title: The Efficacy of an In-Service Education Program Designed to Enhance the Effectiveness of Physical Restraints.
abstract: BACKGROUND
  Physical restraints are used to enhance the safety of patients and to avoid injury. However, physical restraints may cause injuries if improperly used or if they are used in the absence of continuous monitoring. Nursing staff who use physical restraints often lack sufficient related knowledge, which may increase the risk to patient safety.
  
  
  OBJECTIVE
  This study investigates the impact of an in-service education program for nursing staff that is designed to improve physical-restraint-related knowledge, attitudes, behaviors, and techniques.
  
  
  METHODS
  A pretest-posttest design and a quasi-experimental method were employed to evaluate the effectiveness of the in-service education program. One hundred thirty-six nursing staff from four adult intensive care units (ICUs), including two medical ICUs and two surgical ICUs, in a medical center in central Taiwan were enrolled as participants. The experimental group (EG) and the control group (CG) were composed of patients from one randomly assigned medical ICU and one randomly assigned surgical ICU each. The pretest data on physical-restraint-related knowledge, attitudes, behaviors, and techniques were collected before the in-service education program. The EG received 2 hours of classroom education on guidelines and techniques related to physical restraints. The posttest data for the two groups were collected a month after implementation of the in-service education program. General Estimation Equation was used to measure and analyze the data repeatedly.
  
  
  RESULTS
  The posttest scores of the EG for knowledge and technique were significantly higher than the pretest scores (p < .0001). However, the posttest scores of the EG for attitudes and behaviors did not significantly differ from the pretest scores.
  
  
  CONCLUSIONS
  In-service education for physical restraints enhances relevant knowledge and techniques but does not significantly affect attitudes or behaviors. Correct implementation of physical restraints not only promotes the quality of nursing care for patients in the ICU but also reduces the risk of physical-restraint-related complications. This study highlights the importance of changing the thoughts and concepts related to the use of physical restraints within the overall caring strategy of hospitals.
authors.affiliation: 1MSN, RN, Supervisor, Department of Nursing, Taichung Veterans General Hospital 2MSN, RN, Department of Nursing, Taichung Veterans General Hospital 3PhD, Senior Consultant, Science and English Editing Department, Herbacée International Company, Ltd. 4PhD, RN, Deputy Director, Department of Nursing, Taichung Veterans General Hospital.
authors.forename: Yin-Yin
authors.initials: YY
authors.lastname: Chang
authors.forename: Hsiu-Hui
authors.initials: HH
authors.lastname: Yu
authors.forename: El-Wui
authors.initials: el-W
authors.lastname: Loh
authors.forename: Li-Yin
authors.initials: LY
authors.lastname: Chang
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004509:Education, Nursing, Continuing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000193:education* / Q000523:psychology*; D061214:Patient Safety; D015397:Program Evaluation; D012149:Restraint, Physical; D011795:Surveys and Questionnaires; D013624:Taiwan