Critical care nursing: caring for patients who are agitated

Freeman, Samantha; Teece, Angela

doi:10.1136/eb-2017-102782

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…The use of subjective descriptors further emphasises the lack of objective clinical guidance for staff caring for agitated or delirious patients. It is difficult to quantify at what point the use of restraint becomes clinically necessary (Freeman & Teece, ). Hurlock‐Chorostecki and Kielb () demonstrated how education and culture change reduced reliance on physical restraints on their unit.…”

Section: Discussionmentioning

confidence: 99%

“…Chemical and physical restraint are widespread in critical care, and bedside nurses are the main decision-makers in restraint management (Li & Fawcett, 2014). However, agitation can be subjectively interpreted, leading to challenges in identifying the point at which restraint becomes appropriate (Freeman & Teece, 2017) and subsequent wide variations in practice.…”

Section: Introductionmentioning

confidence: 99%

“…Subjective diagnosis of delirium is associated with significant under-detection(van Eijk, 2012) and delays the appropriate treatment of underlying causes.The use of subjective descriptors further emphasises the lack of objective clinical guidance for staff caring for agitated or delirious patients. It is difficult to quantify at what point the use of restraint becomes clinically necessary(Freeman & Teece, 2017).…”

mentioning

confidence: 99%

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Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit

Teece

Baker

Smith

2019

Journal of Clinical Nursing

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Aims and objectives To identify key determinants, which lead to the decision to apply physical or chemical restraint on the critical care unit. Background Psychomotor agitation and hyperactive delirium are frequently cited as clinical rationale for initiating chemical and physical restraint in critical care. Current restraint guidance is over a decade old, and wide variations in nursing and prescribing practice are evident. It is unclear whether restraint use is grounded in evidence‐based practice or custom and culture. Study design Integrative review. Method Seven health sciences databases were searched to identify published and grey literature (1995–2019), with additional hand‐searching. The systematic deselection process followed PRISMA guidance. Studies were included if they identified physical or chemical restraint as a method of agitation management in adult critical care units. Quality appraisal was undertaken using Mixed Methods Appraisal Tool. Data were extracted, and thematic analysis undertaken. Results A total of 23 studies were included. Four main themes were identified: the lack of standardised practice, patient characteristics associated with restraint use, the struggle in practice and the decision to apply restraint. Conclusions There are wide variations in restraint use despite the presence of international guidance. Nurses are the primary decision‐makers in applying restraint and report that caring for delirious patients is physically and psychologically challenging. The decision to restrain can be influenced by the working environment, patient behaviours and clinical acuity. Enhanced clinical support and guidance for nurses caring for delirious patients is indicated. Relevance to clinical practice Delirium and agitation pose a potential threat to patient safety and the maintenance of life‐preserving therapies. Restraint is viewed as one method of preserving patient safety. However, use appears to be influenced by previous adverse experiences and subjective patient descriptors, rather than robust evidence‐based knowledge. The need for a precise language to describe restraint and quantify when it becomes necessary is indicated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit

Teece

Baker

Smith

2019

Journal of Clinical Nursing

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“…53 To improve patient outcomes, written physician orders, family-co-ordinated multidisciplinary decision-making with psychiatric support, and tools indicating the determinants for clinical use of PR and delirium scoring are needed. 54 In this study, nurses identified workload as one reason for not using alternatives to PR. Compared with other studies, the nurse-topatient ratio is very low in Turkey.…”

Section: Nurses' Demographic and Professional Factorsmentioning

confidence: 99%

Nurses' knowledge and attitudes regarding physical restraint in Turkish intensive care units

Ertuğrul

Özden

2020

Nursing in Critical Care

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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.

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Predictors of physical restraint use on critical care units: An observational structural equation modeling approach

Olds

Cramer

2021

International Journal of Nursing Studies

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Critical care nursing: caring for patients who are agitated

Abstract: This month's opinion draws on an EBN Twitter chat that focused on caring for patients who are agitated. Access the blog at

Cited by 3 publications

References 13 publications

Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit

Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit

Nurses' knowledge and attitudes regarding physical restraint in Turkish intensive care units

Predictors of physical restraint use on critical care units: An observational structural equation modeling approach

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