Influence of mutual support and a culture of blame among staff in acute care units on the frequency of physical restraint use in patients undergoing mechanical ventilation

Abstract

Aim: Reducing the use of physical restraint in intensive care units is challenging, and little is known about the influence of culture on physical restraint use in this setting. The present study aims to verify the hypothesis that mutual support and a culture of blame among staff are associated with higher physical restraint use for mechanically ventilated patients. Methods: We undertook a survey of nurses in intensive care units caring for mechanically ventilated patients in acute care units. The perceived frequency of physical restraint, mutual support, and culture of blame were measured. We predefined a high frequency physical restraint use group and compared the institutional characteristics, human resources, mutual support, and culture of blame between this group and the others (the control). Results: Three hundred and thirty-three responses were analyzed. The mean number of beds per nurse was not significantly different between the groups; the mean and percentage of positive responses about mutual support and a culture of blame were significantly lower in the high frequency physical restraint use group. After adjusting variables in a multivariable regression analysis, a less positive response about the culture of blame was the only independent factor to predict high frequency physical restraint use. Conclusion: The study suggests that changing the culture of blame, rather than increasing the number of nurses, is important for reducing physical restraint use.

An Intervention to Optimize Attitudes Toward Adverse Events Reporting Among Tunisian Critical Care Nurses

“…1,8 However, it is undeniable, as reported by several studies in critical care, that it is the blame and the punishment of the personnel who make the error that is often the consequence of the reporting, which is a major source of poor quality of care and nonimprovement of the system. [13][14][15] This was also demonstrated in our baseline survey where the dimension related to perceived blame (D1) had a low score of 27.4%. According to this dimension, the majority of professionals find that reporting AEs lets others check up on them (62.5%) and creates problems for them (89.6%), and even the careers staff who report AEs suffer (57%).…”

“…Reporting these errors, the goal of which should be to recognize their root causes, is fundamental to preventing their subsequent reproduction 1,8 . However, it is undeniable, as reported by several studies in critical care, that it is the blame and the punishment of the personnel who make the error that is often the consequence of the reporting, which is a major source of poor quality of care and nonimprovement of the system 13–15 . This was also demonstrated in our baseline survey where the dimension related to perceived blame (D1) had a low score of 27.4%.…”

Translation, reliability and validity of Japanese version the TeamSTEPPS® teamwork perceptions questionnaire

“…The translation process followed the back translation method based on a guideline (Sousa & Rojjanasrirat, 2011). A part of the translation process in this study was reported in the previous study (Unoki et al, 2020). The translation team consisted of two nurse educators and five clinical nurses.…”

Understanding the decision‐making of critical care nurses when restraining a patient with psychomotor agitation secondary to hyperactive delirium: A ‘Think Aloud’ study.

“…The nurse's experience of managing delirium was downplayed. Such resentment can erode team cohesion and promote divisions between medical and nursing staff (Palacios‐Cena et al, 2016; Unoki et al, 2020). Delirium is an important form of organ dysfunction which has profound short‐ and long‐term impacts on patient recovery (Salluh et al, 2015).…”