Elderly patients' reports of physical restraint experiences in intensive care units

2001 ◽  
Vol 10 (3) ◽  
pp. 168-171 ◽  
Author(s):  
A Minnick ◽  
RM Leipzig ◽  
ME Johnson
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Intensive Care Units ◽  
Physical Restraint ◽  
Surgical Intensive Care Unit ◽  
Physical Restraints ◽  
Surgical Intensive Care ◽  
Staff Members ◽  
Well Elderly

BACKGROUND: Use of physical restraints has undesirable sequelae. As they weigh the risks and benefits of protocols for reducing the use of restraints, staff members in intensive care units, where restraints are most used in hospitals, need to know how well elderly patients remember being restrained and how patients perceive the use of restraints. OBJECTIVES: To estimate the proportion of patients who remember being restrained, describe the experience from the patients' perspectives, and describe any distress caused by use of restraints within the overall experience of being in the intensive care unit. METHODS: Transcripts of semistructured, audiotaped interviews of patients who had been in the medical or surgical intensive care unit in any of 3 eastern and midwestern medical centers were analyzed by question and for overall themes. RESULTS: Six patients (40%) remembered some aspect of being restrained but did not report great distress. Patients accepted restraints as needed because of the lack of alternatives. Patients reported remembering that they should not perform certain behaviors but being unable to stop themselves. Patients cited hallucinations and intubation as major stressors in the intensive care unit. Patients' continuing health problems after discharge from the intensive care unit severely limited recruitment of subjects. CONCLUSIONS: Patients do not remember great distress specifically related to the use of restraints, but the overall situation leading to use of restraints is disturbing if remembered. The discovery of methods to reduce the distress of intubation and hallucinations could decrease use of restraints.

scholarly journals Comparative Analysis of Different Methods of Pain Management for Elderly Patients in the Surgical Intensive Care Unit

2017 ◽  
Vol 11 (3) ◽  
pp. 186-190
Author(s):  
Becki Wan-Yu Huang ◽  
Benjamin Ing-Tiau Kuo ◽  
Chien-Chuan Chen ◽  
Wen-Han Chang ◽  
Fang-Ju Sun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Comparative Analysis ◽  
Pain Management ◽  
Elderly Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Using a Decision Wheel to Reduce Use of Restraints in a Medical-Surgical Intensive Care Unit

2016 ◽  
Vol 25 (6) ◽  
pp. 479-486 ◽  
Author(s):  
Stacy Hevener ◽  
Barbara Rickabaugh ◽  
Toby Marsh
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Decision Support ◽  
Intensive Care Units ◽  
Decision Support Tool ◽  
Educational Activity ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Support Tool ◽  
Unplanned Extubations

Background Little information is available on the use of tools in intensive care units to help nurses determine when to restrain a patient. Patients in medical-surgical intensive care units are often restrained for their safety to prevent them from removing therapeutic devices. Research indicates that restraints do not necessarily prevent injuries or removal of devices by patients. Objectives To decrease use of restraints in a medical-surgical intensive care unit and to determine if a decision support tool is useful in helping bedside nurses determine whether or not to restrain a patient. Methods A quasi-experimental study design was used for this pilot study. Data were collected for each patient each shift indicating if therapeutic devices were removed and if restraints were used. An online educational activity supplemented by 1-on-1 discussion about proper use of restraints, alternatives, and use of a restraint decision tool was provided. Frequency of restraint use was determined. Descriptive statistics and thematic analysis were used to examine nurses’ perceptions of the decision support tool. Results Use of restraints was reduced 32%. No unplanned extubations or disruption of life-threatening therapeutic devices by unrestrained patients occurred. Conclusions With implementation of the decision support tool, nurses decreased their use of restraints yet maintained patients’ safety. A decision support tool may help nurses who are undecided or who need reassurance on their decision to restrain or not restrain a patient.

Infection incidence and outcomes in the surgical intensive care unit among elderly patients

2007 ◽  
Vol 205 (3) ◽  
pp. S40 ◽  
Author(s):  
Brian R. Swenson ◽  
Kimberley Popovsky ◽  
Traci Hedrick ◽  
Judy Jenkins ◽  
Shannon McElearney ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Elderly Patients ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Infection Incidence

Feasibility of a Mindfulness-Based Intervention for Surgical Intensive Care Unit Personnel

2017 ◽  
Vol 26 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Beth A. Steinberg ◽  
Maryanna Klatt ◽  
Anne-Marie Duchemin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Work Engagement ◽  
Intervention Group ◽  
Surgical Intensive Care Unit ◽  
Control Group ◽  
Negative Effects ◽  
Surgical Intensive Care ◽  
Utrecht Work Engagement Scale

Background Surgical intensive care unit personnel are exposed to catastrophic situations as they care for seriously injured or ill patients. Few interventions have been developed to reduce the negative effects of work stress in this environment. Objective This pilot study evaluated the feasibility of a workplace intervention for increasing resilience to stress. The intervention was implemented within the unique constraints characteristic of surgical intensive care units. Methods Participants were randomly assigned to an intervention or control group. The mindfulness-based intervention included meditation, mild yoga movement, and music and was conducted in a group format 1 hour a week for 8 weeks in a surgical intensive care unit during work hours. Assessments were performed 1 week before and 1 week after the intervention. Results The intervention was well received, with a 97% overall retention rate and 100% retention in the intervention group. Work satisfaction, measured with the Utrecht Work Engagement Scale, increased significantly in the intervention group with no change in the control group. Negative correlations were found between the vigor subscale scores of the Utrecht Work Engagement Scale and scores for emotional exhaustion on the Maslach Burnout Inventory and scores for burnout on the Professional Quality of Life scale. Participants rated recognizing their stress response as a main benefit of the intervention. Conclusion Workplace group interventions aimed at decreasing the negative effects of stress can be applied within hospital intensive care units. Despite many constraints, attendance at weekly sessions was high. Institutional support was critical for implementation of this program.

Determinants of Nurses’ Use of Physical Restraints in Surgical Intensive Care Unit Patients

2017 ◽  
Vol 26 (5) ◽  
pp. 373-379 ◽  
Author(s):  
Jeanne Dolan ◽  
Sara E. Dolan Looby
Keyword(s):  
Intensive Care Unit ◽  
Content Analysis ◽  
Intensive Care ◽  
Patient Specific ◽  
Surgical Intensive Care Unit ◽  
Physical Restraints ◽  
Surgical Intensive Care ◽  
Critical Thought ◽  
Patients At Risk ◽  
Intensive Care Unit Nurses

Background Physical restraints are used in intensive care units, particularly among patients at risk for self-terminating necessary treatment interventions, including endotracheal tubes and invasive catheters. Assessments conducted by intensive care unit nurses often influence the collaborative decision to initiate and discontinue restraints in critical care patients. However, little is known about factors that influence the critical thought processes of intensive care unit nurses in determining use of restraints. Objectives To describe nurses’ determinants of initiation and discontinuation of restraints in surgical intensive care unit patients. Methods Semistructured interviews were conducted to identify and describe determinants of initiation and discontinuation of physical restraints. Demographic and employment data were collected via questionnaire. Interviews were recorded, transcribed, and analyzed by using conventional content analysis to establish categories and identify themes. Results A total of 13 nurses (mean age 43 [SD, 12] years, 92% female, mean of 18 [SD, 12] years of practice as a registered nurse, 69% bachelor of science in nursing) participated in the study. Content analysis revealed 3 general categories and 8 themes that indicated the thoughtful reflection processes nurses in a surgical intensive care unit use to determine use of restraints. Conclusions Top priorities were ensuring patient safety and comfort. Nurses synthesized factors including practice experience, patient-specific behaviors and risk, and patients’ need for devices in determining use of restraints.

Opinions of nurses on the ethical problems encountered while working as a team in intensive care units

2018 ◽  
Vol 13 (3) ◽  
pp. 120-125
Author(s):  
Oya Ögenler ◽  
Ahmet Dağ ◽  
Havva Doğan ◽  
Talip Genç ◽  
Hürmüs Kuzgun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
University Hospital ◽  
Surgical Intensive Care Unit ◽  
University Graduates ◽  
Surgical Intensive Care ◽  
Ethical Problems ◽  
Item Data ◽  
Intensive Care Unit Nurses

Background The intensive care unit entails working as a team in rescuing patients from life-threatening conditions. The care being given by the team could also be done by nurses and other health professionals through the coordinated use of all medical practices. Objective To determine the opinion of nurses on the ethical problems they experienced while working as a team in the intensive care units of a university hospital. Method The descriptive research was conducted on nurses working in intensive care units (n = 96). A 56-item data collection form consisting of two parts developed by the researchers was used. Frequency (percent) and median were evaluated, and statistical calculations were used for group comparisons. Results Out of the 82 (85.4%) nurses who participated in the study, 65 (82.3%) were university graduates. About 52 (66.7%) of the participants were female with a mean age of 28.12 ± 5.84; 26 (31.6%) had intensive care certification, and 54 (65.1%) had ethical training. The internal intensive care unit nurses were less satisfied with their jobs, able to use tools, said that they had the right to refuse the patient compared to the surgical intensive care unit nurses. Discussion and conclusions: It is a positive situation for the participants to score low with ethical problems based on suggestion as the probability of meeting with their teammates. However, it is important that the problems that affect the motivation of the nurses are different according to the intensive care unit and the employees.

scholarly journals Decreasing Delirium Through Music: A Randomized Pilot Trial

2020 ◽  
Vol 29 (2) ◽  
pp. e31-e38 ◽  
Author(s):  
Sikandar H. Khan ◽  
Chenjia Xu ◽  
Russell Purpura ◽  
Sana Durrani ◽  
Heidi Lindroth ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Controlled Trial ◽  
Pilot Trial ◽  
Median Number ◽  
Assessment Method ◽  
Recruitment Rate ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care

Background Management of delirium in intensive care units is challenging because effective therapies are lacking. Music is a promising nonpharmacological intervention. Objectives To determine the feasibility and acceptability of personalized music (PM), slow-tempo music (STM), and attention control (AC) in patients receiving mechanical ventilation in an intensive care unit, and to estimate the effect of music on delirium. Methods A randomized controlled trial was performed in an academic medical-surgical intensive care unit. After particular inclusion and exclusion criteria were applied, patients were randomized to groups listening to PM, relaxing STM, or an audiobook (AC group). Sessions lasted 1 hour and were given twice daily for up to 7 days. Patients wore noise-canceling headphones and used mp3 players to listen to their music/audiobook. Delirium and delirium severity were assessed twice daily by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and the CAM-ICU-7, respectively. Results Of the 1589 patients screened, 117 (7.4%) were eligible. Of those, 52 (44.4%) were randomized, with a recruitment rate of 5 patients per month. Adherence was higher in the groups listening to music (80% in the PM and STM groups vs 30% in the AC group; P = .01), and 80% of patients surveyed rated the music as enjoyable. The median number (interquartile range) of delirium/coma-free days by day 7 was 2 (1-6) for PM, 3 (1-6) for STM, and 2 (0-3) for AC (P = .32). Median delirium severity was 5.5 (1-7) for PM, 3.5 (0-7) for STM, and 4 (1-6.5) for AC (P = .78). Conclusions Music delivery is acceptable to patients and is feasible in intensive care units. Further research testing use of this promising intervention to reduce delirium is warranted.

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