Restraints in intensive care units—A mixed method study

Langley, Gayle; Schmollgruber, Shelley; Egan, Anthony

doi:10.1016/j.iccn.2010.12.001

Cited by 73 publications

(95 citation statements)

References 20 publications

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“…Therefore, in order to implement the Society of Critical Care Medicine guidelines to limit the use of physical restraint, more efforts should be made to alert nursing staff on the harmful effects of using physical restraint and to suggest alternatives. 3,11 One of the strengths of our study is that the study population is a good representation of the Dutch ICU population. A large number of patients were included from 25 ICUs, creating a study sample of a quarter of all Dutch ICUs.…”

Section: Multivariate Univariatementioning

confidence: 99%

“…The scope of the use of physical restraint is still unclear; however; frequencies between 0% and 100% have been reported. 2,[10][11][12][13] In previous studies, 2,10 the frequency of physical restraint was estimated by using surveys, a method that may be subject to bias. In observational studies [11][12][13][14] in which patients were individually examined, few different centers or ICUs were included.…”

mentioning

confidence: 99%

“…2,[10][11][12][13] In previous studies, 2,10 the frequency of physical restraint was estimated by using surveys, a method that may be subject to bias. In observational studies [11][12][13][14] in which patients were individually examined, few different centers or ICUs were included. A recent French investigation 10 indicated that in 82% of ICUs, physical restraint was used at least once during mechanical ventilation in more than 50% of the patients.…”

mentioning

confidence: 99%

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Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

Kooi

Peelen

Raijmakers

et al. 2015

American Journal of Critical Care

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Background Increasing evidence indicates that harmful effects are associated with the use of physical restraint. Objectives To characterize the use of physical restraint in intensive care units. Prevalence, adherence to protocols, and correlates of the use of physical restraint were determined. For comparisons between ICUs, adjustments were made for differences in patients' characteristics. Methods A prospective, cross-sectional, observational multicenter study with a representative sample (n = 25) of all Dutch intensive care units, ranging from local hospitals to academic centers. Each unit was visited twice, and all 379 patients admitted during these visits were included and were examined for use of physical restraint. Results Physical restraint was used in 23% of all patients (range, 0%-56% for different units). Of all 346 nurses interviewed, 31% reported using a protocol when applying physical restraint. When corrections were made for clustering within units, the risk for use of physical restraint was increased in patients with delirium or coma, in patients who could not communicate verbally, and in patients receiving psychoactive or sedative medications. Sex, severity of illness, and nurse to patient ratio were not independently related to use of physical restraint. In 11 units (44%), use of physical restraint was more frequent than expected on the basis of patients' characteristics, although this finding was not significant. Conclusions Physical restraint is frequently used in Dutch intensive care units. The differences in frequency between units suggest that opportunities exist to limit the use of physical restraint.

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Section: Multivariate Univariatementioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

Kooi

Peelen

Raijmakers

et al. 2015

American Journal of Critical Care

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“…Therefore, the use of different types of restraint (physical and chemical) is often seen as simple solutions for agitated patients in ICUs [9]. Also, Nirmalan and colleagues [10] reported that the use of chemical restraints such as anxiolytics and sedatives drugs to facilitate dealing with a patient has benefits in controlling patient's behaviors, although it is associated with the risk of sedation-related psychosis.…”

Section: Introductionmentioning

confidence: 99%

Improving ICU Nurses’ Practices of Physical Restraints in Jordan: Effect of an Educational Program

Nasrate¹,

Shamlawi²,

Darawad³

2017

Health

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Background: Physical Restraint (PR) has been widely used in the intensive care units, which aims to protect patients and maintain their safety. With all benefits of PR, there are many complications and risks from improper utilization. Further, no Jordanian studies have found to educate nurses regarding the proper PR utilization. Purpose: To evaluate the impact of an educational program on nurses' knowledge, attitude and practice regarding PR use in ICUs. Methods: A pre-experiment with one-group pretest-posttest design was used among 40 ICU nurses. A self-administered questionnaire was used to evaluate nurses before the education program and two weeks after its completion. Results: After implementation of the program, nurses demonstrated a significant difference in knowledge scores between pretest (M = 10.35 ± 1.73) and posttest (M = 13.30 ± 1.47) (t = 9.92; df = 39; P = 0.000), attitudes scores (M = 27.90 ± 2.79 vs. M = 30.40 ± 2.32) (t = 4.61; df = 39; P = 0.000), and practice scores (M = 36.85 ± 1.98 vs. M = 40.52 ± 1.60) (t = 11.59; df = 39; P = 0.000). Conclusion: Service-education program can improve ICU nurses' knowledge, and enhance their attitudes and practices towards physical restraint. Such improvement is expected to be reflected in improving the quality of care delivered to the patients, and decreasing complications of malpractice regarding physical restraint.

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“…These injuries include pressure ulcers and nosocomial infections 8,9 as well as bruising, lacerations, nerve injury, and strangulation. 10,11 Bladder and bowel incontinence, decreased cognitive ability and awareness, mobility problems, and increased disorientation have also been associated with physical restraint use, 8 as have feelings of demoralization, isolation, and loss of freedom. 11 Yet, despite these known potential complications, physical restraint use in critical care environments continues both internationally and in the United States.…”

mentioning

confidence: 99%

Nurses’ Attitudes, Clinical Experience, and Practice Issues With Use of Physical Restraints in Critical Care Units

Stinson

2016

American Journal of Critical Care

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Background Physical restraints are more likely to be used in critical care units than in other hospital units because use of invasive procedures and mechanical ventilation is more common in critical care units. Initiation and maintenance of physical restraint devices is largely a nursing responsibility. Previous clinical experience is a variable often suggested to be related to intensive care nurses’ use of physical restraints. Objective To examine the relationships between registered nurses’ clinical experience, their practice issues (nurses’ actions while caring for patients who are physically restrained), and their attitudes toward the use of physical restraints (feelings about use of restraints and about caring for patients who are restrained) in critical care units. Methods In a descriptive correlational study, data were collected online via the Physical Restraint Questionnaire. Participants’ (n = 413) clinical experience was classified by using Patricia Benner’s novice to expert framework. Results No strong correlation was found to explain any variance between attitudes toward use of physical restraints in critical care and clinical experience in nursing in general, clinical experience in critical care, and nursing practice issues with use of physical restraints. However, nurses with more clinical experience were more likely to have learned about use of physical restraints in their basic nursing curriculum. Conclusions The reported lack of content addressing use of physical restraints in today’s nursing curricula is a concern, as physical restraints are commonly used in critical care units.

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Restraints in intensive care units—A mixed method study

Cited by 73 publications

References 20 publications

Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

Use of Physical Restraints in Dutch Intensive Care Units: A Prospective Multicenter Study

Improving ICU Nurses’ Practices of Physical Restraints in Jordan: Effect of an Educational Program

Nurses’ Attitudes, Clinical Experience, and Practice Issues With Use of Physical Restraints in Critical Care Units

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