Physical restraint practices in an adult intensive care unit: A prospective observational study.
Aim and objectives: To conduct a diagnostic evaluation of physical restraint practice using the integrated‐Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework. Background: Evidence indicates that physical restraints are associated with adverse physical, emotional and...
| Publicado en: | Journal of Clinical Nursing (John Wiley & Sons, Inc.) Vol. 32; no. 7/8; pp. 1163 - 1173 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
John Wiley & Sons, Inc.
Apr2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=162295741&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 162295741 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09621067 LVDZ jtl: Journal of Clinical Nursing (John Wiley & Sons, Inc.) issn: 09621067 maglogo: N pubinfo: dt: Apr2023 vid: 32 iid: 7/8 pid: 52269 pub: John Wiley & Sons, Inc. artinfo: ui: 162295741 155418619 162295741 162295741 10.1111/jocn.16264 162295741 ppf: 1163 ppct: 10 formats: tig: atl: Physical restraint practices in an adult intensive care unit: A prospective observational study. aug: au: Alostaz, Ziad Rose, Louise Mehta, Sangeeta Johnston, Linda Dale, Craig affil: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto Ontario,, Canada sug: subj: Restraint, Physical Intensive Care Units Medical Practice Evaluation Conceptual Framework Human Prospective Studies Nonexperimental Studies Restraint, Physical Adverse Effects Implementation Science Ontario Electronic Health Records Record Review Leadership Documentation Male Female Middle Age Device Removal Respiration, Artificial Arousal Interprofessional Relations Extubation Academic Medical Centers Organizational Policies Observational Methods Scales Descriptive Statistics kappa Statistic Data Analysis Software Muscle Weakness Hypnotics and Sedatives Catheters and Tubes Glasgow Coma Scale Clinical Assessment Tools Funding Source Middle Aged: 45-64 years Male Female ab: Aim and objectives: To conduct a diagnostic evaluation of physical restraint practice using the integrated‐Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework. Background: Evidence indicates that physical restraints are associated with adverse physical, emotional and psychological sequelae and do not consistently prevent intensive care unit (ICU) patient‐initiated device removal. Nevertheless, physical restraints continue to be used extensively in ICUs both in Canada and internationally. Implementation science frameworks have not been previously used to diagnose, develop and guide the implementation of restraint minimisation interventions. Design: A prospective observational study of restrained patients in a 20‐bed, academic ICU in Toronto, Canada. Methods: Data collection methods included patient observation, electronic medical record review, and verbal check with the point‐of‐care nurses. Data were collected pertaining to framework domains of unit culture (restraint application/removal), evaluation capacity (documentation) and leadership (rounds discussion). The reporting of this study followed the STROBE guidelines. Results: A total of 102 restrained patients, 67 (66%) male and mean age 58 years (SD 1.92), were observed. All observed devices were wrist restraints. Restraint application and removal time was verified in 83 and 57 of 102 patients respectively. At application, 96.4% were mechanically ventilated and 71% sedated/unarousable. Nurses confirmed 71% were prophylactically restrained; 7.2% received restraint alternatives. Restraint removal occurred after interprofessional team rounds (87%), during daytime (79%) and following extubation (52.6%). Of the 923 discrete patient observation of physical restraint use, 691 (75%) were not documented. Of the 30 daytime interprofessional team rounds reviewed, physical restraint was discussed at 3 (10%). Conclusion: In this single‐centre study, a culture of prophylactic physical restraint was observed. Future facilitation of restraint minimisation warrants theoretically informed implementation strategies including leadership involvement to advance interprofessional collaboration. Relevance to clinical practice: The findings draw attention to the importance of a preliminary diagnostic study of the context prior to designing, and implementing, a physical restraint minimisation intervention. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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