Establishing Alternatives to Physical Restraint in the Acute Care Setting: A Conceptual Framework to Assist Nursesʼ Decision Making

Abstract

Critical care and acute care nurses must determine ways to deliver optimal patient care without the use of physical restraints. This article explores the application of the clinical decision analysis model to the challenge of finding nonrestraint approaches to care. Clinical decision analysis is a structured, quantified approach for choosing an optimal course of action in a situation that involves tradeoffs among risks and preferences and when outcomes are uncertain. Decision analysis provides a graphic representation of the decision situation that facilitates evaluation of factors relevant to the situation and evaluation of the potential events and outcomes following a chosen strategy. The decision analysis model can be useful for determining guidelines for clinical practices, facilitating discussions among health care providers and patients, and determining areas in need of additional research.

The Future History of Gerontological Nursing

“…Geriatric nursing research has been influential in changing the paradigm for the use of physical restraints in nursing homes and hospitals (25,26), improving the assessment and management of pressure ulcers (27,28), pioneering improvements in assessment and management of urinary incontinence (29), and ensuring appropriate end-of-life care (30,31). In nursing homes, nursing research has led in exploring strategies to improve care for physically and cognitively frail and vulnerable older adults: creating and testing strategies to improve bathing, feeding, and managing difficult and disruptive behaviors (32).…”

Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit: Use of restraining therapies—American College of Critical Care Medicine Task Force 2001–2002

“…The best studied type of patientinitiated treatment interference in the ICU is agitation-related tracheal selfextubation. The reported incidence of self-extubation varies widely, ranging from 2% to 17% of intubated patients (19). The impact of this complication on mortality and morbidity rate has not been well delineated.…”

“…Some authors have suggested that lower caregiver-to-patient ratios increase the use of restraints and related therapies including heavy sedation (19,27,37,38). Some self-extubation studies have observed increased self-extubations in association with decreased nurse staffing ratios (25).…”

Perceptions regarding the use of physical restraints with elderly persons: comparison of Israeli health care nurses and social workers

“…The early 1990s were characterised by publications discussing the results of educational and clinical programmes aimed at reducing the use of physical restraints in long-term care facilities (Bradley et al, 1995;Ejaz et al, 1994;Evans et al, 1997;Neufeld et al, 1995;Schnelle et al, 1992;Werner et al, 1994), and more recently, in acute care settings as well (Barazovski & Rosin, 1997;Cruz et al, 1997;DeSantis et al, 1997;Maruschock, 1996;Minnick et al, 1998;Mion, 1996).…”