In Japan, the aging society has been growing rapidly. In 2055, it is estimated the aging ratio would be 40.5%. The issues of aging society are proposed from several domains of quality of life. The increase of elderly patients and the shortage of care providers are also big issues. Additionally, ethical consideration for patients has been more and more paid attention under the precarious balance. Many nurses experience ethical dilemma toward elderly care, especially, the use of physical restraint for cognitive impairment. Ethical decision to use of physical restraint is entrusted to nurses owned their profession although the final decision and order is authorized by physicians. It is important to explore the perception of the use and the characteristics. In this study, our purpose is to explore the relationship between perception of physical restraint use and social desirability among Japanese nurses.
By referring PRUQ developed by Evans and Strumpf (1988), a measurement of perception of physical restraint use was developed as Japanese language version for the dependent variable. This scale is constructed of 19 items and each item is ranked on terms of importance on a 5-point Likert scale, with 1 denoting not at all important and 5 signifying most important. As the independent variable, Crowne & Marlow`s social desirability scale (MC-SDS) was selected. This scale contains 33 items divided into 2 dimensions: impression management and self-deception. Each item was chosen with applicable or not in terms of self-tendency. As the demographic data, sex, age, tenure, year of experience, work status, license status, academic status were collected.
The convenience sample (N=310) of nursing care staff working in two acute hospitals located in Kanto district, Japan. The demographic characteristics of the study population were 31 male and 279 female. The distribution of age was 33.7±10.4. 10% of total nurses were graduated from bachelor schools. As the result of factor analysis, PRUQ was divided into 6 categories by the reasons such as (1) falling, (2) elderly, (3) incidents, (4) severe incidents, (5) shortage of staffs, (6) general interests for ethical issues. The consequences of Pearson correlation analysis, 1) there were negatively significant relations between SD-self-deception and PRUQ-falling, incidents and severe incidents (p<0.05), 2) there was negatively significant relation between SD-impression management and general interest for ethical issues (p<0.05), 3)academic status was significantly related to PRUQ-severe incidents(p<0.05), although there was no significant relation between academic status and SD scores. Subsequently, respondents were divided into 3 groups, such as high-scored SD, medium-scored SD and low-scored SD. The result of Pearson correction analysis of each group had different features. At the low-SD group, there were negatively correlated between age and PRUQ-elderly and severe incidents (p<0.05). At the mid-SD group, there were negatively correlated between age and all PRUQ items (p<0.05 or p<0.01). At the high-SD group, there was negatively correlated between age and PRUQ-severe incidents (p<0.05).
It is important to assess the bias of social desirability of participants in the case of that their ethical decision making is studied. This result implies the use of physical restraint is affected by their social culture and age. To establish ethical climate applied to professional code should be demonstrated.