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Yıldız İ, Özkaraman A. Vascular complications in extremities of physically restrained intensive care unit patients: A prospective, observational study. Nurs Crit Care 2024; 29:931-942. [PMID: 38937619 DOI: 10.1111/nicc.13107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/29/2024] [Accepted: 05/31/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Physical restraint is used to prevent agitation, to continue treatments and to ensure safety in intensive care patients. Physical restraint has negative effects on physical and psychological health, and physical restraint should not be used unless necessary. AIMS The purpose of this study was to evaluate the development of vascular complications in extremities of physically restrained patients hospitalized in the intensive care unit (ICU) and the associated factors. STUDY DESIGN A prospective, observational study. The study was conducted between September 1, 2022, and March 31, 2023 in eight ICUs of a hospital located in the inner regions of Türkiye. The development of vascular complications (discolouration, distemperature, variations in capillary refill time, fluctuations in peripheral pulse, skin ulceration and oedema in the area of physical restraint) rate in patients hospitalized in the ICUs who were physically restrained. Independent sample t test, Mann-Whitney U test and Pearson-χ2 test were used to analyse the data. RESULTS During the study, 2409 patients were admitted to ICUs. Physical restraint was applied to 209 of these patients. Of the 209 patients, 112 patients who met the inclusion criteria were included in the study. The physical restraint site of the patients was evaluated an average of 230.12 times and physical restraint was terminated in 9.8% of the patients (n = 112) because of vascular complications that developed in the physical restraint site. The rate of vascular complications at the site of physical restraint was higher in patients with endotracheal tubes (p < .05), lower GCS scores (p < .05) and higher INR values (p < .05). Patients with skin ulceration at the restraint site received more massages and cream applications (%95CL = 1. 1.692-34.734, OR = 7.667, p = .032). It was determined that more massage was applied to patients with changes in skin temperature at the restraint site (%95Cl = 1.062-11.599, OR = 3.510, p = .032). CONCLUSIONS Vascular complications may develop at the restraint site in patients hospitalized in the ICU. This may be more common in ICU patients with endotracheal tube, lower GCS score and higher INR values. RELEVANCE TO CLINICAL PRACTICE Nurses should closely monitor ICUs patients with endotracheal tube, lower GCS score and higher INR values, and implement care interventions to prevent the development of vascular complications.
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Affiliation(s)
| | - Ayse Özkaraman
- Department of Nursing, Faculty of Health Sciences, Eskisehir Osmangazi University, Odunpazarı, Eskişehir, Türkiye
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Dauvergne JE, Ferey K, Croizard V, Chauvin M, Mainguy N, Mathelier N, Jehanno A, Maugars N, Badre G, Maze F, Chartier M, Vastral S, Epain G, Baudiniere L, Ronceray M, Lebidan M, Flattres D, Ambrosi X. Prevalence and risk factors of the use of physical restraint and impact of a decision support tool: A before-and-after study. Nurs Crit Care 2024; 29:987-996. [PMID: 37400076 DOI: 10.1111/nicc.12945] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/31/2023] [Accepted: 06/07/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Physical restraint is frequently used in intensive care units to prevent patients' life-threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool. AIMS Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use. STUDY DESIGN A large observational, multicentre study with a repeated one-day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect. RESULTS During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%-31.4%) and 25% (95% CI: 21.5%-29.1%) respectively (χ2 = 1.35; p = .24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p = .14). The patient-to-nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p < .001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5-10.2]). CONCLUSION The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial. RELEVANCE TO CLINICAL PRACTICE The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint.
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Affiliation(s)
- Jérôme E Dauvergne
- Service d'anesthésie-réanimation, hôpital Laënnec, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Kim Ferey
- Service de réanimation polyvalente, Centre hospitalier de Blois, Blois, Cedex, France
| | - Véronique Croizard
- Service de réanimation chirurgicale, hôpital Trousseau, Centre hospitalier universitaire de Tours, Tours, Cedex, France
| | - Morgan Chauvin
- Service de réanimation chirurgicale, Centre hospitalier universitaire de Rennes, Rennes, Cedex, France
| | - Nolwenn Mainguy
- Service de réanimation polyvalente, Centre hospitalier bretagne-atlantique, Vannes, Cedex, France
| | - Noeline Mathelier
- Service d'anesthésie-réanimation chirurgicale et brûlés, Hôtel Dieu, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Anaëlle Jehanno
- Service de réanimation, Centre hospitalier bretagne sud, Lorient, Cedex, France
| | - Nadège Maugars
- Service de soins intensifs de pneumologie, hôpital Laënnec, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Gaëtan Badre
- Service de réanimation polyvalente, Centre hospitalier de Chartres, Chartres, France
| | - Françoise Maze
- Service de réanimation chirurgicale, Centre hospitalier universitaire de Brest, Brest, France
| | - Marie Chartier
- Service de réanimation chirurgicale, Centre hospitalier universitaire d'Angers, Angers, France
| | - Servane Vastral
- Service de réanimation polyvalente, Centre hospitalier de Saint Nazaire, Saint-Nazaire, France
| | - Graziella Epain
- Service de réanimation chirurgicale, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Lucie Baudiniere
- Service de réanimation neurochirurgicale, Centre hospitalier universitaire de Poitiers, Poitiers, France
| | - Mathilde Ronceray
- Service de réanimation neurochirurgicale, hôpital Bretonneau, Centre hospitalier universitaire de Tours, Tours, Cedex, France
| | - Mathias Lebidan
- Service de réanimation chirurgie thoracique et cardio vasculaire, Centre hospitalier universitaire de Rennes, Rennes, Cedex, France
| | - Delphine Flattres
- Service d'anesthésie-réanimation chirurgicale et brûlés, Hôtel Dieu, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
| | - Xavier Ambrosi
- Service d'anesthésie-réanimation, hôpital Laënnec, Centre hospitalier universitaire de Nantes, Nantes, Cedex, France
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Berger S, Grzonka P, Amacher SA, Hunziker S, Frei AI, Sutter R. Adverse events related to physical restraint use in intensive care units: A review of the literature. JOURNAL OF INTENSIVE MEDICINE 2024; 4:318-325. [PMID: 39035621 PMCID: PMC11258505 DOI: 10.1016/j.jointm.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 07/23/2024]
Abstract
Physical restraints are widely used and accepted as protective measures during treatment in intensive care unit (ICU). This review of the literature summarizes the adverse events and outcomes associated with physical restraint use, and the risk factors associated with their use during treatment in the ICU. The PubMed, Scopus, and Google Scholar databases were screened using predefined search terms to identify studies pertaining to adverse events and/or outcomes associated with physical restraint use, and the factors associated with their use in adult patients admitted to the ICU. A total of 24 articles (including 6126 patients) that were published between 2006 and 2022 were identified. The described adverse events associated with physical restraint use included skin injuries, subsequent delirium, neurofunctional impairment, and a higher rate of post-traumatic stress disorder. Subsequent delirium was the most frequent adverse event to be reported. No alternative measures to physical restraints were discussed, and only one study reported a standardized protocol for their use. Although physical restraint use has been reported to be associated with adverse events (including neurofunctional impairment) in the literature, the available evidence is limited. Although causality cannot be confirmed, a definite association appears to exist. Our findings suggest that it is essential to improve awareness regarding their adverse impact and optimize approaches for their detection, management, and prevention using protocols or checklists.
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Affiliation(s)
- Sebastian Berger
- Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Pascale Grzonka
- Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Simon A. Amacher
- Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Medical faculty, University of Basel, Basel, Switzerland
| | - Anja I. Frei
- Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Clinic for Intensive Care, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Kim J, Yang Y. Factors affecting nursing practice of patient physical restraint among nurses. Arch Public Health 2024; 82:9. [PMID: 38225653 PMCID: PMC10790459 DOI: 10.1186/s13690-024-01238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND This study was aimed to identify perception, knowledge, attitude and nursing practice toward use of physical restraints among clinical nurses. METHODS The research participants were 180 nurses from general hospitals located in Korea. Data were collected using self-report questionnaires regarding perception, attitude, knowledge, and nursing practice on application of physical restraints and analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression. RESULTS There were significant negative relationships attitudes towards the use of physical restraints with knowledge (r = -.32, p < .001). Knowledge showed a positive correlation with nursing practice (r = .28, p < .001). Factors affecting nursing practice of clinical nurses were identified as knowledge (β = .23), education experiences on physical restraints (Yes) (β = .18), and work unit (ICU) (β = .43). The explanation power of this regression model was 22% and it was statistically significant (F = 7.45, p < .001). CONCLUSION This study suggests that knowledge, education experiences on physical restraints, and work unit were the strongest predictor on nursing practice toward use of patient physical restraints. Therefore, developing and applying evidence-based educational intervention programs by work unit to reduce the inappropriate use of physical restraints in hospitals are required.
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Affiliation(s)
- Jihyun Kim
- Department of Nursing, Kunsan College of Nursing, Kunsan, South Korea
| | - Yaki Yang
- Department of Nursing, College of Medicine, Wonkwang University, Iksan, South Korea.
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Cortinhal VSJ, Correia ASC, Deodato Fernandes SJ. Nursing Ethical Decision Making on Adult Physical Restraint: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:75. [PMID: 38248539 PMCID: PMC10815796 DOI: 10.3390/ijerph21010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE to map the existing knowledge on nursing ethical decision making in the physical restraint of hospitalised adults. (1) Background: physical restraint is a technique that conditions the free movement of the body, with risks and benefits. The prevalence of physical restraint in healthcare suffers a wide variation, considering the environment or pathology, and it raises ethical issues that hinders decision making. This article intends to analyse and discuss this problem, starting from a literature review that will provoke a grounded discussion on the ethical and legal aspects. Inclusion criteria are: studies on physical restraint (C) and ethical nursing decision making (C) in hospitalized adults (P); (2) methods: a three-step search strategy was used according to the JBI. The databases consulted were CINAHL Plus with Full Text (EBSCOhost), MEDLINE Full Text (EBSCOhost), Nursing and Allied Health Collection: Comprehensive and Cochrane Database of Systematic Reviews (by Cochrane Library, RCAAP and Google Scholar. All articles were analysed by two independent reviewers; (3) results: according to the inclusion criteria, 18 articles were included. The categories that influence ethical decision in nursing are: consequence of the decision, the context, the nature of the decision in terms of its complexity, the principles of the ethical decision in nursing, ethical issues and universal values; (4) conclusions: the findings of this review provide evidence that there is extensive knowledge regarding nursing ethical decision making in adult physical restriction, also, it is considered an ethical issue with many associated assumptions. In this article we aim to confront all these issues from a legal perspective.
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Affiliation(s)
- Vanessa Sofia Jorge Cortinhal
- Centro Hospitalar Barreiro Montijo, EPE, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Ana Sofia Castro Correia
- Centro Hospitalar de Lisboa Ocidental, EPE, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Sérgio Joaquim Deodato Fernandes
- School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa,1649-023 Lisbon, Portugal
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
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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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Alostaz Z, Rose L, Mehta S, Johnston L, Dale C. Physical restraint practices in an adult intensive care unit: A prospective observational study. J Clin Nurs 2023; 32:1163-1172. [PMID: 35194883 DOI: 10.1111/jocn.16264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To conduct a diagnostic evaluation of physical restraint practice using the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. BACKGROUND Evidence indicates that physical restraints are associated with adverse physical, emotional and psychological sequelae and do not consistently prevent intensive care unit (ICU) patient-initiated device removal. Nevertheless, physical restraints continue to be used extensively in ICUs both in Canada and internationally. Implementation science frameworks have not been previously used to diagnose, develop and guide the implementation of restraint minimisation interventions. DESIGN A prospective observational study of restrained patients in a 20-bed, academic ICU in Toronto, Canada. METHODS Data collection methods included patient observation, electronic medical record review, and verbal check with the point-of-care nurses. Data were collected pertaining to framework domains of unit culture (restraint application/removal), evaluation capacity (documentation) and leadership (rounds discussion). The reporting of this study followed the STROBE guidelines. RESULTS A total of 102 restrained patients, 67 (66%) male and mean age 58 years (SD 1.92), were observed. All observed devices were wrist restraints. Restraint application and removal time was verified in 83 and 57 of 102 patients respectively. At application, 96.4% were mechanically ventilated and 71% sedated/unarousable. Nurses confirmed 71% were prophylactically restrained; 7.2% received restraint alternatives. Restraint removal occurred after interprofessional team rounds (87%), during daytime (79%) and following extubation (52.6%). Of the 923 discrete patient observation of physical restraint use, 691 (75%) were not documented. Of the 30 daytime interprofessional team rounds reviewed, physical restraint was discussed at 3 (10%). CONCLUSION In this single-centre study, a culture of prophylactic physical restraint was observed. Future facilitation of restraint minimisation warrants theoretically informed implementation strategies including leadership involvement to advance interprofessional collaboration. RELEVANCE TO CLINICAL PRACTICE The findings draw attention to the importance of a preliminary diagnostic study of the context prior to designing, and implementing, a physical restraint minimisation intervention.
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Affiliation(s)
- Ziad Alostaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sangeeta Mehta
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Canada
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Canada
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Guenna Holmgren A, von Vogelsang AC, Lindblad A, Juth N. Understanding nurses' justification of restraint in a neurosurgical setting: A qualitative interview study. Nurs Ethics 2023; 30:71-85. [PMID: 36266990 PMCID: PMC9902980 DOI: 10.1177/09697330221111447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite its negative impact on patients and nurses, the use of restraint in somatic health care continues in many settings. Understanding the reasons and justifications for the use of restraint among nurses is crucial in order to manage this challenge. AIM To understand nurses' justifications for restraint use in neurosurgical care. RESEARCH DESIGN A qualitative, descriptive design was used. Data were analysed with inductive qualitative content analysis. PARTICIPANTS AND RESEARCH CONTEXT Semi-structured interviews with 15 nurses working in three neurosurgical departments in Sweden. ETHICAL CONSIDERATIONS Approved by The Regional Ethics Committee, Stockholm, Sweden. FINDINGS The analysis resulted in three categories. The category Patient factors influencing restraint use describes patient factors that trigger restraint, such as a diminished decision-making competence, restlessness, and need for invasive devices. The category Specific reasons for justifying restraint describes reasons for restraining patients, such as restraint being used for the sake of the patient or for the sake of others. The category General reasoning in justifying restraint describes how nurses reason when using restraint, and the decision to use restraint was often based on a consequentialist approach where the nurses' weighed the pros and cons of different alternatives. DISCUSSION Nurses with experience of restraint use were engaged in a constant process of justifying and balancing different options and actions. Restraint was considered legitimate if the benefit exceeded the suffering, but decisions on which restraint measures to use and when to use them depended on the values of the individual nurse. CONCLUSION How nurses reason when justifying restraint, why they use restraint, and who they use restraint on must be considered when creating programs and guidelines to reduce the use of restraint and to ensure that when it is used it is used carefully, appropriately, and with respect.
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Affiliation(s)
- Amina Guenna Holmgren
- Amina Guenna Holmgren, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18a, Stockholm SE-171 77, Sweden.
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Yalcinturk AA, Ustun B. Medical errors room: The effect of simulation training on increasing the awareness of nursing students about the medical errors they may encounter in psychiatry clinics. Arch Psychiatr Nurs 2023; 43:37-42. [PMID: 37032013 DOI: 10.1016/j.apnu.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/04/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023]
Abstract
AIM This study aimed at investigating the effect of simulation training on increasing the awareness of nursing students about medical errors they may encounter in psychiatry clinics. METHODS This study was quasi-experimental and included pre-test and post-test control groups. The intervention group (n = 41) was provided with "Medical Errors Room" simulation training while the control group (n = 41) was trained by using the presentation method. RESULTS Considering the increase in the awareness of all students about medical errors, it was determined that the awareness of the students in the intervention group was higher than the students in the control group (p < 0.05). CONCLUSION It was concluded that with the "Medical Error Room" simulation training, the awareness of nursing students, who will be among the health professionals of the future, about medical errors can be increased.
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Affiliation(s)
| | - Besti Ustun
- University of Istinye, Faculty of Health Sciences, Department of Nursing, Istanbul, Turkey.
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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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Acevedo-Nuevo M, Martín-Arribas MC, González-Gil MT, Solís-Muñoz M, Arias-Rivera S, Royuela-Vicente A. The use of mechanical restraint in critical care units: Characterisation, application standards and related factors. Results of a multicentre study. ENFERMERIA INTENSIVA 2022; 33:212-224. [PMID: 36369124 DOI: 10.1016/j.enfie.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement. METHOD Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals). RESULTS A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = -.431) and in the subgroup of patients with ETT (r = -.521). CONCLUSIONS Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.
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Affiliation(s)
- M Acevedo-Nuevo
- Organización Nacional de Trasplantes, Madrid, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain.
| | - M C Martín-Arribas
- Subdirección General de Investigación en Terapia Celular y Medicina Regenerativa, Instituto de Salud Carlos III, Madrid, Spain
| | - M T González-Gil
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Universidad Autónoma de Madrid, Madrid, Spain
| | - M Solís-Muñoz
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain
| | - S Arias-Rivera
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - A Royuela-Vicente
- Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, Spain; Unidad de Bioestadística, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Perez D, Murphy G, Wilkes L, Peters K. Being tied down—The experience of being physically restrained while mechanically ventilated in
ICU. J Adv Nurs 2022; 78:3760-3771. [DOI: 10.1111/jan.15354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Dawn Perez
- School of Nursing and Midwifery Western Sydney University Penrith New South Wales Australia
| | - Gillian Murphy
- School of Nursing and Midwifery/Translational Health Research Institute (THRI) Western Sydney University Penrith New South Wales Australia
| | - Lesley Wilkes
- School of Nursing and Midwifery Western Sydney University Penrith New South Wales Australia
| | - Kath Peters
- School of Nursing and Midwifery/Translational Health Research Institute (THRI) Western Sydney University Penrith New South Wales Australia
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Acevedo-Nuevo M, Martín-Arribas M, González-Gil M, Solís-Muñoz M, Arias-Rivera S, Royuela-Vicente A. Uso de contenciones mecánicas en unidades de cuidados críticos: caracterización, estándares de aplicación y factores relacionados. Resultados de un estudio multicéntrico. ENFERMERIA INTENSIVA 2022. [DOI: 10.1016/j.enfi.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Siegrist‐Dreier S, Barbezat I, Thomann S, Richter D, Hahn S, Schmitt K. Restraining patients in acute care hospitals-A qualitative study on the experiences of healthcare staff. Nurs Open 2022; 9:1311-1321. [PMID: 35088948 PMCID: PMC8859077 DOI: 10.1002/nop2.1175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/29/2021] [Accepted: 12/15/2021] [Indexed: 11/11/2022] Open
Abstract
AIM The focus was to explore the perceptions and experiences of healthcare workers with respect to the use of restraints in acute care hospitals. DESIGN The study followed a qualitative design. METHODS Three topic-based focus group interviews were conducted, involving 19 participants from the fields of nursing, physical therapy and medicine. For data collection and analysis, the method of mapping techniques for rapid qualitative data analysis was used. After discussing and validating the individual mind maps, all data were condensed to identify the key findings. RESULTS Participants described restraints as safety measures for the patients. The implementation of most restraints was led by nurses. The use of restraints differed significantly, even in the interprofessional team. Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision-making process.
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Affiliation(s)
- Sandra Siegrist‐Dreier
- Department of Health ProfessionsDivision of NursingBern University of Applied SciencesBernSwitzerland
| | - Isabelle Barbezat
- Academic‐Practice‐PartnershipUniversity Hospital of BernBernSwitzerland
| | - Silvia Thomann
- Department of Health ProfessionsDivision of NursingBern University of Applied SciencesBernSwitzerland
| | - Dirk Richter
- Department of Health ProfessionsDivision of NursingBern University of Applied SciencesBernSwitzerland
| | - Sabine Hahn
- Department of Health ProfessionsDivision of NursingBern University of Applied SciencesBernSwitzerland
| | - Kai‐Uwe Schmitt
- Department of Health ProfessionsDivision of NursingBern University of Applied SciencesBernSwitzerland
- Academic‐Practice‐PartnershipUniversity Hospital of BernBernSwitzerland
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Seo Y, Lee HJ, Ha EJ, Ha TS. 2021 KSCCM clinical practice guidelines for pain, agitation, delirium, immobility, and sleep disturbance in the intensive care unit. Acute Crit Care 2022; 37:1-25. [PMID: 35279975 PMCID: PMC8918705 DOI: 10.4266/acc.2022.00094] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/22/2022] [Indexed: 01/12/2023] Open
Abstract
We revised and expanded the “2010 Guideline for the Use of Sedatives and Analgesics in the Adult Intensive Care Unit (ICU).” We revised the 2010 Guideline based mainly on the 2018 “Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption (PADIS) in Adult Patients in the ICU,” which was an updated 2013 pain, agitation, and delirium guideline with the inclusion of two additional topics (rehabilitation/mobility and sleep). Since it was not possible to hold face-to-face meetings of panels due to the coronavirus disease 2019 (COVID-19) pandemic, all discussions took place via virtual conference platforms and e-mail with the participation of all panelists. All authors drafted the recommendations, and all panelists discussed and revised the recommendations several times. The quality of evidence for each recommendation was classified as high (level A), moderate (level B), or low/very low (level C), and all panelists voted on the quality level of each recommendation. The participating panelists had no conflicts of interest on related topics. The development of this guideline was independent of any industry funding. The Pain, Agitation/Sedation, Delirium, Immobility (rehabilitation/mobilization), and Sleep Disturbance panels issued 42 recommendations (level A, 6; level B, 18; and level C, 18). The 2021 clinical practice guideline provides up-to-date information on how to prevent and manage pain, agitation/sedation, delirium, immobility, and sleep disturbance in adult ICU patients. We believe that these guidelines can provide an integrated method for clinicians to manage PADIS in adult ICU patients.
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The Use of Physical Restraints in Italian Intensive Care Units: Results From a Multicenter Observational Study. Dimens Crit Care Nurs 2022; 41:57-63. [PMID: 35099150 DOI: 10.1097/dcc.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The use of physical restraints (PRs) varies across countries and clinical settings, with intensive care units having the highest frequency. Although many investigations on the use of PRs have been conducted worldwide, few studies are reported in the Italian context. OBJECTIVES The aims of this study were to describe PR rates and types and to observe the factors associated with PR use. METHODS In this observational study, 2 methods were used to collect data: direct observation and review of patients' documentations. RESULTS We performed 328 observations on 146 critically ill patients. Physical restraints were applied in 56.7% (n = 186) of these observations. Bilateral wrist ties were used for most PR episodes (n = 135, 72.6%), followed by unilateral wrist ties (12.9%). The most documented reasons were preventing patients from self-extubation (n = 93, 50.0%) and preserving indwelling lines and tubes (n = 60, 32.2%). In the multivariate logistic regression analysis, patients who were cared for during the night shift were almost 4 times more likely to be restrained than patients in the morning shifts (odds ratio, 3.84; P = .001) and patients with endotracheal tube were 3.5 times more likely to be restricted than spontaneously breathing patients (odds ratio, 3.59; P < .001). DISCUSSIONS Physical restraints are commonly used among critically ill patients in Italian intensive care units. There is a need to share the metrics for an efficient and accurate measurement of PR usage and trends and to document the reason for restraints, type of restraints, timeframe, and decision-making criteria.
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Nomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med 2022; 26:192-198. [PMID: 35712746 PMCID: PMC8857706 DOI: 10.5005/jp-journals-10071-24103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background/aim Patients in the intensive care units (ICUs) are at high risk of developing delirium and agitation. Physical restraint (PR) has increased to control these patients which accompanies by adverse consequences. The aim was to determine the PR use and associated factors in patients hospitalized at the ICUs in the North of Iran. Materials and methods In this cross-sectional study, a total of 272 patients in 3 ICUs of 5 Azar referral hospital affiliated to Golestan University of Medical Sciences (Gorgan, Iran) in 2018 were included. Confusion assessment method for the ICU (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), acute physiology and chronic health evaluation II (APACHE II), and Glasgow Coma Scale (GCS) were used to evaluate delirium, sedation level, disease severity, and level of consciousness, respectively. Analysis was done by STATA version 14.2 (StataCorp LP, College Station, Texas), univariate and multiple analyses. Results Data from 272 patients were analyzed (mean age of 45.8 ± 21.3 years). PR was used for 74.5% of patients. Restrained patients had more severe disease [mean of APACHE II score, 20.20 (7.5) vs 11.6 (7.1)], longer length of stay [mean of 10 (5.5) vs 5.5 (4.6) days], and lower level of consciousness [mean of GCS score, 8.7 (3.5) vs 13.5 (3.3)] than patients without it. CAM-ICU was positive in majority of patients (79.5 vs 10.4%) and agitation level of RASS score was higher in restrained patients (31.7 vs 3.0%). Associated factors in multiple analysis were use of sedative and psychoactive drugs [odds ratio (OR), 2.85; 95% confidence interval (CI): 1.04-7.82], presence of delirium (OR, 15.13; 95% CI: 4.61-49.65), deep sedation (OR, 0.04; 95% CI: 0.00-0.45), and GCS score (OR, 0.69; 95% CI: 0.53-0.9). Conclusion This study revealed the high use of PR in the ICUs, and use of sedative and psychoactive drugs, presence of delirium, deep sedation, and GCS score were such associated factors. How to cite this article Nomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med 2022;26(2):192-198.
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Affiliation(s)
- Mahin Nomali
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Student Research Center, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Yadegari
- Bandar-e gaz Shohada Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahdis Nomali
- Alejalil Hospital, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mahnaz Modanloo
- Nursing Research Center, Faculty of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
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Kawai Y, Hamamoto M, Miura A, Yamaguchi M, Masuda Y, Iwata M, Kanbe M, Ikematsu Y. Prevalence of and factors associated with physical restraint use in the intensive care unit: a multicenter prospective observational study in Japan. Intern Emerg Med 2022; 17:37-42. [PMID: 33852145 DOI: 10.1007/s11739-021-02737-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/02/2021] [Indexed: 11/26/2022]
Abstract
Physical restraint is widely used in the intensive care unit (ICU) to ensure patient safety despite its ethical implications. We performed a prospective observational study in six ICUs in Japan to determine the prevalence of and factors associated with physical restraint use in the ICU, a phenomenon that has not yet been reported on in Japan. Data were collected on 10 random days between November 2018 and February 2019. We evaluated physical restraint use in ICU patients aged ≥ 20 years during the data collection days. Among the 787 observations, the prevalence of physical restraint use was 32.9%; however, it was 41.5% in patients receiving invasive mechanical ventilation (IMV). The average age of patients was 68.5 years, and the average Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score was 19.4. Among the included patients, 52.1% received IMV, and 17.2% were diagnosed with delirium. Logistic regression analysis revealed that the independent factors [odds ratio (95% confidence interval)] associated with physical restraint use were age [1.02 (1.00-1.05)], APACHE II score [1.05 (1.01-1.09)], IMV [2.15 (1.16-4.01)], central venous catheter indwelling [2.66 (1.46-4.85)], sedative medication [2.98 (1.72-5.17)], agitation [7.83 (2.96-20.8)], and delirium [4.16 (2.37-7.29)]. Approximately one-third of the ICU patients required physical restraint in Japan. In addition, physical restraint use was influenced by disease severity, mental condition, and the medical apparatus used. Based on these findings, further investigations are imperative to develop strategies to reduce physical restraint use.
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Affiliation(s)
- Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Miya Hamamoto
- Department of Nursing, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Atsuko Miura
- Intensive Care Unit, Toyohashi Municipal Hospital, 50 Aza Hachiken Nishi, Aotake-cho, Toyohashi, Aichi, 441-8570, Japan
| | - Mayumi Yamaguchi
- Intensive Care Unit, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan
| | - Yukari Masuda
- National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Maiko Iwata
- Department of Nursing, Nagoya City University Hospital, 1 Kawasumi Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8602, Japan
| | - Miki Kanbe
- Department of Nursing, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Yuko Ikematsu
- Department of Nursing, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-Minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan
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Freeman S, Yorke J, Dark P. The patient and their family's perspectives on agitation and its management in adult critical care: A qualitative study. Intensive Crit Care Nurs 2021; 69:103163. [PMID: 34893394 DOI: 10.1016/j.iccn.2021.103163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Agitation is frequently experienced by patients during critical illness, this is distressing for both the patient and their family. In addition, an acute episode of agitation can create management dilemmas for clinical teams. What is not understood is the patient and family's perspective of agitation and any subsequent management strategies employed. OBJECTIVE To understand the perspectives of patients and family members on the experience of agitation in adult critical care. METHOD An interpretive qualitative study using semi-structured interviews was undertaken with 13 participants, patient participants (n = 7) with the mean critical care length of stay 59 days (±70.88 days). Family members (n = 6) all opted to be interviewed with the patient present. FINDINGS Three themes generated from the data: 1) The recollection of sensations and delusions. 2) Communication and its impact. 3) Managing agitation, what helped and what did not. CONCLUSION The presence of family members has a positive effect on the patient during episodes of agitation. Their involvement in care requires promotion.
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Acevedo-Nuevo M, González-Gil MT, Martin-Arribas MC. Physical Restraint Use in Intensive Care Units: Exploring the Decision-Making Process and New Proposals. A Multimethod Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211826. [PMID: 34831583 PMCID: PMC8623552 DOI: 10.3390/ijerph182211826] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/24/2022]
Abstract
Aim: The general aim of this study was to explore the decision-making process followed by Intensive Care Unit (ICU) health professionals with respect to physical restraint (PR) administration and management, along with the factors that influence it. Method: A qual-quant multimethod design was sequenced in two stages: an initial stage following a qualitative methodology; and second, quantitative with a predominant descriptive approach. The multicenter study was undertaken at 17 ICUs belonging to 11 public hospitals in the Madrid region (Spain) across the period 2015 through 2019. The qualitative stage was performed from an interpretative phenomenological perspective. A total of eight discussion groups (DG) were held, with the participation of 23 nurses, 12 patient care nursing assistants, and seven physicians. Intentional purposive sampling was carried out. DG were tape-recorded and transcribed. A thematic analysis of the latent content was performed. In the quantitative stage, we maintained a 96-h observation period at each ICU. Variables pertaining to general descriptive elements of each ICU, institutional pain-agitation/sedation-delirium (PAD) monitoring policies and elements linked to quality of PR use were recorded. A descriptive analysis was performed, and the relationship between the variables was analyzed. The level of significance was set at p ≤ 0.05. Findings: A total of 1070 patients were observed, amounting to a median prevalence of PR use of 19.11% (min: 0%–max: 44.44%). The differences observed between ICUs could be explained by a difference in restraint conceptualization. The various actors involved jointly build up a health care culture and a conceptualization of the terms “safety-risk”, which determine decision-making about the use of restraints at each ICU. These shared meanings are the germ of beliefs, values, and rituals which, in this case, determine the greater or lesser use of restraints. There were different profiles of PR use among the units studied: preventive restraints versus “Zero” restraints. The differences corresponded to aspects such as: systematic use of tools for assessment of PAD; interpretation of patient behavior; the decision-making process, the significance attributed to patient safety and restraints; and the feelings generated by PR use. The restraint–free model requires an approach to safety from a holistic perspective, with the involvement of all team members and the family.
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Affiliation(s)
- María Acevedo-Nuevo
- Transplant National Organization, Health Ministry, 28029 Madrid, Spain
- Correspondence:
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KILIÇ G, POLAT Ü. Yoğun Bakım Hemşirelerinin Yaşlılara Yönelik Tutumları ile Fiziksel Tespit Edici Kullanımları Arasındaki İlişki. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2021. [DOI: 10.17517/ksutfd.953286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Amaç: Yoğun bakım hemşirelerinin yaşlılara yönelik tutumları ile fiziksel tespit edici kullanımına ilişkin bilgi, tutum ve uygulamaları arasındaki ilişkiyi belirlemek.
Yöntem: Araştırma, kesitsel tipte olup, şubat-nisan 2016 tarihleri arasında iki üniversite hastanesi ve bir özel hastanenin yoğun bakım ünitelerinde çalışan 107 hemşire ile yapılmıştır. Araştırmada veriler, 'Anket Formu', ‘Hemşirelerin Fiziksel Tespit Edici Kullanımına İlişkin Bilgi Düzeyi, Tutum ve Uygulamaları Ölçeği’ ile 'Yaşlı Ayrımcılığı Tutum Ölçeği (YATÖ)' kullanılarak toplanmıştır.
Bulgular: Yoğun bakım hemşirelerin fiziksel tespit kullanımına ilişkin bilgi puan ortalaması 7.22±1.59, tutum puan ortalaması 31.60±5.80, uygulama puan ortalaması 37.64±2.99 olarak bulunmuştur. Yoğun bakım hemşirelerinin YATÖ toplam puan ortalaması 86.13±9.44 olarak bulundu. Hemşirelerin fiziksel tespit kullanımına ilişkin bilgi düzeyi, tutum ve uygulamaları ile yaşlılara yönelik tutumları arasında istatistiksel olarak anlamlı ilişki bulunmadı(p>0.05).
Tartışma ve Sonuç: Hemşirelerin fiziksel tespit edici kullanımına ilişkin bilgi düzeylerinin iyi, tutumlarının olumlu ve uygulamalarının yeterli düzeyde olduğu ve yaşlılara yönelik tutumlarının ise olumlu olduğu bulundu. Yoğun bakım hemşirelerinin fiziksel tespit uygulamasını, yaşlı hastanın güvenliğini sağlamada bakımın bir parçası olarak gördükleri düşünülmektedir.
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Canzan F, Mezzalira E, Solato G, Mortari L, Brugnolli A, Saiani L, Debiasi M, Ambrosi E. Nurses' Views on the Use of Physical Restraints in Intensive Care: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189646. [PMID: 34574571 PMCID: PMC8464991 DOI: 10.3390/ijerph18189646] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/10/2021] [Accepted: 09/10/2021] [Indexed: 12/03/2022]
Abstract
Despite the worldwide promotion of a “restraint-free” model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses’ feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient’s bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person.
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Affiliation(s)
- Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
- Correspondence: ; Tel.: +39-045-8027288
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
| | - Giorgio Solato
- Cardiac Surgery Unit, San Bortolo Hospital, Viale Ferdinando Rodolfi, 37, 36100 Vicenza, Italy;
| | - Luigina Mortari
- Department of Human Sciences, University of Verona, Lungadige Porta Vittoria, 17, 37129 Verona, Italy;
| | - Anna Brugnolli
- Centre of Higher Education for Health Sciences, Azienda Provinciale per i Servizi Sanitari, Via Briamasco 2, 38121 Trento, Italy; (A.B.); (M.D.)
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
| | - Martina Debiasi
- Centre of Higher Education for Health Sciences, Azienda Provinciale per i Servizi Sanitari, Via Briamasco 2, 38121 Trento, Italy; (A.B.); (M.D.)
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Strada Le Grazie 8, 37134 Verona, Italy; (E.M.); (L.S.); (E.A.)
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Guenna Holmgren A, Juth N, Lindblad A, von Vogelsang AC. Nurses' experiences of using restraint in neurosurgical care - A qualitative interview study. J Clin Nurs 2021; 31:2259-2270. [PMID: 34514650 DOI: 10.1111/jocn.16044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/18/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To describe nurses' experiences of using restraint in neurosurgical care. BACKGROUND Despite reports of negative consequences, and conflicts with key values in healthcare, restraint measures are still practised in somatic healthcare worldwide. When using restraint, basic principles of nursing collide, creating dilemmas known to be perceived as difficult for many nurses. Patients in neurosurgical care are at high risk of being subjected to restraint, but research on nurses' experiences of using restraint in neurosurgical care are scarce. DESIGN A qualitative, descriptive design guided by a naturalistic inquiry was used. METHODS Semi-structured interviews with 15 nurses working in three neurosurgical departments in Sweden were analysed with inductive qualitative content analysis. COREQ reporting guidelines were used as reporting checklist. RESULTS The analysis resulted in one overarching theme, The struggling professional, and two categories. The category Internal struggle describes nurses' conflicting emotions and internal struggle when engaging in restraint. The category The struggle in clinical practice, describes how nurses struggle with handling restraint in clinical practice, and how the use of restraint is based on individual assessment rather than guidelines. CONCLUSION Nurses' experience restraint in neurosurgical care as a multi-layered struggle, ranging from inner doubts to practical issues. In order to enhance patient safety, there is a need for policies and guidelines regarding the use of restraint, as well as structured discussions and reflections for nurses engaged in the practice. RELEVANCE TO CLINICAL PRACTICE The results highlight the importance of clear guidelines, openness, support and teamwork for nurses working with patients at risk to be subjected to restraint, in order to create a safer care for patients as well as healthcare personnel. When developing guidelines and policies concerning restraint in somatic care, both practical issues such as the decision-making process, and the emotional effect on nurses should be considered.
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Affiliation(s)
- Amina Guenna Holmgren
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Niklas Juth
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Stockholm Centre for Healthcare Ethics (CHE), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Department of Neurosurgery, Heart, Vascular and Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Physical Restraints and Post-Traumatic Stress Disorder in Survivors of Critical Illness. A Systematic Review and Meta-analysis. Ann Am Thorac Soc 2021; 18:689-697. [PMID: 33075240 DOI: 10.1513/annalsats.202006-738oc] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Physical restraints are used liberally in some intensive care units (ICUs) to prevent patient harm from device removal or falls. Although the intention of restraint use is patient safety, their application may inadvertently cause physical or psychological harm. Physical restraints may contribute to post-traumatic stress disorder (PTSD), but there is a paucity of supportive data.Objectives: To investigate the association between physical restraint use and PTSD symptoms in ICU survivors. Secondary objectives were to examine the cognitive and physical outcomes associated with physical restraint use and to assess interventions that may be effective in reducing restraint use.Methods: A systematic review of English language studies in PubMed, Medline, Embase, CINAHL, and CENTRAL between January 1, 1990, to February 8, 2020 was performed. Observational or randomized studies that reported on restraint use and associated outcomes, or interventions to reduce restraint use, in critically ill adult patients were identified. Two independent reviewers completed the review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.Results: We identified 794 articles, of which 37 met inclusion criteria and were included. Thirty of these studies related to patient outcomes including PTSD, delirium, mechanical ventilation hours, and physical injury. Seven related to interventions to reduce physical restraint use. The quality of studies was not high; only four of the included studies were assessed to have a low risk of bias. Three studies found a significant relationship between restraint use and PTSD, but their results could not be pooled for analysis. Pooled data indicated a significant association between physical restraint use and delirium (odds ratio [OR], 11.54; 95% confidence interval [CI], 6.66-20.01; P < 0.001) and duration of mechanical ventilation (mean difference in days, 3.35; 95% CI, 1.95-4.75; P < 0.001). We also found that interventions, such as nursing education, may effectively reduce restraint use by approximately 50% (OR, 0.48; 95% CI, 0.32-0.73; P < 0.001). The impact that a reduction in restraint use may have on associated outcomes was not examined.Conclusions: Physical restraint use may be associated with PTSD in ICU survivors and is associated with delirium and longer duration of mechanical ventilation. Nurse education is likely effective in reducing rates of physical restraint among ICU patients.
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Santos GFD, Oliveira EG, Souza RCS. Good practices for physical restraint in intensive care units: integrative review. Rev Bras Enferm 2021; 74:e20201166. [PMID: 34259731 DOI: 10.1590/0034-7167-2020-1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to describe the available evidence on indications, complications, care and alternative strategies in the use of physical restraint in adult patients in Intensive Care Units.Methods: an integrative review conducted in the LILACS, Nursing Database, Índice Bibliográfico Español en Ciencias de la Salud, Scopus and CINAHL databases and the PubMed portal, in the period from June to August 2018. RESULTS the final selection was of 19 articles, from which the indications, complications, care and alternative strategies were extracted. The studies were conducted between the years 2003 and 2018, with a predominance of the United States; they were mostly classified (58%) in level 6 evidence, being performed by nurses, with multi-professional participation of psychologists, pharmacists, physicians, and nurses. CONCLUSIONS the most common practices regarding physical restriction were described, and the need for the elaboration and implementation of protocols on intervention to support decision making was observed.
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Physical Restraints in Critically Ill Children: A Multicenter Longitudinal Point Prevalence Study. Crit Care Med 2021; 49:1955-1962. [PMID: 34166295 DOI: 10.1097/ccm.0000000000005111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We elucidate to investigate the prevalence of and factors associated with the use of physical restraints among critically ill or injured children in PICUs. DESIGN This was a multicenter, longitudinal point prevalence study. SETTING We included 26 PICUs in Japan. PATIENTS Included children were 1 month to 10 years old. We screened all admitted patients in the PICUs on three study dates (in March, June, and September 2019). INTERVENTION None. MEASUREMENTS AND MAIN RESULTS We collected prevalence and demographic characteristics of critically ill or injured children with physical restraints, as well as details of physical restraints, including indications and treatments provided. A total of 398 children were screened in the participating PICUs on the three data collection dates. The prevalence of children with physical restraints was 53% (211/398). Wrist restraint bands were the most frequently used means (55%, 117/211) for potential contingent events. The adjusted odds of using physical restraint in patients 1-2 years old was 2.3 (95% CI, 1.3-4.0) compared with children less than 1 year old. When looking at the individual hospital effect, units without a prespecified practice policy for physical restraints management or those with more than 10 beds were more likely to use physical restraints. CONCLUSIONS The prevalence of physical restraints in critically ill or injured children was high, and significant variation was observed among PICUs. Our study findings suggested that patient age, unit size, and practice policy of physical restraint could be associated with more frequent use of physical restraints.
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Kısacık ÖG, Sönmez M, Coşğun T. Use of Physical Restraints in Critical Care Units: Nurses' Knowledge, Attitudes, and Practices. Crit Care Nurse 2021; 40:37-47. [PMID: 32476027 DOI: 10.4037/ccn2020856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Various factors affect the use of physical restraints in the intensive care unit, with nurses' knowledge and attitudes being the strongest determinants. OBJECTIVE To determine Turkish intensive care unit nurses' knowledge, attitudes, and practices regarding physical restraints and factors influencing them. METHODS This cross-sectional, correlational study was conducted in the intensive care units of state and university hospitals. A total of 191 nurses provided information on their sociodemographic and professional characteristics and completed a questionnaire on their knowledge, attitudes, and practices regarding physical restraints. RESULTS Statistically significant differences were found between average knowledge scores according to type of intensive care unit, weekly working hours, work shift, and frequency of using physical restraints, with the highest scores found in nurses who worked in the surgical unit, worked 40 hours a week, worked only during the day, and used physical restraints every day. Significant differences were found between average attitude scores according to type of intensive care unit, with the highest scores found in nurses who worked in the cardiology unit. Significant differences were found between average practice scores according to level of education and use of physical restraints without a physician's order, with the highest scores found in nurses with undergraduate and postgraduate degrees and those who did not use physical restraints without a physician's order. CONCLUSIONS This study revealed inadequate knowledge about physical restraints and some unsafe practices among participants. Evidence-based guidelines and laws regarding physical restraints are needed, as well as regular training programs for involved personnel.
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Affiliation(s)
- Öznur Gürlek Kısacık
- Öznur Gürlek Kısacık is an assistant professor, Nursing Department, Faculty of Health Science, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Münevver Sönmez
- Münevver Sönmez is an assistant professor, Nursing Department, Faculty of Health Science, Bülent Ecevit Health Sciences University, Zonguldak, Turkey
| | - Tuğba Coşğun
- Tuğba Coşğun is a clinical nurse, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
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Shields LBE, Edelen A, Daniels MW, Flanders K. Decline in Physical Restraint Use Following Implementation of Institutional Guidelines. J Nurs Adm 2021; 51:318-323. [PMID: 34006803 DOI: 10.1097/nna.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the strategies implemented at our institution to reduce medical restraint use. BACKGROUND Restraints have been utilized to prevent agitation, self-extubations, and falls, although they are often associated with negative repercussions for nurses and patients. METHODS The restraint data at our institution were compared with the National Database of Nursing Quality Indicators (NDNQI) benchmark. We also described the measures taken to improve restraint documentation. RESULTS The number of patients in medical restraints, medical restraint hours, medical restraints/patient-days, and deaths in restraints at our institution all significantly decreased (P < 0.00001). There were 27 self-extubations of restrained patients compared with 11 self-extubations of nonrestrained patients. The percentage of inpatients with restraints in critical care and step-down areas declined and remained below the NDNQI benchmark. CONCLUSIONS This study reports the processes implemented to reduce restraint use through enhanced communication and increased documentation. Further exploration into factors that may attain a restraint-free environment is warranted.
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Affiliation(s)
- Lisa B E Shields
- Author Affiliations: Medical Research Associate, Norton Neuroscience Institute (Dr Shields), and Manager of Quality and Regulation, Quality Research Management (Ms Edelen), Norton Healthcare; Biostatistician (Mr Daniels), Department of Bioinformatics & Biostatistics, University of Louisville; Vice President of Patient Care Services and Chief Nursing Officer (Dr Flanders), Practice Administration, Norton Healthcare, Louisville, Kentucky
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Chen X, Zhuang Y, Lao Y, Qiao L, Chen Y, Guo F. Development and implementation of a novel decision support tool on physical restraint use in critically ill adult patients. Int J Nurs Pract 2021; 28:e12961. [PMID: 34075650 DOI: 10.1111/ijn.12961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/20/2021] [Accepted: 04/24/2021] [Indexed: 01/22/2023]
Abstract
AIM To investigate whether a novel decision support tool would effectively minimize physical restraint use in critically ill adult patients. DESIGN A nonequivalent quasi-experimental design combined with a descriptive qualitative approach was used. METHODS A Restraint Decision Tree was developed based on a qualitative study that explored the barriers to employ the Restraint Decision Wheel. During the quasi-experimental study, patients admitted to the unit between October 2017 and March 2018 were enrolled as the control group receiving the Restraint Decision Wheel (n = 528), whereas patients between April 2018 and September 2018 were enrolled as the intervention group receiving the Restraint Decision Tree (n = 564). The physical restraint rate, accidental catheter removal rate and nurses' satisfaction were compared. RESULTS The Restraint Decision Tree significantly decreased physical restraint use. No significant difference in the rate of accidental catheter removal was found. Nurses reported increased satisfaction with the restraint decision-making. CONCLUSIONS The Restraint Decision Tree could minimize physical restraint use. Physicians' involvement in the restraint decision-making and nurses' competence in delirium assessment may be essential for successful implementation of the Restraint Decision Tree.
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Affiliation(s)
- Xiangping Chen
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiyu Zhuang
- Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuewen Lao
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijie Qiao
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yueliang Chen
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Guo
- Intensive Care Unit, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Knowledge, Attitude, and Practice of Nurses Working in the Adult Intensive-Care Unit and Associated Factors towards the Use of Physical Restraint in Federally Administered Hospitals in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study. Crit Care Res Pract 2021; 2021:5585140. [PMID: 34123421 PMCID: PMC8169276 DOI: 10.1155/2021/5585140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background Physical restraint is any chemical or physical involuntary method restricting an individual's movement, physical activity, or normal access to the body. Physical restraints are prescribed by the physician, but the ICU nurse remains the decision maker responsible in assessing the need, application, and removal of PR on patients in the ICU setting. Objectives This cross-sectional descriptive study was carried out to determine the knowledge, attitudes, and practices of nurses working in adult ICU and associated factors towards the use of physical restraints in federally administered hospitals in Addis Ababa, Ethiopia, 2019. Methods The study was conducted in ICUs of Federal Hospitals in Addis Ababa, Ethiopia, 2019. A hospital-based descriptive cross-sectional study design was carried out. By census, a total of 126 nurses were included. The data were checked for their completeness and were entered to EpiData version 4.2 and analyzed using SPSS version 25 software with 95% CI. Also, the Pearson correlation coefficient and binary logistic regression analysis were used to find an association. Result Majority of nurses was found to be aged between 21 and 30 years, (62.5%) have worked 2–5 years, and (83%) were degree graduates. The nurses' knowledge score was 6.1 ± 2.6 (50.8%) with possible range 0–11, the attitude score was 14.1 ± 3.1 (64%) with possible range 0–22, and the practice score was 13.9 ± 3.8 (63.18%) with possible range 0–22. Their demographical characteristics such as gender, working year, and education levels were not significantly associated with knowledge, attitudes, and practices (P > 0.05). Only age significantly associated with practice. Lack of a written policy or guideline and not being trained on application of physical restraint were significantly associated with knowledge. Also, practice was associated with knowledge and attitude. Conclusion According to the study, there was a poor level of nurses' knowledge, proper attitude, and satisfactory practice toward the use of physical restraints.
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Sharifi A, Arsalani N, Fallahi-Khoshknab M, Mohammadi-Shahbolaghi F. The principles of physical restraint use for hospitalized elderly people: an integrated literature review. Syst Rev 2021; 10:129. [PMID: 33931096 PMCID: PMC8088072 DOI: 10.1186/s13643-021-01676-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/15/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Physical restraint (PR) is a routine care measure in many hospital wards to ensure patient safety. However, it is associated with many different professional, legal, and ethical challenges. Some guidelines and principles have been developed in some countries for appropriate PR use. The present study aimed to explore the principles of PR use for hospitalized elderly people. METHODS This was an integrative review. For data collection, a literature search was conducted in Persian and English databases, namely Magiran, Scientific Information Database (SID), Scopus, Google Scholar, Web of Science, and PubMed as well as the websites of healthcare organizations and associations. Eligibility criteria were publication in English or Persian between January 1, 2010, and January 1, 2021, and description of the principles of PR use for hospitalized elderly people. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for document screening and selection, while the critical appraisal tools of the Joanna Briggs Institute (JBI) and the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument were used for quality appraisal. The data were analyzed through constant comparison. RESULTS Primarily, 772 records were retrieved, while only twenty were eligible for the study. The principles of PR use for hospitalized elderly people were categorized into six main categories, namely principles of education for PR use, principles of decision making for PR use, principles of implementing the PR procedure, principles of monitoring patients with PR, principles of PR use documentation, and principles of PR management. CONCLUSION PR should be used only by trained healthcare providers, with the consent of patient or his/her family members, with standard devices and safe techniques, based on clear guidelines, and under close managerial supervision. Moreover, elderly people with PR should continuously be monitored for any PR-related complications. The findings of the present study can be used for developing clear PR-related guidelines.
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Affiliation(s)
- Azam Sharifi
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Arsalani
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Masoud Fallahi-Khoshknab
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi-Shahbolaghi
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Almomani MH, Khater WA, Qasem BAA, Joseph RA. Nurses' knowledge and practices of physical restraints in intensive care units: An observational study. Nurs Open 2021; 8:262-272. [PMID: 33318834 PMCID: PMC7729655 DOI: 10.1002/nop2.625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/27/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022] Open
Abstract
Aim To investigate the knowledge and practice of physical restraints (PR) among Jordanian intensive care unit (ICU) nurses. Design A descriptive, observational design was used. Methods A convenience sampling was used to recruit participants. We examined the knowledge of PR in 301 nurses (knowledge check) and the real-time practice of PR in 81 nurses (direct observation) in ICU. A knowledge questionnaire was used to collect data on knowledge about PR use, and data on their practice of PR were observed and documented using an observation checklist. Results The mean scores of nurses' knowledge and practices were 61.5 (SD = 12.1) and 57.4 (SD = 9.7), respectively. More than half of nurses had poor knowledge of PR use and incorrect practice of implementing PR (51.5% and 60.5%, respectively). Results indicated a positive correlation between nurses' knowledge and their use of PR.
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Affiliation(s)
- Maysa H. Almomani
- Department of Adult Health NursingFaculty of NursingJordan University of Science and TechnologyIrbidJordan
| | - Wejdan A. Khater
- Department of Adult Health NursingFaculty of NursingJordan University of Science and TechnologyIrbidJordan
| | | | - Rachel A. Joseph
- Department of NursingCollege of Health SciencesWest Chester University of PennsylvaniaWest ChesterPAUSA
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Chang YC, Campbell ML, Yen WJ, Yang CC, Peng CK, Chen YJ. Cross-cultural adaptation and psychometric testing of a Chinese version of respiratory distress observation scale. Heart Lung 2020; 50:166-172. [PMID: 33232932 DOI: 10.1016/j.hrtlng.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Yu-Chuan Chang
- Department of Nursing, Tri-Service General Hospital, No.325, Sec.2, Chenggong Rd.,Neihu District, Taipei 114, Taiwan
| | | | - Wen-Jiuan Yen
- School of Nursing, Chung Shan Medical University, No. 110, Sec.1, Jianguo N. Rd, Taichung 402, Taiwan
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei 114, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Ju Chen
- School of Nursing, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei 114, Taiwan.
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Lei R, Jiang X, Liu Q, He H. Nurse education to reduce physical restraints use in ICU: A scoping review. Nurs Crit Care 2020; 27:824-837. [PMID: 32969127 DOI: 10.1111/nicc.12557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physical restraints are defined as a manual approach to reduce a patient's physical movement and has been regarded as a protective nursing measure in the intensive care unit (ICU) to avoid unplanned extubation, falls, and other unexpected events. However, the limitations and changes associated with physical restraints have been verified by several studies. Restraint minimization has been advocated by studies worldwide; however, the most effective interventions are still being explored. AIM To identify and map nurse education strategies that reduce the use of physical restraints in the ICU. DESIGN AND METHODS A systematic literature search that followed the steps of a scoping review was performed in the Cochrane, PubMed, Embase, CINAHL, CNKI, Wan Fang Data, and VIP databases. We included studies that focused on nurse education aiming to reduce the use of physical restraints and/or use physical restraints reasonably. RESULTS The included studies (n = 12) described a variety of education strategies. Two delivery modes, eight common course durations, 14 main topics, two types of teaching methods with various materials, and two kinds of outcome measurements were identified and compared. CONCLUSION There are a variety of nurse education activities that could effectively improve ICU nurses' knowledge, attitudes, and behaviours towards physical restraints. However, the strategies of nurse education, such as delivery mode, teaching methods, and outcome measurements, require further study. RELEVANCE TO CLINICAL PRACTICE Nurse education on physical restraints should be carried out in ICUs. Online courses, practical sessions, and simulated scenarios should be a part of future nurse education. In addition to nurses' knowledge and attitude changes, frequency of physical restraints and other patient-related outcomes should also be considered for outcome evaluation.
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Affiliation(s)
- Ruobing Lei
- Nursing Department; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Xiaoping Jiang
- Nursing Department; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
| | - Qin Liu
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, P.R. China
| | - Hui He
- Nursing Department; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders (Chongqing); China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, P.R. China
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Ertuğrul B, Özden D. Nurses' knowledge and attitudes regarding physical restraint in Turkish intensive care units. Nurs Crit Care 2020; 26:253-261. [PMID: 32881252 DOI: 10.1111/nicc.12541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Physical restraint is still widely used despite studies supporting a reduction in its use. The development of guidelines to reduce the use of PR first requires the identification of factors related to the use of alternative methods. AIM This study aimed to determine factors associated with the use of alternatives to physical restraint (PR) in intensive care units. DESIGN This was a cross-sectional descriptive study. METHODS Data were collected from adult intensive care units of three hospitals in Turkey using the Physical Restraint Knowledge, Attitude and Practice Scale and a questionnaire including open-ended questions. RESULTS Overall, 202 nurses (80% response rate) completed the questionnaire. Nurses' knowledge, attitude, and practice scores regarding PR were 6.89 ± 1.79, 29.85 ± 4.93, and 36.76 ± 3.36, respectively. PR was reported to be necessary for patients at risk of self-harm, with dangerous behaviours, and who were trying to remove their catheters. Most nurses (64.9%) stated that they needed a written doctor's order. Analysis of free-text responses showed that patient disorientation (because of delirium, sedation, or agitation), nurses' workload, and lack of training regarding restraint were the primary reasons why nurses could not use alternatives. The main alternatives suggested by nurses were categorized as sedation, communication, and environmental regulation. Logistic regression analysis identified training (P = .009), working unit (P = .001), and nurses' practice score to use PR (P = .004) as independent risk factors for not using alternative methods of PR. CONCLUSIONS The results of this study revealed a moderate level of knowledge, attitude, and practice among nurses regarding the use of PR. Thus, education of nurses about the prevention of delirium and alternatives to PR according to the characteristics of their units is required. RELEVANCE TO CLINICAL PRACTICE Clinical guidelines and in-service training need to be developed to increase the use of alternatives to PR and delirium management.
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Affiliation(s)
- Büşra Ertuğrul
- Dokuz Eylul University, Institute of Health Sciences, Nursing Faculty, Izmir, Turkey
| | - Dilek Özden
- Dokuz Eylul University, Institute of Health Sciences, Nursing Faculty, Izmir, Turkey
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Factors influencing critical care nurses’ intentions to use physical restraints adopting the theory of planned behaviour: A cross-sectional multicentre study. Aust Crit Care 2020; 33:426-435. [DOI: 10.1016/j.aucc.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 01/22/2023] Open
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Zulian LR, Mori S, Teraoka EC, Miyasaki VYK, Zanei SSV, Whitaker IY. Factors associated with the use of physical restraint in intensive care patients. Rev Esc Enferm USP 2020; 54:e03571. [PMID: 32696938 DOI: 10.1590/s1980-220x2018058503571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/22/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify the frequency of physical restraint in patients and the factors associated with its use in the intensive care unit. METHOD An observational and prospective study on the use of restraint in patients observed over two days, considering the variables: age and gender, personal and clinical characteristics, devices, adverse event and restraint use. The frequency was verified in three groups of patients with different conditions by applying the Chi-Squared, Likelihood Ratio or Kruskal-Wallis tests. The association of the variables was verified with the Multinomial Logistic Regression. RESULTS Eighty-four (84) patients participated. Restraint was observed in 77.4% of the 84 analyzed patients, and was more frequent in the presence of sedation, agitation and invasive devices. The chance of being restrained was at least five times higher in sedation conditions, whether in weaning or daily awakening, mechanical ventilation weaning, agitation or the presence of invasive devices. CONCLUSION Restraint use was high and was associated with female gender, sedation, agitation and invasive airway. It is emphasized and important to apply policies to reduce restraint use in intensive care.
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Affiliation(s)
| | - Satomi Mori
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Shen X, Hu B, Pang X, Lin J, Yin X, Jiang Y, Zhao Y, Liu Q, Zhu X. Nurses' behaviours towards physical restraint use in the ICU: A descriptive qualitative study. Int J Nurs Pract 2020; 27:e12868. [PMID: 32608564 DOI: 10.1111/ijn.12868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 04/22/2020] [Accepted: 05/09/2020] [Indexed: 12/12/2022]
Abstract
AIMS AND OBJECTIVES The study aims to explore and describe nurses' behaviours towards physical restraint (PR) use in intensive care units (ICUs) and identify key characteristics of these experiences. BACKGROUND Patients within the ICU are always vulnerable, which requires a thoughtful deliberation when employing PR in ethically laden situations. Considering that the qualitative study on nurses' behaviours towards PR use in ICUs is limited, a deep understanding of how nurses reason and restrict patients is necessary before developing a minimizing programme in hospitals. METHODS A descriptive qualitative study was conducted in this paper. Data were collected by 24 semistructured, in-depth and individual interviews about PR, where 24 nurses were drawn from six ICUs of four hospital settings from a comprehensive tertiary care hospital in Qingdao. The QSR NVivo 11.0 software program was used to manage the interview data, and data analysis was guided by the Qualitative Analysis Guide of Leuven. The checklist of Consolidated Criteria for Reporting Qualitative Studies was followed as a guideline in reporting the study. RESULTS Regarding PR, nurses' behaviours start with a hazard perception, followed by hesitation about whether to restrict the patient. They would usually decide to apply PR when they think that no other choice to control the situation is available. Then, they would reflect on and rationalize their behaviours. Nurses, intensivists, patients and their families participate in and affect this process directly or indirectly. CONCLUSIONS Nurses' behaviours towards PR use comprise a series of complex processes centred on safety. Nurses' decision making should be performed with the participation of intensivists, patients and family caregivers.
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Affiliation(s)
- Xiufang Shen
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Bo Hu
- Department of Thoracic surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Xufeng Pang
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jing Lin
- Intensive Care Unit, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaomeng Yin
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Yuanyuan Jiang
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Yaling Zhao
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Qingwei Liu
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
| | - Xiuli Zhu
- School of Nursing, Department of Medicine, Qingdao University, Qingdao, China
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Lawson TN, Tan A, Thrane SE, Happ MB, Mion LC, Tate J, Balas MC. Predictors of New-Onset Physical Restraint Use in Critically Ill Adults. Am J Crit Care 2020; 29:92-102. [PMID: 32114609 DOI: 10.4037/ajcc2020361] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Physical restraints are frequently used for intensive care patients and are associated with substantial morbidity. The effects of common evidence-based critical care interventions on use of physical restraints remain unclear. OBJECTIVE To identify independent predictors of new-onset use of physical restraints in critically ill adults. METHODS Secondary analysis of a prospective cohort study involving 5 adult intensive care units in a tertiary care medical center in the United States. Use of physical restraints was determined via daily in-person assessments and medical record review. Mixed-effects logistic regression analysis was used to examine factors associated with new-onset use of physical restraints, adjusting for covariates and within-subject correlation among intensive care unit days. RESULTS Of 145 patients who were free of physical restraints within 48 hours of intensive care unit admission, 24 (16.6%) had restraints newly applied during their stay. In adjusted models, delirium (odds ratio [OR], 5.09; 95% CI, 1.83-14.14), endotracheal tube presence (OR, 3.47; 95% CI, 1.22-9.86), and benzodiazepine administration (OR, 3.17; 95% CI, 1.28-7.81) significantly increased the odds of next-day use of physical restraints. Tracheostomy was associated with significantly lowered odds of next-day restraint use (OR, 0.13; 95% CI, 0.02-0.73). Compared with patients with a target sedation level, patients who were in a coma (OR, 2.56; 95% CI, 0.80-8.18) or deeply sedated (OR, 2.53; 95% CI, 0.91-7.08) had higher odds of next-day use of physical restraints, and agitated patients (OR, 0.08; 95% CI, 0.00-2.07) were less likely to experience restraint use. CONCLUSION Several potentially modifiable risk factors are associated with next-day use of physical restraints.
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Affiliation(s)
- Thomas N Lawson
- Thomas N. Lawson is a doctoral student at The Ohio State University College of Nursing and an acute care nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alai Tan
- Alai Tan is a research associate professor, The Ohio State University College of Nursing
| | - Susan E Thrane
- Susan E. Thrane is an assistant professor, The Ohio State University College of Nursing
| | - Mary Beth Happ
- Mary Beth Happ is a professor and Associate Dean for Research and Innovation, The Ohio State University College of Nursing
| | - Lorraine C Mion
- Lorraine C. Mion is a professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center
| | - Judith Tate
- Judith Tate is an assistant professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center
| | - Michele C Balas
- Thomas N. Lawson is a doctoral student at The Ohio State University College of Nursing and an acute care nurse practitioner at The Ohio State University Wexner Medical Center, Columbus, Ohio. Alai Tan is a research associate professor, Susan E. Thrane is an assistant professor, Mary Beth Happ is a professor and Associate Dean for Research and Innovation, and Michele C. Balas is an associate professor, The Ohio State University College of Nursing. Lorraine C. Mion is a professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center. Judith Tate is an assistant professor, The Ohio State University College of Nursing and a nurse scientist, The Ohio State University Wexner Medical Center
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Salehi Z, Joolaee S, Hajibabaee F, Ghezeljeh TN. The challenges of using physical restraint in intensive care units in Iran: A qualitative study. J Intensive Care Soc 2020; 22:34-40. [PMID: 33643430 DOI: 10.1177/1751143719892785] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018-2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.
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Affiliation(s)
- Zahra Salehi
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Soodabeh Joolaee
- Nursing Care Research Centre, Iran University of Medical Sciences, Isfahan, Tehran, Iran.,Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, Canada
| | - Fatemeh Hajibabaee
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Centre, Iran University of Medical Sciences, Isfahan, Tehran, Iran
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Guo H, Shen YL, Yang L, Tang L, Li L, Liu QX, Wang HY, Liu YJ. Evaluation and analysis of the effect of continuing education on nurses' physical restraint knowledge, attitude, and behavior. JOURNAL OF INTEGRATIVE NURSING 2020. [DOI: 10.4103/jin.jin_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Teece A, Baker J, Smith H. Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit. J Clin Nurs 2019; 29:5-19. [DOI: 10.1111/jocn.15052] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/05/2019] [Accepted: 08/24/2019] [Indexed: 01/04/2023]
Affiliation(s)
- Angela Teece
- School of Healthcare University of Leeds Leeds UK
| | - John Baker
- School of Healthcare University of Leeds Leeds UK
| | - Helen Smith
- School of Healthcare University of Leeds Leeds UK
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Guenna Holmgren A, Juth N, Lindblad A, von Vogelsang AC. Restraint in a Neurosurgical Setting: A Mixed-Methods Study. World Neurosurg 2019; 133:104-111. [PMID: 31568917 DOI: 10.1016/j.wneu.2019.09.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the extent to which restraint is used in neurosurgical care, under what circumstances, and how it is documented. METHODS A cross-sectional study with a mixed-methods approach was used to identify neurosurgical inpatients subjected to restraint. The data were collected in 2 phases: (1) a study-specific questionnaire was distributed to nurses in which they identified if restraints had occurred during their shifts, and if so, which restraint and to which patient; and (2) scrutinizing of electronic medical records of patients identified by the questionnaires. Numeric data were analyzed using descriptive and analytic statistical methods, and textual data were analyzed using qualitative content analysis. The findings from the different data sources were compared and merged. RESULTS Of the 517 patients admitted to the studied department during the study period, 58 (11%) were reported to have been subjected to restraint and most of the restraining events occurred in the neurointensive care unit. Most restraint measures were not documented in the electronic medical records. The identified patients were predominantly diagnosed with traumatic brain injury or subarachnoid hemorrhage. The qualitative content analysis showed the circumstances when restraints were used: when patients were considered a danger to self or others (theme) and which symptoms and behaviors (categories) were observed in relation to the use of restraint. CONCLUSIONS Restraint in neurosurgical care is mostly used to prevent patients from harming themselves or others. Because of the lack of documentation, restraint measures cannot be openly assessed, thus putting patients' safety at risk.
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Affiliation(s)
- Amina Guenna Holmgren
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden.
| | - Niklas Juth
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
| | - Anna Lindblad
- Department of Learning, Informatics, Management and Ethics (LIME), Stockholm Centre for Healthcare Ethics (CHE), Karolinska Institutet, Stockholm, Sweden
| | - Ann-Christin von Vogelsang
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Neuro Theme, Karolinska University Hospital, Stockholm, Sweden
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Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 2019; 46:e825-e873. [PMID: 30113379 DOI: 10.1097/ccm.0000000000003299] [Citation(s) in RCA: 1834] [Impact Index Per Article: 366.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To update and expand the 2013 Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the ICU. DESIGN Thirty-two international experts, four methodologists, and four critical illness survivors met virtually at least monthly. All section groups gathered face-to-face at annual Society of Critical Care Medicine congresses; virtual connections included those unable to attend. A formal conflict of interest policy was developed a priori and enforced throughout the process. Teleconferences and electronic discussions among subgroups and whole panel were part of the guidelines' development. A general content review was completed face-to-face by all panel members in January 2017. METHODS Content experts, methodologists, and ICU survivors were represented in each of the five sections of the guidelines: Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as "strong," "conditional," or "good" practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. RESULTS The Pain, Agitation/Sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered prioritized question list remained without recommendation. CONCLUSIONS We found substantial agreement among a large, interdisciplinary cohort of international experts regarding evidence supporting recommendations, and the remaining literature gaps in the assessment, prevention, and treatment of Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) in critically ill adults. Highlighting this evidence and the research needs will improve Pain, Agitation/sedation, Delirium, Immobility (mobilization/rehabilitation), and Sleep (disruption) management and provide the foundation for improved outcomes and science in this vulnerable population.
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Cui N, Long M, Zhou S, Zhang T, He C, Gan X. Knowledge, Attitudes, and Practices of Chinese Critical Care Nurses Regarding Physical Restraint. J Contin Educ Nurs 2019; 50:121-126. [PMID: 30835322 DOI: 10.3928/00220124-20190218-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND This multicenter cross-sectional study sought to determine the knowledge, attitudes, and practices regarding the use of physical restraints by Chinese nurses in intensive care units (ICUs) of tertiary hospitals. METHOD A scale technique was used to measure the knowledge, attitudes, and practices of 383 RNs from eight tertiary hospitals in Chongqing, China. RESULTS A total of 383 valid questionnaires were returned, for a response rate of 89.49%. Approximately 8.1% of the nurses were male, 67.1% had a bachelor's degree or above, and 55.09% were ICU specialists. The average age was 28.62 years (SD = 4.56). The mean scores were 74.33 of 111 (SD = 9.552), 24.41 of 40 (SD = 4.872), and 65.66 of 130 (SD = 20.880) regarding knowledge, attitudes, and nursing practices, respectively. For the attitude scale, the scores of nurses who were certified ICU specialists and had extensive working experience were higher than those with less experience; the difference was statistically significant (p < .05). CONCLUSION Results indicated that nurses employed in the ICUs of tertiary hospitals in Chongqing, China, have relatively insufficient knowledge, comparatively incorrect attitudes, and unreasonable means of practicing physical restraint. Continuing education should focus strongly on the relationship between physical restraint and unplanned extubation, and guidelines on physical restraint urgently need to be developed. [J Contin Educ Nurs. 2019;50(3):121-126.].
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Noel C, Mallemat H. Sedation and Analgesia for Mechanically Ventilated Patients in the Emergency Department. Emerg Med Clin North Am 2019; 37:545-556. [PMID: 31262420 DOI: 10.1016/j.emc.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mechanically ventilated patients can experience significant pain and anxiety associated with their care. These symptoms should be aggressively treated, but can be challenging to manage without a systematic approach. This article reviews recent literature, current guidelines, and best practices in managing pain, agitation, and anxiety in mechanically ventilated patients in the emergency department.
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Affiliation(s)
- Christopher Noel
- Critical Care Medicine, Cooper University Hospital, One Cooper Plaza, D427C, Camden, NJ 08103, USA.
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Ertuğrul B, Özden D. The effect of physical restraint on neurovascular complications in intensive care units. Aust Crit Care 2019; 33:30-38. [PMID: 31079994 DOI: 10.1016/j.aucc.2019.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To reduce the neurovascular complications caused by physical restraint in intensive care patients, there is a need to examine the occurrence of neurovascular complications and their rate. OBJECTIVES The objective of this research was to investigate the effect of physical restraint on the occurrence of neurovascular complications and their rate. METHODS A prospective observational cohort study was carried out. A total of 90 patients from anaesthesia and internal intensive care units participated in this study. Patients were assessed at intervals of 24 h for 4 days using the following instruments: Individual Characteristics Form, Richmond Agitation-Sedation Scale (RASS), Behavioral Pain Scale, and Complication Diagnostic Diary. RESULTS Redness (p < 0.001), limb movement (p < 0.001), oedema (p < 0.001), and colour complication (p < 0.001) increased, whereas pulse strength (p < 0.001) decreased in physically restrained sites on the arm from day 1 to day 4. Redness was increased in patients physically restrained with all types of materials (p < 0.001; p < 0.001; p = 0.020). Although there was a statistically significant difference in terms of movement (p = 0.006; p = 0.003) and oedema (p < 0.001; p < 0.001), both with a roll of gauze and tough cuff, these complications were not significantly different in patients restrained with green foam tie (p > 0.05). According to logistic regression analysis, material type, position of the limb, space between the physical restraint and limb, age, RASS, and pain were independent risk factors for neurovascular complications. RASS and pain were independent protective factors against movement complications. CONCLUSIONS The duration of physical restraint increases neurovascular complications. This study revealed that nurses did not regularly check the restrained wrist and did not focus on the peripheral circulation. It is necessary to develop training programs, standards, and appropriate follow-up strategies in intensive care units in Turkey.
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Affiliation(s)
- Büşra Ertuğrul
- Dokuz Eylul University, Institute of Health Sciences, Nursing Faculty, Izmir, Turkey.
| | - Dilek Özden
- Dokuz Eylul University, Institute of Health Sciences, Nursing Faculty, Izmir, Turkey
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Perez D, Peters K, Wilkes L, Murphy G. Physical restraints in intensive care–An integrative review. Aust Crit Care 2019; 32:165-174. [DOI: 10.1016/j.aucc.2017.12.089] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022] Open
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Mahmood SA, Mahmood OS, El-Menyar AA, Asim MM, Abdelbari AAA, Chughtai TS, Al-Thani HA. Self-Extubation in Patients with Traumatic Head Injury: Determinants, Complications, and Outcomes. Anesth Essays Res 2019; 13:589-595. [PMID: 31602083 PMCID: PMC6775851 DOI: 10.4103/aer.aer_92_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Self-extubation is a common clinical problem associated with mechanical ventilation in trauma patients worldwide. Objectives This study aimed to evaluate the predisposing factors, complications, and outcomes of self-extubation in patients with head injury. Methods This was a retrospective cohort study. Settings The study was conducted in a trauma intensive care unit (TICU). Patients All intubated patients with head injury admitted to TICU between 2013 and 2015 were included in the study. Interventions Planned compared to selfextubation during weaning from sedation. Measurements Risk, predictors, and outcomes of self-extubation were measured. Main Results A total of 321 patients with head injury required mechanical ventilation, of which 39 (12%) had self-extubation and 12 (30.7%) had reintubation. The median Glasgow Coma Scale, head abbreviated injury score, and injury severity score were 9, 3, and 27, respectively. The incidence of self-extubation was 0.92/100 ventilated days. Self-extubated patients were more likely to be older, develop agitation (P = 0.001), and require restraints (P = 0.001) than those who had planned extubation. Furthermore, self-extubation was associated with more use of propofol (P = 0.002) and tramadol (P = 0.001). Patients with self-extubation had higher Ramsay sedation score (P = 0.01), had prolonged hospital length of stay (P = 0.03), and were more likely to develop sepsis (P = 0.003) when compared to the planned extubation group. The overall in-hospital mortality was significantly higher in the planned extubation group (P = 0.001). Age-adjusted predictors of self-extubation were sedation use (adjusted odds ratio [aOR]: 0.06; P = 0.001), restraint use (aOR: 10.4; P = 0.001), and tramadol use (aOR: 7.21; P = 0.01). Conclusions More than one-tenth of patients with traumatic head injury develop self-extubation; this group of patients is more likely to have prescribed tramadol, develop agitation, and have longer hospital length of stay and less sedation use. Further prospective studies are needed to assess the predictors of self-extubation in TICU.
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Affiliation(s)
- Saeed A Mahmood
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | | | - Ayman A El-Menyar
- Department of Surgery, Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar.,Department of Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Mohammad M Asim
- Department of Surgery, Clinical Research, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | | | - Talat Saeed Chughtai
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
| | - Hassan A Al-Thani
- Department of Surgery, Trauma Surgery Section, Hamad General Hospital, Doha, Qatar
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Via-Clavero G, Claramunt-Domènech L, García-Lamigueiro A, Sánchez-Sánchez MM, Secanella-Martínez M, Aguirre-Recio E, Sandalinas-Mulero I, Ortega-Guerrero Á, Yuste-Bustos F, Delgado-Hito P. Analysis of a nurses' knowledge survey on the use of physical restraint in intensive care units. ENFERMERIA INTENSIVA 2018; 30:47-58. [PMID: 30587429 DOI: 10.1016/j.enfi.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/12/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine nurses' knowledge level regarding physical restraint use in intensive care units and its associated factors. METHOD A cross-sectional multicentre study was carried out in 12 critical care units of 8 hospitals in Spain (n=354 nurses). An 'ad-hoc' knowledge survey was developed, and their content was validated by experts. The survey obtained a test-retest stability of ICC=.71 (95% CI: .57-.81) in a previous pilot study. A final 8-item tool was designed. Sociodemographic and professional variables from the participants were collected; as well as structural and clinical variables from the units analyzed. A descriptive and association analysis between variables was performed. A p-value <.05 was deemed statistically significant. RESULTS Two hundred and fifty nurses answered the survey (70.62%). Mean age of the participants was 36.80 (SD 9.54) with 10.75 (SD 8.38) years of professional experience in critical care. Seventy-three point six percent had never received previous training about physical restraints. Knowledge mean value was 4.21 (SD 1.39) (range 0-8). Knowledge level was associated with the referral hospital (p<.001). Nurses with a higher knowledge level are more likely to work in units with informed consent sheets for physical restraint use (p<.001); flexible family visiting (p<.001); analgo-sedation protocol (p=.011), and units in which nurses had autonomy to manage analgo-sedation (p<.001). Individual sociodemographic and professional data was not associated with knowledge level. CONCLUSIONS Further training regarding physical restraint use is needed for critical care nurses. The work environment where nursing care is given has a great influence on nurses' knowledge level about this intervention.
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Affiliation(s)
- G Via-Clavero
- Unidad de Cuidados Intensivos, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Departamento de Enfermería Fundamental y Médico-Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, España; Grup de Recerca Infermera GRIN-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - L Claramunt-Domènech
- Unidad de Cuidados Intensivos, Hospital Universitari Joan XXIII, Tarragona, España
| | - A García-Lamigueiro
- Unidad de Cuidados Intensivos, Hospital Universitari Doctor Josep Trueta, Girona, España
| | | | - M Secanella-Martínez
- Unidad de Cuidados Intensivos, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España
| | - E Aguirre-Recio
- Unidad de Cuidados Intensivos, Consorci Sanitari del Maresme, Hospital de Mataró, Mataró, Barcelona, España
| | - I Sandalinas-Mulero
- Unidad de Cuidados Intensivos, Hospital Mútua Terrassa, Terrassa, Barcelona, España
| | - Á Ortega-Guerrero
- Unidad de Cuidados Intensivos, Hospital Quirónsalud Málaga, Málaga, España
| | - F Yuste-Bustos
- Unidad de Cuidados Intensivos, Hospital San Juan de Dios de Córdoba, Córdoba, España
| | - P Delgado-Hito
- Departamento de Enfermería Fundamental y Médico-Quirúrgica, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Barcelona, España; Grup de Recerca Infermera GRIN-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España
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