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Under a Creative Commons license Open access AbstractObjectiveTo identify the elements informing the successful implementation of nonpharmacologic physical restraint minimization interventions in adult intensive care unit patients. To map those elements to innovation, context, recipients and facilitation domains of the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and to describe the outcomes of those interventions. MethodologyA scoping review of studies published in English reporting on restraint minimization interventions in adult intensive care units. We searched seven databases (MEDLINE, CIHAHL, Embase, Web of Science, Cochrane Library, PROSPERO and Joanna Briggs) from inception to 2021. Two authors independently screened articles for inclusion, extracted study characteristics and mapped intervention data to the i-PARIHS domains. ResultsSeven studies met inclusion criteria. Innovations comprised multicomponent interventions including education, decision aids/protocols and restraint alternatives. No studies utilised an implementation science framework to diagnose the baseline practice context. A commonly reported barrier to restraint minimization was a risk averse culture. Change was mostly driven by the external context (i.e. national regulations). Overall, nurses were the primary facilitators and recipients of practice change. Outcomes were changes in restraint incidence and prevalence abstracted from the medical record. However, no study validated the accuracy of restraint documentation. All studies documented an initial decrease in physical restraint use, but no long-term results were reported. ConclusionRestraint minimization intervention studies report nurse-facilitated multicomponent interventions and short-term practice change. Future restraint minimization research incorporating implementation science frameworks, interprofessional teams and patient/family perspectives is warranted. KeywordsImplementation Intensive care unit Physical restraint Practice change Scoping review Cited by (0)© 2021 The Authors. Published by Elsevier Ltd.
Under a Creative Commons license Open access AbstractPhysical restraint is a common nursing intervention in intensive care units and nurses often use it to ensure patients' safety and to prevent unexpected accidents. However, existing literature indicated that the use of physical restraint is a complex one because of inadequate rationales, the negative physical and emotional effects on patients, but the lack of perceived alternatives. This paper is aimed to interpret the clinical decision-making theories related to the use of physical restraint in intensive care units in order to facilitate our understanding on the use of physical restraint and to evaluate the quality of decisions made by nurses. By reviewing the literature, intuition and heuristics are the main decision-making strategies related to the use of physical restraint in intensive care units because the rapid and reflexive nature of intuition and heuristics allow nurses to have a rapid response to urgent and emergent cases. However, it is problematic if nurses simply count their decision-making on experience rather than incorporate research evidence into clinical practice because of inadequate evidence to support the use of physical restraint. Besides that, such a rapid response may lead nurses to make decisions without adequate assessment and thinking and therefore biases and errors may be generated. Therefore, despite the importance of intuition and heuristics in decision-making in acute settings on the use of physical restraint, it is recommended that nurses should incorporate research evidence with their experience to make decisions and adequate assessment before implementing physical restraint is also necessary. KeywordsClinical decision-making Intensive care units Intuition Heuristics Physical restraint Cited by (0)Copyright © 2014 Chinese Nursing Association. Production and hosting by Elsevier (Singapore) Pte Ltd. What should the nurse do prior to applying physical restraints?What should the nurse do prior to administering physical restraints? Initially, provide a restraint-free environment. The nurse manager is reviewing the use of restraints during an in service with the staff.
Which of the following is the nurse's legal responsibility when applying restraints?Explain: When applying restraints, the nurse must document the type of behavior that prompted her to use them, document the type of restraints used, and obtain a physician's written order for the restraints.
What are the guidelines that nurses should follow when considering restraints ATI?What are the guidelines that nurses should follow when considering whether or not a client requires restraints? Use a restraint when there is no other option and use the least restrictive restraint first.
Which intervention would the nurse implement when caring for a patient who is a high risk for falls?Secure locks on beds, stretcher, & wheel chair. Keep floors clutter/obstacle free (especially the path between bed and bathroom/commode). Place call light & frequently needed objects within patient reach. Answer call light promptly.
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Which intervention would the nurse incorporate into the plan of care for a patient requiring the application of restraints?
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