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Original Research

Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology

Eun Ja Yeun1, Jeong Hwa An2, Jung A Kim3, Mi Soon Jeon4
Korean Journal of Adult Nursing 2013;25(3):344-355.
Published online: June 18, 2013

1Department of Nursing, Konkuk University, Chungju

2Konkuk University Hospital, Chungju

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Corresponding author: Jeon, Mi Soon Department of Nursing, Baekseok University, 115 Anseo-dong, Cheonan 330-704, Korea. Tel: +82-10-9882-6520, Fax: +82-41-550-2829, E-mail: jms@bu.ac.kr
• Received: February 18, 2013   • Accepted: June 24, 2013

© 2013 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to identify on the perceptions of family care-givers toward use of physical restraints according to their values, beliefs, and perceptions using Q methodology.
  • Methods
    Thirty-three family care-givers classified 41 selected Q-statements into 9 points standard. The obtained data were analyzed by using a pc QUANL program.
  • Results
    Principal component analysis identified 4types of the perceptions of family care-givers toward the use of physical restraints. Type I is ‘Rational accepted’, which means that they perceived the restraints are essential therapeutic devices and had cooperative attitude to use of medical staffs' restraints. Type II is ‘Sardonic sensibility’, which means that they have a negative and a cynical attitude to use of physical restraints. Type III is ‘Ambivalent', which means that they have conflicts between rationality and emotion, and type IV is ‘Practical claim of a right', which means they insist that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.
  • Conclusion
    The findings of this study suggest that perceptions toward the use of physical restraints among family care-givers should be understood for patients' safety and dignity in medical circumstance. Based on the results, this study will be useful in developing the customized nursing intervention for supporting family care-givers’ subjectivity considering the Korean context.
  • Key Words: Intensive care units; Family; Perception; Physical restraint; Q-methodology
Figure 1.
Distribution of items and scoring.
kjan-25-344f1.jpg
Table 1.
Q- samples on Physical Restraint
Q- statement
Q1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff.
Q2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint.
Q3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems).
Q4. The physical restraint is a therapeutic method needed to provide patients with better treatment; in this way, it is similar to patient stabilization or injections.
Q5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint.
Q6. I think that the physical restraint must be used only with patients on life-support systems whose consciousness is unclear.
Q7. The senior medical staff has an important role in learning about the application of, or perceptions regarding, the physical restraint.
Q8. I think that patients must bear the discomfort associated with wearing physical restraints.
Q9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use.
Q10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances.
Q11. It is absurd to apply the physical restraint as a result of violation of ward rules.
Q12. I trust the judgment of (fellow) medical staff regarding the application of physical restraints.
Q13. I feel a sense of guilt and pity for patients under physical restraint.
Q14. I think that patients under physical restraint must feel very uncomfortable and confined.
Q15. I think that patients who wear physical restraints must feel disgraced and embarrassed.
Q16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.
Q17. I think that it is absolutely necessary to record when and why a physical restraint is applied or removed, as well as the type of physical restraint that is applied or removed.
Q18. I think that physical restraint use can be reduced when the patient is with a caregiver.
Q19. I think that using a physical restraint is preferable to using drugs to stabilize patients.
Q20. The medical staff uses the physical restraint whenever they think it is necessary.
Q21. The medical staff does not seem to feel any particular emotion when applying physical restraints on patients.
Q22. There is no need to use the restraint on unconscious patients.
Q23. I think that patients or family members have the right to refuse use of the physical restraint.
Q24. If I were a patient, I would refuse or resist wearing a physical restraint.
Q25. I think that wearing the physical restraint is a kind of punishment for patients.
Q26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower.
Q27. The medical staff often becomes flustered when the family of a restrained patient enters the patient's room.
Q28. It is important that the medical staff inform restrained patients that they are being taken care of.
Q29. The physical restraint must be used when the patient cannot be observed from a close distance.
Q30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.
Q31. The medical staff can legally be sued if the physical restraint was used unnecessarily in a situation that did not require it.
Q32. In emergency situations, the nurse can legitimately use the physical restraint without a doctor's orders.
Q33. Application of the physical restraint makes patients more anxious, leading to a loss of orientation.
Q34. The physical restraint is used when the patient is semiconscious and at risk of falling.
Q35. The physical restraint is used to control the behavior of mentally unstable patients.
Q36. The physical restraint must be used for patients that need total rest.
Q37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective.
Q38. It is important to provide the medical staff with education and guidance for dealing with situations in which they might lose control of their emotions due to violent patient behavior.
Q39. It is difficult to apply the physical restraint by predicting patient behavior in advance through careful observation.
Q40. It is important to prevent patients from causing accidents by removing physical restraints themselves.
Q41. The medical staff must monitor changes in the patient's condition and remove the physical restraint at a planned time.
Table 2.
Demographic Characteristics and Factor Analysis of P-sample (N=33)
No. ID Demographic characteristics Factor weight Factor 1 Factor 2 Factor 3 COM. PURE
Gender yr Religion Marital status Use of restraints Type 1 Type 2 Type 3, 4
Type 1 (n=15)
1 30 F 32 Other Unmarried No 0.55 0.44 .07 0.05 0.20 0.97
2 29 M 39 Buddhism Unmarried No 0.55 0.44 .05 -0.10 0.20 0.96
3 12 F 54 Other Married Yes (Family) 1.08 0.64 -.17 0.05 0.44 0.93
4 4 F 25 Buddhism Unmarried No 0.56 0.45 -.10 -0.09 0.22 0.92
5 11 F 18 Buddhism Unmarried Yes (Family) 0.70 0.52 -.17 0.07 0.30 0.89
6 3 M 49 Buddhism Unmarried No 0.86 0.58 -.17 0.23 0.41 0.81
7 23 M 48 Protestant Married Yes (Family) 0.85 0.57 -.26 -0.12 0.41 0.79
8 13 M 50 Protestant Married No 0.93 0.60 -.19 0.26 0.46 0.78
9 15 F 18 Buddhism Unmarried No 0.91 0.59 -.26 -0.26 0.49 0.72
10 22 M 36 None Unmarried No 0.19 0.18 0.11 -0.04 0.05 0.71
11 8 F 55 Buddhism Married No 0.24 0.23 .09 -0.16 0.08 0.62
12 32 F 56 Buddhism Married Yes (Family) 0.27 0.26 0.10 0.19 0.11 0.59
13 33 M 30 Buddhism Unmarried Yes (Family) 0.31 0.28 .07 -0.24 0.14 0.55
14 2 F 51 Other Married Yes (Family) 0.34 0.31 .08 0.27 0.18 0.55
15 5 M 43 Catholic Married No 0.62 0.48 -.16 0.41 0.42 0.54
Type 2 (n=13)
16 28 F 30 None Unmarried No 0.43 0.05 0.37 -.03 0.14 0.98
17 9 F 29 None Unmarried No 0.61 -0.01 0.47 .09 0.23 0.96
18 25 M 46 Catholic Married No 0.56 -0.03 0.45 -.09 0.21 0.95
19 14 M 30 None Unmarried No 0.70 -0.14 0.52 0.12 0.29 0.89
20 19 F 43 None Married No 0.77 -0.19 0.54 .07 0.34 0.87
21 31 F 46 Catholic Married Yes (Family) 1.18 -0.39 0.66 0.11 0.60 0.73
22 20 M 35 None Unmarried No 0.29 0.07 0.27 -.16 0.10 0.72
23 17 M 51 None Unmarried No 0.19 0.08 0.19 -.09 0.05 0.71
24 21 F 26 None Unmarried No 0.72 -0.28 0.52 -.23 0.48 0.68
25 24 F 42 None Married No 1.93 -0.58 0.77 .01 0.93 0.64
26 18 M 48 None Unmarried Yes (Family) 0.40 -0.16 0.35 -.22 0.19 0.63
27 16 M 27 None Unmarried No 0.42 -0.23 0.37 0.22 0.24 0.57
28 7 F 46 Buddhism Married No 0.31 -0.12 0.28 0.27 0.17 0.49
Type 3 (n=2)
29 6 M 49 Buddhism Married No 0.83 0.09 0.18 0.57 0.36 0.88
30 27 F 45 None Married No 0.37 -0.07 0.21 0.33 0.16 0.70
Type 4 (n=3)
31 26 M 50 Catholic Married Yes (Family) 1.12 0.10 0.01 -0.65 0.43 0.98
32 1 M 60 None Married No 0.19 -0.09 0.02 -0.18 0.04 0.76
33 10 F 26 None Unmarried No 0.31 0.22 0.11 -0.28 0.14 0.58
Eigen value and variances for each factor   Eigen values   10.33 3.86 1.63  
Variance 0.31 0.12 0.05
Cumulative 0.31 0.43 0.48
Correlation between types     Type 1 Type 2 Type 3 Type 4  
Type 1 0.32 0.32 0.23
Type 2 0.12 0.42
Type 3   -0.22

ID=identification; COM=communality.

Table 3.
Item Descriptions and Descending Array of Z-scores for Each Type
Types Q- statement Z-scores
Type 1 3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems).† 2.22
34. The physical restraint is used when the patient is semiconscious and at risk of falling. 1.44
4. The physical restraint is a therapeutic method needed to provide patients with better treatment; in this way, it is similar to patient stabilization or injections.† 1.38
1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff. 1.26
40. It is important to prevent patients from causing accidents by removing physical restraints themselves. 1.24
28. It is important that the medical staff inform restrained patients that they are being taken care of. 1.21
16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints. 1.21
24. If I were a patient, I would refuse or resist wearing a physical restraint.† -1.17
31. The medical staff can legally be sued if the physical restraint was used unnecessarily in a situation that did not require it.† -1.19
22. There is no need to use the restraint on unconscious patients. -1.31
10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances.† -1.82
25. I think that wearing the physical restraint is a kind of punishment for patients.† -1.99
30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.† -2.33
Type 2 37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective.† 1.41
16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints. 1.38
15. I think that patients who wear physical restraints must feel disgraced and embarrassed.† 1.35
17. I think that it is absolutely necessary to record when and why a physical restraint is applied or removed, as well as the type of physical restraint that is applied or removed.† 1.30
5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint. 1.27
2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint. 1.19
14. I think that patients under physical restraint must feel very uncomfortable and confined. 1.18
38. It is important to provide the medical staff with education and guidance for dealing with situations in which they might lose control of their emotions due to violent patient behavior. 1.05
10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances. -1.09
9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use. -1.17
20. The medical staff uses the physical restraint whenever they think it is necessary.† -1.23
26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower. -1.28
8. I think that patients must bear the discomfort associated with wearing physical restraints.† -1.43
19. I think that using a physical restraint is preferable to using drugs to stabilize patients. -1.57
30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin. -1.65

†Difference of Z-score (greater and lesser±1) than all others.

Table 3.
Item Descriptions and Descending Array of Z-scores for Each Type (Continued)
Types Q- statement Z-scores
Type 3 25. I think that wearing the physical restraint is a kind of punishment for patients. -1.84
3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems). 1.75
34. The physical restraint is used when the patient is semiconscious and at risk of falling. 1.66
1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff. 1.51
14. I think that patients under physical restraint must feel very uncomfortable and confined. 1.51
22. There is no need to use the restraint on unconscious patients.† 1.31
13. I feel a sense of guilt and pity for patients under physical restraint.† 1.27
20. The medical staff uses the physical restraint whenever they think it is necessary.† 1.27
37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective. 1.22
16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.† -1.07
21. The medical staff does not seem to feel any particular emotion when applying physical restraints on patients. -1.07
27. The medical staff often becomes flustered when the family of a restrained patient enters the patient's room. -1.12
26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower. -1.12
18. I think that physical restraint use can be reduced when the patient is with a caregiver.† -1.31
9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use.† -1.46
23. I think that patients or family members have the right to refuse use of the physical restraint.† -1.55
19. I think that using a physical restraint is preferable to using drugs to stabilize patients. -1.55
32. In emergency situations, the nurse can legitimately use the physical restraint without a doctor's orders.† -2.14
Type 4 11. It is absurd to apply the physical restraint as a result of violation of ward rules.† 2.18
28. It is important that the medical staff inform restrained patients that they are being taken care of. 1.62
5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint.† 1.50
16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints. 1.41
2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint. 1.36
40. It is important to prevent patients from causing accidents by removing physical restraints themselves. 1.31
23. I think that patients or family members have the right to refuse use of the physical restraint.† 1.01
26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower.† 1.01
19. I think that using a physical restraint is preferable to using drugs to stabilize patients. -1.08
20. The medical staff uses the physical restraint whenever they think it is necessary.† -1.20
12. I trust the judgment of (fellow) medical staff regarding the application of physical restraints.† -1.39
30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin. -1.73
22. There is no need to use the restraint on unconscious patients.† -1.85
36. The physical restraint must be used for patients that need total rest.† -2.30

†Difference of Z-score (greater and lesser±1) than all others.

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      So-Yeon Ha, Yi-Kyung Ha, Myung-Hee Kim
      Journal of the Korea Academia-Industrial cooperation Society.2015; 16(5): 3293.     CrossRef

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    Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology
    Korean J Adult Nurs. 2013;25(3):344-355.   Published online June 30, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.3.344
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    Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology
    Korean J Adult Nurs. 2013;25(3):344-355.   Published online June 30, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.3.344
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    Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology
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    Figure 1. Distribution of items and scoring.

    Figure 1.

    Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology

    Q- samples on Physical Restraint

    Q- statement
    Q1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff.
    Q2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint.
    Q3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems).
    Q4. The physical restraint is a therapeutic method needed to provide patients with better treatment; in this way, it is similar to patient stabilization or injections.
    Q5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint.
    Q6. I think that the physical restraint must be used only with patients on life-support systems whose consciousness is unclear.
    Q7. The senior medical staff has an important role in learning about the application of, or perceptions regarding, the physical restraint.
    Q8. I think that patients must bear the discomfort associated with wearing physical restraints.
    Q9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use.
    Q10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances.
    Q11. It is absurd to apply the physical restraint as a result of violation of ward rules.
    Q12. I trust the judgment of (fellow) medical staff regarding the application of physical restraints.
    Q13. I feel a sense of guilt and pity for patients under physical restraint.
    Q14. I think that patients under physical restraint must feel very uncomfortable and confined.
    Q15. I think that patients who wear physical restraints must feel disgraced and embarrassed.
    Q16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.
    Q17. I think that it is absolutely necessary to record when and why a physical restraint is applied or removed, as well as the type of physical restraint that is applied or removed.
    Q18. I think that physical restraint use can be reduced when the patient is with a caregiver.
    Q19. I think that using a physical restraint is preferable to using drugs to stabilize patients.
    Q20. The medical staff uses the physical restraint whenever they think it is necessary.
    Q21. The medical staff does not seem to feel any particular emotion when applying physical restraints on patients.
    Q22. There is no need to use the restraint on unconscious patients.
    Q23. I think that patients or family members have the right to refuse use of the physical restraint.
    Q24. If I were a patient, I would refuse or resist wearing a physical restraint.
    Q25. I think that wearing the physical restraint is a kind of punishment for patients.
    Q26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower.
    Q27. The medical staff often becomes flustered when the family of a restrained patient enters the patient's room.
    Q28. It is important that the medical staff inform restrained patients that they are being taken care of.
    Q29. The physical restraint must be used when the patient cannot be observed from a close distance.
    Q30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.
    Q31. The medical staff can legally be sued if the physical restraint was used unnecessarily in a situation that did not require it.
    Q32. In emergency situations, the nurse can legitimately use the physical restraint without a doctor's orders.
    Q33. Application of the physical restraint makes patients more anxious, leading to a loss of orientation.
    Q34. The physical restraint is used when the patient is semiconscious and at risk of falling.
    Q35. The physical restraint is used to control the behavior of mentally unstable patients.
    Q36. The physical restraint must be used for patients that need total rest.
    Q37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective.
    Q38. It is important to provide the medical staff with education and guidance for dealing with situations in which they might lose control of their emotions due to violent patient behavior.
    Q39. It is difficult to apply the physical restraint by predicting patient behavior in advance through careful observation.
    Q40. It is important to prevent patients from causing accidents by removing physical restraints themselves.
    Q41. The medical staff must monitor changes in the patient's condition and remove the physical restraint at a planned time.

    Demographic Characteristics and Factor Analysis of P-sample (N=33)

    No. ID Demographic characteristics Factor weight Factor 1 Factor 2 Factor 3 COM. PURE
    Gender yr Religion Marital status Use of restraints Type 1 Type 2 Type 3, 4
    Type 1 (n=15)
    1 30 F 32 Other Unmarried No 0.55 0.44 .07 0.05 0.20 0.97
    2 29 M 39 Buddhism Unmarried No 0.55 0.44 .05 -0.10 0.20 0.96
    3 12 F 54 Other Married Yes (Family) 1.08 0.64 -.17 0.05 0.44 0.93
    4 4 F 25 Buddhism Unmarried No 0.56 0.45 -.10 -0.09 0.22 0.92
    5 11 F 18 Buddhism Unmarried Yes (Family) 0.70 0.52 -.17 0.07 0.30 0.89
    6 3 M 49 Buddhism Unmarried No 0.86 0.58 -.17 0.23 0.41 0.81
    7 23 M 48 Protestant Married Yes (Family) 0.85 0.57 -.26 -0.12 0.41 0.79
    8 13 M 50 Protestant Married No 0.93 0.60 -.19 0.26 0.46 0.78
    9 15 F 18 Buddhism Unmarried No 0.91 0.59 -.26 -0.26 0.49 0.72
    10 22 M 36 None Unmarried No 0.19 0.18 0.11 -0.04 0.05 0.71
    11 8 F 55 Buddhism Married No 0.24 0.23 .09 -0.16 0.08 0.62
    12 32 F 56 Buddhism Married Yes (Family) 0.27 0.26 0.10 0.19 0.11 0.59
    13 33 M 30 Buddhism Unmarried Yes (Family) 0.31 0.28 .07 -0.24 0.14 0.55
    14 2 F 51 Other Married Yes (Family) 0.34 0.31 .08 0.27 0.18 0.55
    15 5 M 43 Catholic Married No 0.62 0.48 -.16 0.41 0.42 0.54
    Type 2 (n=13)
    16 28 F 30 None Unmarried No 0.43 0.05 0.37 -.03 0.14 0.98
    17 9 F 29 None Unmarried No 0.61 -0.01 0.47 .09 0.23 0.96
    18 25 M 46 Catholic Married No 0.56 -0.03 0.45 -.09 0.21 0.95
    19 14 M 30 None Unmarried No 0.70 -0.14 0.52 0.12 0.29 0.89
    20 19 F 43 None Married No 0.77 -0.19 0.54 .07 0.34 0.87
    21 31 F 46 Catholic Married Yes (Family) 1.18 -0.39 0.66 0.11 0.60 0.73
    22 20 M 35 None Unmarried No 0.29 0.07 0.27 -.16 0.10 0.72
    23 17 M 51 None Unmarried No 0.19 0.08 0.19 -.09 0.05 0.71
    24 21 F 26 None Unmarried No 0.72 -0.28 0.52 -.23 0.48 0.68
    25 24 F 42 None Married No 1.93 -0.58 0.77 .01 0.93 0.64
    26 18 M 48 None Unmarried Yes (Family) 0.40 -0.16 0.35 -.22 0.19 0.63
    27 16 M 27 None Unmarried No 0.42 -0.23 0.37 0.22 0.24 0.57
    28 7 F 46 Buddhism Married No 0.31 -0.12 0.28 0.27 0.17 0.49
    Type 3 (n=2)
    29 6 M 49 Buddhism Married No 0.83 0.09 0.18 0.57 0.36 0.88
    30 27 F 45 None Married No 0.37 -0.07 0.21 0.33 0.16 0.70
    Type 4 (n=3)
    31 26 M 50 Catholic Married Yes (Family) 1.12 0.10 0.01 -0.65 0.43 0.98
    32 1 M 60 None Married No 0.19 -0.09 0.02 -0.18 0.04 0.76
    33 10 F 26 None Unmarried No 0.31 0.22 0.11 -0.28 0.14 0.58
    Eigen value and variances for each factor   Eigen values   10.33 3.86 1.63  
    Variance 0.31 0.12 0.05
    Cumulative 0.31 0.43 0.48
    Correlation between types     Type 1 Type 2 Type 3 Type 4  
    Type 1 0.32 0.32 0.23
    Type 2 0.12 0.42
    Type 3   -0.22

    ID=identification; COM=communality.

    Item Descriptions and Descending Array of Z-scores for Each Type

    Types Q- statement Z-scores
    Type 1 3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems).† 2.22
    34. The physical restraint is used when the patient is semiconscious and at risk of falling. 1.44
    4. The physical restraint is a therapeutic method needed to provide patients with better treatment; in this way, it is similar to patient stabilization or injections.† 1.38
    1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff. 1.26
    40. It is important to prevent patients from causing accidents by removing physical restraints themselves. 1.24
    28. It is important that the medical staff inform restrained patients that they are being taken care of. 1.21
    16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints. 1.21
    24. If I were a patient, I would refuse or resist wearing a physical restraint.† -1.17
    31. The medical staff can legally be sued if the physical restraint was used unnecessarily in a situation that did not require it.† -1.19
    22. There is no need to use the restraint on unconscious patients. -1.31
    10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances.† -1.82
    25. I think that wearing the physical restraint is a kind of punishment for patients.† -1.99
    30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin.† -2.33
    Type 2 37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective.† 1.41
    16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints. 1.38
    15. I think that patients who wear physical restraints must feel disgraced and embarrassed.† 1.35
    17. I think that it is absolutely necessary to record when and why a physical restraint is applied or removed, as well as the type of physical restraint that is applied or removed.† 1.30
    5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint. 1.27
    2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint. 1.19
    14. I think that patients under physical restraint must feel very uncomfortable and confined. 1.18
    38. It is important to provide the medical staff with education and guidance for dealing with situations in which they might lose control of their emotions due to violent patient behavior. 1.05
    10. I think that the medical staff uses their power and authority to apply the physical restraint even under minor circumstances. -1.09
    9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use. -1.17
    20. The medical staff uses the physical restraint whenever they think it is necessary.† -1.23
    26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower. -1.28
    8. I think that patients must bear the discomfort associated with wearing physical restraints.† -1.43
    19. I think that using a physical restraint is preferable to using drugs to stabilize patients. -1.57
    30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin. -1.65

    †Difference of Z-score (greater and lesser±1) than all others.

    Item Descriptions and Descending Array of Z-scores for Each Type (Continued)

    Types Q- statement Z-scores
    Type 3 25. I think that wearing the physical restraint is a kind of punishment for patients. -1.84
    3. Patients that do not wear the physical restraint can encounter more dangerous situations (self-injury, removal of life-support systems). 1.75
    34. The physical restraint is used when the patient is semiconscious and at risk of falling. 1.66
    1. I think that the physical restraint is a protection (safety) device used to prevent injury of patients or medical staff. 1.51
    14. I think that patients under physical restraint must feel very uncomfortable and confined. 1.51
    22. There is no need to use the restraint on unconscious patients.† 1.31
    13. I feel a sense of guilt and pity for patients under physical restraint.† 1.27
    20. The medical staff uses the physical restraint whenever they think it is necessary.† 1.27
    37. The physical restraint must be used for a minimum period of time when other therapeutic measures (medication, position change, etc.) are ineffective. 1.22
    16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints.† -1.07
    21. The medical staff does not seem to feel any particular emotion when applying physical restraints on patients. -1.07
    27. The medical staff often becomes flustered when the family of a restrained patient enters the patient's room. -1.12
    26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower. -1.12
    18. I think that physical restraint use can be reduced when the patient is with a caregiver.† -1.31
    9. I think that very few measures exist that can be used to reduce the side effects of physical restraint use.† -1.46
    23. I think that patients or family members have the right to refuse use of the physical restraint.† -1.55
    19. I think that using a physical restraint is preferable to using drugs to stabilize patients. -1.55
    32. In emergency situations, the nurse can legitimately use the physical restraint without a doctor's orders.† -2.14
    Type 4 11. It is absurd to apply the physical restraint as a result of violation of ward rules.† 2.18
    28. It is important that the medical staff inform restrained patients that they are being taken care of. 1.62
    5. I think that it is necessary to check frequently with patients about the kinds of discomfort they experience under physical restraint.† 1.50
    16. I think that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints. 1.41
    2. Appropriate measures must be developed to reduce the physical pain that patients experience during application of the physical restraint. 1.36
    40. It is important to prevent patients from causing accidents by removing physical restraints themselves. 1.31
    23. I think that patients or family members have the right to refuse use of the physical restraint.† 1.01
    26. I think that the main reason for using the physical restraint is related to a lack of hospital manpower.† 1.01
    19. I think that using a physical restraint is preferable to using drugs to stabilize patients. -1.08
    20. The medical staff uses the physical restraint whenever they think it is necessary.† -1.20
    12. I trust the judgment of (fellow) medical staff regarding the application of physical restraints.† -1.39
    30. The physical restraint must be applied tightly, with no space remaining between it and the patient's skin. -1.73
    22. There is no need to use the restraint on unconscious patients.† -1.85
    36. The physical restraint must be used for patients that need total rest.† -2.30

    †Difference of Z-score (greater and lesser±1) than all others.
    Table 1. Q- samples on Physical Restraint

    Table 2. Demographic Characteristics and Factor Analysis of P-sample (N=33)

    ID=identification; COM=communality.

    Table 3. Item Descriptions and Descending Array of Z-scores for Each Type

    Difference of Z-score (greater and lesser±1) than all others.

    Table 3. Item Descriptions and Descending Array of Z-scores for Each Type (Continued)

    Difference of Z-score (greater and lesser±1) than all others.

    Table 1.

    Table 2.

    Table 3.

    Table 3.

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