Physical restraint intervention in the intensive care unit: An observational pilot study

Gülendam Hakverdioğlu Yönt; Süreyya Bulut; Maria Müller-Staub; Hüseyin Kizilirmak

doi:10.1111/2047-3095.12468

Physical restraint intervention in the intensive care unit: An observational pilot study

Int J Nurs Knowl. 2024 May 9. doi: 10.1111/2047-3095.12468. Online ahead of print.

Authors

Gülendam Hakverdioğlu Yönt¹, Süreyya Bulut², Maria Müller-Staub³, Hüseyin Kizilirmak⁴

Affiliations

¹ Department of Nursing Fundamentals , Faculty of Health Sciences, İzmir Tınaztepe University, Izmir, Turkey.
² Department of Nursing Fundamentals, Faculty of Nursing, Aydın Adnan Menderes University, Aydın, Turkey.
³ Pflege PBS, Wil, Switzerland.
⁴ Sarıyer Hamidiye Etfal Training and Research Hospital, Anesthesia and Reanimation Intensive Care Unit, Nursing, Istanbul, Turkey.

PMID: 38725225
DOI: 10.1111/2047-3095.12468

Abstract

Purpose: Physical restraint (PR) is applied for patients' safety and to prevent the removal of inserted devices. No matter how well applied, PR causes undesired effects and discomfort to patients. Because PR-Guidelines are not yet implemented in Turkey, an observational study was performed to get baseline data on the type and number of PR-activities and on patients' complications in intensive care unit (ICU) patients.

Methods: An observational pilot study was conducted in anesthesia and reanimation adult ICUs in a midsized general hospital in Turkey. Included were 31 patients and two data collection tools: a basic form (patient demographics, medical information, and complications) and a PR observation guide on nurses' PR-activities. Descriptive statistics (frequencies, percentages, and mean and standard deviation) were used for data evaluation.

Findings: Most patients (61.3%) were male, and 74.2% were aged 60-79 years. Almost a third was unconscious (Glasgow Coma Scale <9) and at risk for falling. Of the total 33 activities of the Nursing Interventions Classification (NIC), 13 were never applied in 33% of patients. The most applied activity was "provide sufficient staff to assist with the safe application of physical restraining devices or manual restraints" (96.8%). Least applied were "explain inpatient and significant others the behaviors necessary for the termination of the intervention," "Provide the dependent patient with a means of summoning help" (6.5%), and "Teach family the risks and benefits of restraint reduction" (3.2%). Overall, 58.1% of patients had PR complications.

Conclusions: For the first time, PR NIC activities were evaluated in a Turkish ICU. Findings show low performance of NIC activities and a high complication rate.

Implications for nursing practice: The findings provide the basis to implement a PR-Guideline in Turkish ICUs to enhance patients' safety and comfort.

Keywords: NIC nursing intervention physical restraint; Turkey; intensive care unit; observational study; patient safety.