The effect of physical restraint on neurovascular complications in intensive care units

Ertuğrul, Büşra; Özden, Dilek

doi:10.1016/j.aucc.2019.03.002

Cited by 29 publications

(29 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17 Emotional complications for the patient include fear, depression, and dignity. 18 Besides patients, nurses may also experience emotional, ethical, and mental problems 19 and face negative feelings such as sadness, guilt, and pity due to PR use. 20 Nurses may decide on PR use based on the nonmaleficence principle of ethical practice and in order to ensure patient safety.…”

Section: Introductionmentioning

confidence: 99%

The challenges of using physical restraint in intensive care units in Iran: A qualitative study

Salehi

Joolaee

Hajibabaee

et al. 2020

Journal of the Intensive Care Society

View full text Add to dashboard Cite

Background Physical restraint is widely used in intensive care units to ensure patient safety, manage agitated patients, and prevent the removal of medical equipment connected to them. However, physical restraint use is a major healthcare challenge worldwide. Aim This study aimed to explore nurses' experiences of the challenges of physical restraint use in intensive care units. Methods This qualitative study was conducted in 2018–2019. Twenty critical care nurses were purposively recruited from the intensive care units of four hospitals in Tehran, Iran. Data were collected via in-depth semi-structured interviews, concurrently analyzed via Graneheim and Lundman's conventional content analysis approach, and managed via MAXQDA software (v. 10.0). Findings Three main themes were identified (i) organizational barriers to effective physical restraint use (lack of quality educations for nurses about physical restraint use, lack of standard guidelines for physical restraint use, lack of standard physical restraint equipment), (ii) ignoring patients' wholeness (their health and rights), and (iii) distress over physical restraint use (emotional and mental distress, moral conflict, and inability to find an appropriate alternative for physical restraint). Conclusion Critical care nurses face different organizational, ethical, and emotional challenges in using physical restraint. Healthcare managers and authorities can reduce these challenges by developing standard evidence-based guidelines, equipping hospital wards with standard equipment, implementing in-service educational programs, supervising nurses' practice, and empowering them for finding and using alternatives to physical restraint. Nurses can also reduce these challenges through careful patient assessment, using appropriate alternatives to physical restraint, and consulting with their expert colleagues.

show abstract

Section: Introductionmentioning

confidence: 99%

The challenges of using physical restraint in intensive care units in Iran: A qualitative study

Salehi

Joolaee

Hajibabaee

et al. 2020

Journal of the Intensive Care Society

View full text Add to dashboard Cite

show abstract

“…18,19 In addition, while PR does not significantly reduce unplanned extubation rates, it causes physiological complications such as cutaneous, vascular, neural, and musculoskeletal damage. 4,5,11,[20][21][22][23] The use of PR is also an ethical issue as it affects patient autonomy, dignity, and independence. 24 Despite studies reporting the reduced use of PR, it is still widely used.…”

Section: Introductionmentioning

confidence: 99%

Nurses' knowledge and attitudes regarding physical restraint in Turkish intensive care units

Ertuğrul

Özden

2020

Nursing in Critical Care

Self Cite

View full text Add to dashboard Cite

Background: Physical restraint is still widely used despite studies supporting a reduction in its use. The development of guidelines to reduce the use of PR first requires the identification of factors related to the use of alternative methods.Aim: This study aimed to determine factors associated with the use of alternatives to physical restraint (PR) in intensive care units.Design: This was a cross-sectional descriptive study.Methods: Data were collected from adult intensive care units of three hospitals in Turkey using the Physical Restraint Knowledge, Attitude and Practice Scale and a questionnaire including open-ended questions.Results: Overall, 202 nurses (80% response rate) completed the questionnaire.Nurses' knowledge, attitude, and practice scores regarding PR were 6.89 ± 1.79, 29.85 ± 4.93, and 36.76 ± 3.36, respectively. PR was reported to be necessary for patients at risk of self-harm, with dangerous behaviours, and who were trying to remove their catheters. Most nurses (64.9%) stated that they needed a written doctor's order. Analysis of free-text responses showed that patient disorientation (because of delirium, sedation, or agitation), nurses' workload, and lack of training regarding restraint were the primary reasons why nurses could not use alternatives.The main alternatives suggested by nurses were categorized as sedation, communication, and environmental regulation. Logistic regression analysis identified training (P = .009), working unit (P = .001), and nurses' practice score to use PR (P = .004) as independent risk factors for not using alternative methods of PR. Conclusions:The results of this study revealed a moderate level of knowledge, attitude, and practice among nurses regarding the use of PR. Thus, education of nurses about the prevention of delirium and alternatives to PR according to the characteristics of their units is required.

show abstract

“…On the contrary, some studies have found that PRs do not prevent UE (11,12) and increase its incidence and the likelihood of reintubation (12,13). The related complications caused by PRs include neurovascular complications, such as edema and mobility impairment of restrained limbs (14), an increased incidence of pressure ulcers (15), prolonged length of hospital stay (12), and increased use of benzodiazepines, opioids, and antipsychotics (16), which can incite greater agitation in restrained patients (16). At the same time, PRs are a risk factor for delirium (17,18) and may also increase the incidence of post-traumatic stress disorder after ICU discharge (18), emotional disorders (19), depression, body image disturbance, social isolation, dignity loss, and decline of perceptual and sensory abilities (20).…”

Section: Study Protocolmentioning

confidence: 99%

Protocol for the adaptation of clinical practice guidelines for the management of physical restraints in critically ill patients

et al. 2021

View full text Add to dashboard Cite

Background: The effectiveness of physical restraints (PRs) in the prevention of unplanned extubation has been increasingly questioned, and several countries have developed clinical practice guidelines for reducing the use of PRs. However, some countries, including China, have failed to establish their guidelines, and the adaptation of existing guidelines to local circumstances may be an attractive alternative.Methods: Following the guideline definition of Institute of Medicine, the guideline will be adapted following the CAN-IMPLEMENT©. Guideline scope and clinical questions will be established based on an integrative review, retrospective study, and stakeholder interviews. The guideline's quality will be assessed by the Appraisal of Guidelines for Research and Evaluation II and Appraisal of Guidelines Research and Evaluation-Recommendations Excellence. A systematic review and meta-analysis will be evaluated by A Measurement Tool to Assess Systematic Reviews. The guidelines will meet the criteria of the RIGHT-Ad@ pt Checklist.Discussion: This study describes the proposed protocol for adapting clinical practice guidelines on PRs in critically ill patients. We believe the guideline will help health professionals, especially critical care nurses, deliver safe, high-quality patient care by reducing the implementation of PRs in China.

show abstract

The effect of physical restraint on neurovascular complications in intensive care units

Cited by 29 publications

References 40 publications

The challenges of using physical restraint in intensive care units in Iran: A qualitative study

The challenges of using physical restraint in intensive care units in Iran: A qualitative study

Nurses' knowledge and attitudes regarding physical restraint in Turkish intensive care units

Protocol for the adaptation of clinical practice guidelines for the management of physical restraints in critically ill patients

Contact Info

Product

Resources

About