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

2020 ◽  
pp. 175114371989278
Author(s):  
Zahra Salehi ◽  
Soodabeh Joolaee ◽  
Fatemeh Hajibabaee ◽  
Tahereh Najafi Ghezeljeh
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Qualitative Study ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Structured Interviews ◽  
Standard Equipment ◽  
Restraint Use ◽  
Ensure Patient Safety

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.

Eliciting critical care nurses’ beliefs regarding physical restraint use

2018 ◽  
Vol 26 (5) ◽  
pp. 1458-1472 ◽  
Author(s):  
Gemma Via-Clavero ◽  
Marta Sanjuán-Naváis ◽  
Marta Romero-García ◽  
Laura de la Cueva-Ariza ◽  
Gemma Martínez-Estalella ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Theory Of Planned Behaviour ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Control Beliefs ◽  
Physical Restraints ◽  
Planned Behaviour ◽  
Restraint Use ◽  
And Control

Background: Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses’ intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses’ beliefs regarding the use of physical restraints would provide additional social information about nurses’ intention to perform this practice. Aim: To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. Research design: A belief elicitation study was conducted. Participants and research context: Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. Ethical considerations: Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. Findings: Nurses framed the use of restraints as a way of prioritising patients’ physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients’ relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients’ medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. Discussion: Safety arguments based on the surrounding work environment were discussed. Conclusion: Nurses’ behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives’ involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

Factors behind ethical dilemmas regarding physical restraint for critical care nurses

2019 ◽  
Vol 27 (2) ◽  
pp. 598-608 ◽  
Author(s):  
Zahra Salehi ◽  
Tahereh Najafi Ghezeljeh ◽  
Fatemeh Hajibabaee ◽  
Soodabeh Joolaee
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Content Analysis ◽  
Intensive Care ◽  
Ethical Dilemmas ◽  
Physical Restraint ◽  
Critical Care Nurses ◽  
Legal Problems ◽  
Restraint Use ◽  
Conventional Content Analysis

Background: Physical restraint is among the commonly used methods for ensuring patient safety in intensive care units. However, nurses usually experience ethical dilemmas over using physical restraint because they need to weigh patient autonomy against patient safety. Aim: The aim of this study was to explore factors behind ethical dilemmas for critical care nurses over using physical restraint for patients. Design: This is a qualitative study using conventional content analysis approach, as suggested by Graneheim and Lundman, to analyze the data. Methods: Seventeen critical care nurses were purposefully recruited from the four intensive care units in Tehran, Iran. Data were collected through in-depth semi-structured interviews and were concurrently analyzed through conventional content analysis as suggested by Graneheim and Lundman. Ethical consideration: This study was approved by the Ethics Committee of Iran University of Medical Sciences, Tehran, Iran with the code: IR.IUMS.REC.1397.795. Before interviews, participants were provided with explanations about the aim of the study, the confidentiality of the data, their freedom to participate, and the right to withdraw the study, and their free access to the study findings. Finally, their consents were obtained, and interviews were started. Results: Factors behind ethical dilemmas for critical care nurses over using physical restraint were categorized into three main categories, namely the outcomes of using physical restraint, the outcomes of not using physical restraint, and emotional distress for nurses. The outcomes of using physical restraint were categorized into the three subcategories of ensuring patient safety, physical damage to patients, and mental damage to the patient. The outcomes of not using physical restraint fell into two subcategories, namely the risks associated with not using physical restraint and legal problems for nurses. Finally, the two subcategories of the emotional distress for nurses main category were nurses’ negative feelings about restraint use and uncertainty over the decision on physical restraint use. Conclusion: Decision-making for restraint use is often associated with ethical dilemmas, because nurses need to weight the outcomes of its use against the outcomes of not using it and also consider patient safety and autonomy. Health authorities are recommended to develop clear evidence-based guidelines for restraint use and develop and implement educational and counseling programs for nurses on the principles of ethical nursing practice, patient rights, physical restraint guidelines and protocols, and management of emotional, ethical, and legal problems associated with physical restraint use.

scholarly journals Nurses’ Knowledge, Attitude, and Influencing Factors regarding Physical Restraint Use in the Intensive Care Unit: A Multicenter Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Tilahun Kassew ◽  
Ambaye Dejen Tilahun ◽  
Bikis Liyew
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Influencing Factors ◽  
Physical Restraint ◽  
Cross Sectional ◽  
Restraint Use ◽  
Academic Qualification ◽  
Level Of Knowledge ◽  
Knowledge And Attitude ◽  
Nurses Knowledge

Background. Physical restraint is a common practice in the intensive care units which often result in frequent skin laceration at restraint site, limb edema, restricted circulation, and worsening of agitation that may even end in death. Despite the sensitivity of the problem, however, it is felt that there are nurses’ evidence-based practice gaps in Ethiopia. To emphasize the importance of this subject, relevant evidence is required to develop protocols and to raise evidence-based practices of health professionals. So, this study aimed to assess the knowledge, attitude, and influencing factors of nurses regarding physical restraint use in the intensive care units in northwest Ethiopia. Methods. An institution-based cross-sectional study was maintained from March to September 2019 at Amhara regional state referral hospitals, northwest Ethiopia. A total of 260 nurses in the intensive care units were invited to take part in the study by a convenience sampling technique. The Level of Knowledge, Attitudes, and Practices of Staff regarding Physical Restraints Questionnaire was used to assess the nurses’ knowledge and attitude. Linear regression analysis was employed to examine the influencing factors of knowledge and attitude. Adjusted unstandardized beta (β) coefficient with a 95% confidence interval was used to report the result of association with a p value < 0.05 statistical significance level. Result. The mean scores of nurses’ knowledge and attitude regarding physical restraint use among critically ill patients were 7.81 ± 1.89 and 33.75 ± 6.50, respectively. These mean scores are above the scale midpoint nearer to the higher ranges which imply a moderate level of knowledge and a good attitude regarding physical restraint. Lower academic qualification and short (<2 years) work experience were associated with lower-level of knowledge, and reading about restraint from any source and taken training regarding restraints were factors associated with a higher knowledge. Diploma and bachelor’s in academic qualification were significantly associated with a negative attitude regarding restraint. Besides, there was a more positive attitude among nurses with a higher level of knowledge and who received training regarding physical restraint use. Conclusion. The nurses working in the intensive care unit had a moderate level of knowledge and a good attitude regarding physical restraint use. So, developing and providing educational and in-service training to the nurses regarding physical restraint are necessary to strengthen the quality of care for critically ill patients.

scholarly journals Predictors of physical restraint use in Canadian intensive care units

Critical Care ◽  
2014 ◽  
Vol 18 (2) ◽  
pp. R46 ◽  
Author(s):  
Elena Luk ◽  
Barbara Sneyers ◽  
Louise Rose ◽  
Marc M Perreault ◽  
David R Williamson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Restraint Use

Critical care nurses provide their perspectives of patients' symptoms in intensive care units

Heart & Lung ◽  
2008 ◽  
Vol 37 (6) ◽  
pp. 466-475 ◽  
Author(s):  
Kathleen A. Puntillo ◽  
Deborah Smith ◽  
Shoshana Arai ◽  
Nancy Stotts
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Critical Care Nurses

scholarly journals Professional Stress and Health among Critical Care Nurses in Serbia

2012 ◽  
Vol 63 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Dragana Milutinović ◽  
Boris Golubović ◽  
Nina Brkić ◽  
Bela Prokeš
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Somatic Symptoms ◽  
Critical Care Nurses ◽  
Working Environment ◽  
Stress Factors ◽  
Sample Population ◽  
Professional Stress ◽  
Stress And Health

Professional Stress and Health among Critical Care Nurses in SerbiaThe aim of this study was to identify and analyse professional stressors, evaluate the level of stress in nurses in Intensive Care Units (ICU), and assess the correlation between the perception of stress and psychological and somatic symptoms or diseases shown by nurses. The research, designed as a cross-sectional study, was carried out in the Intensive Care Units (ICU), in health centres in Serbia. The sample population encompassed 1000 nurses. Expanded Nursing Stress Scale (ENSS) was used as the research instrument. ENSS revealed a valid metric characteristic within our sample population. Nurses from ICUs rated situations involving physical and psychological working environments as the most stressful ones, whereas situations related to social working environment were described as less stressful; however, the differences in the perception of stressfulness of these environments were minor. Socio-demographic determinants of the participants (age, marital status and education level) significantly affected the perception of stress at work. Significant differences in the perception of stressfulness of particular stress factors were observed among nurses with respect to psychological and somatic symptoms (such as headache, insomnia, fatigue, despair, lower back pain, mood swings etc.) and certain diseases (such as hypertension, myocardial infarction, stroke, diabetes mellitus etc). In view of permanent escalation of professional stressors, creating a supportive working environment is essential for positive health outcomes, prevention of job-related diseases and better protection of already ill nurses.

scholarly journals Ethical Issues Recognized by Critical Care Nurses in the Intensive Care Units of a Tertiary Hospital during Two Separate Periods

2015 ◽  
Vol 30 (4) ◽  
pp. 495 ◽  
Author(s):  
Dong Won Park ◽  
Jae Young Moon ◽  
Eun Yong Ku ◽  
Sun Jong Kim ◽  
Young-Mo Koo ◽  
...  
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Ethical Issues ◽  
Tertiary Hospital ◽  
Critical Care Nurses

Physical restraint use in intensive care units across Europe: The PRICE study

2010 ◽  
Vol 26 (5) ◽  
pp. 241-245 ◽  
Author(s):  
Julie Benbenbishty ◽  
Sheila Adam ◽  
Ruth Endacott
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Restraint Use

scholarly journals Nurses’ Views on the Use of Physical Restraints in Intensive Care: A Qualitative Study

2021 ◽  
Vol 18 (18) ◽  
pp. 9646
Author(s):  
Federica Canzan ◽  
Elisabetta Mezzalira ◽  
Giorgio Solato ◽  
Luigina Mortari ◽  
Anna Brugnolli ◽  
...  
Keyword(s):  
Intensive Care ◽  
Family Involvement ◽  
Care Setting ◽  
Physical Restraint ◽  
Intensive Care Setting ◽  
Physical Restraints ◽  
Structured Interviews ◽  
Psychosocial Effects ◽  
Restraint Use ◽  
The Many

Despite the worldwide promotion of a “restraint-free” model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses’ feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient’s bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person.

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