Physical restraint: experiences, attitudes and opinions of adult intensive care unit nurses

Abstract

Background: Patients within the adult intensive care unit have the potential to develop delirium and agitation. This can result in the patient displaying unwanted behaviours such as attempting to remove the medical devices to which they are attached. Some adult intensive care units within the UK are starting to adopt physical restraint as a method of managing unwanted behaviours.

Aim: To determine the experiences, attitudes and opinions of adult intensive care nurses in relation to the application of physical restraint.

Design: Questionnaire survey.

Methods: A postal questionnaire was distributed to all nurses (n = 192) within two purposefully selected large adult intensive care units in the UK.

Results: Data were collected between November 2012 and February 2013. The questionnaire was completed by 38·9% (n = 75) of the nurses contacted. All believed that physical restraint had a place, with the majority of the view that the reason for its application was to maintain patient safety. Some expressed discomfort about the use of physical restraint. Nurses were happy to discuss the use of restraint with families. There was a perceived need for training and support for nursing staff as well as the need for medical staff to support the decision-making process.

Conclusion: Nurses require more support and evidence to base their decision-making upon. They require guidance from professional bodies as well as support from medical colleagues. The findings have limited generalizability as they can only be applied to the units accessed and the response rate was poor.

Relevance to clinical practice: Alternative approaches such as pain management, sleep promotion and the involvement of relatives need to be explored before physical restraint policy can be written. Further research is required into the safety of physical restraint, alternative methods of managing the risk of agitation and identifying predisposing factors to accidental device removal.

Keywords: Intensive care; Nurses; Opinion; Physical restraint; Questionnaire survey design.