Use of Physical Restraints in Adult Critical Care: A Bicultural Study

Abstract

• Background Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices.• Objectives To describe the relationship between patients’ characteristics, environment, and use of physical restraints in the United States and Norway.• Methods Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients’ acuity level.• Results Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample.• Conclusions Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.

Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit

“…Variations in practice were found internationally (Benbenbishty et al, 2010;Martin & Mathisen, 2005)…”

“…Clinical acuity and the use of physical restraint were considered in one international study (Martin & Mathisen, 2005). The Nursing…”

“…CAM-ICU-positive patients were also found to receive greater doses of sedation (Micek et al, 2005;Svenningsen et al, 2013). Agitation scores featured in four studies (Luk et al, 2015(Luk et al, , 2014Martin & Mathisen, 2005;Svenningsen et al, 2013). Typically, a higher score indicates greater levels of psychomotor agitation, which was associated with the use of chemical or physical restraint.…”

Physical restraints practice in adult intensive care units in Egypt

“…There are many forms of physical restraints, including wrist, ankle, chest, and waist (Maccioli et al, 2003). Adult ICUs use physical restraints much more than other units (Martin & Marthisen 2005), because critically ill patients may experience confusion or agitation in ICUs (Bray et al, 2004). Furthermore, a critical care environment may increase patients' stress and agitation (Powers, 1999).…”

“…Many studies have reported the adverse effects of physical restraints, including physical and psychological injuries (Morrison et al, 2000;Choi & Song, 2003;Bray et al, 2004;Cotter, 2005). The reported physical injuries include: hypertension, tachycardia, impaired circulation, nerve and skin injury, orthostatic hypotension, urinary and fecal incontinence, edema, pressure ulcers, strangulation, contractures, cardiac arrest, muscle atrophy, and death from asphyxia (Morrison et al, 2000;Cotter, 2005;Martin & Marthisen, 2005). Psychological consequences of restraints involve increased agitation (Eşer et al, 2007), feeling of anger and fear (Rotondi & Chelluri, 2002), and the risk of developing post-traumatic stress disorder (Jones et al, 2007).…”