Topic: Coercion and Restraints in Healthcare Directions: Pick a topic related to the course. (Coercion and Restraints in Healthcare)Research the topic.Identify a clinical case related to your chosen

Topic: Coercion and Restraints in Healthcare Directions: Pick a topic related to the course. (Coercion and Restraints in Healthcare)Research the topic.Identify a clinical case related to your chosen
Framework for Clinical Ethical Decision-Making [Adapted from Clinical Ethics (7th ed.) Jonsen, Siegler & Winslade; McGraw-Hill: 2010] Medical (Treatment) Indications Underlying principles: beneficence, nonmaleficence What is the health problem? Diagnosis? Prognosis? What is the range of treatment options? Are any legally forbidden? Are any morally/ethically repugnant? What is the goal of each treatment option? Common problems: Who judges futility? Who determines “benefit”? Patient Preferences Underlying principle: respect for autonomy What are the patient’s preferences regarding the treatment options identified above? Is the patient’s decision-making capacity in question? If the patient is unable to communicate preferences at this time, is there verbal or written evidence of what his/her preferences might have been (e.g., living will or conversations with others)? If no written or verbal evidence of the patient’s preferences exist a) have all potential sources been exhausted, and b) is there “relational” evidence based on how the patient lived his/her life and prior health care choices? With minors, patient preferences are “held in trust”. What are the parents’ views of what is in the minor’s best interests. Common problems: Are we questioning the quality of the informed consent? The quality of the capacity for consent? Or our view of the quality of the preference expressed? Quality of life Underlying principles: beneficence, nonmaleficence, and respect for autonomy If possible, the patient’s view of his/her quality of life is respected. If the patient’s view is unknowable, whose standards do we use to judge quality of life? What are the clinical facts devoid of judgments of worth? Consider ability to communicate in any way, mobility, sensory perceptions, pain, etc. Do care providers, family members or others have biases that influence their evaluation of the patient’s quality of life? How do their unique perspectives differ? Suggestion: Compare quality of life for each treatment option outlined in step one based on the clinical facts in the case rather than on subjective judgments. Contextual Features Underlying principle: Justice (fairness), fidelity, etc. Who is the primary beneficiary of treatment? (Patient? Family? MD? RNs?) Are there family issues that might influence treatment decisions? Provider issues? Is there conflict between any of the involved parties (MDs, RNs, family)? Are there religious or cultural issues? Are there problems of allocation of resources? How does the law affect treatment decisions? Is there a conflict of interest on the part of the providers or institution?
Topic: Coercion and Restraints in Healthcare Directions: Pick a topic related to the course. (Coercion and Restraints in Healthcare)Research the topic.Identify a clinical case related to your chosen
PHIL 230 Assignment Learning Objectives: Access resources (i.e. database, internet, reference librarian, Writing Center) to fulfill requirements of project. Use APA format to cite resources used. Create and present a presentation on a Clinical case using the Jonsen Model. Directions: Pick a topic related to the course. Research the topic. Identify a clinical case related to your chosen topic. Analyze the case using an organized model such as the Jonsen Model. Prepare 2-3page minimum written summary to accompany your presentation. This includes at least 3 resources in APA format. Due date listed. Submit the written summary on the due date. Create a presentation on the case you selected. Give a 15 minute presentation of your case to the class which will serve as an ethics committee. Submit a hard copy of the entire presentation to the instructor the day of the presentation. Points: 40 assignment points are possible for this presentation. Refer to Rubric for grading. Rubric for PHIL 230 Presentations Evidence of research into the basic facts of the case 8 points Did not show evidence of research into the basic facts of the case OR incorrect information 4 points Showed some evidence of research into the basic facts of the case. Key points provided but limited OR minor errors. 6 points Thoroughly showed evidence of research into the basic facts of the case. 8 points. Citation 6 points Major errors in APA citation. OR Did not use at least three sources, including one periodical and one reference source OR one free website 2 points Minor errors in APA citation. Using at least three sources, including one periodical and one reference source OR one free website 4 points. Correctly cited sources, using APA guideline. Using at least three sources, including one periodical and one reference source OR one free website 6points. Jonsen Model 8 points Used 2 or less of the main factors in the Jonsen Model for sorting out the facts in the case. 4 points. Used a minimum of 3 of the main factors in the Jonsen Model for sorting the facts of the case 6 points. Used the Jonsen Model correctly for sorting the facts of the case 8 points. Presentation 10 points One member of the group gave the oral presentation OR some members demonstrated lack of knowledge on subject matter OR Speech was difficult to understand (too quiet, too fast, poor pronunciation, etc.). 6 points All members of the group participated, but unequally, in the oral presentation OR Some members demonstrated lack of knowledge on subject matter OR Speech was somewhat difficult to understand (too quiet, too fast, poor pronunciation, etc.). 8 points. All members of the group participated equally in the oral presentation. Members demonstrate knowledge on subject matter. Speech was clear and easy to understand. 10 points. Timeliness 8 points Project was submitted late AND/OR presentation was longer OR shorter than 15 minutes. 4 points Project was submitted by due date. Presentation was longer OR shorter than 15 minutes. 6 points. Project was submitted by due date. Presentation was 15 minutes in length. 8 points. 3
Topic: Coercion and Restraints in Healthcare Directions: Pick a topic related to the course. (Coercion and Restraints in Healthcare)Research the topic.Identify a clinical case related to your chosen
Psychiatric Nurses’ Attitude and Practice toward Physical Restraint Amal Sobhy Mahmoud ⁎ Psychiatric Nursing and Mental Health, Faculty of Nursing, Port Said University abstract Aim: This study was to assess psychiatric nurses’ attitude and practice toward physical restraint among mentally ill patients.Methods: A descriptive research design was used to achieve the study objective. The present study was carried out in three specialized governmental mental hospitals and two psychiatric wards in general hospital. A convenient purposive sample of 96 nurses who were working in the previously mentioned setting was included.The tool used for data collection was the Self-Administered Structured Questionnaire; it included three parts: Thefi rst comprised items concerned with demographic characteristics of the nurses, the second comprised 10 item measuring nurses’ attitudes toward physical restraint, and the third was used to assess nurses’ practices regarding use of physical restraint.Results: There were insigni ficant differences between attitudes and practices in relation to nurses’ sex, level of education, years of experience and work place. Moreover, a positive signi ficant correlation was found between nurses’ total attitude scores, and practices regarding use of physical restraint.Conclusion: Psychiatric nurses have positive attitude and adequate practice toward using physical restraints as an alternative management for psychiatric patients. It is important for psychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. The study recommended that it is important forpsychiatric nurses to acknowledge that physical restraints should be implemented as the last resort. © 2016 Elsevier Inc. All rights reserved. In psychiatric hospitals, patients’ violence and threats of violence constitute serious emergencies that may be dif ficult to handle by staff. Physical restraints (PRs) refer to any physical methods of restricting a person’s freedom of movement, physical activity or normal access to his or her body ( Martin, 2002 ). Moreover it is used in psychiatric health care settings as one of the psychiatric managements to reduce the risk of harm among psychiatric patients whether it is directed toward self or toward others ( Gelkopt Roffe, Behrbak, Melamed, Werbloff et al., 2009 ). The use of PR as an intervention in the care of psychiatric patients goes back to the beginning of the science of psychiatry. However, it is still one of the challenging questions in the psychiatric services and has always been considered as a moral argument ( Iversen, 2009; Steinert, Lepping, Bernhardsgrütter, et al., 2010 ). Physical restraint in- cludes devices designed to limit a patient’s physical movements such as limb holders, safety vests and bandages. It is used to handle violent and maladaptive behaviors, manage patients with severe mental disor- ders, prevent injury and reduce agitation and aggression ( Capezuti, 2004; Chien, Chan, Lam, & Kam, 2005; Akansel, 2007 ). Nurses are closely involved in caring for restrained patients. The common absence of medical orders for starting or removing physical restraints indicates that the nurses mostly make these decisions. Their roles start with the selection of the least restricting arm restraint device available, followed by ones responsible and ending with modifying the patient care plan based on an hourly assessment of the patient’s re- sponse and physical condition ( De Jonghe et al., 2013 ). Several attempts have been made to reduce the integration of re- straints in the clinical practice, as most studies used educational ap- proaches in order to encourage nurses to use alternative measures instead of physical restraint. All studies delivered intensive training ses- sions and introduced a nurse specialist as a consultant; however, the success rate of these interventions in different countries has been vari- able; for example a successful educational intervention applied on nurses working in the USA proved to be ineffective in The Netherlands ( Huizing, Hamers, Gulpers, Berger, 2006; Becker, Koczy, & Klie, 2007; Capezuti et al., 2007 ). In general, research findings revealed that patients as a result of being restrained reported that they felt angry, helpless, sad, and power- less, punished, embarrassed, and that their right to autonomy and priva- cy has been violated, in addition to a feeling of loss of self worth, degradation, demoralization and humiliation while they are restrained ( The American Psychiatric Nurses Association, 2001; The JOANNA Briggs Institute, 2002; Elgamal, 2006 ). Most of the patients’ subjective experiences highlight the negative impact of physical restraint on the patients. These experiences were summarized in two themes: restric- tion and discomfort. Restriction relates to loss of freedom and control over what is happening during hospitalization, while discomfort is Archives of Psychiatric Nursing 31 (2017) 2 –7 ⁎Corresponding Author: Amal Sobhy Mahmoud, Assistant Prof., Psychiatric Nursing and Mental Health, Faculty of Nursing, Port Said University. E-mail address: [email protected] . http://dx.doi.org/10.1016/j.apnu.2016.07.013 0883-9417/© 2016 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Archives of Psychiatric Nursing journal homepage: www.elsevier.com/locate/apnu caused by enforced immobility, i.e. from patient narrative comment: “I felt like a dog and cried all night, it hurts me to have to be tied up, and I’m in a jail stuck, I couldn’t even bring my hands together ”(Sailas and Wahlbeck, 2005; Suen et al., 2006 ). A study about psychiatric staff’s thoughts and feelings about re- straint use, found that the risk of harm and the use of restraint con flicted with nurses’ role to protect. Nurses did not want to use restraints as a fi rst option ( Aschen, 1995; Hennessy, McNeely, Whittington, Strasser, & Archea, 1997; Karlsson, 2000; Hantikainen & Ka¨ppeli, 2000 ). In most of the studies the nursing staff reported a range of emotional reac- tion felt while doing restraint procedure, including anxiety, anger, feel- ing bored or distressed, crying, inadequacy, hopelessness, frustration, fear, guilt, dissatisfaction, isolation, being overwhelmed, feeling drained, vengeance and repugnance ( Kamel, Maximos, & Gaafar, 2007 ). In another study the nursing staff described how they had come hardened to the experience of restraint. Some of them reported that they had no emotional reaction and many reported automatic responding during restraint event in which they did not feel any emo- tion. This lack of feeling among nurses might be due to the fact that the practice had become so ritualized that it does not provoke any reac- tion ( Sequeira & Halstead, 2004 ). Nurses’ attitudes toward physical re- straints described as ambivalent, characterized by respect for a person’s dignity and by anxiety and the responsibility for the resident’s safety. Nurses described feelings of frustration and guilt when they used physical restraints against the will of a resident ( Hantikainen & Ka¨ppeli, 2000; Karlsson, 2000 ). Attitudes toward physical restraint can affect on nurses’ perfor- mance and behavior, especially psychiatric patients who already confronting and discrimination, which may express also by profes- sionals and the general public ( Emrich, Thomson, & Moore, 2003 ). Get- ting in touch with psychiatric patients and getting knowledge can help in replacing the myths with facts, decreasing stigma and affecting atti- tudes positively ( Halters, 2004 ). Physical restraints are a common practice in psychiatric hospitals, with prevalence rates ranging between 33% and 68% in hospital settings ( Hamers & Huizing, 2005 ). Since nurses’ attitude and practice play an important role in psychiatric health care setting, it was deemed impor- tant to develop a restraint policy and educate nurses how to implement it because hospitals in Sudan do not have policies and there are illegal uses of restraint recorded. AIM OF THE STUDY The Aim of This Study Was to Assess psychiatric nurses’ attitude and practice toward physical re- straint among mentally ill patients. Objective of the Present Study Was to • identify psychiatric nurses attitudes toward restrained patients. • evaluate psychiatric nurses practices regarding physical restraint. SUBJECTS AND METHODS Research Design A descriptive research design was used in the study. Setting The present study was carried out in Khartoum-Republic of Sudan hospitals. It included three specialized governmental mental hospitals (Abdalal Aledrecee, Taha Bahser and Altegani Almahi) and two Psychi- atric wards in two general hospitals (Alselah Altibi and Khartoum Teaching Hospital). Subjects The study was conducted on a convenient purposive sample consisting of 96 nurses who were working in these hospitals in the time of data collection according to following criteria: from both sexes and working in different psychiatric departments. Any deviations from these criteria were excluded. The questionnaire was distributed to all nurses with mentioned criteria, and the response rate was 63% with 96 nurses from all respondents. Tools of Data Collection Data Were collected through Self-Administered Structured Questionnaire, which aimed to as- sess nurses’ attitude and practice regarding use of physical restraints. It was adopted from Janelli, Kanski, Scherer, and Neary (1992) and adapted by researchers in Arabic format in order to have a suitable lan- guage to suit the nurses’ level of understanding. Then, it was revised by using of panel of experts for the content validity. It included three parts as follows: The first part: It comprised items concerned with demographic characteristics of the nurses such as age, sex, quali fications, educational level, years of ex- perience and work place. The second part: It comprised 10 items measuring nurses’ attitudes toward using of physical restraint, rated on a 4-point Likert scale in which four = ‘ strongly agree ’and one = ‘strongly disagree ’. Thus, high scores with cutoff point 24 –40 re flected positive attitudes and low scores with cut- off point 10 –23 re flected negative attitudes (potential range: 10 –40). The third part: It was used to assess nurses’ practices regarding the use of physical restraint, which comprised 18 items assessing the issues in nursing care provided to patients immediately, before or during restraint such as ‘explain procedures to patient and signi ficant others. ’The items re- ported to be done were scored “1”and the items not done were scored “ 0”. For each area, the scores of the items were summed-up and the total divided by the number of the items, giving a mean score for the part. These scores were converted into a percent score, and means and stan- dard deviations were computed. The nurses’ practice was considered adequate if the percent score was 60% or more and inadequate if less than 60%. The Cronbach’s alpha coef ficients of parts two and three were 0.73 and 0.78. Pilot Study A pilot study was conducted after the development of the tools and before starting the data collection. It included 10% from nurses’ works in the previously mentioned settings and then excluded from the study sample. The purpose of the pilot study was to test the applicability, fea- sibility and clarity of the tools, and it served to estimate the time needed to complete the tools. Simple modi fications of the tools were done. Field Work The data were collected from 20 February to 30 July 2014. Two days per week were speci fied for data collection. The days were Sunday and Thursday from 9.30 to 12.30 p.m. The investigator interviewed, ob- served and filled in the tools from each nurse individually. The approx- imate time spent with each nurse during the interview was 30 to 45 min; nurses interview number ranged from 1 to 6 nurses per day. 3 A.S. Mahmoud / Archives of Psychiatric Nursing 31 (2017) 2 –7 An of ficial permission was granted by the hospitals and the Ministry of Health in Khartoum City. Ethical Consideration The aim of the research was explained to the head nurses and nurses. Verbal consent was obtained from each nurse to participate in the study after clarifying the procedure of the study. Nurses were informed about their right to refuse participation and to withdraw at any time without any consequences. Con fidentiality of data was ensured. Statistical Analysis Data were collected and fed into the computer for analysis and pre- sentation. Data were entered and analyzed using SPSS 20.0 statistical software package. Data were presented using descriptive statistics in the form of frequencies and percentages for qualitative variable, Chi- square and Pearson correlation coef ficient. Statistically signi ficant dif- ference was considered when P-Value ≤0.05. RESULTS The respondents in this study were 96 nurses with a mean age 34.5 ± 2.5 years, 45.8% of nurses were aged between 30 and 50 years old, more than half of them were female (53.1%), and the largest group of the study nurses (74.0%) studied in nursing secondary school. Most of nurses had period of experience 4 –8 years (37.5%), and 53.1% of them work in male ward. Table 1 describes the nurse’s attitude toward the physical restraint. More than half of them disagreed with the statement that “the main reason for restraints are used in the hospital is shortage of staff ” (58.3%), while less than half of them “feel embarrassed when the family enters the room of patient who is restrained (47.9%) and the patient suf- fers from loss of dignity when placed in restraints ”(47.9%), followed by “ feels that placing a patient in restraints can decrease nursing care time (42.7%), and “feel guilty when placing a patient in restraints ”(39.6%). About two thirds of nurses try to use alternative nursing measures be- fore restraining the patient (61.4%) followed by 46.9% who apply re- straints to assure legal protection for nurses and hospital and 45.8% who feel bad if the patient gets more upset after restraints are applied. Table 2 reflects that more than half of the nurses have no suf ficient staff during physical restraints (65.6%), do not assess patient condition every 10 –15 min (56.3%) and do not document the patient intervention (39.6%); 46.9% of the nurses do not monitor patient skin frequently in restrained extremities and do not talk with the client during the procedure (38.5%), while about one third of nurses do not involve the patient in making decisions (33.3%). Table 3 revealed that 53.8% of female nurses and, 44.9% aged be- tween 30 and 50 years were holding more positive attitudes toward physical restraints. In addition, nurses who had nursing secondary school (73.1%) experience the positive attitudes toward physical re- straint, and nurses working in male wards (50.0%) for the years of expe- rience 8 years (35.9%) and more had positive attitudes. Also, the table indicated that the female nurses (54.8%) with age group from 30 to 50 years (46.6%), nurses who had nursing secondary school (73.9%), those working in male wards (50.7%), and those with years of experi- ence 8 years and more (35.6%) had inadequate practices toward physi- cal restraint. Moreover, there are insigni ficant differences between attitudes and practices in relation to nurses’ sex, level of education, years of experience and work place. Table 4 shows that there is a positive signi ficant correlation between nurses’ total attitude and practices regarding use of physical restraint. DISCUSSION Traditionally, the burden of keeping patients safe and their medical equipment intact has been left to the nurses. Using restraints to prevent Table 1 Nurses Attitude toward Use of Physical Restraints. Nurses (96) Agree Strongly agree Disagree Strongly disagree N% N% N% N% I try alternative nursing measures before restraining the patient. 59 61.4 30 31.3 5 5.2 2 2.1 I feel that it is more important to let the patient in restraints know that I care about him or her. 36 37.5 24 25.0 31 32.3 5 5.21 feels that the main reason restraints are used in the hospital is shortage of staff. 9 9.4 11 11.5 56 58.3 20 20.8 I feel embarrassed when the family enters the room of patient who is restrained and they have not been noti fied. 26 27.1 15 15.6 46 47.9 9 9.4 I believe that the family members have the right to refuse the use of restraints. 42 43.8 21 21.9 24 25.0 9 9.4I feel guilty when placing a patient in restraints. 32 33.3 19 19.8 38 39.6 7 7.3It makes me feel bad if the patient gets more upset after restraints are applied. 44 45.8 37 38.5 11 11.5 4 4.2I feel that placing a patient in restraints can decrease nursing care time. 18 18.8 10 10.4 41 42.7 27 28.1It’s important to apply restraints to assure legal protection for nurses and hospital. 45 46.9 37 38.5 9 9.4 5 5.2A patient suffers a loss of dignity when placed in restraints. 15 15.6 17 17.7 46 47.9 18 18.8 Table 2Nurses’ Practices toward Use of Physical Restraint (n = 96). Action Done Not done N% N% Monitor patient cognitive function that leads to unsafe behavior. 43 44.8 53 55.2 Explain the reason for intervention to the patient and signi ficant other. 45 46.9 51 53.1 Explain procedures to patient and signi ficant others 7 7.3 89 92.7 Prepare equipment needed 38 39.6 58 60.4Provide suf ficient staff (at least 3 persons) 33 34.4 63 65.6 Talk with the client during the procedure 59 61.5 37 38.5 Make sure that the bed is comfortable 21 21.9 75 78.1 Place patient in recumbent potion 23 23.7 73 76.0Make the restraints slack enough 15 15.6 81 84.4Fasten the straps of the restraints to the bed frame. 21 21.9 75 78.1Apply the restraint in such a way that it can be releasedquickly 8 8.3 88 91.7 Provide positive reinforcement 36 37.5 60 62.5 Administer major tranquilizers as ordered 28 29.2 68 70.8 Monitor patient skin frequently in restrained extremities 51 53.1 45 46.9 Assessment patient condition 10 –15 min 58 60.4 38 39.6 Involve patient in making decisions 64 66.7 32 33.3Remove restraints gradually 10 10.4 86 89.6Document of intervention 54 56.2 42 43.8 4 A.S. Mahmoud / Archives of Psychiatric Nursing 31 (2017) 2 –7 injury is a long lasting practice; nurses reported feelings of guilt over this practice yet they felt they had no options ( Lusis, 2000 ). Despite growing literature about restricting the use of restrain, this practice is common in acute or residential settings and prevalence of physical re- straint use is high ( Evans, Wood, & Lambert, 2002; Irwing, 2002 ). The psychiatric care setting is perhaps the last major health care setting in which PR remains common and perceived as an unquestioned practice, in which it is used as a protective intervention in psychiatric settings ( Petti, Mohr, Somers, & Sims, 2001 ). The findings of the present study revealed that, one quarter of nurses disagreed with the statement that ‘family members have the right to re- fuse the use of restraints ’. This revealed the need to increase awareness of patient’s rights and ethical issues related to use of PR to avoid allega- tions of assault. This result is consistent with Azab and Abu Negm (2013) who did a study to assess ICU nurses’ knowledge, attitude and practice regarding use of PR in the ICU settings at Ain Shams University Hospitals and factors in fluencing it and Suen et al. (2006) who studied factors in fluencing practices of staff with regard to the use of restraints in rehabilitative settings and found that most of the respondent nurses disagreed with the statement that ‘Family members have the right to refuse the use of restraints. ’It is important to note that if restraint is decided to be done for individuals without capacity, it must be the least restrictive of their basic rights and freedoms, in their best interests and after failure of other alternative non-restrictive methods ( Hine, 2007 ). The result of the current study is consistent with Azab and Abu Negm (2013) who mentioned several alternative methods that could be used before applying PR, such as providing companionship and su- pervision, offering physical and diversional activities, playing soft back- ground music, manipulating environments, evaluating the effects of drugs that may be contributing to a patient’s agitation and using care plans to meet the needs of individual clients ( Suen et al., 2006 ). Less than half of the respondent nurses in this study indicated that they do not record data about PR use in patient’s chart (type of restraint used, indication for use, time of application and the related nursing care). Because of this insuf ficient practice, it is hard to say why patients are being physically restrained, or what kinds of results were observed. This result is consistent with Choi and Song (2003) and Azab and Abu Negm (2013) who found that there was no documentation in nursing notes on PR in three quarter of the studied restrained cases. This was at- tributed to the consideration of PR by health professionals as not being an important intervention that requires recording and communication ( Macpherson, Lofgren, Granieri, & Myllenbeck, 1990 ). However, the re- cent regulatory standards of PR use raised the importance of its docu- mentation due to its legal and ethical implications. It has been known from the present results that psychiatric nurses have positive attitudes toward using of physical restraints. This finding of nurses’ attitudes re flects their agreement about using of physical re- straint for psychiatric patients, and such finding could be explained by the fact that nurses perceive agitated psychiatric patients as dangerous and consequently, they agree with the use of restraint because they per- ceive that restraint may reduce the complications that might occur. On the other hand, nurses think that controlled patients should be released from restraint. Further studies supporting this evidence were found by Elgamal (2006) and Wai-Tong and Isabella (2007 ); additional support- ive evidence was found by Sajat (2008) and Mohammed (2015 ). Our results revealed that female nurses with age group of 30 to 50 years are holding positive attitudes than male nurses and other nurses from other age groups. The positive attitudes toward physical restraint are experienced by nurses who had diploma and were working in male wards for the years of experience 8 years and more. The findings above indicated that psychiatric nurses are in fluenced by their experi- ences which they have learned during the period of their employment as psychiatric nurse; this explanation proves the theory of attitude change. According to Tyler and Schuller (2012) , the attitudes that are demonstrated by young individuals are less than those demonstrated by older persons. The interpretation of this differentiation is in two ways: the first one is a “psychological explanation ”which sees that younger individuals are open to change their attitudes; the second one is a “life style explanation ”which sees that young individuals Table 3 Comparison between Nurses’ Attitude and Practices toward Use of Physical Restraint in Relation to Socio-Demographic Characteristics (n = 96). Attitude χ2Test P Practice χ2Test P Positive (78) Negative (18) Adequate (23) Inadequate (73) N% N% N % N % Age (years): b 30 Years old 33 42.3 7 38.9 1.07 .585 10 43.5 30 41.1 .231 .891 30 – 35 44.9 10 55.6 11 47.8 34 46.6 50+ 10 12.8 1 5.6 2 8.7 9 12.3Gender:Female 42 53.8 9 50.0 .087 .486 11 47.8 40 54.8 .341 .635Male 36 46.2 9 50.0 12 52.2 33 45.2Education background: Bachelor 21 26.9 4 22.2 .168 .468 6 26.1 19 26.1 .000 1.00 Nursing Secondary School 57 73.1 14 77.8 17 73.9 54 73.9Years of experience:b 4 years 24 30.8 2 11.1 5 21.7 21 28.8 4- 26 33.3 10 55.6 4.04 .133 10 43.5 26 35.6 .611 .7378- 28 35.9 6 33.3 8 34.8 26 35.6 Work places:Emergency 22 28.2 3 16.7 1.69 .428 5 21.7 20 27.4 Female word 17 21.8 3 16.7 4 17.4 16 21.9 .729 .695 Male word 39 50.0 12 66.7 14 60.9 37 50.7 Mean ± SD 26.864 ± 3.529 6.343 ± 3.862Min. and Max. 20 –35 0 –14 Table 4 Correlation between Nurses’ Total Scores of Attitudes and Practices toward Use of PhysicalRestraint (n = 96). Total Attitudes Score Total Practices Score r −.266 p P.009* 5 A.S. Mahmoud / Archives of Psychiatric Nursing 31 (2017) 2 –7 have more change-inducing experiences than older persons but Mohammed (2015) disagreed with this result. In addition, the present results revealed that there are insigni ficant differences between nurses’ attitudes in relation to nurses’ sex, level of education, years of experience and work place. The finding above could be explained by psychiatric nurses’ experience in this area of work that re flects the insigni ficant relationship in spite of the positive attitudes that they hold toward using of restraint. On the other hand, the insigni ficant relationship may be due to decreased conditions that need restraints in some of psychiatric wards considering that some of families did not admit their agitated patients to hospital due to stigma- tization. A study presented supportive evidence that found Hamers et al. (2009) and Huang, Chuang, and Chiang (2009) who found that there is no association with nurses’ characteristics. The present study revealed that about half of nurses with age group of 30 to 50 years perform physical restraints inadequately, in which, it was found that the level of nurses ’practice concerning physical re- straints increased with older nurses. These findings are generally in line with McMillan and Jane (2004) and Al-Khaled, Zahran, and El-Soussi (2011) who concluded that professionals mature age wise nurses who have experience tend to make a better adjustment when compared with younger peers. The results of current study indicated that most of nurses who had diploma are applying restraining adequately. This can be explained by the fact that diploma nurses apply restraints frequently while, B.Sc. nurses frequently work as a supervisor than as a staff nurse. Al-Khaled et al. (2011) disagreed with this result. In relation to nurses’ experience, this study showed that nurses with a higher experience are performing the procedure of restraining better than others. This could be explained by the fact that experiences and continuous training enhance performances and practices. These find- ings are congruent with Gillis (1997) and Al-Khaled et al. (2011) the fact that experiences and continuous training enhance personal perfor- mances and practices. There are insigni ficant differences between nurses’ practices in rela- tion to years of experience and work place. These results disagree with Al-Khaled et al. (2011) who found that there is a signi ficant relation be- tween nurses’ practices and years of experience. The present study revealed that there is a positive signi ficant corre- lation between nurses’ total attitude, and practices regarding use of physical restraint. These findings are generally in line with Karlsson, Bucht, Eriksson, and Sandman (2001) who concluded that the attitudes of Swedish nursing staff toward the use of physical restraints were strongly connected to their use in practice. CONCLUSIONS “ Psychiatric nurses have positive attitude and adequate practice to- ward using physical restraints as an [alternative management for ag- gressive psychiatric patients and not for all the patients] ”. The study recommended that it is important for psychiatric nurses to acknowl- edge that physical restraints should be implemented as the last resort. That psychiatric nurses either have or do not have the knowledge on the application of how physical restraints should be implemented as the last resort is not at all addressed within the body of this work. 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