Impact of a Restraint Management Bundle on Restraint Use in an Intensive Care Unit

Hall, Debra K.; Zimbro, Kathie S.; Maduro, Ralitsa S.; Petrovitch, Deborah; Schneider, Patricia Ver; Morgan, Merri K.

doi:10.1097/ncq.0000000000000273

Cited by 32 publications

(34 citation statements)

References 12 publications

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“…Critical Care Research and Practice among others [1]. Apart from the use of PR in critical care settings, it can result in prolonged hospital stays, complications, and ethical issues as a result of nurses' inadequate knowledge on and negative attitude with improper practices regarding PR use [7,19,27,29] which reduces power from even the most beneficial medical treatments [34]. Improving ICU nurses' knowledge, attitude, and practice on the use of restraining, therefore, is essential to prevent the complications of it and to enhance ICU care services.…”

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confidence: 99%

Nurses’ Knowledge, Attitude, and Influencing Factors regarding Physical Restraint Use in the Intensive Care Unit: A Multicenter Cross-Sectional Study

Kassew

Tilahun

Liyew

2020

Critical Care Research and Practice

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Background. Physical restraint is a common practice in the intensive care units which often result in frequent skin laceration at restraint site, limb edema, restricted circulation, and worsening of agitation that may even end in death. Despite the sensitivity of the problem, however, it is felt that there are nurses’ evidence-based practice gaps in Ethiopia. To emphasize the importance of this subject, relevant evidence is required to develop protocols and to raise evidence-based practices of health professionals. So, this study aimed to assess the knowledge, attitude, and influencing factors of nurses regarding physical restraint use in the intensive care units in northwest Ethiopia. Methods. An institution-based cross-sectional study was maintained from March to September 2019 at Amhara regional state referral hospitals, northwest Ethiopia. A total of 260 nurses in the intensive care units were invited to take part in the study by a convenience sampling technique. The Level of Knowledge, Attitudes, and Practices of Staff regarding Physical Restraints Questionnaire was used to assess the nurses’ knowledge and attitude. Linear regression analysis was employed to examine the influencing factors of knowledge and attitude. Adjusted unstandardized beta (β) coefficient with a 95% confidence interval was used to report the result of association with a p value < 0.05 statistical significance level. Result. The mean scores of nurses’ knowledge and attitude regarding physical restraint use among critically ill patients were 7.81 ± 1.89 and 33.75 ± 6.50, respectively. These mean scores are above the scale midpoint nearer to the higher ranges which imply a moderate level of knowledge and a good attitude regarding physical restraint. Lower academic qualification and short (<2 years) work experience were associated with lower-level of knowledge, and reading about restraint from any source and taken training regarding restraints were factors associated with a higher knowledge. Diploma and bachelor’s in academic qualification were significantly associated with a negative attitude regarding restraint. Besides, there was a more positive attitude among nurses with a higher level of knowledge and who received training regarding physical restraint use. Conclusion. The nurses working in the intensive care unit had a moderate level of knowledge and a good attitude regarding physical restraint use. So, developing and providing educational and in-service training to the nurses regarding physical restraint are necessary to strengthen the quality of care for critically ill patients.

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confidence: 99%

Nurses’ Knowledge, Attitude, and Influencing Factors regarding Physical Restraint Use in the Intensive Care Unit: A Multicenter Cross-Sectional Study

Kassew

Tilahun

Liyew

2020

Critical Care Research and Practice

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“…PR is widely used in intensive care unit settings among critically ill patients' to reduce the risk of a patient's falling, prevent removal of life support equipment and procedures, and reduce the risk of patients harming himself or others among (1). Physically Restrained patients in the ICU encounter prolonged hospital stays and complications results from restraint as a result of nurses' improper practices (behavior) of restraining (6,17,18,31) which reduces power from even the most beneficial medical treatments (32). Improving nurses' practice on the use of restraining, therefore, is crucial to prevent the complication of it and to enhance ICU care service.…”

Section: Discussionmentioning

confidence: 99%

Practice and the Influencing Factors of Nurses Working in the Intensive Care Unit regarding Physical Restraint use: Multi-centered cross-sectional study

Kassew¹,

Tilahun²,

Wudu³

2020

Preprint

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Background: Nurses working in the intensive care unit commonly use physical restraint on critically ill patients. The main reason for the restraining of patients is to prevent the dislodgement of invasive procedures/ medical equipment, reduce agitation. Patients are exposed to different complications from physical restraint like worsening of agitation and delirium, fall injury, limb edema, restricted circulation, and skin laceration at restraint site, and death as a result of nurses’ improper practice regarding restraining. Despite this impact, there was no documented study in Ethiopia in this regard. Objective: To assess practice and its influencing factors of nurses working in the Intensive Care Unit regarding physical restraint Methods: An institution-based cross-sectional study was conducted from July to August 2019 at Amhara regional state referral hospitals, Northwest Ethiopia. All (260) nurses working in the intensive care unit were invited to participate through a convenience sampling technique. Structured questionnaires which consist of socio-demographic, professional characteristics and Level of Knowledge, Attitudes and Practices of Staff Regarding Physical Restraints Questionnaire were used. Simple and multiple linear regression and beta (β) coefficient at 95% confidence interval was employed with p-value<0.05 as statistical significance. Result: The mean score of nurses’ practice regarding physical restraint use among critically ill patients was 30.94±5.44. Nurses with short (≤2 years) experience of the intensive care unit, received educational training during graduate class regarding restraining, knowledge and attitude scores were the factors significantly associated with nurses’ practice score regarding physical restraining use. Conclusion: The practice regarding physical restraint use among critically ill patients among participant nurses’ was a satisfactory. The administrators’ should develop and provide educational and in-service training programs for nurses working in intensive care unit settings regarding physical restraint use and its alternatives, which is crucial for the nurses’ to improve their behavior of restraining. Keywords: Intensive care unit, Nurses’, Practice, Physical restraint

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“…This follows in meaningful results including 30% reduction in restrained and 55% in restraints hours 30 . Besides, Hall et al, 10 developed an evidence-based project called Restraint Management Bundle (RMB) program in critical care setting which was intended to minimize restraint, educating staffs and upgrade patient's quality and safety. Along with, interdisciplinary team members designed a patient-centric strategy to reduce restraint use by patient's characteristics.…”

Section: Alternativesmentioning

confidence: 99%

“…This RMB project succinct provides a frame to manage in reducing restraint, which minimizes harm and gains patient safety 10 . Another Canadian study presented that there is increased ICU nurses' knowledge after the advancing education of the evidence regarding restraint 24 through a PR training plan appeared statistically notable reduction in the use of restraint after one year 14 .…”

Section: 9%) Accompanying the Implementation Of A Programmentioning

confidence: 99%

“…Clinical justification to use PR in ICUs is to support ongoing treatment such as accessing invasive medical devices to avoid unplanned treatment intrusion and potentially life-threatening consequences promoting safety and desired prognosis 4,7,8 . In contrast, PR use in the ICUs is questionable globally 9 because research has shown that restrained patient encounter prolongs hospital stays and complications results from immobility 7 , adverse psychological consequences like agitation, delirium and possibly lethal complication of critical illness 1,10 . Indeed, because of pre-existing medical conditions 11 , critically ill patients itself are highly at risk for the development of agitation and delirium 2 which has been suggested that the prevalence of these problems in ICUs varies hugely in the literature from 15% to 87% 11 .…”

Section: Introductionmentioning

confidence: 99%

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Reducing Physical Restraint Use in Critically Ill Patients

Duwadi

Budal

Hua

2018

Int. j. endorsing health sci. res.

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Background: Patients in critical care setting often encounter severe delirium and agitation putting them at risk of harm. So it has become a common trend to restraint patient physically in intensive care units. However, physical restraint has several adverse physical, psychological and ethical consequences. Awareness regarding significant risk associated with physical restraint, continuing education and skills stabilize the patient's safety and potential complication regarding ethical and legal issues to physical restraint in critical care settings. This study aims to address if any alternatives have been tested regarding physical restraint to improve the patient care for critical care. Methodology: A search conducted using the PubMed, Medline and Google Scholar including physical restraint use in critical care setting from 1994 to 2017. Studies published in English were included whereas articles published in psychiatric care, children and outside the hospital were excluded. The keywords used were critical care, critically ill, ICU patient safety and physical restraint. The Boolean phrases were used to clarify the quality of search results: ''physical restraint & critical care,'' ''physical restraint & critically ill'' ''physical restraint & ICU,'' physical restraint & patient safety.'' Additionally, reference lists of selected papers were then evaluated further. Results: Enhanced knowledge, focused education and continuing training to improve skills in using restraint alternatives, awareness of the risk, early identification, conduct proper institutional policies and guidelines, and proactive intervention is the significant measures in alleviating physical restraint use in critical care settings. Conclusion: A restraint-free environment not only promotes patient safety but also ensure greater caregivers' job satisfaction reducing ethical issues.

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Impact of a Restraint Management Bundle on Restraint Use in an Intensive Care Unit

Cited by 32 publications

References 12 publications

Nurses’ Knowledge, Attitude, and Influencing Factors regarding Physical Restraint Use in the Intensive Care Unit: A Multicenter Cross-Sectional Study

Nurses’ Knowledge, Attitude, and Influencing Factors regarding Physical Restraint Use in the Intensive Care Unit: A Multicenter Cross-Sectional Study

Practice and the Influencing Factors of Nurses Working in the Intensive Care Unit regarding Physical Restraint use: Multi-centered cross-sectional study

Reducing Physical Restraint Use in Critically Ill Patients

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