Eliciting critical care nurses’ beliefs regarding physical restraint use

Via‐Clavero, Gemma; Sanjuán-Naváis, Marta; Romero-García, Marta; Cueva-Ariza, Laura de la; Martínez-Estalella, G.; Plata-Menchaca, Erika P.; Hito, Pilar Delgado

doi:10.1177/0969733017752547

Cited by 42 publications

(69 citation statements)

References 31 publications

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“…This review adds knowledge regarding the identified rationales and determinants for restraint use in clinical practice and suggests that guidance is not consistently followed. Previous studies have highlighted uncertainties regarding the efficacy of physical restraint in preserving patient safety (Freeman, Yorke, & Dark, ) and the impact of nurses' beliefs on restraint use (Via‐Clavero et al, ). This review builds on these studies by exploring how the decision to apply restraint is made through an identification of patient, nurse and environment‐centred determinants and influences.…”

Section: Discussionmentioning

confidence: 99%

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%

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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“…Most patients in intensive care units (ICUs) suffer from confusion, hallucination, delusion, restlessness, 1 and agitation. 2 They may also show behaviors such as increased mobility, shaking beds, pulling wires and catheters, attempting to get out of the bed, throwing things around, and damaging self and others.…”

Section: Introductionmentioning

confidence: 99%

“…According to the ethical principle of autonomy, the patient should be the main decision-maker for all care-related, diagnostic, and therapeutic interventions, including physical restraint. 1 However, because of the possibility of self-harm and impaired consciousness, clinical decisions for patients in ICUs are usually made through the paternalistic approach. 16 The justification for using this approach is that healthcare providers better know the best decisions.…”

Section: Introductionmentioning

confidence: 99%

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Factors behind ethical dilemmas regarding physical restraint for critical care nurses

et al. 2019

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Background: Physical restraint is among the commonly used methods for ensuring patient safety in intensive care units. However, nurses usually experience ethical dilemmas over using physical restraint because they need to weigh patient autonomy against patient safety. Aim: The aim of this study was to explore factors behind ethical dilemmas for critical care nurses over using physical restraint for patients. Design: This is a qualitative study using conventional content analysis approach, as suggested by Graneheim and Lundman, to analyze the data. Methods: Seventeen critical care nurses were purposefully recruited from the four intensive care units in Tehran, Iran. Data were collected through in-depth semi-structured interviews and were concurrently analyzed through conventional content analysis as suggested by Graneheim and Lundman. Ethical consideration: This study was approved by the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran with the code: IR.IUMS.REC.1397.795. Before interviews, participants were provided with explanations about the aim of the study, the confidentiality of the data, their freedom to participate, and the right to withdraw the study, and their free access to the study findings. Finally, their consents were obtained, and interviews were started. Results: Factors behind ethical dilemmas for critical care nurses over using physical restraint were categorized into three main categories, namely the outcomes of using physical restraint, the outcomes of not using physical restraint, and emotional distress for nurses. The outcomes of using physical restraint were categorized into the three subcategories of ensuring patient safety, physical damage to patients, and mental damage to the patient. The outcomes of not using physical restraint fell into two subcategories, namely the risks associated with not using physical restraint and legal problems for nurses. Finally, the two subcategories of the emotional distress for nurses main category were nurses’ negative feelings about restraint use and uncertainty over the decision on physical restraint use. Conclusion: Decision-making for restraint use is often associated with ethical dilemmas, because nurses need to weight the outcomes of its use against the outcomes of not using it and also consider patient safety and autonomy. Health authorities are recommended to develop clear evidence-based guidelines for restraint use and develop and implement educational and counseling programs for nurses on the principles of ethical nursing practice, patient rights, physical restraint guidelines and protocols, and management of emotional, ethical, and legal problems associated with physical restraint use.

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“…12,17 Nursing students' moral courage seems to develop gradually along with their ethical competence, the development leading towards independent acting in ethical situations. 17 In nursing practice, clinical competence, 2,3 nurses' behavioural and control beliefs, 32 a good ethical climate 3,8,30 and discussion of ethical questions 2 can strengthen moral courage. Furthermore, nurse managers can promote ethical climate by encouraging discussion and collaboration between professionals.…”

Section: Introductionmentioning

confidence: 99%

Analysis of graduating nursing students’ moral courage in six European countries

Koskinen¹,

Pajakoski

Linares

et al. 2020

Nurs Ethics

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Background: Moral courage is defined as courage to act according to one’s own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses’ career. Aim: To analyse graduating nursing students’ moral courage and the factors associated with it in six European countries. Research design: A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed with a single question (visual analogue scale 0–100), the questionnaire also covered several background variables. Participants and research context: The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students’ moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires. Ethical considerations: Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent. Results: The mean of graduating nursing students’ self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0–100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students’ moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves. Discussion and conclusions: In all countries, the graduating nursing students’ moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research.

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Eliciting critical care nurses’ beliefs regarding physical restraint use

Cited by 42 publications

References 31 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

Factors behind ethical dilemmas regarding physical restraint for critical care nurses

Analysis of graduating nursing students’ moral courage in six European countries

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