The Development of a Holistic Nursing Practice Guideline for Restraint the Patient in Intensive Care Unit using Evidence Based Practice
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Abstract
Abstract
This research and development study aimed to (1) develop evidence-based holistic nursing practice guidelines for the use of physical restraints in intensive care units, (2) evaluate the outcomes of the implemented guidelines, and (3) enhance nurses’ competency in assessing and managing critically ill patients under physical restraint. The study was conducted across six intensive care units in four phases: identifying clinical issues, searching for evidence-based practices, developing and implementing the guidelines, and evaluating the outcomes. The sample consisted of 80 critically ill patients, divided equally into experimental and control groups, and 80 intensive care nurses. The nursing practice guidelines, used as a research instrument, demonstrated a content validity index of 0.85 and an overall quality score of 85.67%. Data collection tools included a questionnaire assessing patient or family feelings post-restraint, a nurse satisfaction questionnaire, and a nurse competency evaluation form. These instruments showed a content validity index of 1.0, with Cronbach’s alpha coefficients of 0.82, 0.80, and 0.94, respectively. Data were analyzed using mean, percentage, standard deviation, chi-square test, t-tests, and repeated measures ANOVA.
The results showed that: (1) the developed nursing practice guidelines consisted of three phases—pre-restraint, during restraint, and restraint termination; (2) the restraint rate and average duration of restraint in the experimental group were significantly lower than those in the control group (p < 0.05); (3) no local complications were observed in either group; (4) the control group had a higher incidence of unplanned removal of invasive medical devices than the experimental group; (5) the experimental group reported more positive feelings and fewer negative feelings after restraint use compared to the control group in all aspects; and (6) nurses' competency scores were significantly higher after the training than before, and continued to increase one month after the conclusion of the study. Nurses also reported a high level of satisfaction with the guidelines.
These findings suggest that the holistic, evidence-based nursing practice guidelines should be continuously implemented and further developed.
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References
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