Assessment of nurse's knowledge, attitudes, and practice regarding physical restraints among critical ILL patients

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National Journal of Advanced Research
15
National Journal of Advanced Research
ISSN: 2455-216X
Impact Factor: RJIF 5.12
www.allnationaljournal.com
Volume 4; Issue 1; January 2018; Page No. 15-22
Assessment of nurse's knowledge, attitudes, and practice regarding physical restraints among critical
ILL patients
1 Abeer El-Said Hassane El-sol, 2 Ragaa Gasim Ahmed Mohmmed
1 Lecturer of Medical-Surgical Nursing, Faculty of Nursing, Menoufia University, Egypt
1 Faculty of Applied Medical Sciences, Nursing Department, Al-Baha University, Saudi – Arabia
2 Assistant Professor of Pediatric Nursing, Faculty of Applied Medical Sciences, Nursing Department, Albaha University, Saudi Arabia
Abstract
Nurses in critical ill setting as ICU mostly use physical restraints to maintain the patients’ devices and therapy, such as
endotracheal tubes, central lines, and arterial lines. Around 80% of critical ill patients admitted into different types of ICUs may
need to apply physical restraints due to alterations in their level of consciousness during a stay in ICU. Nurses' knowledge, attitude
and practice about physical restraints play an important role in nursing care provided to restrained patients and prevent its
complications. The assessment of nurses' knowledge, attitude and practice related to the applied restraint influence on nursing care
and recognizing its weakness and strength.
Aim of the study: To assess nurse's knowledge, attitudes, and practice regarding physical restraints among critically ill patients.
Methodology: A descriptive design was used.
Subjects & Setting: The target population of this study consisted of 60 nurses who working at Alshaab Teaching Hospital during
the study period.
Tools: Structured Interviewing Questionnaire: consists of four parts:
Part-1: Socio-demographic designed questionnaire was used to collect the demographic data related to nurses in the study;
Part-2: Structured designed questionnaire was used to collect the nurses' knowledge;
Part-3: Structured designed questionnaire was used to collect the nurses' attitude and
Part-4: Structured designed questionnaire was used to collect the nurses' practice related to physical restraints.
The results: Most of studied sample were female, had bachelor degree in nursing, more than 5 years of experiences, aged between
21-30 years old, and not attended a previous educational program about physical restraints. The majority of the nurses had a fair
level of knowledge, improper attitude and about 91.7% of nurses had a satisfactory level of practice toward application of physical
restraints among critical ill patients. As relationship between sociodemograhpic characters & nurses` knowledge, attitude &
practice, there was no significant correlation between nurses' age and knowledge, attitude & practice, there was a statistical
significant correlation between nurses’ gender and knowledge and practice only. There was statistical significant correlation
between nurse’s qualification and practice only, finally there was a statistical significant correlation between nurses’ experience
years and attitude and practice score.
Conclusion: The present study concluded that, there was a fair level of nurses' knowledge, improper attitude and satisfactory
practice to physical restraints among critically ill patients.
Recommendation: conduct in-service training programs for nurses working in all critical care settings about physical restraints
and the hospital should develop evidence-based written guidelines or policies on physical restraint to be accessible for all nurses
and physicians in order to follow.
Keywords: critical ill patients, physical restraints, nurses' knowledge, attitude and practice, level of consciousness alteration
1. Introduction
Critically ill patients are the classifications of patients require
continuous nursing monitoring and specialized care due to
their life threatening conditions or injuries [1] Furthermore,
they have the possibility of developing the alteration in their
level of consciousness as confusion. So they can remove the
connected life support and monitoring devices; as
endotracheal tubes; nasogastric tube, arterial line, central lines
and harming themselves [2].
Around 80% of critical ill patients admitted into different
types of ICUs may need to apply of physical restraints due to
alterations in their level of consciousness during stay in ICU
[3]. Additional, use of physical restraint among medical ICU
patients was higher too (12.6 to 50.1%) if compared with
surgical ICUs patients was (14.5 to 34%) [4].
Physical restraint is defined as “any device, material or
equipment closed or attached to a patient’s body to limit the
patient’s movement freely, physical activity or usual access to
his or her body [5]. The prevalence of physical restraints
application among confused patient is 62% and 65% to
prevent risk of falling [6].
The application of physical restraint for critically ill patients is
a complex decision and is depends on patient characters, the
practitioner, and the environment. There are many types of

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restraints can be applied as wrist restraints, mitts, elbow
immobilizers, belts, vests, leg restraints and bed side rails [7].
The main indication of physical and chemical restraint is
maintaining the patient safety during the alteration in her/his
consciousness level; but the use of chemical restraint is related
to the risk of sedation. Accordingly the patient's status in
critical care setting, the practice of physical restraint use as a
way to prevent the confused patients' interference during
providing nursing care [8].
Physical restraint is contraindicated in patient with edema,
cyanosis, pressure ulcers, aspiration and breathing problems,
contractures, fractures and paralysis, also its application need
for informed consent from patients or family as ethical
concerns relate to patients’ right to respect patients' autonomy
and dignity [5]. Also, they have an effect on patient and family
reactions, including detention, reduced patient’s self-esteem,
increased worry and aloneness. Additional physical restraints
have an effect on nurse’s feelings, such guilt and
disappointment when they apply it to their patients [9].
Complications of physical restraint application among critical
ill patients may develop pressure sore, limb edema, restricted
circulation, and skin laceration at restraint site [10]. These
complications can be prevented by the closely monitoring and
change of care plan by nurses; the nursing care plan should be
containing regular changes of patient position, skin care and a
sufficient range of motion [5]. The assessment of the patient’s
response hourly, removing the restraints every two hours,
frequent change of patient’s position, in addition to assessing
the patient for any physical and/or psychological effects of
restraining [1].
Many factors can be affected on application physical restraints
as; nurses’ number, their qualification, experience, and
knowledge regarding of use physical restraint. Nurses'
knowledge, attitude and practice about physical restraints play
an important role in nursing care provided to restrained
patients and prevent its complications. The assessment of
nurses' knowledge, attitude and practice related to the applied
restraint effect on nursing care and recognizing its weakness
and strength [11]. So the study aim is to assess nurse's
knowledge, attitudes, and practice regarding physical
restraints among critical ill patients.
1.1 Significance of the study
The food and drug administration (FDA) reported that at least
100 deaths happen yearly in the USA from the inappropriate
practice of physical restraints [5]. Physical restraints applied
among hospitalized patients in intensive care unit patients by
33% - 68% in rather than other ward patients less than 30%
[12].
In Sudan, physical restraint is the most conservative practice
among ICU patients. Although there are no enough researches
about the assessment of nurses' knowledge; practice and
attitude regarding physical restraint application for critically
ill patients. This assessment is very important to identify the
need of the team nursing to education and training, which is
essential in preparing the qualified nurses and develop a good
practice for physical restraint patients.
1.2 The aim of the study
To assess nurse's knowledge, attitudes, and practice regarding
physical restraints among critical ill patients.
1.3 Research question
Q1: What are the nurses' knowledge, attitudes, and practice
about physical restraints?
Q2-Is presence of the relationship among nurse's knowledge,
attitudes, and practice and their socio-demographic
characteristics?
2. Methods
Design: A descriptive hospital based design was used for this
study
Setting: The study was conducted in ICU, Intermediate A
,
and Intermediate B, at Alshaab Teaching Hospital -
Khartoum.
Subjects: The target population of this study consisted of 60
nurses who working at Alshaab Teaching Hospital during the
study period.
Inclusion Criteria: Nurses willing to participate
Exclusion Criteria: Nurses on vacation
A tool for the study: The data for this study were collected
using the following tool
Structured Interviewing Questionnaire: consists of four
parts:-
 Part-1: Socio-demographic designed questionnaire was
used to collect the demographic data related to nurses in
the study; which included the following characteristics:
nurses' sex, age, qualification, a number of years'
experience, previous education on physical restraint, and
type of ICU.
 Part-2: Structured designed questionnaire was used to
collect the nurses' knowledge related to physical restraints
consists of 15 multiple choice questions; each question has
2 choices (agree or disagree) only one is correct.
 Part-3: Structured designed questionnaire was used to
collect the nurses' attitude related to physical restraints
consists of 11 multiple choice questions; each question has
3 choices (agree, disagree, and non-decided) only one is
correct.
 Part-4: Structured designed questionnaire was used to
collect the nurses' practice related to physical restraints
consists of 13 multiple choice questions; each question has
3 choices (always, sometimes, never) only one is correct.
Part of 2, 3& 4 from tools adopted from [13] and modified by
researchers.
Validity of the tools
The tools were tested for their content by three experts in the
field of Medical-Surgical Nursing and Pediatric Nursing to
ascertain relevance and completeness.
Scoring system for the following parts
1-Part 2 nurses` knowledge regarding physical restraints
among critical care patients
 We have 15 items (all items are positive statements)

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 Different responses scored as follows: 1 = Agree & 0 =
Disagree
 The maximum score is 15 (1*15) (Respondents remained
positive (i.e. Agreed) to the positive statements &
minimum score is 0 (0*15) (Respondents in this category
remained negative (i.e. Disagreed) to the positive
statements.
 Poor level of knowledge: 0-7 it represents (less than 50%)
 A fair level of knowledge: 8-11 it represents (from 50 to
75%)
 Good level of knowledge: 12-15 it represents (more than
75%)
2-Part 3 nurses` attitude regarding physical restraints
among critical care patients
 We have 11 items (all items are positive statements)
 Different responses scored as follows: 2 = Agree, 1=Non-
decided & 0 = Disagree
 The maximum score is 22 (2*11) (Respondents remained
positive (i.e. Agreed) to the positive statements &
minimum score is 0 (0*11) (Respondents in this category
remained negative (i.e. Disagreed) to the positive
statements)
 Proper Attitude: 14-22 it represents (more than 60%)
 Improper attitude: 0-13 it represents (less than 60%)
3-Part 4 nurses` practice regarding physical restraints
among critical care patients
 We have 13 items (all items are positive statements)
 Different responses scored as follows: 2 = Always,
1=Sometimes & 0 = Never
 The maximum score is 26 (2*13) (Respondents remained
positive (i.e. Always) to the positive statements &
minimum score is 0 (0*13) (Respondents in this category
remained negative (i.e. Never) to the positive statements)
 Unsatisfactory practice: 0-12 it represented (less than
50%)
 Satisfactory practice: 13-19 it represented (from 50 to
75%)
 Good practice: 20-26 it represented (more than 75%)
Procedure of data collection
A verbal agreement was obtained from the director of the
hospital and to the head of each unit, and then approval for
carrying out the study was obtained after explaining the aim of
the study. Nurses were approached individually to explain the
purpose and the nature of the study
.
Duration of study: Data were collected throughout a period
of the 3-months between October & December 2017.
Ethical consideration
A verbal consent was taken from nurses to participate in the
study after explanation of the purpose of the study
.
 Informing study subjects' that the confidentiality and
privacy of any obtained information will be ensured
.
 Respecting the right of the study sample to be withdrawn
from the study at any time.
 A tool was developed by researchers.
 Tools of the study were implemented by the researcher
using the interview questionnaire sheet to assess nurses'
knowledge, attitudes, and practice regarding physical
restraints among critical care patients.
 The questionnaire was distributed to the nurses and the
researcher was present during data collection for any help
and guidance for nurses.
 Each interview was implemented on an individual basis
and lasted for about 20-30 minute for each tool according
to the nurse's attention and willing to cooperate or talk
with the researcher.
 Data were collected over a period of 3 months (October &
December/ 2017).
Data management
Data were collected by questionnaire for the nurses by a
researcher. Knowledge, attitude and practice of nurses were
calculated. Manual coding was done to check any error in
coding. The manual coding and tables were developed before
entering the data. Double entry of data by researchers was
done to prevent potential data entry error. The data were
checked and cleaned by performing preliminary frequency
distribution to enhance accuracy and reliability.
Statistical analysis
The data collected were tabulated & analyzed by SPSS
(statistical package for the social science software) statistical
package version 20 on IBM compatible computer. Two types
of statistics were done: Descriptive statistics: were expressed
as mean and standard deviation (X+SD) for quantitative data
or number and percentage (No & %) for qualitative data.
Analytic statistics: as F= ANOVA and t= student`s t test.
P-value at 0.05 was used to determine significance
regarding
 P-value > 0.05 to be statistically insignificant.
 P-value ≤ 0.05 to be statistically significant.
 P-value ≤ 0.001 to be highly statistically significant.
3. Results
Table 1: Demographic characteristics of the studied group
Study group (n=60)
Socio-demographic characteristics
%
No.
56.7
34
21-30 years old
Age (years)
30.0
18
31-40 years old
13.3
8
41 -50 years old
30.0
18
Male
Gender
70.0
42
Female

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13.3
8
Diploma
Qualification
71.7
43
Bachelor
15.0
9
Master
36.7
22
Less than 5 years
Experience years
63.3
38
More than 5 years
20.0
12
Yes
Previous education program on physical restraint
80.0
48
No
28.3
17
Intermediate A(CCU 1)
Type of CC nurses
25.0
15
Intermediate B(CCU 2)
46.7
28
ICU
Table (1): represents the characters of the study nurses in ICU.
It showed that; more than half of the study sample aged
between 21-30 years old, regarding to nurses’ gender about 70
% of the nurses were female, in relation to the nurse's
qualification more than two third from sample had a bachelor
degree in nursing, as nurses’ years of experience in ICU, most
of the nurses had more than 5 experiences years for nursing
profession in ICU settings, finally the majority of studied
sample not attended previous educational program about
physical restraints.
Table 2: Assessment of nurses` knowledge regarding physical restraints among critical ill patients (n=60)
Statement
Agree
No (%)
Disagree
No (%)
Mean ± SD
Physical restraints designed to prevent patient’s injury and their application was safety.
50 (83.3)
10 (16.7)
0.83±0.37
A restraint is legal only if it is necessary from patient harm.
35 (58.3)
25 (41.7)
0.58±0.49
From patients' rights are refusing the application of a restraint.
26 (43.3)
34 (56.7)
0.43±0.50
Its application requires a doctor’s order.
29 (48.3)
31 (51.7)
0.48±0.50
The disturbance in the patient’s level of consciousness disturbance requires application of a restraint.
20 (33.3)
40 (66.7)
0.33±0.47
The nurse should be released a restraint every 2 hours.
35 (58.3)
25 (41.7)
0.58±0.49
Restraints should be applied not tightly, with pad between the restraint and patient’s skin.
7 (11.7)
53 (88.3)
0.12±0.32
If a patient restrained while lying flat in bed, maybe incidence of choking.
40 (66.7)
20 (33.3)
0.67±0.47
There is many patients' complication due to physical restraints as skin breaks up or restlessness.
53 (88.3)
7 (11.7)
0.88±0.32
Never attached the restraint to the side rails after restrained patient.
26 (43.3)
34 (56.7)
0.43±0.50
Assessment and record for the restrained patient are important every shift.
53 (88.3)
7 (11.7)
0.88±0.32
A nurse can be charged with assault if he/she applies restraints when they are not needed.
31 (51.7)
29 (48.3)
0.52±0.50
In an emergency situation, it is legally a nurse can restrain a patient without a physician’s order.
8 (13.3)
52 (86.7)
0.13±0.34
May be presence of effective alternatives to restraints.
29 (48.3)
31 (51.7)
0.48±0.50
May be the presence of a relationship between the deaths and the use of vest restraints.
29 (48.3)
31 (51.7)
0.48±0.50
Total nurses` knowledge mean score regarding Physical Restraints among Critical Ill Patients
7.85±1.86
Table (2): illustrates nurses’ knowledge toward the use of
physical restraints. It was found that, mean of total nurses` knowledge score was7. 85 ±1.86.
Fig 1: Categories of nurses' knowledge regarding physical restraints among critical ill patients (n=60)
Figure (1): Illustrates level of nurses’ knowledge. It was
demonstrated that more than half of the nurses had a fair level of knowledge toward application of physical restraints among
critical ill patients.

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Table 3: Assessment of nurses` attitude regarding physical restraints among critical ill patients (n=60)
Statement
Agree
No (%)
Disagree
No (%)
Non
decided
No (%)
Mean ±
SD
I think that patient’s family members have the right to refuse the use of restraints.
3 (5)
23 (38.3)
34 (56.7)
0.67±0.57
I think that the nurses have the right to refuse the application of patient restraints.
11
(18.3)
39 (65)
10 (16.7)
0.53±0.79
If, i am a patient, I should have the right to refuse/oppose when restraints apply to me.
52
(86.7)
4 (6.7)
4 (6.7)
1.80±0.54
I believe that placing a patient in restraints is wrong.
0 (0)
52 (86.7)
8 (13.3)
0.13±0.34
I think that the main cause of restraints application in the hospital is limited staff number.
30 (50)
26 (43.3)
4 (6.7)
1.07±0.97
I feel with uncomfortable senses when the family enters the patient’s room, and they see
him/ her restrained.
45 (75)
8 (13.3)
7 (11.7)
1.62±0.71
The hospital administration is legally responsible for using restraints to keep the patient safe.
59
(98.3)
0 (0)
1 (1.7)
1.98±0.12
It makes me feel terrible if the patient gets more upset after restraints are applied.
28
(46.7)
5 (8.3)
27 (45)
1.38±0.64
I think that it is more important to let the patients with agitation or disturbed consciousness
levels in restraints during I provide care for them.
29
(48.3)
31 (51.7)
0 (0)
0.97±1.0
I think that a patient suffers a loss of dignity when placed in restraints.
14
(23.3)
11 (18.3)
35 (58.3)
1.05±0.64
In general, I think that I have all knowledge needed for caring for a restrained patient.
14
(23.3)
12 (20)
34 (56.7)
1.03±0.66
Total nurses` attitude mean score regarding Physical Restraints among critical ill patients
12.23±1.86
Table (3): Shows nurses’ attitudes toward the use of physical
restraints. It was shown that, total nurses` attitude means score regarding use of physical restraints was 12.23±1.86.
Fig 2: Categories of nurses' attitude regarding physical restraints among critical ill patients (n=60)
Figure (2): Demonstrates of nurses’ attitude. It was
represented that more than two third of nurses had improper attitude regarding to the application of physical restraints
among critical ill patients.
Table 4: Assessment of nurses` practice regarding physical restraints among critical ill patients (n=60)
Statement
Always
No (%)
Sometimes
No (%)
Never
No (%)
Mean ±
SD
Before restraining the patient, I attempt another alternative nursing measure.
3 (5)
43 (71.7)
14
(23.3)
0.82±0.50
I take the decision for restraining a patient with a physician.
23
(38.3)
33 (55)
4 (6.7)
1.32±0.59
When I assess the patient and discover him/her not need to be restrained, I suggest to the
doctor remove it.
26
(43.3)
31 (51.7)
3 (5)
1.38±0.58
I respond rapidly to the call from the restrained patient as soon as possible.
35
(58.3)
25 (41.7)
0 (0)
1.58±0.49
I check the restraints at least every 2 h to make ensure they are in the proper position.
31
(51.7)
28 (46.7)
1 (1.7)
1.50±0.53
I inspect carefully the patient’s skin for abrasions or break up during I bathe him/her.
42 (70)
18 (30)
0 (0)
1.70±0.46
I explain to family members the cause of the patient is being restrained.
10
(16.7)
43 (71.7)
7
(11.7)
1.05±0.53
I explain to the patient, the restraint(s) will be removed when disappear its indications.
17
(28.3)
26 (43.3)
17
(28.3)
1.0±0.75

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Most of the patients are restrained when the staff is short more than is full.
31
(51.7)
28 (46.7)
1 (1.7)
1.50±0.53
Within our ward, staff members make an effort together to find out methods to control the
behavior of patients other than by using physical restraints.
10
(16.7)
24 (40)
26
(43.3)
0.73±0.73
I regularly assess if the restraint should be removed.
26
(43.3)
23 (38.3)
11
(18.3)
1.25±0.75
If physical restraints are applied, I record on the patient’s file the type of restraint used, the
causes for applying it, the time of application, and the needed nursing care.
38
(63.3)
22 (36.7)
0 (0)
1.63±0.48
I regularly assess and record the effect of physical restraint when applied to a patient.
37
(61.7)
23 (38.3)
0 (0)
1.62±0.49
Total nurses` practice mean score regarding Physical Restraints among critical care patients
17.08±2.09
Table (4): Represents nurses’ practice toward the use of
physical restraints. It was documented that, total nurses` practice mean score regarding application of physical
restraints for critically ill patients was 17.08±2.09.
Fig 3: Categories of nurses practice regarding physical restraints among critical ill patients (n=60)
Figure (3): Displays of categories of nurses' practice. It was
found that, about 91.7% of nurses had a satisfactory level of
practice, 1.7% of nurses had an unsatisfactory level of practice
and 6.7% of nurses had a good level of practice regarding the
application of physical restraints among critical ill patients.
Table 5: Relationship among sociodemograhpic characters & nurses` knowledge, attitude & practice regarding physical restraints among critical
ill patients
Practice score
Mean ± SD
Attitude scores
Mean ± SD
Knowledge score
Mean ± SD
NO.
Socio-demographic characteristics
17.23±0.78
12.29±2.0
7.55±2.35
34
21-30 years old
Age (years)
17.27±3.17
12.38±1.64
8.33±0.90
18
31-40 years old
16.0±2.82
11.62±1.76
8.0±0.53
8
41 -50 years old
F=1.24
F=0.49
F=1.04
Test of significance
0.29 NS
0.61 NS
0.35 NS
P value
18.16±0.38
12.38±0.77
9.05±2.36
18
Male
Gender
16.61±2.34
12.16±2.17
7.33±1.33
42
Female
t=4.14
t=0.58
t=2.89
Test of significance
≤0.001 HS
0.56 NS
0.008 S
P value
16.0±2.82
11.62±1.76
8.0±0.53
8
Diploma
Qualification
16.97±0.85
12.58±1.91
7.67±2.15
43
Bachelor
18.55±4.21
11.11±1.05
8.55±0.52
9
Master
F=3.65
F=3.0
F=0.85
Test of significance
0.03 S
0.06 NS
0.43 NS
P value
17.68±0.47
13.40±1.18
8.09±2.74
22
Less than 5 years
Experience years
16.73±0.52
11.55±1.85
7.71±1.11
38
More than 5 years
t=2.21
t=4.73
t=0.62
Test of significance
0.03 S
≤0.001 HS
0.54 NS
P value
18.66±3.60
11.08±0.90
8.41±0.51
12
Yes
Previous education program on physical restraint
16.68±1.29
12.52±1.93
7.70±2.05
48
No
t=3.14
t=2.49
t=2.13
Test of significance
0.003 S
0.01 S
0.03 S
P value
17.23±1.88
12.35±1.83
7.94±1.85
17
Intermediate A (CCU 1)
Type of CC nurses
17.13±1.99
12.40±1.95
8.20±1.82
15
Intermediate B(CCU 2)
16.96±2.31
12.07±1.88
7.60±1.93
28
ICU
F=0.09
F=0.19
F=0.51
Test of significance
0.91 NS
0.82 NS
0.60 NS
P value

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Table (5): Represents relationship among sociodemograhpic
characters & nurses` knowledge, attitude & practice regarding
physical restraints among critical ill patients. It was reported
that; regarding to nurses' age, there was no statistical
significant correlation between nurses' age and knowledge,
attitude & practice regarding physical restraints. While in
relation to nurses’ gender, there was a statistical significant
correlation between nurses’ gender and knowledge and
practice only. Regards to nurses’ qualification, there was a
statistical significant correlation between nurse's qualification
and practice only. As regards to nurses' years of experience in
ICU, there was a statistical significant correlation between
nurses’ experience years and attitude and practice score.
4. Discussion
Most critically ill patients may have multiple traumas, or other
diagnosis can lead to the possibility of alteration in level of
consciousness as confusion and agitation, which causing the
observed behavioral problem [7]. So application of physical
restraint is helpful in a void patients' interference during
treatment. Physical restraints may cause many adverse
reactions, so the restrained patients need to equip nurses with
adequate knowledge and good practice which contributing to
proper attitude and enable nurses to modify their care plan
toward preventing the physical restraint complications [14].
Assessment of nurse's knowledge, attitudes, and practice
regarding physical restraints very important in gathering the
information about the current and future nursing care to ensure
the quality of care provided to patient and recognizing its
weakness and strength. The aim of the current study was to
assess nurse's knowledge, attitudes, and practice regarding
physical restraints among critical ill patients.
Regarding to socio-demographic characteristics of the
studied sample
The current study documented that, most of studied nurses
were female, their age in between 21-30 years old, and not
received any previous educational program or training about
physical restraints, these results supported by Youns G and
Ahmed S (2015) [15]; they stated, most of their sample was
female and aged in between 20-30 years old and did not
attended past training or educational program about physical
restraints. In relation to the education level and experiences
years among the sample, the study reported that, the majority
of sample had bachelor degree in nursing and more than 5
experiences years in nursing profession within ICU settings,
the results in line with Dolan & Dolan Looby (2017) [16]; they
said that, most of the participated nurses in their study had
more years of practice as a registered nurse in caring of
critically ill patients at ICUs and they had a bachelor degree of
nursing science.
In relation to the level of nurses` knowledge about
application of physical restraints.
The present study reported that, mean of total nurses`
knowledge score was7.85±1.86, which reflected they had a
fair level of knowledge toward application of physical
restraints among critically ill patients, these results agreed
with Al-Khaled T, Zahran E & El Soussi A (2011) [17] & Abed
El-latief (2015) [5]; they stated that, most of nurses included in
the study had poor knowledge towards the use of physical
restraints.
As regards to the level of nurses` attitude toward
application of physical restraints.
The available study approved that, total nurses` attitude mean
score regarding use of physical restraints was 12.23±1.86, it
meant most of the nurses had an improper level of attitude
related to the application of physical restraints among
critically ill patients, these findings supported by Chien W. T.
& Lee I. Y. M. (2013) [18] & Abed El-latief (2015) [5]; they
said that, high percentage of the participant nurses in their
studies had a negative attitude regarding the application of
physical restraints among ICUs patients.
As regards to the level of nurses` practice about
application of physical restraints.
The current study documented that, total nurses` practice
mean score regarding application of physical restraints for
critically ill patients was 17.08±2.09 and about 91.7% from
the studied nurses had a satisfactory level of practice
associated with the application of physical restraints among
critically ill patients, these results in the same line with Abed
El-latief 2015 [5]; who said that, most of the sample had a
moderate level of practice regarding physical restraints.
Concerning to the relationship among socio-demograhpic
characters & nurses` knowledge, attitude & practice
regarding physical restraints among critical ill patients.
The findings of the exciting study revealed that, there was no
statistical significance between nurses’ qualification and
knowledge regarding physical restraints; these results agreed
with Azab S.M.S. & Abu Negm L. (2013) [19] & Abed El-
latief (2015) [5] ;they reported that, there were non-significant
differences in knowledge score between nurses had a diploma
and bachelor degree in nursing.
Regards to nurses’ qualification, the present study reported
that, there was a positive correlation between nurses’
qualification and practice, these findings agreed with Matthew
& Eileen (2011) [20]; who stated that Bachelor degree of
nursing science (BSN) superior than diploma nurses regarding
to professional practices. The researcher explanation was the
baccalaureate degree nurses received more training on
restraining though they were undergraduates as a procedure
involved in the fundamental and other course of nursing.
In relation to nurses’ gender, the current study revealed that,
there was a positive correlation between nurses’ gender and
knowledge and practice; these findings disagreed with Taha
NM & Ali ZH (2013) [7]; they stated that nurses' gender had
no effect on their knowledge and practice related use of
physical restraints.
Concerning to nurses' years of experience, the available study
documented that, there was a positive correlation between
nurses’ experience years and attitude and practice score, these
results in line with Al-Khaled et al., (2011) [17]; Younis and
Sayed (2017) [8] & Hamers et al., (2009) [21]; they said that the
nurses had more experience years; they are acting the best
technique with positive attitude related to physical restraints
than less years of experienced nurses.

National Journal of Advanced Research
22
5. Conclusion
The present study concluded that, there was a fair level of
nurses' knowledge, improper attitude and satisfactory practice
toward physical restraints among critical ill patients.
Moreover, there was no statistical correlation between nurses'
age and knowledge, attitude & practice, there was statistical a
positive correlation between nurses’ gender and knowledge
and practice only. There was statistical significance between
nurses’ qualification and practice only, finally there was
statistical significance between nurses’ experience years and
attitude and practice score.
6. Recommendation
Based on the results of the current study, the researchers
recommended that conduct in-service educational and training
programs for nurses working in all critical care settings as
ICUs about physical restraint use and its alternatives. The
hospital should develop evidence-based written a protocol for
guidelines or policies on physical restraint to be reachable for
all nurses and physicians in order to follow.
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