Physical restraints in intensive care–An integrative review

Perez, Dawn; Peters, Kathleen; Wilkes, Lesley M; Murphy, Gillian

doi:10.1016/j.aucc.2017.12.089

Cited by 81 publications

(121 citation statements)

References 24 publications

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“…However, the use of physical restraints in different countries varies considerably. For example, the use of physical restraints in European general ICU populations ranges from 10-50%, 76% in Canada, and up to 87% in American surgical ICUs [75][76][77]. According to one meta-analysis, the prevalence of physical restraint use in Iranian medical-surgical ICUs was 47.6%, in keeping with the ndings of this analysis [78].…”

Section: Discussionsupporting

confidence: 69%

“…According to one meta-analysis, the prevalence of physical restraint use in Iranian medical-surgical ICUs was 47.6%, in keeping with the ndings of this analysis [78]. Similarly, physical restraint applications havepreviously been identi ed as an independent risk factor for development of ICU delirium [75,79]. As restraint use increased two-and three-fold, observed incidence of ICU delirium increased 2.38-and 3.62-fold respectively.…”

Section: Discussionsupporting

confidence: 67%

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Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

Moghadam

Miller

Rahimi–Bashar

et al. 2020

Preprint

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Background: To address whether in intensive care unit (ICU) patients, which factors correlate with development of delirium (primary outcome), as well as more rapid delirium onset and recurrence (secondary outcomes).Methods: A retrospective secondary analysis of 4,200 patients was collected from two academic medical centers. Delirium was assessed with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in all patients. Univariate and multivariate Cox models, logistic regression analysis, and Chi-square Automatic Interaction Detector (CHAID) decision tree modeling were used to explore delirium risk factors.Results: Increased delirium risk as associated with exposed only to artificial light (AL) hazard ratio (HR) 1.84 (95% CI: 1.66-2.044, P<0.001), physical restraint application 1.11 (95% CI: 1.001-1.226, P=0.049), and high nursing care requirements (>8 hours per 8-hour shift) 1.18 (95% CI: 1.048-1.338, P=0.007). Delirium incidence was inversely associated with greater family engagement 0.092 (95% CI: 0.014-0.596, P=0.012), low staff burnout and anticipated turnover scores 0.093 (95% CI: 0.014-0.600, P=0.013), non-ICU length-of-stay (LOS)<15 days 0.725 (95% CI: 0.655-0.804, P<0.001), and ICU LOS ≤15 days 0.509 (95% CI: 0.456-0.567, P<0.001). CHAID modelling indicated that AL exposure and age <65 years conveyed a high risk of delirium incidence, whereas SOFA score ≤11, APACHE IV score >15 and natural light (NL) exposure were associated with moderate risk, and female sex were associated with low risk. More rapid time to delirium onset correlated with baseline sleep disturbance (P=0.049), high nursing care requirements (P=0.019), and prolonged ICU and non-ICU hospital LOS (P<0.001). Delirium recurrence correlated with age>65 years (HR 2.198; %95 CI: 1.101-4.388, P=0.026) and high nursing care requirements (HR 1.978, 95% CI: 1.096-3.569), with CHAID modeling identifying AL exposure (P<0.001) and age >65 years (P=0.032) as predictive variables.Conclusion: Development of ICU delirium correlated with application of physical restraints, high nursing care requirements, prolonged ICU and non-ICU LOS, exposure exclusively to AL (rather than natural), less family engagement, and greater staff burnout and anticipated turnover scores. ICU delirium occurred more rapidly in patients with baseline sleep disturbance, and recurrence correlated with presence of delirium on ICU admission, exclusive AL exposure, and high nursing care requirements.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionsupporting

confidence: 67%

Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

Moghadam

Miller

Rahimi–Bashar

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…1 International studies in different countries show that the use of PR in different countries varies from 0 to 100%. [6][7][8] Depending on geographical location, being 87% in a USA surgical ICU, 9 76% in a Canadian General ICU, 10 and 50% in France. 11 Prevalence was generally lower in Norway ICU, being 14.36%, 12 11% in Germany General ICU, 13 and 7% in Australia.…”

Section: Introductionmentioning

confidence: 99%

The challenges of using physical restraint in intensive care units in Iran: A qualitative study

Salehi

Joolaee

Hajibabaee

et al. 2020

Journal of the Intensive Care Society

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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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“…Careful thought must be given to modifying restraint policies to ensure a fair balance, based on evidence, meeting the above standards and including regular review. Notably, evidence from the US and Europe suggest that physical and mechanical restraints are ineffective at preventing forcible tracheal extubation, and increase the risk of inadequate supervision [41].…”

Section: Patient Carementioning

confidence: 99%

COVID‐19: legal implications for critical care

et al. 2020

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The COVID-19 pandemic has caused an unprecedented challenge for the provision of critical care. Anticipating an unsustainable burden on the health service, the UK Government introduced numerous legislative measures culminating in the Coronavirus Act, which interfere with existing legislation and rights. However, the existing standards and legal frameworks relevant to critical care clinicians are not extinguished, but anticipated to adapt to a new context. This new context influences the standard of care that can be reasonably provided and yields many human rights considerations, for example, in the use of restraints, or the restrictions placed on patients and visitors under the Infection Prevention and Control guidance. The changing landscape has also highlighted previously unrecognised legal dilemmas. The perceived difficulties in the provision of personal protective equipment for employees pose a legal risk for Trusts and a regulatory risk for clinicians. The spectre of rationing critical care poses a number of legal issues. Notably, the flux between clinical decisions based on best interests towards decisions explicitly based on resource considerations should be underpinned by an authoritative public policy decision to preserve legitimacy and lawfulness. Such a policy should be medically coherent, legally robust and ethically justified. The current crisis poses numerous challenges for clinicians aspiring to remain faithful to medicolegal and human rights principles developed over many decades, especially when such principles could easily be dismissed. However, it is exactly at such times that these principles are needed the most and clinicians play a disproportionate role in safeguarding them for the most vulnerable.

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Physical restraints in intensive care–An integrative review

Cited by 81 publications

References 24 publications

Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

Predictors of Delirium Incidence, Time to Onset, and Recurrence in a Mixed Medical-surgical ICU Population: A Secondary Analysis Using Cox and CHIAD Decision Tree Modeling

The challenges of using physical restraint in intensive care units in Iran: A qualitative study

COVID‐19: legal implications for critical care

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