Patient agitation and its management in adult critical care: A integrative review and narrative synthesis

Freeman, Samantha; Yorke, Janelle; Dark, Paul

doi:10.1111/jocn.14258

Cited by 22 publications

(12 citation statements)

References 37 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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“…Critically ill patients admitted to intensive care units (ICU) often need more invasive operations (e.g., mechanical ventilation and hemodialysis) due to the needs from their condition (4), which can also lead to acute pain, discomfort, sleep deprivation, agitation, and delirium (5). Agitation, for example, can propel patients to resist the ventilator, thus increasing the oxygen consumption, causing them to accidentally remove various devices and catheters on them and even posing life-threatening risks (6). Therefore, the main reason for the use of PR around ICU is to prevent patients from accidentally removing the catheters or devices needed to protect their safety (7).…”

Section: Introductionmentioning

confidence: 99%

“…The definition of PR is "Any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person's body that he/she cannot control or remove easily" (8). Although PR was used to prevent UE, there were many studies that proved PR is one of the risk factors that account for UE and cannot protect patient safety (6,9). Indeed, its use has been proven to cause pressure injuries (10) and worsen agitation (11), delirium (12), and neurovascular complications (13).…”

Section: Introductionmentioning

confidence: 99%

“Patient Comfort Can Be Sacrificed for Patient Safety”—Perception and Practice Reported by Critical Care Nurses Toward Physical Restraints: A Qualitative Descriptive Study

et al. 2021

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Aim: The aim of the study was to explore the perception and practice of physical restraints used by critical care nurses.Design: A qualitative descriptive design was used.Method: From December 2019 to May 2020, a one-to-one, semi-structured in-depth interview with 10 critical care nurses from two intensive care units in a tertiary general hospital with 3,200 beds in China was conducted using the method of purposeful sampling. The data were analyzed using inductive thematic analysis.Findings: The perception of physical restraints among critical care nurses was that patient comfort can be sacrificed for patient safety. Physical restraints protected patient safety by preventing patients from unplanned extubation but influenced patient comfort. Physical restraints were common practice of critical care nurses. Relative physical restraints provided patients with more freedom of movement and rationalization of physical restraints which were the practical strategies.Conclusion: The study identified problems in critical care nurses' perception and practice on physical restraints. Critical care nurses are confident that physical restraints can protect patient safety, and the influence of physical restraints on patient comfort is just like the side effect. Although physical restraints were common practice, critical care nurses still faced dilemmas in the implementation of physical restraints. Relative physical restraints and rationalization of physical restraints help critical care nurses cope with the “bad feelings,” which may also be the cause of unplanned extubation. It is necessary for the adaptation of clinical practice guidelines about physical restraints for critically ill patients in the Chinese context, to change the perception and practice of critical care nurses and deliver safe and high-quality patient care.

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“…These stressors can agitate the patients and increase their anxiety [3,4]. Evidence shows that agitated patients are at increased risk of self-extubation, requiring re-intubation [5,6]. In addition, agitation and anxiety increase patients' needs for opioids and benzodiazepines [5], the interventions that can have significant adverse effects, such as respiratory depression, hypotension, urinary retention, and nausea and vomiting [7].…”

Section: Introductionmentioning

confidence: 99%

The effects of foot reflexology on agitation and extubation time in male patients following coronary artery bypass surgery: A randomized controlled clinical trial

Allahbakhhsian

Gholizadeh

Allahbakhshian

et al. 2020

Complementary Therapies in Clinical Practice

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Background and purpose: This study examined the effects of foot reflexology on agitation and extubation time of male patients following coronary artery bypass graft surgery. Materials and methods:In this randomized three-arm controlled clinical trial, participants (n=120) were randomly assigned to the intervention, placebo, or control groups. The intervention group received foot reflexology massage for 15 minutes. Agitation was assessed using the Richmond Agitation-Sedation Scale before the intervention (Time 1) and immediately (Time 2) and 10 minutes after the intervention (Time 3). Extubation time was measured as the time from gaining full consciousness to endotracheal extubation.Results: Agitation reduced in all groups from Time 1 to Time 3 (p˂0.05); however, the intervention group showed a significantly higher reduction at Time 2 (p<0.001) and Time 3 (p<0.001). Also, extubation time was significantly shorter in the intervention group (p<0.01). Conclusion:Foot reflexology may be introduced as a nursing intervention to facilitate the weaning process in the cardiac ICUs.

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Patient agitation and its management in adult critical care: A integrative review and narrative synthesis

Cited by 22 publications

References 37 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

“Patient Comfort Can Be Sacrificed for Patient Safety”—Perception and Practice Reported by Critical Care Nurses Toward Physical Restraints: A Qualitative Descriptive Study

The effects of foot reflexology on agitation and extubation time in male patients following coronary artery bypass surgery: A randomized controlled clinical trial

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