Difference of Physical Restraint Knowledge, Attitudes and Practice Between Nurses and Nursing Assistants in Long-Term Care Facilities: A Cross-Sectional Study

Background: Physical restraint (PR) is widespread use among older adults in long-term care (LTC) facilities, which has negative effects on older adults' health and quality of care. Considering that research on PR use in Chinese LTC facilities is rare, assessment of nursing staff's knowledge, attitude, and practice (KAP) is a prerequisite before minimized PR program and staff training project development. Purpose: This study aimed at determining the differentiation of levels and factors of KAP toward PR use between nurses and nursing assistants in LTC facilities. Methods: A cross-sectional study was conducted in six Chinese LTC facilities from November to December in 2019 and May to June in 2020. A total of 316 nursing staff, comprising 69 nurses and 247 nursing assistants were investigated using the Chinese version of the Staff Knowledge, Attitudes and Practices Questionnaire regarding PR. One-way analysis of variance, chi-squared test, Welch test, the Mann-Whitney U-test, and multiple linear regression were performed for data analysis. Results: Mean scores of overall knowledge, attitude, and practice were 5.90 +/- 2.27, 31.97 +/- 3.01, 30.89 +/- 4.82, respectively. PR knowledge and practice of nurses were significantly higher than that of nursing assistants (all P<0.001), whereas PR attitude with no significant difference (P=0.084). In-school training, in-job training, and knowledge on PR significantly affected PR practice of nurses and nursing assistants. Further, nursing assistants' practice was also significantly predicted by education (6=0.131, P=0.019), age (6= - 0.140, P=0.034), monthly income (6=-0.184, P=0.002), and attitude (6=0.130, P=0.030). In-job training (6=0.283, P<0.001), age (6= - 0.164, P=0.021), and knowledge (6=0.292, P<0.001) significantly affected nursing assistants' attitude, while their knowledge was influenced by monthly income (6=0.153, P=0.019) and work years in LTC (6=0.343, P<0.001). Conclusion: Specific knowledge deficits, negative fields of attitude, and practice were dissimilar between nurses and nursing assistants. The targeted and stratified PR education approaches were suggested to prompt their KAP.

Automated summary

This study aimed to assess the knowledge, attitude, and practice (KAP) towards physical restraint (PR) use among nurses and nursing assistants in Chinese long-term care (LTC) facilities. The results showed that nurses had significantly higher scores in PR knowledge and practice compared to nursing assistants, while PR attitude did not differ significantly. Factors such as in-school training, in-job training, and knowledge on PR significantly influenced PR practice among both groups. Targeted and stratified PR education approaches are suggested to improve the KAP among nurses and nursing assistants.