Reducing Physical Restraint Use in Critically Ill Patients

Abstract

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.

Effect of Clinical Pathway Application on Stroke Patients’ Outcomes

“…The current study reported that; existence of improvement in stroke severity among study group than control group at third and fourth measurements by proper application of care pathway; this result supported by [21] they documented that; proper identification of stroke severity is an indicator for appropriate planned care by neurologists and neuroscience nurses, wherever they observing and changes in the patient's neurological status and measuring stroke severity for early recovery and improving from stroke. On the other hand the improvement in stroke severity among study group occurred by the effect application clinical pathway which included performing of coma arousal technique; this result supported by [22] and [23] they reported that; proper nursing care and application of coma arousal technique decreased occurrence of physiological parameters adverse events by. The researcher explained that; the stroke severity among study group decreased by application of planned care and closed follow up via clinical pathway team.…”

Comparison of SAPS III and SOFA score for the prediction of mortality among ICU patients.

“…The negative effect of older age and other associated factors, including diagnosis at admission, comorbidities and functional status, has been recognized in numerous studies [2][3][4][5][6][7] . Hence, these factors together are better at predicting ICU outcomes than the age alone 8,9,10 . The instruments used are sophisticated, but still, the morbidity and mortality rates are very high.…”

Assessment of Nurses' Performance Regarding Physical Restraining in Intensive Care Units

“…Clinical justification to use PR in intensive care units is to support ongoing treatment such as accessing invasive medical devices and to avoid unplanned treatment intrusion (Duwadi, et al, 2019).…”

“…Without a doubt, the use of restraint techniques in ICUs is for the protection of the patients, reducing the possibility of intentional as well as unintentional removal of medical equipment. Help the patient who refuses to cooperate with bedside procedures as well (Duwadi, et al, 2019).…”