Measurement of effects of restraint on injured children in the emergency room.

This investigation was conducted to determine if there are physiological changes that occur when children are restrained in the emergency room for short periods of time. The hypothesis tested was that children who are restrained in a mummy fashion for a fifteen minute period of time will show and increase in stress as compared to pre-restraint values measured by 1) changes in heart rate, blood pressure, and skin conductance, and by 2) changes in verbal and non-verbal behaviors. The sample consisted of 16 children between the ages of 24 months and 57 months in age. All subjects were admitted to the St. Benedict’s Hospital emergency room, Ogden, Utah, for the repair and treatment of minor lacerations. After admission, each subject was taken to a private area of the emergency room where the electrodes of a custom built dermograph were fastened to the plantar surface of the right foot. Five minute pre-restraint measurements were taken of skin conductance levels, pulse and blood pressure. After base measurements were completed subjects were gently but securely restrained in a mummy fashion by use of a “Papoose Boardâ€. During the restraining period, verbal and non-verbal behaviors were noted. After the fifteen minute period of restraint and continuous recording of skin conductance levels, pulse and blood pressure measurements were taken again. At this time, the subjects were rated on general degree of cooperation and level of displayed fear. The ratings were based on verbal and non-verbal behaviors. The injuries were then treated and the patients released from restraints. Parental interviews were conducted to determine the basic temperamental characteristics of each subject. After the data were collected, the family was discharged. The T-test for related samples was computed for all physiological variables comparing pre-restraint to restraint conditions. Significance was set at the .05 level. Results showed that t-scores for blood pressure, pulse, and mean skin conductance were not significant. Thus, the hypothesis that children who are restrained for short periods of time will show an increase in stress as compared to pre-restraint conditions as measured by changes in heart rate, blood pressure and skin conductance was not supported. It was found, however, that instead of all subjects experiencing a general increase in stress when restrained, they seemed to group into three distinct categories, or levels of stress. The first level was “high stress under restraint.†These subjects experienced a mean difference of more than ten points in skin conductance levels when pre-restraint and restraint conditions were compared. The second group was characterized as experiencing “minimal stress under restraint.†This group of patients showed a mean difference of less than ten points between pre-restraint and restraint conditions. The final group seemed to be calmed or comforted by the restraint condition. The second part of the hypothesis tested during the course of this investigation was that children when restrained, will show an increase in stress which is related to the variables of age, sex, birth order, temperament, degree of cooperation and displayed fear. A through examination of the data revealed few correlations between these variables and the stress conditions. The second part of the hypothesis was not supported. Examination of the data for descriptive purposes showed some relationships between variables.