Physical restraint in geriatric psychology

The use of physical restraint is a fact which we confront in everyday practice. The objective of this article is to establish some basic operating guidelines in order to prevent the use of physical restraint and which procedures to follow when its use is unavoidable. The authors describe some adequate instances when use of physical restraint may be required and they identify different methods and their procedures. Its use may cause a series of complications, specific risks and general risks, which one needs be aware of in order to prevent them. Considering the importance of having protocols for all these aspects in each center, the authors propose the contents on a clinical report sheet to facilitate a good control of the restraint used for each patient. This article was submitted as an oral report at the 8th Congress of the Catalonian-Balearic Geriatrics and Gerontology Association and at the 4th Conference of Current Practices in Psycho-Geriatrics.     

ICU患者身体约束现状及问题分析

目的了解目前临床ICU患者身体约束及护理现状,并分析存在的问题。方法通过查阅病例及身体约束相关护理文件获得患者资料,观察目前临床针对患者身体约束的评判依据、采取的约束方法、约束时间等,并参考临床实践指南相关指标,分析其差距及存在的问题。结果共纳入231例患者,其中64例患者使用身体约束,约束使用率为27.7%,约束总时长为7 906 h,平均约束时长为123.5 h,约束工具全部为约束带。在身体约束护理方面,医嘱与执行不相符合率为18.0%,护士在使用身体约束前均未使用评估工具进行评估。结论 ICU患者身体约束存在约束方法欠规范,缺乏适时有效的评估等问题,还需进一步规范约束方法,正确评估约束适用对象,提高约束效果,进而改善患者健康结局。     

Physical restraint and subcutaneous hematoma in an anticoagulated patient

A large subcutaneous hematoma extending from the breastbone region to the left axillary region and left flank developed in a 86-year-old anticoagulated man because of repeated microtrauma from a physical restraint used to prevent his rising from a chair. Physicians, nurses, and physiotherapists should recognize that physical restraints causing pressure on the skin increase hemorrhagic risk in patients who take low molecular weight heparin. Accordingly, they should systematically check for hemorrhagic complications and attempt to limit the use of such devices.     

Physical restraint in mental health nursing: A concept analysis

ObjectivePhysical restraint is frequently used in medical services, such as in mental health settings, intensive care units and nursing homes, but its nature varies in different institutions. By reviewing related literature, this study aims to clarify the concept of physical restraint in mental health nursing.MethodThree databases (PubMed, PsycINFO and CINAHL) were retrieved, and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.ResultsPhysical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement. It should be the last option used by qualified personnel. Antecedents of physical restraint are improper behavior (violence and disturbance) of patients, medical assessment prior to implementation and legislation governing clinical usage. Consequences of physical restraint are alleviation of conflict, physical injury, mental trauma and invisible impact on the institution.DiscussionThis study defined the characteristics of physical restraint in mental health nursing. The proposed concept analysis provided theoretical foundation for future studies.     

Physical restraint during procedures: issues and implications for practice.

Physical restraint or holding down a child or young person with cancer is generally accepted to ensure success in carrying out the various procedures involved throughout the disease trajectory. Over the past several years, health care staff have become more aware of the issues surrounding physical restraint. However, the research around the effects of being involved in physical restraint is extremely limited. Nurses continue to have little education in the pertinent issues, restraint techniques, and alternative strategies. This article aims to highlight areas that nurses caring for children and young people with cancer need to consider. Strategies for improving practice are also discussed with the thought that nurses will be stimulated to re-evaluate the use of physical restraint in this group of children and young people.     

Physical restraint of the hospitalized elderly: perceptions of patients and nurses

Twenty elderly restrained patients and their primary nurses (N = 18) were studied to determine (a) the subjective impact of physical restraints on the patient and (b) the nurses' beliefs about use of restraints. Despite reported cognitive impairments, patients vividly described anger, discomfort, resistance, and fear in response to the experience of physical restraint. The decision to restrain posed a conflict between protection of the patient and beliefs about professional behavior for the nursing staff. Lack of interdisciplinary collaboration in decisions to use a physical restraint was also apparent. The findings suggest that the use of physical restraint is not a benign practice and support the need for developing alternatives more consistent with professional practice and quality care.     

Physical restraint in mechanically ventilated ICU patients: a survey of French practice

Purpose

To characterize the perceived utilization of physical restraint (PR) in mechanically ventilated intensive care unit (ICU) patients and to identify clinical and structural factors influencing PR use.

Methods

A questionnaire was personally handed to one intensivist in 130 ICUs in France then collected on-site 2?weeks later.

Results

The questionnaire was returned by 121 ICUs (response rate, 93?%), 66?% of which were medical-surgical ICUs. Median patient-to-nurse ratio was 2.8 (2.5?C3.0). In 82?% of ICUs, PR is used at least once during mechanical ventilation in more than 50?% of patients. In 65?% of ICUs, PR, when used, is applied for more than 50?% of mechanical ventilation duration. Physical restraint is often used during awakening from sedation and when agitation occurs and is less commonly used in patients receiving deep sedation or neuromuscular blockers or having severe tetraparesis. In 29?% of ICUs, PR is used in more than 50?% of awake, calm and co-operative patients. PR is started without written medical order in more than 50?% of patients in 68?% of ICUs, and removed without written medical order in more than 50?% of patients in 77?% of ICUs. Only 21?% of ICUs have a written local procedure for PR use.

Conclusions

This survey in a country with a relatively high patient-to-nurse ratio shows that PR is frequently used in patients receiving mechanical ventilation, with wide variations according to patient condition. The common absence of medical orders for starting or removing PR indicates that these decisions are mostly made by the nurses.     

Physical restraint reduction in the acute rehabilitation setting: a quality improvement study.

A prospective, continuous quality improvement study was implemented at a hospital on two rehabilitation units: stroke and brain injury. The purpose of the study was to decrease restraint use by 25% and to maintain fall rates no greater than 10% over baseline. A multi-component restraint reduction program was implemented that focused on administrative support, education, consultation, and feedback. Monthly restraint rates and fall rates were monitored and compared to the previous year's rates. Both units reduced restraint use. Importantly, this reduction was accomplished at the same time as a decline in fall rates.     

Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff

Background

Physical restraint in psychiatric units is a common practice but extremely controversial and poorly evaluated by methodologically appropriate investigations. The cultural issues and professionals' perceptions and attitudes are substantial contributors to the frequency of restraint that tend to be elevated.AimIn this qualitative study, we aimed to understand the experiences and perceptions of nursing staff regarding physical restraint in psychiatric units.

Physical restraint use among nursing home residents: A comparison of two data collection methods

Background  

In view of the issues surrounding physical restraint use, it is important to have a method of measurement as valid and reliable as possible. We determined the sensitivity and specificity of physical restraint use a) reported by nursing staff and b) reviewed from medical and nursing records in nursing home settings, by comparing these methods with direct observation.