PR is widely used in intensive care unit settings among critically ill patients’ to reduce the risk of a patient’s falling, prevent removal of life support equipment and procedures, and reduce the risk of patients harming himself or others among (1). Physically Restrained patients in the ICU encounter prolonged hospital stays and complications results from restraint as a result of nurses’ improper practices (behavior) of restraining (6, 17, 18, 31) which reduces power from even the most beneficial medical treatments (32). Improving nurses’ practice on the use of restraining, therefore, is crucial to prevent the complication of it and to enhance ICU care service.
This study indicated that; mean total score of nurses’ practice was 30.94 ± 5.44, which reflected the majority of the nurses’ had satisfactory practices regarding PR use. The proportions of the nurses who score above the mean score were 56.5%. It indicates that 43.5% of the participants had unsatisfactory practices regarding PR use. This result is agreed with the studies held in Jordan and India (8, 33). The mean score of this study is higher than the studies held in Egypt, Saudi-Arabia, and Malaysia (13–15). The possible reason for the variation might be attributed to that most of the participants in those studies were diploma in their educational qualification but the majority of the nurses in this study were bachelor's and master’s in their educational level. So this finding supposed to increase the mean score of practice regarding PR use.
The nurses’ practices mean score of this study is lower than the study held in Turkey and United States (16, 19, 31). The difference of this result might be most of the participants in those studies were got In-service training and the presence of hospitals guideline regarding physical restraint but there is no one who had took In-service training and absence of guidelines regarding PR for the care of critically ill patients. So this finding supposed to decrease the mean score of nurses’ clinical practice.
Regarding predictor variables; short (≤ 2 years) experience at ICU (β= -1.34, 95% CI: (-2.47, -0.21)) was significantly associated with improper practice regarding PR use. The possible reason might be when the nurses had short years of experience; they are facing problems for applying the best nursing activities properly regarding physical restraints than long years of experienced nurses (34, 35). This finding was consistent with the previous study (15). This study showed that received educational training about PR during graduate class (β = 1.49, 95% CI: (0.16, 2.82)) had a positive correlation with nurses’ practice regarding PR use. If nurses learned related to restraining in their graduate class, this influences them to have a piece of better subjective information (awareness), feeling and performs proper clinical practice regarding the restraining of critically ill patients. This indicates the need for effective educational training regarding restraining by developing the program aimed at maximizing understanding of patient's rights and autonomy, ethical and legal aspects of restraining patient, impact and dangers of PR and restraint alternatives (13, 36, 37). This finding was consistent with other studies (13, 14) which showed proper practice regarding PR use was associated with nurses who had got training in their graduate class.
The nurses’ knowledge score (β = 0.40, 95% CI: (0.03, 0.78)) was positively associated with the nurses’ practice score regarding PR use. The possible reason might be based on the theory of planned behavior, adequate knowledge of nurses is essential for the basis of their behavior to better subjective feelings regarding restraint use on critically ill patients and to perform appropriate nursing activities during constraints. This may increase the likelihood of a proper practice regarding restraint use on patients. This result is in agreement with other studies (13, 14, 22). Indeed, this study showed that a higher attitude score (β = 0.37, 95% CI: (0.27, 0.47)) was significantly associated with more proper nurses’ practice regarding restraining. The possible reason might be that nurses’ with better subjective feelings and beliefs about restraint use, put themselves in place of patients and their families on the use of PR. This feeling and thought can guide nurses to prefer alternative methods and performs them appropriately when used (14). This result is in agreement with other studies (13, 14, 22). This reveals that in-service training for nursing staff concerning the physical restraining of ICU patients is crucial. The training can improve nurses’ knowledge, attitude and then practice through the reduction of the frequency of complications related to PR among these patients (38).
The participants were nurses’ who were motivated to participate in the study, which limits the external generalizability of the result. Practices regarding PR use were assessed via a self-report questionnaire, which might not reflect the actual behavior of nurses. Since the study design was cross-sectional, as a result of its nature; it is difficult to show the cause-effect relationship between predictors and nurses’ practice regarding PR use.