge regarding restraint policy among staff nurses

working in Kamineni hospitals and inferential statistics such as unpaired t-test, were

utilized to test the stated hypothesis. Chi-square test was used to find association

between knowledge and selected demographic variables.

Objectives of the Study:

1. To assess the Pretest knowledge and Posttest knowledge of staff nurses

34
 regarding restraint policy of NABH.

2. To evaluate the effectiveness of STP among staff nurses regarding restraint

policy of NABH.

3. To find the association between posttest knowledge scores of staff nurses with

selected demographic variables.

Hypothesis:H1: The mean post-test knowledge scores will be significantly higher than

their mean pretest knowledge scores after administration of structure teaching

programme as measured by structured knowledge questionnaire at 0.05 level of

significant.

Organization and presentation of data

The data was organized under the following headings:

 SECTION I: Distribution of the staff nurses based upon their demographic

variables.

 SECTION II: Comparison of pretest and posttest knowledge regarding restraint

policy of NABH among staff nurses.

 SECTION III: Association between the knowledge levels and the selected

demographic variables of staff nurses.

35
 SECTION- I

Table-1: Frequency and Percentage distribution of Demographic Data of staff

nurses regarding infection control policies. N=30

S.No Demographic Variables Frequency(N) Percentage

1 Age
a) 20-25 years 22 73.3%
b) 26-30 years 04 13.3%
c) 31-35 years 02 6.66%
02
d) 36- 40 years 6.66%
2 Gender
a) a) Male 03 10%
b) b) Female 27 90%
3 Professional Qualification
a) GNM 09 30%
b) B.Sc (N) 18 60%
c) Post B.Sc (N) 02 6.66%
01
d) M.Sc (N) 3.33%
4 Area of work
a) a) Intensive care units 10 33.33%
b) b) Post-operative units 05 16.66%
c) c) General wards 10 33.33%
05
d) d) Emergency department 16.66%

5 Work experience

36
 a) a) Less than 1 year 09 10%
b) b) 1.1 – 2 yrs 10 20%
c) c) 2.1 – 3 yrs 05 23.3%
d) d) Above 3 years 06 46.6%
6 Previous knowledge
a) a) Yes 17 56.66%
b) b) No 13 43.33%
7 Source of information
a) a) Training programme 03 17.64%
b) b) In- service education 10 33.33%
c) c) Conferences 04 23.52%
0
d) d) Internet 0%

Table 1 described demographic data of staff nurses. With regard to age of staff

nurses 22(73.3%) were in the age group of 20-25 years, 4(13.3%) were in the age group

of 26-30 years, 2(6.66%) were in the age group of 31-35 years and, 2(6.66 %) were in

the age group of 36-40 years. Male nurses were 3(10%) and female nurses were

27(90%). With regard to professional qualification 09(30%) were studied GNM,

18(60%) were studied B.Sc (N), 2(6.66%) were studied Post B.Sc (N) and 1(3.33%)

was studied M.Sc (N). Among 30 staff nurses 10(33.33%) were working in Intensive

care units, 5(16.66%) were working in post operative units, 10(33.33%) were working

in general wards and 5(16.66%) were working in emergency department.

With regard to work experience 09(10%) staff nurses had experience less than 1

year, 10(20%) staff nurses had 1.1- 2years experience, 5(23.3%) had more 2.1- 3years

of experience and 06(46.6%) had above 3 years of experience. As per previous

knowledge 17(56.66%) had previous knowledge on restraint policy and remaining

13(43.33%) were not having any previous knowledge regarding restraint policy. Source

of information 03(17.64%) through training programme, 10 (33.33%) had knowledge

37
through in-service education, and 04 (23.52%) through conference and 0% through

internet.

SECTION - II

Table-2: Comparison of pre-test and post-test knowledge scores of staff nurses

regardingrestraint policy.N=30

Classification Range Pre test Post test

of
of Frequency Percentage Frequency Percentage
knowledge scores
scores

Below average 1-10 03 10% 00 00%

Average 11-20 26 86.66% 08 26.66%

Above average 21-30 01 3.33% 22 73.33%

38
Figure 3:Comparison of pre-test and post-test knowledge level

N=30

100%
90% 86.66%
80% 73.33%
70%
60%
50% pre test
post test
40%
30% 26.66%
20%
10.00%
10%
0.00% 1.00%
0%
below average average above average

Table 2 and figure 3: shows the comparison of pre-test and post- test knowledge

scores of staff nurses regarding restraint policy. In pre-test below average score was

10%,average score was 86%, 1% was above average score. Where as in post test it is

decreased 0%, 26% comes under the average, and 73.33% comes under above average

score.

39
Fig.2 Comparison of pre-test and post-test knowledge scores of staff nurses

regarding restraint policy.

Table 2 and figure 2 shows the comparison of pre-test and post-test knowledge

scores of staff nurses regarding restraint policy with a maximum score of 30 and least

score 0. The scores ranged between 1-10 indicating below average knowledge and 10%

staff nurses fall under this range in the pretest and in the posttest none of the subjects

fall under this range. The scores ranged between 11-20 indicating average knowledge

and 86.66% staff nurses were fall under this range in the pre test and in the post test

26.66%% staff nurses fall under this range. The scores ranged between 21-30 indicating

above average knowledge 3.33% in pretest and in posttest after administration of STP

knowledge was enhanced to73.33%.

Table 3: comparision of pretest and post test knowledge scores mean and standerd

deviation scores on restraint policy of NABH

Paired t-test
Criteria Pretest Post test

40
 Standerd deviation 3.59 4.42
tcal = 13.51

t tab = 2.045
Mean 14.83 22.83

Note : * significant at 0.05 level of significance, df (degree of freedom)=29,

tcal= table calculated value, tab = table value

table 3shows that the over all knowledge mean score of pre-test was 14.83 and

standard deviation was 3.59, the post knowledge mean score wereincreased to 22.83

and standard deviation is 4.42.the overall caliculated table value at 0.05 level of

significance at df=29 was 2.045 and caliculated value was 13.51as the caliculated value

is greater than the table value. It is evident that there was a significant association

between pre-test knowledge and scores and post test knowledge scores of staff nurses

on restraint policy of NABH after the administartion of structured teaching progarmme

on restraint policy. This indicated that was stuctured teaching programme on restraint

policy was effective

table 4: Comparision of post test knowledge scores with physical and chemical

restraints.

Physical restraints Chemical restraints

Comparision of post test

41
 knowledge scores

Frequency Percentage Frequency Percentage

16.66% 15 50%
Below aveerage 05

18 60% 12 40%
Average

Above average 04 23.33% 03 10%

Standerd deviation 6.287 6.64

Mean 16.15 11.5

Table 4shows that comparision post test knowledge scores with physical

restraints and chemical restraints the physical restraints below average is5(16.66%),

average is 18(60%), and above average is 07(23.33%), the standerd deviation is 6.27

and the mean is 16.15. where as chemical restraints below average consists of

15(50%),average score is 12(40%), and above average is 03(10%), standerd deviation

is 6.64 and the mean is 11.5. it is evident that there is significant changes between

physical restraints knowledge scores and chemical restraints knowledge scores,staff are

having increased knowledge level than the chemical restraints.

SECTION III

Association between the knowledge levels and the selected demographic variables

among staff nurses regarding restraint policy

42
 In this present study there was an association between the post-test knowledge

scores of restraint policy with their selected demographic variable i.e,. previous

knowledge.

The association between the post test knowledge scores and age of staff nurses

on restraint policy, the calculated table value was 1.007, where the table value is 7.82

with 3 degree of freedom at 0.05 level of significance. The calculated value is lesser

than the table value; hence there is no significant association between the post test

knowledge scores and age of staff nurses.

The association between the post test knowledge scores and gender of staff

nurses. The calculated table value was 0.062, where the table value is 3.84 with 1

degree of freedom at 0.05 level of significance. The calculated value is lesser than the

table value; therefore there is no association between the post test knowledge scores and

gender of staff nurses.

The association between the post test knowledge scores and qualification of

staff nurses. The calculated table value was2.68 , where the table value is 7.82 with 3

degree of freedom at 0.05 level of significance. The calculated value is less than the

table value; therefore there is no association between the post test knowledge scores and

qualification of staff nurses.

The association between the post test knowledge scores and working area of

staff nurses. The calculated table value was0.07 , where the table value is 7.82 with 3

degree of freedom at 0.05 level of significance. The calculated value is less than the

table value; therefore there is no association between the post test knowledge scores and

working area of staff nurses.

43
 The association between the post test knowledge scores and experience of staff

nurses. The calculated table value was21.31 , where the table value is 7.82 with 3

degree of freedom at 0.05 level of significance. The calculated value is less than the

table value; therefore there is association between the post test knowledge scores and

experience of staff nurses.

The association between the post test knowledge scores and previous knowledge

of staff nurses. The calculated table value was8.26 , where the table value is 3.84 with 1

degree of freedom at 0.05 level of significance. The calculated value is greater than the

table value; therefore there is association between the post test knowledge scores and

previous knowledge of staff nurses.

The association between the post test knowledge scores and knowledge source

of staff nurses. The calculated table value was5.23 , where the table value is 5.99 with 2

degree of freedom at 0.05 level of significance. The calculated value is lesser than the

table value; therefore there is no association between the post test knowledge scores

and sorce of information of staff nurses.

SUMMARY:

This chapter deals with the analysis and interpretation of the data related to the

knowledge regarding restraint policy of NABH among staff nurses at Kamineni

Hospitals, L.B. Nagar, Hyderabad. Interpretations were done with the help of

descriptive and inferential statistics to meet the objectives of the study.

CHAPTER – V

SUMMARY,DISCUSSION,CONCLUSION,IMPLICATIONS,

44
 LIMITATIONS AND RECOMMENDATIONS

This chapter presents a brief summary of research study, discussion on the study

findings, conclusion and implication for the field of nursing, limitations of the study

and recommendations for the future.

Summary:

Hospital is the health care institution providing care to the patients with different

types of diseases. Patient safety is also one of the importent thing while treating the

disease condition, patients with memory, sleeping, incontinence, pain, uncontrolled

body movement must be carefully assessed for best ways to keep them safe from falling

for that we are using restraints to prevent fall and self harm and harm to others. Nurses

should carefully monitor the restrained patients, and nurses require knowledge

regarding restraits usage.

The present study was undertaken was to assess “Effectiveness of Structured

Teaching programme on knowledge regarding resstraint policy of NABH among staff

nurses working at Kamineni Hospitals, L.B. Nagar, Hyderabad”.

Objectives:

1. To assess the Knowledge Regarding restraint policy among staff nurses.

2. To determine the effectiveness of structured teaching programme Regarding

restraint policy among staff nurses.

3. .To find out the association between Post test knowledge scores on regarding

restraint policy among staff nurses and demographic variable.

Hypothesis:

45
 H1: There will be a significant difference between Pre test and Post test

knowledge scores after structured teaching programme regarding restraint policy among

staff nurses as measured by the structured questionnaire at 0.05 level of significance

The present study is aimed at assessing the knowledge of staff nurses on

restraint policy.The conceptual framework used in the present study was based on

king’s goal attainment theory.

One group pre-test and post-test design was selected from pre-experimental

design for the present study to assess the effectiveness of structured teaching

programme on Knowledge level of staff nurses regarding restraint policy. Sample was

selected by convenient sampling technique.

Based on the review of the literature, under guidance of the experts and with the

investigators personal and professional experience, a structured knowledge

questionnaire was prepared to collect the data regarding restraint policy infection. After

going through review and literature the structured questionnaire was developed on

restraint policy.

Based on the review of the literature, under guidance of the experts and with the

investigators personal and professional experience, a structured knowledge

questionnaire was prepared to collect the data regarding restraint policy. After going

through review and literature the structured teaching programme was developed on

restraint policy.

Content validity of the tool will be done by experts. Pilot study was conducted

at ozone hospital, kothapet, Hyderabad. Pilot study results found to be feasible to

46
conduct main study as the reliability of the tool was obtained by spit half method “r”

value was 0.70.

Ethical approval to conduct the study was taken from the ethical committee of

the institution. A formal permission was sought from the Chief executive officer of

Kamineni Hospitals, L.B Nagar, Hyderabad to conduct the main study. The purpose of

study was explained to the sample and an informed consent was taken before starting

the study. A pre-test was conducted by administering the questionnaire to the staff

nurses on restraint policy.

On the same day Structured teaching programme was given to staff nurses. The

post test was conducted by using the same questionnaire after seven days. Scoring was

done manually and master sheet was prepared. Both descriptive and inferential statistics

were used for data analysis.

The major findings of the study were described demographic data of staff

nurses wit age of staff nurses majority were 22(73.3%) were in the age group of 20-25

years, 4(13.3%) were in the age group of 26-30 years, 2(6.66%) were in the age group

of 31-35 years and, 2(6.66 %) were in the age group of 36-40 years. Male nurses were

3(10%) and female nurses were 27(90%). With regard to professional qualification

09(30%) were studied GNM, 18(60%) were studied B.Sc b (N), 2(6.66%) were studied

Post B.Sc (N) and 1(3.33%) was studied M.Sc (N). Among 30 staff nurses 10(33.33%)

were working in Intensive care units, 5(16.66%) were working in post operative units,

10(33.33%) were working in general wards and 5(16.66%) were working in emergency

department. With regard to work experience 09(10%) staff nurses had experience less

than 1 year, 10(20%) staff nurses had 1.1- 2years experience, 5(23.3%) had more 2.1-

3years of experience and 06(46.6%) had above 3 years of experience. As per previous

47
knowledge 17(56.66%) had previous knowledge on restraint policy and remaining

13(43.33%) were not having any previous knowledge regarding restraint policy. Source

of information 03(17.64%) through training programme, 10 (33.33%) had knowledge

through in-service education, and 04 (23.52%) through conference and 0% through

internet.

Discussion:

The findings of the study have been discussed in terms of objectives stated and

other research findings

Implications:

The study findings have certain important implications for nursing profession

i.e. nursing education, nursing administration, nursing practice and nursing research.

Nursing education:

Nursing education aims at preparing nurses who will be able to plan and provide

comprehensive care to individuals and families after the completion of educational

programmes. Nursing curriculum should include the topic such as restraint policy so

that students gain knowledge regarding restraint policy and able to know the policies as

it helps to prevent related risks and to have better prognosis. More emphasis should be

placed on staff nurses on restraint policy. Nurses need to equip themselves regarding

restraint policy by attending in-service education programmes.

Nursing practice:

48
 All the nurses who work either in hospital or in community set up and any other

health care personnel have to take the opportunity to identify the measures for restraint

policy. Nurse has to conduct various health talks, awareness programmes and educate

staff nurses.

Nursing administration:

It helps the nurse administrator in the formulation of policies, protocols,

guidelines to conduct awareness programmes regardingretraint policy. Based on

awareness programme, she has to organize health camps on management of restraint

required patients. The administrator should support the employees for conducting health

education programmes by the provision of adequate funds to develop educational

material like posters, handouts, pamphlets, and self-instructional module. The nurse

administrator should motivate the employees by providing financial (monetary awards)

and nonfinancial (promotion) incentives for their active involvement in organization of

various health education programmes.

Nursing research:

The present study can be taken as reference material for doing further studies on

restraint policy.

 Further studies can be use this study as their reviews

 Further studies can be conducted by utilizing various educational interventions

like self-instructional module, information booklet etc.

Conclusion

49
 The present study was aimed at assessing the Effectiveness of Structured

Teaching Programme on Knowledge regarding restraint policy of NABH among staff

nurses working at kamineni hospital,L. b nagar, Hyderabad, Telangana. Objectives of

the study were to assess the Pretest and posttest knowledge of staff nurses regarding

restraint policy of NABH, to evaluate the effectiveness of STP among staff nurses

regarding restraint policy of NABH, to find association between posttest knowledge

scores of staff nurses with selected demographic variables. The null hypothesisH0the

mean post-test knowledge scores will be lower than their mean pretest knowledge

scores after administration of structure teaching programme as measured by structured

knowledge questionnaire at 0.05 level of significant, so there will be null hypothesis is

rejected. The hypothesis H1 postulated for the study was, the mean post-test knowledge

scores will be significantly higher than their mean pretest knowledge scores after

administration of structure teaching programme, as measured by structured knowledge

questionnaire at 0.05 level of significance. H2 was there will be significant association

between post-test knowledge scores of staff nurses with selected demographic variables

at 0.05 level of significance.

The results revealed that majority 70% of the staff nurses had below average

knowledge on pre-test. Whereas in post-test,majority 73.33% of staff nurses had above

average knowledge. Hence H1 was acce8pted, structured teaching programme was

effective in improving the staff nurses knowledge on restraint policy of NABH.

Limitations

 Study was limited to staff nurses who are working in the selected kamineni

hospital. L. B. nagar, Hyderabad.

Recommendations

50
  The study can be replicated on large sample

 A similar study can be conducted with quasi experimental approach

 A comparative study can be conducted between two settings

 Future research can be conducted regarding impact of restraintson the lives of

sufferers, their family.

 A longitudinal study can be conducted to evaluate the effectiveness of structured

teaching programme.

Summary:

This chapter has dealt with the summary of present study, major findings of the

study, discussion, and conclusions, implications derived from the study, limitations, and

recommendations for further study.

LIST OF REFERENCES

51
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 APPENDIX-I

LETTER SEEKING CONSENT FROM OF THE PARTICIPANT IN THE

STUDY

Dear Participant,

Iam a student of post graduate nursing program at Kamineni College of Nursing

as a part of this program. Iam doing research study on Effectiveness of structured teaching

programme on prevention of dialysis catheter related blood stream infections, at selected

hospitals, Hyderabad.

I would like to give you some questions regarding prevention of dialysis

catheter related blood stream infections. The information given by you will be used for

research purpose and will be kept in confidential. The successful completion of study;

largely depends on your active Cooperation and participation.

Thanking you,

Yours sincerely (Ms.Yangala kalpana)

Consent form

I here with, consent for the above said study knowing that all the information

provided by me will be treated with at most confidentially by the investigator.

Date:

Place:

Signature of the participant

57
 APPENDIX-II

LETTER TO THE EXPERT FOR THE CONTENT VALIDITY OF THE TOOL

To Date

Respected Sir/Madam

Subject: KCON Hyderabad MSC (N) course 2015-2017 permission to MSC(N) 2 nd year

students dissertation and establishing content validity for tool and suggestion from

experts request regarding

This is to inform Ms. Kalpana 2 nd year

MSC (N) bonafied student of this college,

need to conduct a study for partial fulfilment of P.G programme as per Dr.NTR

University norms on Effectiveness of structured teaching programme restraint policy of

nabh among staff nurses working at kamineni hospitals, l.b. nagar, hyderabad”.

Objectives of the study:

1. To assess the Knowledge Regarding restraint policy among staff nurses.

2. To determine the effectiveness of structured teaching programme Regarding

restraint policy among staff nurses.

3. .To find out the association between Post test knowledge scores on regarding

restraint policy among staff nurses and demographic variable.

Thanking you,

Yours faithfully

Dr.Mrs.M.Geetha Srinivas rao

58
EVALUATION CRITERIA TOOL FOR CONTENT VALIDITY

s. no Criteria Relevant Relevant to Not relevant Remarks

certain extent
I Formulating
the objectives

II Selection of
items

III Organisation
of the item

IV Feasibility of
the content

V Any other
suggestions

PLACE:

DATE: SIGNATURE OF THE EXPERT

59
 APPENDIX-III

LETTER SEEKING PERMISSION TO CONDUCT PILOT STUDY

60
 APPENDIX-IV

LETTER SEEKING PERMISSION TO CONDUCT MAINSTUDY

61