Manejo de la inmovilización terapéutica en Unidades de Cuidados Críticos: aproximación fenomenológica a la realidad enfermera

Eliciting critical care nurses’ beliefs regarding physical restraint use

“…The use of a questionnaire with open-ended questions has proven to be effective, inasmuch as the majority of aspects reported by other qualitative studies have been included. 3,22,24 Despite the recognised harms regarding the use of physical restraint and their unclear effectiveness to avoid unplanned self-extubation, critical care nurses continue referring to them as safety devices and as means to prevent unplanned treatment interferences. Similar to previous studies, nurses related these safety arguments to environmental factors such as the patient's condition, high workload and staff-shortage.…”

“…Situations involving analgesia and sedation treatment were also reported by Falcó-Pegueroles et al 20 to be a frequent source of ethical conflict in our context. Likewise, Acevedo-Nuevo et al 22 pointed out that in ICUs where physical restraint are frequently applied, the regular use of validated tools to monitor pain, sedation and delirium was not the rule. This study also reflected that nurses' interpretation of patient's behaviour differs depending on the unit workplace and their policies regarding physical restraint use.…”

“…Furthermore, the researchers documented that nurses felt defenceless when they have to use physical restraint, as they perceived that all the applicable options up to them have been exhausted. 22 Studies on physical restraint use in the ICU have focused on prevalence, risk factors and nurses' experiences and practices. 1,3,6,23,24 However, research regarding the effect of social influences on nurses' individual beliefs regarding physical restraint use is not yet well documented.…”

Cuidados a pacientes em uso de oxigenação por membrana extracorpórea

“…It was evidenced, in studies, that there is an instability, mainly of the respiratory parameter, during the execution of the nursing care in patients using ECMO. [25][26] There is a need for cooperation between doctors and nurses in the evaluation of patients who use this device to analyze the tolerance level of nursing care. 26 It was evidenced that the daily nursing care protocol is composed of care such as bed bath and lifting with a scoop stretcher (stretcher that allows patient elevation in order to minimize the mobilization of restricted patients in the bed), allowing performing intimate cleaning and removing dirt, changing endotracheal tube positioning and dressing changes as needed.…”

“…It is noteworthy that the difficult sedation of the patient, besides the intense use of pharmacological strategies, can contribute to the development of nausea, vomiting, hypotension and delirium. 26…”