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Zhou J, Qin Q, Chen S, Zhang H. Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence and Justice in the Use of Physical Restraints. J Multidiscip Healthc 2024; 17:1619-1627. [PMID: 38628615 PMCID: PMC11020279 DOI: 10.2147/jmdh.s455910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
In intensive care units, patients are often restrained to ensure their safety, with physical restraints being the most commonly used method. However, physical restraints compromises the patient's freedom, health and comfort, and nurses often face moral dilemmas when deciding whether to use physical restraints. This article examines physical restraints through the four universal principles of autonomy, beneficence, non-maleficence and justice. Through these principles, the authors will critically explore whether the physical restraints of patients by nurses is ethical in practice and what moral issues exist. This paper also explores conflicts and moral dilemmas for nurses in this context. Finally, suggestions are made on changes to education and clinical practice.
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Affiliation(s)
- Junya Zhou
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Qingzhu Qin
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Songge Chen
- Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
| | - Hongmei Zhang
- Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People’s Hospital; Zhengzhou University People’s Hospital, Zhengzhou, Henan, 450003, People’s Republic of China
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Inoue S, Nakanishi N, Amaya F, Fujinami Y, Hatakeyama J, Hifumi T, Iida Y, Kawakami D, Kawai Y, Kondo Y, Liu K, Nakamura K, Nishida T, Sumita H, Taito S, Takaki S, Tsuboi N, Unoki T, Yoshino Y, Nishida O. Post-intensive care syndrome: Recent advances and future directions. Acute Med Surg 2024; 11:e929. [PMID: 38385144 PMCID: PMC10879727 DOI: 10.1002/ams2.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 12/23/2023] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long-term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post-intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post-intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post-intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post-intensive care syndrome.
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Affiliation(s)
- Shigeaki Inoue
- Department of Emergency and Critical Care MedicineWakayama Medical UniversityWakayamaJapan
| | - Nobuto Nakanishi
- Division of Disaster and Emergency Medicine, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Fumimasa Amaya
- Department of Pain Management and Palliative Care MedicineKyoto Prefectural University of MedicineKyotoJapan
| | - Yoshihisa Fujinami
- Department of Emergency MedicineKakogawa Central City HospitalKakogawaJapan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care MedicineOsaka Medical and Pharmaceutical UniversityTakatsukiJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalTokyoJapan
| | - Yuki Iida
- Faculty of Physical Therapy, School of Health SciencesToyohashi Sozo UniversityToyohashiJapan
| | - Daisuke Kawakami
- Department of Intensive Care MedicineAso Iizuka HospitalFukuokaJapan
| | - Yusuke Kawai
- Department of NursingFujita Health University HospitalToyoakeJapan
| | - Yutaka Kondo
- Department of Emergency and Critical Care MedicineJuntendo University Urayasu HospitalUrayasuJapan
| | - Keibun Liu
- Critical Care Research GroupThe Prince Charles HospitalChermsideQueenslandAustralia
- Faculty of MedicineThe University of Queensland, Mayne Medical SchoolHerstonQueenslandAustralia
- Non‐Profit Organization ICU Collaboration Network (ICON)TokyoJapan
| | - Kensuke Nakamura
- Department of Critical Care MedicineYokohama City University School of MedicineYokohamaJapan
| | - Takeshi Nishida
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
| | | | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and SupportHiroshima University HospitalHiroshimaJapan
| | - Shunsuke Takaki
- Department of Critical Care MedicineYokohama City University School of MedicineYokohamaJapan
| | - Norihiko Tsuboi
- Division of Critical Care Medicine, Department of Critical Care and AnesthesiaNational Center for Child Health and DevelopmentSetagayaJapan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of NursingSapporo City UniversitySapporoJapan
- Teine Keijinkai HospitalSapporoJapan
| | - Yasuyo Yoshino
- Department of Nursing, Faculty of NursingKomazawa Women's UniversityTokyoJapan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care MedicineFujita Health University School of MedicineToyoakeJapan
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Cheng J, Lao Y, Chen X, Qiao X, Sui W, Gong X, Zhuang Y. Dynamic Nomogram for Subsyndromal Delirium in Adult Intensive Care Unit: A Prospective Cohort Study. Neuropsychiatr Dis Treat 2023; 19:2535-2548. [PMID: 38029051 PMCID: PMC10676691 DOI: 10.2147/ndt.s432776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To develop a dynamic nomogram of subsyndromal delirium (SSD) in intensive care unit (ICU) patients and internally validate its efficacy in predicting SSD. Patients and Methods Patients who met the inclusion and exclusion criteria in the ICU of a tertiary hospital in Zhejiang from September 2021 to June 2022 were selected as the research objects. The patient data were randomly divided into the training set and validation set according to the ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to screen the predictors of SSD, and R software was used to construct a dynamic nomogram. Receiver operating characteristic (ROC) curve, calibration band and decision curve were used to evaluate the discrimination, calibration and clinical effectiveness of the model. Results A total of 1000 eligible patients were included, including 700 in the training set and 300 in the validation set. Age, drinking history, C reactive protein level, APACHE II, indwelling urinary catheter, mechanical ventilation, cerebrovascular disease, respiratory failure, constraint, dexmedetomidine, and propofol were predictors of SSD in ICU patients. The ROC curve values of the training set was 0.902 (95% confidence interval: 0.879-0.925), the best cutoff value was 0.264, the specificity was 78.4%, and the sensitivity was 88.0%. The ROC curve values of the validation set was 0.888 (95% confidence interval: 0.850-0.930), the best cutoff value was 0.543, the specificity was 94.9%, and the sensitivity was 70.9%. The calibration band showed good calibration in the training and validation set. Decision curve analysis showed that the net benefit in the model was significantly high. Conclusion The dynamic nomogram has good predictive performance, so it is a precise and effective tool for medical staff to predict and manage SSD in the early stage.
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Affiliation(s)
- Junning Cheng
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Yuewen Lao
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Xiangping Chen
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Xiaoting Qiao
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Weijing Sui
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Xiaoyan Gong
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
| | - Yiyu Zhuang
- Nursing Department, Zhejiang University School of Medicine Sir Run Run Shaw Hospital, Hangzhou, People’s Republic of China
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Cui N, Zhang H, Gan S, Zhang Y, Chen D, Guo P, Wu J, Li Z, Jin J. Prevalence and Influencing Factors of Physical Restraints in Intensive Care Units: A Retrospective Cohort Study. Risk Manag Healthc Policy 2023; 16:945-956. [PMID: 37228847 PMCID: PMC10204753 DOI: 10.2147/rmhp.s408919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
Purpose Physical restraints are used routinely in intensive care units (ICUs) and have negative effects. It is critical to identify the impact factors of physical restraints on critically ill patients. The present study investigated the prevalence of physical restraints and impact factors associated with their use in a large cohort of critically ill patients over one year. Patients and Methods A retrospective cohort study was performed in multiple ICUs at a tertiary hospital in China in 2019 using observational data from electronic medical records. The data consisted of demographics and clinical variables. Logistic regression was used to assess the independent impact factors for the use of physical restraint. Results The analysis consisted of 3776 critically ill patients with a prevalence of physical restraint use of 48.8%. The logistic regression analysis indicated that physical restraint use was associated with independent risk factors, including surgical ICU admission, pain, tracheal tube placement, and abdominal drainage tube placement. Physical restraint use was associated with independent protective factors, including male sex, light sedation, muscle strength, and ICU length of stay. Conclusion The prevalence of physical restraint use in critically ill patients was high. Tracheal tubes, surgical ICU, pain, abdominal drainage tubes, light sedation, and muscle strength were independent variables associated with the use of physical restraint. These results will assist health professionals in identifying high-risk physical restraint patients based on their impact factors. Early removal of the tracheal tube and abdominal drainage tube, pain relief, light sedation, and improvements in muscle strength may help reduce the use of physical restraints.
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Affiliation(s)
- Nianqi Cui
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, People’s Republic of China
- School of Nursing, Kunming Medical University, Kunming, Yunnan, People’s Republic of China
| | - Hui Zhang
- Department of Cardiology, Guizhou Provincial People’s Hospital, Guiyang, Guizhou, People’s Republic of China
| | - Sijie Gan
- Product Development Center, Zhejiang Xinhua Mobile Media Co. Ltd, Hangzhou, Zhejiang, People’s Republic of China
| | - Yuping Zhang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, People’s Republic of China
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Pingping Guo
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Jingjie Wu
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhuang Li
- Medical Faculty, Yunnan College of Business Management, Kunming, Yunnan, People’s Republic of China
| | - Jingfen Jin
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine (SAHZU), Hangzhou, Zhejiang, People’s Republic of China
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
- Dean’s Office, Changxing Branch Hospital of SAHZU, Huzhou, Zhejiang, People’s Republic of China
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Wang Y, Liu Y, Tian YL, Gu SL. A Nomogram for Predicting Physical Restraint of Patients in Intensive Care Unit. Emerg Med Int 2023; 2023:6618366. [PMID: 37101766 PMCID: PMC10125770 DOI: 10.1155/2023/6618366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/28/2023] Open
Abstract
Background Despite its ethical implications, physical restraint (PR) is widely used in the intensive care unit (ICU) to guarantee the safety of patients. This study investigated the frequency and risk factors of PR use for patients in the ICU to establish a predictive nomogram. Methods Clinical parameters of patients admitted to the ICU of Jiangsu Province Hospital from January 2021 to July 2021 were retrospectively collected. Independent risk factors of PR were analyzed by univariate and multivariate logistic regression analyses. The R software was used to establish the nomogram. Model performance was validated using the concordance-index (C-index) and calibration curves. Results The rate of PR use was 46.32% (233/503 patients). Age (B = 0.036, odds ratio [OR]: 1.037, 95% confidence interval [CI]: 1.022-1.052, P < 0.001), consciousness disorder (B = 0.770, OR: 2.159, 95% CI: 1.216-3.832, P=0.009), coma (B = -1.666, OR: 0.189, 95% CI: 0.101-0.353, P < 0.001), passive activity (B = 1.014, OR: 2.756, 95% CI: 1.644-4.618, P < 0.001), delirium (B = 0.993, OR: 2.699, 95% CI: 1.097-6.642, P=0.031), -3 < Richmond Agitation Sedation Scale (RASS) score <2 (B = 0.698, OR: 2.009, 95% CI: 1.026-3.935, P=0.042), RASS score ≥2 (B = 1.253, OR: 3.499, 95% CI: 1.126-10.875, P=0.030), and mechanical ventilation (B = 1.696, OR: 5.455, 95% CI: 2.804-10.611, P < 0.001) were identified as independent risk factors for PR in the ICU (P < 0.05) and included in the nomogram. The C-index was 0.830, and the calibration curve indicated good discriminatory ability and accuracy (mean absolute error: 0.026). Conclusion The prediction nomogram model of PR in ICU was established based on age, mobility, delirium, consciousness, RASS score, and mechanical ventilation. It showed good discrimination and accuracy. This nomogram may predict the probability of PR use in the ICU and guide nurses in developing precise interventions to reduce the rate of PR.
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Affiliation(s)
- Yun Wang
- Department of Geriatric ICU, Jiangsu Province Hospital, Nanjing, China
| | - Ying Liu
- Department of ICU, Jiangsu Province Hospital, Nanjing, China
| | - Ya-Li Tian
- Department of Geriatric ICU, Jiangsu Province Hospital, Nanjing, China
| | - Su-Lian Gu
- Department of Neurology ICU, Jiangsu Province Hospital, Nanjing, China
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García Andreu MDM, Díez-Manglano J. Restraint measures in the agitated patient, safety or danger? Med Clin (Barc) 2022; 159:541-542. [PMID: 36064505 DOI: 10.1016/j.medcli.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 02/03/2023]
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Cui N, Zhang Y, Li Q, Tang J, Li Y, Zhang H, Chen D, Jin J. Quality appraisal of guidelines on physical restraints in intensive care units: A systematic review. Intensive Crit Care Nurs 2021; 70:103193. [PMID: 34980516 DOI: 10.1016/j.iccn.2021.103193] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Guidelines concerning the use of physical restraints in medical facilities have been published and amended over the years. However, the quality and suitability of these guidelines have not been appraised. OBJECTIVES This study aims to assess the suitability and quality of guidelines for the use of physical restraints in intensive care units with the AGREE-REX and AGREE Ⅱ instruments. METHODS A systematic search of electronic databases (e.g., EMBASE), cross-database search platforms (e.g., Clinical Key), guideline web portals (e.g., Guidelines International Network) and society websites (e.g., Society of Critical Care Medicine) was conducted from January 2011 to December 2020. The methodological quality was assessed using AGREE Ⅱ, and the recommendation quality and suitability were assessed using AGREE-REX instruments. RESULTS A total of eight guidelines were included. The criteria for overall quality and suitability of guidelines for the use of physical restraints were met by 50-72% and 59-76%, respectively. The "Values and Preferences" domain had the lowest score (38% ± 9%). The criteria for methodological quality of the guidelines were met by 50-83%. Two domains, "Applicability" and "Editorial Independence", achieved lower scores. There was a strong, positive correlation between the overall methodological quality of guidelines and the overall quality of recommendations (r = 0.968). CONCLUSION There is a potential feasibility of guideline adaptation for the management of physical restraints. In order to implement a physical restraint guideline, the following aspects should be considered: (i) minimize the use of physical restraints, (ii) analyze barriers and facilitators relative to the local context, (iii) consider any specifications, and (iv) modify recommendations to local situation or individual conditions of the patient.
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Affiliation(s)
- Nianqi Cui
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Yuping Zhang
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China
| | - Qian Li
- Department of Critical Care Medicine, SAHZU, Hangzhou, China
| | - Jiaying Tang
- Department of Emergency Medicine, SAHZU, Hangzhou, China
| | - Yao Li
- Department of Emergency Medicine, SAHZU, Hangzhou, China
| | - Hui Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Dandan Chen
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingfen Jin
- Department of Nursing, The Second Affiliated Hospital Zhejiang University School of Medicine (SAHZU), Hangzhou, China; Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China; Changxing Branch Hospital of SAHZU, Huzhou, China.
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