Coming to Grips—How Nurses Deal With Restlessness, Confusion, and Physical Restraints on a Neurological/Neurosurgical Ward

Abstract

Physical restraints are viewed as potentially dangerous objects for patient safety. Contemporary efforts mainly focus on preventing bad outcomes in restraint use, while little attention is paid under what circumstances physical restraints are applied harmlessly. The aim of this research was to understand how physical restraints are used by neurology/neurosurgery ward nurses in relation to the protocol. In ethnographic action research, the Functional Resonance Analysis Method (FRAM) was used to map and compare physical restraints as part of daily ward care against the protocol of physical restraints. Comparison between protocol and actual practice revealed that dealing with restlessness and confusion is a collective nursing skill vital in dealing with physical restraints, while the protocol failed to account for these aspects. Supporting and maintaining this skillset throughout this and similar nursing teams can prevent future misguided application physical restraints, offering valuable starting point in managing patient safety for these potentially dangerous objects.

Restraints in Neurosurgery Departments: An Underrated Risk, a Perfect Storm

“…This topic is well known and deeply assessed in other clinical contexts such as mental health, 4 but less is known about neurosurgery patients. 5 This article aims to critically analyze why restraints' exposure can represent a boosted risk for these patients, according to the evidence available.…”

“…The decision-making capacity can be impaired; restlessness is often present and progressively worsening. 5 These situations can be challenging for healthcare professionals. 1,8 Intensive care can require restraints to prevent the removal of endotracheal tubes, intra-arterial devices, and external ventriculoperitoneal shunts.…”

“…11 The lack of transparency may lead to unsafe healthcare and poorer knowledge of the phenomenon. 1 Notably, nursing a confused/ aggressive patient often requires experience and time 5 : when preventive measures fail, nurses apply alternative criteria-often creative-to handle these situations, such as creating a low-stimulus environment or distracting the patient with activities. These deescalation interventions are essential to prevent unmanageable behaviors.…”

“…The situations described before are typical of other fields (internal medicine, intensive care unit, and surgery department), but they all converge in neurosurgery patients' nursing, creating a unique “super-risk.” An aggravating factor is that the use of sedative drugs is not always possible, because it interferes with neurological observation, which is particularly important in acute and postacute phases. 5 Balancing beneficence, resources, and urgent needs requires considerable effort. In the intensive care unit, reducing the use of sedative drugs can minimize the drug's adverse effects and promote patient rehabilitation, but it increases the probability of restraint use.…”