Physical restraint precipitates delirium in stroke patients

Rollo, Eleonora; Callea, Antonio; Brunetti, Valerio; Vollono, Catello; Marotta, Jessica; Marca, Giacomo Della

doi:10.1016/j.jns.2020.117290

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…In addition to these sources of discomfort, it is reasonable to underline that subjects with H-CPAP have extreme limitations of movements and therefore resistance may be encountered when the subject is asked to switch to prone position. Movement limitation is a known precipitating factor for delirium development as shown by recent works addressing that physical restraint and prohibited self-transfer may favor delirium occurrence [ 36 – 39 ]. Overall, our study suggests that the patient’s discomfort may play a role in favoring the onset of delirium.…”

Section: Discussionmentioning

confidence: 99%

Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

et al. 2022

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Delirium is an acute confusional state characterized by altered level of consciousness and attention. Coronavirus Disease 2019 , caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), can manifest itself with this neuropsychiatric disorder. The endpoints of our study were: the frequency of delirium in subjects with COVID-19 pneumonia; the risk factors that predispose to this condition; and the impact of delirium on mortality. Subjects were consecutively enrolled in a Geriatric Unit from January 5th to March 5th, 2021. Inclusion criteria were: diagnosis of SARS-CoV-2 infection, a radiologically documented pneumonia, and the ability of providing informed consent. Exclusion criteria were: absence of radiological evidence of pneumonia, sepsis, and the need of intensive care unit treatment. All subjects were evaluated by means of Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method-Intensive Care Unit (CAM-ICU) at least twice per day. In the study cohort (n = 71), twenty patients (28.2%) had delirium. Delirium was present on admission in 11.3%, and occurred during hospitalization in 19.0%. Compared to patients without delirium, patients who developed this neuropsychiatric disorder had a higher mortality rate (35% vs 5.9%) and an increased average hospital length of stay (21 days vs 17 days). In the multivariate analysis delirium was associated with frailty (OR = 2.81; CI = 1.4-5.8) and helmet ventilation (OR = 141.05; CI = 4.3-4663.9). Delirium was an independent predictor of mortality. Nearly a third of subjects (28.2%) had delirium during hospitalization for COVID-19. This finding supports the notion that delirium is a common complication of SARS-CoV2 infection. Since delirium is associated with longer hospital stay, and it is an independent marker of increased mortality, clinicians should assess and prevent it.

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Section: Discussionmentioning

confidence: 99%

Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

et al. 2022

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“…Accordingly, the use of PR by family caregivers to avoid interruption of nasogastric tube feeding, limit in-bed movement, and manage agitation in this study confirmed their need for information. On the other hand, patients in the study may have experienced delirium (Holmgren et al, 2020; Matano et al, 2017; Matsuzono et al, 2020; Rollo et al, 2021). It has been reported in the literature that PR leads to the development of delirium during acute stroke (Nakamizo et al, 2021; Rollo et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, patients in the study may have experienced delirium (Holmgren et al, 2020; Matano et al, 2017; Matsuzono et al, 2020; Rollo et al, 2021). It has been reported in the literature that PR leads to the development of delirium during acute stroke (Nakamizo et al, 2021; Rollo et al, 2021). In this regard, it is recommended that multicomponent approaches including PR practice and non-pharmacological-prevention interventions should be employed to reduce stress levels and prevent delirium in patients with stroke (Matsuzono et al, 2020; Nakamizo et al, 2021; Rollo et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies have focused on home or nursing home care, and a number of these studies are dated. In addition, studies on the management of agitation in patients with stroke in the literature have focused on delirium (Matsuzono et al, 2020; Nakamizo et al, 2021; Rollo et al, 2021). There is a need to establish practice-level recommendations that include the role of family caregivers in managing PR in stroke care.…”

Section: Introductionmentioning

confidence: 99%

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Physical Restraint Experiences of Family Caregivers of Patients With Stroke in Turkey: A Qualitative Study

Ertuğrul

Özden

2022

Clin Nurs Res

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The purpose of this study was to explore the experiences and needs of family caregivers of stroke patients who require physical restraints. The themes and sub-themes that emerged included “the reason for the use of PR” (disruptive behaviors of the patient and personal reasons of caregivers), “the turmoil of having to use PR” (inevitableness, comparing benefits and harms, the emotional effect of PR, and physical effects), and “unmet needs and suggestions” (unmeet needs and suggestions). Nurses should take the experiences of patient relatives into account in the process of PR application, organize training programs, and determine application standards for PR.

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“…However, some studies have shown that improper use of restraint can not only fail to achieve the purpose of protection but also have many adverse effects on the physical and mental health of elderly individuals, such as urinary incontinence, asphyxia, falls, limb dysfunction, aggravation of cognitive impairment, increased dependence on others, decline in daily life abilities, and induced delirium in stroke patients (12)(13)(14)(15). Moreover, physical restraint has negative psychological effects on elderly individuals, such as causing embarrassment, loss of dignity, isolation, anxiety, and other negative emotions (16).…”

Section: Introductionmentioning

confidence: 99%

Knowledge, Attitude, and Practice of Nursing Home Staff Regarding Physical Restraint in China: A Cross-Sectional Multicenter Study

Wang

et al. 2022

Front. Public Health

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BackgroundRestraint is widely used in nursing homes to address safety concerns. However, many studies have shown that improper restraint can lead to many adverse outcomes. Nursing staff are the main practitioners of physical restraint in nursing homes and play an important role in restraint decision-making and management. In China, there is still a lack of large-scale surveys on the current situation regarding the use of restraint. This study aimed to identify this situation and the influencing factors of the knowledge, attitude, and practice of nursing staff regarding physical restraint in elderly care institutions.MethodsA cross-sectional multicenter descriptive study was conducted. A total of 311 staff in 25 elderly care institutions in Zhejiang Province were recruited using a quota sampling method. A homemade questionnaire was administered to collect general information and information on knowledge, attitude and practice regarding physical restraint.ResultsThe average scoring rates of the knowledge and attitude dimensions of the 311 staff were 48.7 and 75.6%, respectively. The average scoring rate of the practice dimension of 140 staff who implemented restraint was 80.1%. Educational background and training experience were the influencing factors of restraint knowledge. Training experience, educational background and professional title were the influencing factors of restraint attitude. Restraint knowledge and length of service were the influencing factors of restraint practice.ConclusionsKnowledge of physical restraint among nursing staff is not promising. Their attitude toward restraint was inappropriate or irresponsible in some aspects. Restraint practice is not sufficiently standardized. It is necessary to strengthen restraint training for nursing staff to improve their overall level of restraint knowledge, attitude and practice.

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Physical restraint precipitates delirium in stroke patients

Cited by 10 publications

References 9 publications

Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

Delirium in hospitalized patients with COVID-19 pneumonia: a prospective, cross-sectional, cohort study

Physical Restraint Experiences of Family Caregivers of Patients With Stroke in Turkey: A Qualitative Study

Knowledge, Attitude, and Practice of Nursing Home Staff Regarding Physical Restraint in China: A Cross-Sectional Multicenter Study

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