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Development and Testing of an Instrument to Measure Family’s Emotional Response toward Physically Restrained Patients
Eun-Nam Lee, Su-Jin Ha, Ji-Yeon Kang
Journal of Korean Academy of Nursing 2008;38(4):629-638.
DOI: https://doi.org/10.4040/jkan.2008.38.4.629
Published online: August 31, 2008

1Professor, Department of Nursing, Dong-A University

2Nurse, Intensive Care Unit, Dong-A University Medical Center

3Assistant Professor, Department of Nursing, Dong-A University, Busan, Korea

Address reprint requests to : Lee, Eun Nam Department of Nursing, Dong-A University, 1 Dongdaesin-dong 3 ga, Seo-gu, Busan 602-714, Korea Tel: 82-51-240-2864 Fax: 82-51-240-2947 E-mail: enlee@dau.ac.kr
• Received: June 9, 2008   • Revised: June 11, 2008   • Accepted: July 30, 2008

Copyright © 2008 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    This was a methodological research to develop an instrument to assess the emotional response of family members of physically restrained patients.
  • Methods
    A primary instrument with 68 questions was developed based on literature review and semi-structured interviews with family members. A group of experts revised individual questions and removed 4 irrelevant questions. This secondary instrument, then, was tested with 199 family members of physically restrained patients in intensive care units of a university hospital. The validity and reliability of the instrument were tested by factor analysis.
  • Results
    After item analysis, 3 questions with a correlation coefficient under .30 were discarded and the questions with a factor loading under .45 on Varimax Rotation were also removed. After factor analysis on the final 37 questions, 7 factors were identified; avoidance, shock, helplessness, grudge, depression, anxiousness, and acceptance. The total variance explained was 55.63%. The reliability of this instrument was 0.93 of Cronbach's alpha.
  • Conclusion
    This instrument was statistically reliable and valid to measure family’s emotional response to physical restraints of the patients. This instrument can be useful in assessing the effects of nursing interventions for family members of restrained patients.
  • Keywords: Physical restraints; Family; Emotion; Instrument
Fig. 1.
Conceptual framework of the family’s emotional response on the physically restrained patients.
jkan-38-629f1.jpg
Table 1.
General Characteristics of Subjects (N=199)
Characteristics Category n (%)
Gender Female 110 (55.3)
Male 89 (44.7)
Age (yr) 10-20 13 (6.5)
21-30 43 (21.6)
31-40 40 (20.1)
41-50 47 (23.6)
51-60 48 (24.1)
≥61 8 (4.0)
Education None 7 (3.5)
Elementary school 18 (9.0)
Middle school 30 (15.1)
High school 66 (33.2)
College or more 78 (39.2)
Religion Christian 44 (22.1)
Catholic 15 (7.5)
Buddhism 70 (35.2)
None 70 (35.2)
Job Yes 135 (67.8)
No 64 (32.2)
Income/month (thousand won) ≤2,000 49 (24.6)
2,001-3,000 40 (20.1)
3,001-4,000 53 (26.6)
≥4,001 57 (28.6)
Relationship with patient Children 58 (29.1)
Parents 13 (6.5)
Siblings 61 (30.7)
Grandchildren 9 (4.5)
Spouse 21 (10.6)
Daughter- in-law 8 (4.0)
Relative 29 (14.6)
Table 2.
CVI of Preliminary Questions
Item content CVI (%)
1. It breaks my heart 100.0
2. I am scared 100.0
3. He or She seems to have a lot of pain 87.5
4. I am at a loss for words 100.0
5. I feel awful 100.0
6. I hate myself 100.0
7. I feel myself useless 100.0
8. There is nothing I can do about it 100.0
9. I am worried about the rest of family 62.5
10. It brings tears to my eyes 100.0
11. I am nervous because he or she might be hurted 100.0
12. My life is meaningless 50.0
13. My heart gets choked with emotions 100.0
14. I am afraid 100.0
15. I want to die along 100.0
16. I could not see anything on it 87.5
17. I am speechless 100.0
18. It is all my fault 87.5
19. I do not want to think about it 87.5
20. It is terrible 100.0
21. All I hope is getting better as soon as possible 100.0
22. I think he or she could die in being tied 100.0
23. It drives me crazy 100.0
24. I could not believe it 100.0
25. There seems to be no way to get out of it 100.0
26. I do not want to see it 100.0
27. This should not happen again 75.0
28. I feel miserable 87.5
29. I do not care if his or her condition becomes better 87.5
30. It hurts my feeling 100.0
31. It is better to be restrained than to be hurted from moving a lot 100.0
32. I feel nothing 100.0
33. I feel dizzy 87.5
34. I wish I had better choices 100.0
35. It seems inevitable to use restraints in this situation 100.0
36. I think using restraints is helpful 100.0
37. I never forget him or her on restraints 100.0
38. I am afraid the condition is to be worse 87.5
39. I am afraid he or she would be abandoned while on restraints 75.0
40. I do not understand why he or she should be tied up 100.0
41. I resign myself to my fate 87.5
42. The staffs seem to be coldhearted 87.5
43. I feel bitter for the staffs 100.0
44. I think we should accept the behaviors of staffs 100.0
45. Restraining a patients is for staffs’ convenience 87.5
46. I hate both of doctors and nurses 87.5
47. I believe in staffs’ judgements 87.5
48. Restraining patients is a subhuman behavior 100.0
49. Restraining limits the freedom of human 100.0
50. I do not want to get along with other people 62.5
51. The remaining family members is my only consolation 50.0
52. I feel annoyed 100.0
53. I wish I was sick 100.0
54. It is better to die 87.5
55. I feel desperate 100.0
56. I am shocked 100.0
57. The more I think about it, the more I get worried 87.5
58. There is no other way to get medically treated 87.5
59. I feel like the sky falls down 100.0
60. I can not think at all for a while 87.5
61. I feel upset 100.0
62. I feel sorry for the patient 100.0
63. I hope they untie patient while I am with him or her 75.0
64. The idea first came to me was that I would take the patient out 62.5
65. I wish I could forget everything 100.0
66. I am concerned about his or her psychological status 87.5
67. It is absurd 100.0
68. I feel regret 100.0

CVI=content validity index.

Table 3.
Factor Analysis of 37 Items
Item Factor loading Eigen value Variance explained (%) Cumulative variance (%)
26. I do not want to see it .693 12.811 29.117 29.117
25. There seems to be no way to get out of it .665
24. I could not believe it .610
28. I feel miserable .593
20. I am afraid .544
19. I do not want to think about it .514
52. I feel annoyed .497
18. It is all my fault .496
30. I feel sad .476
59. I feel like the sky falls down .676 2.816 6.400 35.516
60. I can not think at all for a while .665
58. There is no other way to get medically treated .568
54. It is better to die .554
61. I feel upset .527
56. I am shocked .50
62. I feel sorry for the patient .499
2. I am scared .491
4. I am at a loss for words .486
23. It drives me crazy .483
7. I feel myself useless .819 2.446 5.559 41.075
8. There is nothing I can do about it .775
6. I hate myself .691
1. It break my heart .601
43. I feel bitter for the staffs .763 1.718 3.904 44.978
40. I do not understand why he or she should be tied up .708
41. I resign myself to my fate .668
46. I hate both of doctors and nurses .460
13. My heart gets choked with emotions .704 1.658 3.768 48.746
14. I feel awful .695
17. I am speechless .539
16. I could not see anything on it .529
11. I am nervous because he or she might be hurted .468
66. I am concerned about his or her psychological status .712 1.566 3.559 52.305
67. It is absurd .637
68. I feel regret .590
36. I think using restraints is helpful .734 1.462 3.322 55.628
31. It is better to be restrained than to be hurted by moving a lot .564
Table 4.
Item Analysis of the Final Items
Factor Item Corrected item-total correlation Cronbach’s alpha if item deleted Cronbach’s alpha
1. Avoidance 26. I do not want to see it .587 .950 .86
25. There seems to be no way to get out of it .604 .950
24. I could not believe it .578 .950
28. I feel miserable .509 .950
20. I am afraid .615 .950
19. I do not want to think about it .593 .950
52. I feel annoyed .643 .950
18. It is all my fault .552 .950
30. I feel sad .502 .950
2. Shock 59. I feel like the sky falls down .521 .950 .86
60. I can not think at all for a while .540 .950
58. There is no other way to get medically treated .441 .951
54. It is better to die .610 .950
61. I feel upset .573 .950
56. I am shocked .621 .950
62. I feel sorry for the patient .411 .951
2. I am scared .606 .950
4. I am at a loss for words .605 .950
23. It drives me crazy .510 .950
3. Helplessness 7. I feel myself useless .330 .951 .79
8. There is nothing I can do about it .487 .950
6. I hate myself .440 .951
1. It break my heart .377 .951
4. Grudge 43. I feel bitter for the staffs .470 .950 .72
40. I do not understand why he or she should be tied up .427 .951
41. I resign myself to my fate .386 .951
46. I hate both of doctors and nurses .528 .950
5. Depression 13. My heart gets choked with emotions .372 .951 .78
14. I feel awful .485 .950
17. I am speechless .602 .950
16. I could not see anything on it .503 .950
11. I am nervous because he or she might be hurted .545 .950
6. Anxiety 66. I am concerned about his or her psychological status .416 .951 .84
67. It is absurd .566 .950
68. I feel regret .604 .950
7. Acceptance 36. I think using restraints is helpful .327 .951 .61
31. It is better to be restrained than to be hurted by moving a lot .354 .951
Total scale .93
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      Development and Testing of an Instrument to Measure Family’s Emotional Response toward Physically Restrained Patients
      J Korean Acad Nurs. 2008;38(4):629-638.   Published online August 31, 2008
      DOI: https://doi.org/10.4040/jkan.2008.38.4.629
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    Development and Testing of an Instrument to Measure Family’s Emotional Response toward Physically Restrained Patients
    Image
    Fig. 1. Conceptual framework of the family’s emotional response on the physically restrained patients.

    Fig. 1.

    Development and Testing of an Instrument to Measure Family’s Emotional Response toward Physically Restrained Patients
    Characteristics Category n (%)
    Gender Female 110 (55.3)
    Male 89 (44.7)
    Age (yr) 10-20 13 (6.5)
    21-30 43 (21.6)
    31-40 40 (20.1)
    41-50 47 (23.6)
    51-60 48 (24.1)
    ≥61 8 (4.0)
    Education None 7 (3.5)
    Elementary school 18 (9.0)
    Middle school 30 (15.1)
    High school 66 (33.2)
    College or more 78 (39.2)
    Religion Christian 44 (22.1)
    Catholic 15 (7.5)
    Buddhism 70 (35.2)
    None 70 (35.2)
    Job Yes 135 (67.8)
    No 64 (32.2)
    Income/month (thousand won) ≤2,000 49 (24.6)
    2,001-3,000 40 (20.1)
    3,001-4,000 53 (26.6)
    ≥4,001 57 (28.6)
    Relationship with patient Children 58 (29.1)
    Parents 13 (6.5)
    Siblings 61 (30.7)
    Grandchildren 9 (4.5)
    Spouse 21 (10.6)
    Daughter- in-law 8 (4.0)
    Relative 29 (14.6)
    Item content CVI (%)
    1. It breaks my heart 100.0
    2. I am scared 100.0
    3. He or She seems to have a lot of pain 87.5
    4. I am at a loss for words 100.0
    5. I feel awful 100.0
    6. I hate myself 100.0
    7. I feel myself useless 100.0
    8. There is nothing I can do about it 100.0
    9. I am worried about the rest of family 62.5
    10. It brings tears to my eyes 100.0
    11. I am nervous because he or she might be hurted 100.0
    12. My life is meaningless 50.0
    13. My heart gets choked with emotions 100.0
    14. I am afraid 100.0
    15. I want to die along 100.0
    16. I could not see anything on it 87.5
    17. I am speechless 100.0
    18. It is all my fault 87.5
    19. I do not want to think about it 87.5
    20. It is terrible 100.0
    21. All I hope is getting better as soon as possible 100.0
    22. I think he or she could die in being tied 100.0
    23. It drives me crazy 100.0
    24. I could not believe it 100.0
    25. There seems to be no way to get out of it 100.0
    26. I do not want to see it 100.0
    27. This should not happen again 75.0
    28. I feel miserable 87.5
    29. I do not care if his or her condition becomes better 87.5
    30. It hurts my feeling 100.0
    31. It is better to be restrained than to be hurted from moving a lot 100.0
    32. I feel nothing 100.0
    33. I feel dizzy 87.5
    34. I wish I had better choices 100.0
    35. It seems inevitable to use restraints in this situation 100.0
    36. I think using restraints is helpful 100.0
    37. I never forget him or her on restraints 100.0
    38. I am afraid the condition is to be worse 87.5
    39. I am afraid he or she would be abandoned while on restraints 75.0
    40. I do not understand why he or she should be tied up 100.0
    41. I resign myself to my fate 87.5
    42. The staffs seem to be coldhearted 87.5
    43. I feel bitter for the staffs 100.0
    44. I think we should accept the behaviors of staffs 100.0
    45. Restraining a patients is for staffs’ convenience 87.5
    46. I hate both of doctors and nurses 87.5
    47. I believe in staffs’ judgements 87.5
    48. Restraining patients is a subhuman behavior 100.0
    49. Restraining limits the freedom of human 100.0
    50. I do not want to get along with other people 62.5
    51. The remaining family members is my only consolation 50.0
    52. I feel annoyed 100.0
    53. I wish I was sick 100.0
    54. It is better to die 87.5
    55. I feel desperate 100.0
    56. I am shocked 100.0
    57. The more I think about it, the more I get worried 87.5
    58. There is no other way to get medically treated 87.5
    59. I feel like the sky falls down 100.0
    60. I can not think at all for a while 87.5
    61. I feel upset 100.0
    62. I feel sorry for the patient 100.0
    63. I hope they untie patient while I am with him or her 75.0
    64. The idea first came to me was that I would take the patient out 62.5
    65. I wish I could forget everything 100.0
    66. I am concerned about his or her psychological status 87.5
    67. It is absurd 100.0
    68. I feel regret 100.0
    Item Factor loading Eigen value Variance explained (%) Cumulative variance (%)
    26. I do not want to see it .693 12.811 29.117 29.117
    25. There seems to be no way to get out of it .665
    24. I could not believe it .610
    28. I feel miserable .593
    20. I am afraid .544
    19. I do not want to think about it .514
    52. I feel annoyed .497
    18. It is all my fault .496
    30. I feel sad .476
    59. I feel like the sky falls down .676 2.816 6.400 35.516
    60. I can not think at all for a while .665
    58. There is no other way to get medically treated .568
    54. It is better to die .554
    61. I feel upset .527
    56. I am shocked .50
    62. I feel sorry for the patient .499
    2. I am scared .491
    4. I am at a loss for words .486
    23. It drives me crazy .483
    7. I feel myself useless .819 2.446 5.559 41.075
    8. There is nothing I can do about it .775
    6. I hate myself .691
    1. It break my heart .601
    43. I feel bitter for the staffs .763 1.718 3.904 44.978
    40. I do not understand why he or she should be tied up .708
    41. I resign myself to my fate .668
    46. I hate both of doctors and nurses .460
    13. My heart gets choked with emotions .704 1.658 3.768 48.746
    14. I feel awful .695
    17. I am speechless .539
    16. I could not see anything on it .529
    11. I am nervous because he or she might be hurted .468
    66. I am concerned about his or her psychological status .712 1.566 3.559 52.305
    67. It is absurd .637
    68. I feel regret .590
    36. I think using restraints is helpful .734 1.462 3.322 55.628
    31. It is better to be restrained than to be hurted by moving a lot .564
    Factor Item Corrected item-total correlation Cronbach’s alpha if item deleted Cronbach’s alpha
    1. Avoidance 26. I do not want to see it .587 .950 .86
    25. There seems to be no way to get out of it .604 .950
    24. I could not believe it .578 .950
    28. I feel miserable .509 .950
    20. I am afraid .615 .950
    19. I do not want to think about it .593 .950
    52. I feel annoyed .643 .950
    18. It is all my fault .552 .950
    30. I feel sad .502 .950
    2. Shock 59. I feel like the sky falls down .521 .950 .86
    60. I can not think at all for a while .540 .950
    58. There is no other way to get medically treated .441 .951
    54. It is better to die .610 .950
    61. I feel upset .573 .950
    56. I am shocked .621 .950
    62. I feel sorry for the patient .411 .951
    2. I am scared .606 .950
    4. I am at a loss for words .605 .950
    23. It drives me crazy .510 .950
    3. Helplessness 7. I feel myself useless .330 .951 .79
    8. There is nothing I can do about it .487 .950
    6. I hate myself .440 .951
    1. It break my heart .377 .951
    4. Grudge 43. I feel bitter for the staffs .470 .950 .72
    40. I do not understand why he or she should be tied up .427 .951
    41. I resign myself to my fate .386 .951
    46. I hate both of doctors and nurses .528 .950
    5. Depression 13. My heart gets choked with emotions .372 .951 .78
    14. I feel awful .485 .950
    17. I am speechless .602 .950
    16. I could not see anything on it .503 .950
    11. I am nervous because he or she might be hurted .545 .950
    6. Anxiety 66. I am concerned about his or her psychological status .416 .951 .84
    67. It is absurd .566 .950
    68. I feel regret .604 .950
    7. Acceptance 36. I think using restraints is helpful .327 .951 .61
    31. It is better to be restrained than to be hurted by moving a lot .354 .951
    Total scale .93
    Table 1. General Characteristics of Subjects (N=199)

    Table 2. CVI of Preliminary Questions

    CVI=content validity index.

    Table 3. Factor Analysis of 37 Items

    Table 4. Item Analysis of the Final Items

    Table 1.

    Table 2.

    Table 3.

    Table 4.

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