Physical Restraint and Ethical Sensitivity in Intensive Care: From the Physician and Nurse Perspective

doi:10.21203/rs.3.rs-4834834/v1

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Physical Restraint and Ethical Sensitivity in Intensive Care: From the Physician and Nurse Perspective

https://doi.org/10.21203/rs.3.rs-4834834/v1

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Introduction: The study examined the knowledge, attitudes, and practices of nurses and physicians in the intensive care unit regarding physical restraint and ethical dilemmas.

Methods: The study was conducted in four hospitals in Istanbul between February and July 2018 in a descriptive, cross-sectional, and correlational design. The sample consisted of 113 physicians and nurses. The data was collected using a personal information form, a moral sensitivity questionnaire, a nurses' knowledge level, attitudes, and practices scale regarding physical restraints, a Richmond sedation and agitation scale, and a motor activity assessment scale.

Results: 89.4% of the nurses and 78.9% of the physicians had used physical restraint before, 98.9% of the nurses and all of the physicians said that physical restraint could be applied when necessary. It was found that the mean practice score of nurses regarding the use of physical restraints (37.01±3.45) was higher than the practice score of physicians (33.57±5.38), while their knowledge and attitude scores were lower. It was determined that nurses had lower moral sensitivity than physicians due to their higher scores on the moral sensitivity questionnaire. It was found that the gender of healthcare workers and the previous use of physical restraint did not affect moral sensitivity. In contrast, the level of education and the status of working in a private hospital negatively affected moral sensitivity.

Dıscussıon: Conclusion: It was observed that the rate of physical restraint application was high in healthcare workers; moral sensitivity was affected by occupation, educational status, institution of employment, knowledge, attitudes and practices related to physical restraint.

Intensive Care

Physical Restraint

Ethics

Nurse

Physician

Physical restraint is the process of limiting patient movements with a manual technique in patient groups with a high potential to harm themselves or their environment (confused, agitated, dementia, and delirium). Restraint is achieved through physical or mechanical equipment or materials attached to the patient's body and cannot be easily removed (1, 2). Gloves, splints, belts, handcuffs, net beds, restraint vests/shirts, bandages, chairs, sheets, and ropes are commonly used as restraint materials/equipment (3). Physical restraint is used to control patients' agitation or aggressive behaviors, prevent them from removing their medical tools and equipment, prevent them from harming themselves, ensure patient safety by preventing falls from the bed, and maintain the posture of bedridden patients (4). Although different attitudes have been observed in the historical process regarding physical restraint, which was initially started to be used in England, it is known to be widely used in many countries. The recommended application steps during physical restraint are organized in the abbreviation R-E-S-T-R-A-I-N-T. These are respectively: R: Evaluating the current condition of the person, E: Defining the possible injuries and determining the possibility of harm, S: Interviewing the patient's relatives, T: Trying alternative methods first, R: Re-evaluating the patient in terms of the success of alternative methods, A: Informing the patient's relatives and ordering the physician when physical restraint is necessary, I: Ensuring that the restraint is specific to the individual, N: Noting the information about the procedure (date and time), T: Except for psychiatric patients, the restraint period should not last more than 24 hours (3).

This practice must be performed with a physician's order and is mainly achieved by intensive care nurses responsible for the care. Although physical restraint is applied for the patient's benefit, it may have many complications. Therefore, the nurse should ensure that the physician has ordered the restraint before starting the physical restraint procedure. In addition, physical restraint should be applied to the right patient with the appropriate material and fixation method. The patient should be observed frequently, and all procedures and applications should be recorded (5, 6, 7).

Although there are different practices regarding the use of physical restraint, it is essential to consider the patient's benefit in terms of ethics. Ethical sensitivity is also critical for solving ethical problems, bringing clarity, solving an ethical dilemma, and preventing situations that may develop due to dilemmas (8). Ethical sensitivity is moral values in conflicting situations or realizing one's roles and responsibilities in the current situation (9). Ethical sensitivity is essential in intensive care units, as in all units. Apart from the problems that may arise from physical restraint, only informing the patient and their relatives without their consent may also create ethical issues. In a study, relatives of patients in the intensive care unit stated that they wanted to know the procedures performed and the reasons for the procedures (7). In other studies, it was found that nurses had low knowledge about physical detection; they did not prefer alternative interventions, and more than half of the nurses recorded the physical detection they performed (10, 11, 12). This study examined the knowledge and attitudes of nurses and physicians working in the intensive care unit regarding physical restraint and ethical dilemmas.

The study was conducted between February and July 2018 in two large university hospitals and two private hospitals on the European side of Istanbul. These hospitals were chosen because they receive patients from all over Turkey, are considered to be highly representative and have a high patient density. The study was conducted in these four hospitals in Istanbul with a descriptive, cross-sectional and correlational design. The study population consisted of all physicians and nurses (N:197) actively working in the intensive care units of the four hospitals. In determining the sample of the study, the sample calculation with known population was utilized and it was calculated that at least 113 people should be included in the study with a 95% confidence interval and a 6% margin of error. One hundred thirteen physicians and nurses who met the study criteria and volunteered to participate were included in the sample.

Data Collection Tools

Data were collected using a personal information form, moral sensitivity questionnaire, nurses' knowledge level, attitudes and practices scale regarding physical restraints, Richmond sedation-agitation scale, and motor activity assessment scale.

Personal information form: It includes 12 questions, including socio-demographic characteristics, professional characteristics, ideas, and practices regarding physical restraint by the researchers in line with the literature (3, 4, 13).

Moral sensitivity questionnaire (MSQ): The questionnaire developed by Lutzen to assess ethical sensitivity and its validity and reliability made by Tosun is in a seven-point Likert style and includes 30 statements. The questionnaire has six sub-dimensions: autonomy (10,12,15, 16,21,24,27), beneficence (2,5,8,25), holistic approach (1,6,18,29,30), conflict (9,11,14), implementation (4,17,20,28) and orientation (7,13,19,22). The lowest score that can be obtained from the questionnaire is 30, and the highest score is 210. The higher the score, the lower the ethical sensitivity (14). In this study, Cronbach's alpha of the questionnaire was found to be 0.95.

Nurses' knowledge level, attitudes, and practices scale regarding physical restraints:The scale was developed by Suen and reliably validated by Kaya et al. In the first part, there are 11 items measuring nurses' knowledge about the use of physical restraints. Only one of the items in the section needs to be corrected; the correct answer is 1 point, and the incorrect answer is 0 points. The score that can be obtained from the section is between 0-11 points. The higher the score, the higher the level of knowledge. In the second section, there are 12 Likert-style items measuring nurses' attitudes towards using physical restraint. The score from the section is between 12-48 points. The higher the score, the more positive the attitude. In the third part, there are 14 Likert-type items evaluating the practices of nurses regarding the use of physical restraints. The score to be obtained from the section is between 14 and 42. The higher the score, the more appropriate the physical fixation (4, 15). In this study, Cronbach's alpha of the scale was 0.75.

Richmond Sedation and Agitation Scale (RASS): The aim of the scale developed by Cook and Palma (1989) and the validity and reliability of which was performed by Sılay and Akyol, is to determine the sedation and agitation states of severe patients, especially in mechanical ventilation (13). RASS is a valid and reliable scale that are frequently used to determine the sedation and agitation status of mechanically ventilated patients. The RASS is a 10-point scale with 4 levels (+4 to +1) indicating anxiety and agitation, 5 levels (-1 to -5) showing an unarousable state, and 1 level (0) indicating an awake state. Positive numerical values are designed for agitation, and negative numerical values are for sedation. In this study, Cronbach's alpha of the scale was 0.95.

Motor Activity Assessment Scale (MASS): It was developed by Devlin et al. to assess the level of sedation and agitation in intensive care patients. The scale helps to shorten the length of stay in the intensive care unit by reducing the possibility of patients on mechanical ventilation receiving high doses of sedative drugs. MASS, like RASS, is another valid and reliable scale that are frequently used to determine the sedation and agitation status of mechanically ventilated patients. The MASS is evaluated on a scale of 0 to 6 points: "0 points indicates a highly sedated patient", "1-2 points indicates a mildly sedated patient", "3 points indicates a calm and peaceful patient", and "4-6 points indicates a restless and agitated patient" (13, 16). In this study, Cronbach's alpha was 0.95.

Ethical approval

"Ethics Committee Approval" (Date: 26/02/2018, number no: 13) was obtained from the Non-Interventional Clinical Research Ethics Committee of a university in Istanbul, and institutional permission (Decision no: 222045, Date: 27.08.2018) was obtained from Istanbul Provincial Health Directorate. Informed consent was obtained from the pregnant women participating in the study, and the Declaration of Helsinki was followed.

Data analysis

The data obtained in the study were analyzed using the SPSS (Statistical Package for Social Sciences for Windows 22.0) program. Number, percentage, mean, and standard deviation were used as descriptive statistical methods to evaluate the data. In addition, the t-test, ANOVA test, Pearson correlation analysis, and Scheffe test were used as post hoc analyses.

The mean age of nurses was 27.92±6.73 years; 70.2% were female, 57.4% were single, and 56.4% had undergraduate degrees. The mean age of the physicians was 30.00±3.72 years; 78.9% were female, 52.6% were single, and 63.2% had specialty training. It was determined that 88.3% of the nurses participating in the study were clinical nurses, and 84.2% were physician assistants. Among the nurses, 28.7% worked/are working in general ICU, 8.5% in emergency ICU, 8.5% in internal ICU, and 5.3% in neurosurgical ICU; 78. 9% of physicians worked/are working in surgical ICU, 73.7% in neurosurgical ICU, 73.7% in emergency ICU, and 36.8% in internal ICU. The mean duration of employment was 6.38±5.58/year for nurses and 4.23±2.09/year for physicians.

It was found that 89.4% of the nurses and 78.9% of the physicians had previously applied physical restraint; 98.9% of the nurses and 98.9% of the physicians thought that physical restraint should be applied when necessary. It was found that the rate of those who had previously applied physical restraint and said it could be used when necessary was higher than the others but did not express statistical significance (p<0.05).

The mean scores of all subscales of the moral sensitivity questionnaire (autonomy_nurse: 26.26±11.64, autonomy_physician: 21.52±9.47; beneficence_nurse: 14.85±6.10, beneficence_physician: 13.21±6.69; holistic approach_nurse: 19.16±9.21, holistic approach_physician: 14.00±7.53; conflict_nurse: 11.77±4. 03, conflict_physician: 10.57±3.90; practice_nurse: 15.23±6.55, practice_physician: 12.26±4.14; orientation_nurse: 15.28±8.18, orientation_physician: 11.52±6.32) and the mean total score of the questionnaire (nurse: 114.02±41.69, physician: 92.84±36.36) were higher in the nurse group compared to the physician group. It was found statistically significant that the ADA's autonomy, utilization, and conflict sub-dimensions were not affected by professions (p>0.05). In contrast, the holistic approach, implementation, and orientation sub-dimensions and the mean total score of the scale were higher in physicians (p<0.05) (Table 1).

The place of Table 1. Comparison of Moral Sensitivity Questionnaire Score Averages of Healthcare Workers with Professions

It was not found that the gender of healthcare workers did not affect moral sensitivity (p>0.05). It was found to be significant (p<0.05) that the mean scores of autonomy, beneficence, holistic approach, practice, orientation, and moral sensitivity total scores of MSQ of those who graduated from health vocational high school (HCVS) and those who worked in private hospitals were higher than the others. In the mean score of conflict sub-dimension, it was found that the mean scores of HCVS graduates and those who worked in private hospitals were lower than the others but did not show significance (p>0.05). It was observed that the participants' previous use of physical restraint did not affect moral sensitivity (Table 2).

The place of Table 2. Comparison of the Mean Scores of the Moral Sensitivity Questionnaire of Nurses and Physicians with Education, Institution of Employment and Prior Physical Restraint Application Status

It was found that the mean scores of the knowledge level (nurse: 8.53±1.39, physician: 9.15±1.30) and attitude (nurse: 31.27±5.19, physician: 34.31±7.18) of the knowledge level, attitude, and practices scale regarding the use of physical restraints of nurses were lower than those of physicians. In comparison, the mean scores of practices were statistically significantly higher (nurse: 37.01±3.45, physician: 33.57±5.38) (p<0.05) (Table 3). It was determined that the mean attitude scores of nurses with bachelor's degrees were higher than those of HCVS graduates (F=3.624. p=0.031<0.05), and the mean scores of knowledge level and practice were not affected by educational status (p>0.05). It was found that the mean scores of the knowledge level regarding physical restraint were higher (p<0.05), the mean scores of the attitude scale were higher (p<0.05), the mean scores of the attitude scale were higher (p<0.05), and the mean scores of the practice were not affected by the institutional variable (p>0.05), except for one private hospital. It was found that the mean scores of the knowledge level, attitude, and practice scores of healthcare workers regarding the use of physical restraints were not affected by the previous physical restraint practice (p>0.05).

According to MASS, 77.7% of the nurses and 63.2% of the physicians applied physical restraint when the patients were restless and agitated, which is statistically significant (p<0.05) (Table 3). Similarly, according to the RASS, it was determined that all physicians and nurses applied physical restraint when patients were anxious and agitated (Table 3).

The place of Table 3. Comparison of Healthcare Workers' Knowledge, Attitudes and Practices Regarding Sedation, Agitation and Physical Detection of Patients According to Their Professions

There was a positive correlation (p<0.05) between working time in the profession, conflict sub-dimension of the moral sensitivity questionnaire, knowledge and attitude towards physical restraint and age; a negative correlation (p<0.05) between age and all sub-dimensions of the moral sensitivity questionnaire except conflict (p<0. 05); a positive (p<0.05) correlation was found between holistic approach, implementation, orientation, moral sensitivity total score and autonomy and beneficence sub-dimension; a positive (p<0.05) correlation was found between practice, orientation, moral sensitivity total and holistic approach; and a positive (p<0.05) correlation was found between moral sensitivity total and physical restraint practice (Table 4).

The place of Table 4. Correlation of MSQ, Nurses' Knowledge-Attitude-Practice Scale Regarding the Use of Physical Restraints and MASS Scores with Each Other, Age, and Working Time in the Profession

In the study, it was determined that 89.4% of the nurses and 78.9% of the physicians had previously applied physical restraint, almost all of the nurses (98.9%) and all of the physicians thought that physical restraint should be applied when necessary; the rate of those who had previously applied physical restraint and who said that physical restraint could be used when necessary was higher than the others (p>0.05). It has been reported that the application rate of physical restraint in nursing homes abroad is 2-70% (7). In Turkey, studies including intensive care units and general clinics reported that nurses' rate of physical restraint application varied between 81.2-96.1% (4, 10). The results are compatible with the results of other studies in our country and are much higher than those conducted abroad. This suggests that the number of patients is high, the number of staff is low, and that agitated patients frequently apply to avoid disrupting care.

In the study, the mean total score of the moral sensitivity questionnaire and all sub-dimension mean scores (total_nurses:114.02±41.69, total_physicians:92.84±36.36; autonomy_nurses:26.26±11.64, independent_physicians:21.52±9.47; beneficence_nurses:14.85±6.10, beneficence_physicians:13.21±6.69; holistic approach_nurses:19. 16±9.21, holistic approach_physicians:14.00±7.53; conflict_nurses:11.77±4.03, conflict_physicians:10.57±3.90; practice_nurses:15.23±6.55, practice_physicians:12.26±4.14; orientation_nurses:15.28±8.18, orientation_physicians:11.52±6.32) were higher in the nurse group compared to the physician group (Table 1). A high score on the MSQ indicates low ethical sensitivity, whereas a low score indicates high ethical sensitivity. This result shows that the ethical sensitivity of nurses is lower than that of physicians. In Dikmen's (2013) study, it was reported that intensive care nurses scored 87.51±27.79 on the total ADA, 18.24±7.50 on the autonomy sub-dimension, 12.14±5.17 on the beneficence sub-dimension, 12.65±6.69 on the holistic approach sub-dimension, 11.80±2.83 on the conflict sub-dimension, 8.76±3.75 on the implementation sub-dimension and 8.83±5.34 on the orientation sub-dimension. It can be said that the ethical insensitivity of nurses who scored higher than Dikmen's study decreased (17). The reason for this is shown by the fact that nurses who work with few staff for a long time in the intensive care environment undertake all kinds of care and treatment processes for the patients. This inevitably suggests that it is seen more in individuals due to stress, physical fatigue, psychological wear and tear, or occupational deformity.

It was observed that the gender of healthcare workers and previous physical restraint did not affect ethical sensitivity (p>0.05, Table 2). The ethical sensitivity of people who have undergone a similar education system and live with similar moral values in the same cultural structure is identical.

It was found that the mean total scores of autonomy, beneficence, holistic approach, practice, orientation, and moral sensitivity of MSQ of HCVS graduates and those working in private hospitals were higher than the others (p<0.05). In contrast, the mean score of the conflict sub-dimension was lower than the others (p>0.05, Table 2). It was found that HCVS graduates and those working in private hospitals had lower moral sensitivity than the others (except for the conflict sub-dimension of the ADA). This result may be related to the fact that HCVS graduates who had to start working early may have been more affected by professional deformity and may have lower authoritarian structures. It may be related to nurses working in private hospitals being mostly HCVS graduates, depending on the institutional policy.

It was found that the mean scores of knowledge level (nurse: 8.53±1.39, physician: 9.15±1.30) and attitude (nurse: 31.27±5.19, physician: 34.31±7.18) of nurses' knowledge level, attitude, and practice scale regarding the use of physical restraints were lower than those of physicians. In contrast, the mean scores of practice were statistically significantly higher (nurse: 37.01±3.45, physician: 33.57±5.38) (p<0.05). It was found that the participants' professions did not affect their knowledge and attitudes regarding using physical restraints (Table 3). It was reported that 62.4% of the nurses in the literature did not receive training on using physical restraint, and 81.2% applied physical restraint when necessary (4). In other studies, it was reported that nurses had low knowledge about physical restraint, and most used it (3, 10, 11). Similar to the studies in the literature, the study's results suggest that nurses have lower levels of knowledge on this subject but higher levels of practice. This may be associated with the fact that nurses, who spend more time than physicians in the care and follow-up of the patient in intensive care, may decide on the need for physical restraint earlier than physicians due to the difficulty in their care due to the patient's agitation.

According to RASS, the study determined that all nurses and physicians applied physical restraint in cases of anxiety and agitation. According to MASS, 77.7% of nurses and 63.2% of physicians used physical restraint when patients were restless and agitated (p<0.05, Table 3). According to these results, it was understood that most participants applied physical restraint when patients were anxious and agitated. In one study, it was reported that 82.5% of the nurses applied physical restraints to prevent the patient from removing the tubes, and 75.6% applied physical restraints to prevent the patient from falling off the bed (10). The results of the study are in parallel with the literature and suggest that those who had to apply physical restraint did so to prevent patients from harming themselves.

It was observed that the conflict sub-dimension of the moral sensitivity questionnaire, knowledge, and attitude towards physical restraint increased as the working time in the profession increased. At the same time, the other sub-dimensions of the scales decreased. It was seen that moral sensitivity positively affected autonomy, holistic approach, practice, and orientation, benefiting from orientation and practice. It is an expected result that the higher the moral sensitivity, the higher the autonomic behaviors expected from individuals, such as performing and terminating physical restraint at the right time and in the right way. This also shows that people have a holistic approach to the patient and observe the principle of beneficence.

It was observed that the mean age (nurses:27.92±6.73/year; physicians:30.00±3.72/year), gender (nurses:70.2%; physicians:78.9%) and marital status (nurses:57.4%; physicians:52.6%) of health professionals were close to each other. It was determined that 56.4% of the nurses had undergraduate education and 63.2% of the physicians had specialty education. Nurses and physicians who participated in the study had a working period of 4 years or more (nurses: 6.38±5.58/years; physicians: 4.23±2.09/years), the rate of previous physical restraint application was high (nurses:89.4%; physicians:78.9%), and almost all of the participants (98.9%) thought that physical restraint should be applied when necessary. According to the Moral Sensitivity Scale, it was found that nurses had higher moral sensitivity scores than physicians, those who graduated from health vocational high school had higher moral sensitivity scores than others, and those who worked in private hospitals had higher moral sensitivity scores than those who worked in university hospitals, and thus their ethical sensitivity was lower. It was observed that the gender of healthcare workers and the participants' previous use of physical restraint did not affect moral sensitivity. It was found that the mean scores of the knowledge level and attitude of the knowledge level and attitude scale regarding the use of physical restraints of nurses were lower than those of physicians. According to MASS, more than half of the healthcare workers (nurses: 77.7%; doctors: 63.2%) and according to RASS, all healthcare workers applied physical restraint when patients were restless and agitated. It was observed that the age of the health professional and the duration of employment in the profession affected ethical sensitivity, knowledge, attitude and practice towards physical restraint.

Ethics approval and consent to participate: This research was approved by the Biruni University of Non-Interventional Clinical Research Ethics Committee with the codes of ethics (Date: 26/02/2018, number no: 13). Institutional permission (Decision no: 222045, Date: 27.08.2018) was obtained from Istanbul Provincial Health Directorate. Informed consent was obtained from the health professionals participating in the study, and the Declaration of Helsinki was followed.

Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

The authors received no financial support for the realization of this study.

Author Contributions

T.G. and N.A. provided the initial idea, and conceptualized and designed the study. T.G., performed the literature search, in consultation with N.A. and, N.A. assisted with study organization and performed critical revision of the manuscript. T.G. and N.A. provided writing and critical revision of the manuscript. All authors read and approved the final manuscript.

Acknowledgments

We thank all intensive care physicians and nurses who supported the study.

Orhan F, Yakut I. Observing knowledge, manner and level of practice in terms of usage of physical restraints of pediatric intensive care nurses. Turkish Journal of Pediatric Disease 2012;6(3):155-160.
Taha MN, Ali HZ. Physical restraints in critical care units: Impact of a training program on nurses ‘knowledge and practice and on patients’ outcomes, Journal of Nursing & Care 2013;2/2. doi:10.4172/2167-1168.1000135
Balci H. The effect of education on knowledge, attitude and practices of ıntensive care nurses on physical restraint applications (Master Thesis). Konya: Selcuk University; 2016.
Gurdoğan EP, Ugur E, Kinici E, Aksoy B. Knowledge, attitudes, and practices of nurses in intensive care units on physical restraint use and factors affecting nurses’ decisions to use them. Journal of Critical and Intensive Care 2016;7:83-88. doi: 10.5152/dcbybd.2017.1260
Ilhan S. Physical Environment Safety and Risks in Patient Care. In: Sabuncu N, Akça Ay F, edits. Clinical Skills. 2nd Edition. Nobel Bookstore; 2009. s. 394-398.
Goktaş A, Buldukoglu K. Determination of psychiatric clinic nurses’ knowledge, attitudes, and practices regarding the use of physical restraints. Journal of Psychiatric Nursing 2017;(1):1-10. doi: 10.14744/phd.2017.38247
Kahraman BD, Asiret GD, Yildirim G, Akyar I, Aytekin GK, Oz A. Opinions of family caregivers on the use of physical restraints in ıntensive care unit. Journal of Critical and Intensive Care 2015;6,78-83. doi: 10.5152/dcbybd.2015.847
Hakverdioglu G, Demir A, Ulusoy MF. Evaluation of knowledge on physical restraint of intensive care nurses. Turkiye Klinikleri Journal of Medical Sciences 2006;26:634-41.
Pekcan SH. The ethics sensitivity of the doctors and nurses working in yalova and its region (Master Thesis). Istanbul: Marmara University; 2007.
Karagozoglu S, Ozden D, Yildiz FT. Knowledge, attitudes, and practices of turkish intern nurses regarding physical restraints. Clinical Nurse Specialist 2013;27(5):262-271. doi: 10.1097/NUR.0b013e3182a0baec.
Celik S, Karvazli S, Demircan E, Guven N, Durmus O, Duran ES. Knowledge, attitudes and practices of ıntensive care nurses related to using physical restraints. Acıbadem University Health Sciences Journal 2012;3:176-183.
Suen LK, Lai CK, Wong TK, Chow SK. Use of physical restraints in rehabilitation settings: staff knowledge, attitudes and predictors. Journal of Advanced Nursing 2006;55:20–8. doi: 10.1111/j.1365-2648.2006.03883.x.
Silay F, Akyol A. Adaptation of two measurement tools used to assess sedationagitation and pain among patients in intensive care units into Turkish: A reliability and validity study. Journal of Intensive Care Nursing 2018;22(2):50-65.
Tosun H. Moral Sensitivity Questionnaire (MSQ): Turkish adaptation of the validity and reliability. Journal of Contemporary Medicine 2018;8(4):316-321. doi: 10.16899/gopctd.467052
Kaya H, Asti T, Acaroglu R, Erol S, Savci C. Nurses’ knowledge, attitudes and practices related to using physical restraints. Maltepe University Journal of Nursing Science and Art 2008;1(2):21-29.
Korhan EA, Bor C, Uyar M. An assessment of pain in adult patient in intensive care. Journal of Intensive Care Nursing 2012;16(2):57-65.
Dikmen Y. An observation on the moral sensibility of ıntensive care nurses. Cumhuriyet Nursing Journal 2013;2(1):1-7.

Tables 1 to 4 are available in the Supplementary Files section

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Physical Restraint and Ethical Sensitivity in Intensive Care: From the Physician and Nurse Perspective

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