노인시설에서의 억제대 사용에 대한 간호제공자들의 인식 조사

Abstract

The purpose of this study was to investigate perceptions on the use of physical restraints with elderly people among nurses, nurse assistannts, and families of the elderly in two geriatric hospitals and one facility. Data were collected from October, 1999 to May, 2000 using Perception of Restraints Use Questionnaire developed by Strumpf & Evans. The subjects were 76 nurses, 222 nurse assistants and 18 family members. The perception of the use of physical restraints was identified as the highest in the items ´prevention from falling out of a bed´ and ´prevention from falling out of a chair´ followed by ´prevention of pulling out an intravenous line´, ´preventing of pulling out a feeding tube´, and ´prevention from breaking open sutures/removing a dressing´. Four factors were extracted by a factor analysis: ´maintenance of the medical treatment´, ´preventing separation from protection´, ´management of problematic behavior´ and ´prevention of falls´. The nurses revealed a significantly lower score on ´maintenance of the medical treatment´ than the nurse assistants. Among nurse assistants, those aged 40 years or below showed significantly lower score on ´maintenance of the medical treatment´ than their counterparts; those with 3 years or more experience in the field had significantly lower score on ´maintenance of the medical treatment´ and ´preventing separation from protection´ than their counterparts. Most of the families did not know the term, ´restraints´. The reason for using restraints were identified as ´prevention from falling from a wheelchair´ (83.3%) and ´protection of L-tube/wound sites´ (33.3%). Regarding the alternatives to the restraints, nurses reported ´using chemical restraints´ (41.1%), ´one-to-one client care´ (29.4%), and ´improvement in the environment´ (23.5%), while nurse assistants suggested ´using betteer type of restraints´ (25.0%), and ´no other alternatives needed´ (21.4%). Among the family members, 83.3% answered that the restraints were necessary. We should develop the criteria for applying physical restraints, education program for restraints-free care and hospital policy to facilitate communication between health care providers and families of elderly people should be developed. Also, there is a need to improve the environment and alternatives to restraints that give more comfort to the elderly residents.