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

Abstract

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.

Nurses Practice and Influencing Factors regarding Physical Restraint use in the Intensive Care Units in Northwest Ethiopia

“…On the other hand, the level of nurses' practice in this study is lower than those of other studies done in Sakarya and Konya, Turkey, and the United States (25,26,41). The reason for the variation might be the participants in those studies were got ongoing in-service training and the hospitals have guideline regarding restraining; on the opposite in our setting, there are insufficient policies and guidelines on restraint use, and no one has received inservice training that results in a certain improper clinical practice.…”

“…Inappropriate nurses' practice regarding PR use is common in ICUs with the prevalence rate range 1.7%-75% (22)(23)(24)(25). According to the different literatures report, the mean score of nurses' practices ranges from 17.08 to 45.44 (14,24,26). Physically restrained patients in the ICU may encounter adverse psychological and physical consequences such as skin edema, laceration and pain at the restrained site, respiratory distress, worsening of agitation or delirium, and neurovascular complications that may end with death (8,(27)(28)(29).…”

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

“…The nurses' practices mean score of this study is lower than the study held in Turkey and United States (16,19,31). The difference of this result might be most of the participants in those studies were got In-service training and the presence of hospitals guideline regarding physical restraint but there is no one who had took In-service training and absence of guidelines regarding PR for the care of critically ill patients.…”

“…This causes a high rate of complications associated with PR due to insufficient use (17,18). According to different published studies report, the mean score of practice range 17.08-45.44 (8,15,19)Researches showed, restrained patients in the ICU encounter prolonged hospital stays and adverse psychological and physical consequences like agitation, aggression, limb edema, and skin laceration at restraint site, and fall which resulted in a poor quality of health care system (7,20,21). Different studies (22)(23)(24)(25), have shown, more than half of critically ill patients have restrained and they faced complications from PR due to improper practice of nurses on it.…”

The Effects of an Advanced Movable Restraint Design on the Elderly Residents at Long-Term Care Facilities in Taiwan

“…Meanwhile, bedsores that occur during the application of invasive tubes, such as nasogastric and urinary catheters, are significantly correlated with the use of restraints (Raguan, Wolfovitz, & Gil, 2015). Limited movement and reduced interaction with the external world cause such complications as sensory disturbances, reduced ranges of activity, variations in muscle strength, and urinary and fecal incontinence, and may even lead to death in severe cases (Stinson, 2016;Eskandari, Abdullah, Zainal, & Wong, 2018). The use of physical restraints leads to poorer cognitive and activities of daily living (ADL) performance and higher dependence in daily life, and increases the likelihood of falls, pressure sores, and urinary and fecal incontinence (Stinson, 2016;Hofmann & Hahn, 2014).…”