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The purpose was to describe characteristics and outcomes of restrained and nonrestrained patients enrolled in a randomized trial of protocolized sedation compared with protocolized sedation plus daily sedation interruption and to identify patient and treatment factors associated with physical restraint. This was a post hoc secondary analysis using Cox proportional hazards modeling adjusted for center- and time-varying covariates to evaluate predictors of restraint use. A total of 328 (76%) of 430 patients were restrained for a median of 4 days. Restrained patients received higher daily doses of benzodiazepines (105 vs 41 mg midazolam equivalent, P < .0001) and opioids (1524 vs 919 μg fentanyl equivalents, P < .0001), more days of infusions (benzodiazepines 6 vs 4, P < .0001; opioids 7 vs 5, P = .02), and more daily benzodiazepine boluses (0.2 vs 0.1, P < .0001). More restrained patients received haloperidol (23% vs 12%, P = .02) and atypical antipsychotics (17% vs 4%, P = .003). More restrained patients experienced unintentional device removal (26% vs 3%, P < .001) and required reintubation (8% vs 1%, P = .01). In the multivariable analysis, alcohol use was associated with decreased risk of restraint (hazard ratio, 0.22; 95% confidence interval, 0.08-0.58). Physical restraint was common in mechanically ventilated adults managed with a sedation protocol. Restrained patients received more opioids and benzodiazepines. Except for alcohol use, patient characteristics and treatment factors did not predict restraint use.

To explore family perspectives on physical restraint practices and their minimization in an adult intensive care unit. A qualitative descriptive study with one-on-one semi-structured interviews. A deductive content analysis approach was undertaken using the Theoretical Domains Framework. A 20-bed medical, surgical, trauma ICU in Toronto, Canada. Fifteen family members were interviewed. Three themes emerged: (i) barriers and facilitators to restraint minimization. Barriers noted by families included patient agitation posing risks of losing endotracheal tubes, nurse reluctance to remove restraints, lack of family involvement, limited knowledge of alternatives, and a noisy environment. Facilitators included family involvement in decision-making, timely extubation, use of less restrictive alternatives such as mittens, mandating shorter periods of restraints application, and environmental modifications; (ii) unilateral decision-making regarding physical restraint use, where clinicians made decisions with inadequate communication with families nor obtaining consent; and (iii) the emotional impact of physical restraint use, with families experiencing sadness and shock and believing the patient would feel similarly. This qualitative study highlights significant issues surrounding the use of physical restraints, particularly the lack of family involvement in decision-making, the emotional toll on families, and various barriers and facilitators to minimizing restraint use. Effective communication and collaboration between clinicians and families are crucial to addressing these issues. Our findings underscore the critical need to enhance communication between clinicians and families, alongside consent processes. Identifying barriers and facilitators at various levels can inform individualized strategies to reduce restraint use, including integrating alternatives like mittens and involving families in care. Timely introduction of alternatives and family involvement are vital to prevent further emotional distress for families. Prioritizing the reduction of restraint duration is crucial, particularly in settings emphasizing harm minimization.

Physical restraints are frequently used in ICU patients, while their effects are unclear. To explore differences in patient reported mental health outcomes and quality of life between physical restrained and non-physical restrained ICU patients at 3- and 12-months post ICU admission, compared to pre-ICU health status. Prospective cohort study. Patients were included when 16 years or older, admitted for at least 12 h and provided informed consent. Differences between groups were analysed using linear mixed model analyses. Two ICUs, a 35 bed academic ICU and a 12 bed ICU in a teaching hospital in the Netherlands. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale, post-traumatic stress disorder using the Impact of Event Scale-Revised, and Quality of life using the Short Form-36 scores. 2,764 patients were included, of which 486 (17.6 %) were physically restrained for median 2 [IQR 1–6] days. Significantly worse outcomes were reported at 3-months by physically restrained patients (symptoms of depression 0.89, 95 %CI 0.37 to 1.41, p < 0.001; PCS −2.82, 95 %CI −4.47 to −1,17p < 0.001; MCS −2.67, 95 %CI −4.39 to −0.96, p < 0.01). At 12-months, only the PCS scores remained significantly lower (−1.71, 95 %CI −3.42 to −0.004, p < 0.05). Use of physical restraints is associated with worse self-reported symptoms of depression and decreased quality of life 3-months post ICU, and lower physical quality of life after 12-months. Use of physical restraints is associated with statistical significant worse mental and physical outcomes.

To evaluate the negative effect of physical restraint use on the hospital outcomes of older patients. A retrospective cohort study. Internal medicine wards of a tertiary medical center in Taiwan. Subjects aged 65 years and over who were admitted during April to Dec 2017 were recruited for study. Demographic data, geriatric assessments (polypharmacy, visual impairment, hearing impairment, activities of daily living before and after admission, risk of pressure sores, change in consciousness level, mood condition, history of falls in the previous year, risk of malnutrition and pain) and hospital conditions (admission route, department of admission, length of hospital stay and mortality) were collected for analysis. Overall, 4,352 participants (mean age 78.7±8.7 years, 60.2% = male) were enrolled and 8.3% had physical restraint. Results of multivariate logistic regression showed that subjects with physical restraints were at greater risk of functional decline (adjusted odds ratio 2.136, 95% confidence interval 1.322–3.451, p=0.002), longer hospital stays (adjusted odds ratio 5.360, 95% confidence interval 3.627–7.923, p<0.001) and mortality (adjusted odds ratio 4.472, 95% confidence interval 2.794–7.160, p<0.001) after adjustment for covariates. The use of physical restraints during hospitalization increased the risk of adverse hospital outcomes, such as functional decline, longer length of hospital stay and mortality.

Objective: to map the existing knowledge on nursing ethical decision making in the physical restraint of hospitalised adults. (1) Background: physical restraint is a technique that conditions the free movement of the body, with risks and benefits. The prevalence of physical restraint in healthcare suffers a wide variation, considering the environment or pathology, and it raises ethical issues that hinders decision making. This article intends to analyse and discuss this problem, starting from a literature review that will provoke a grounded discussion on the ethical and legal aspects. Inclusion criteria are: studies on physical restraint (C) and ethical nursing decision making (C) in hospitalized adults (P); (2) methods: a three-step search strategy was used according to the JBI. The databases consulted were CINAHL Plus with Full Text (EBSCOhost), MEDLINE Full Text (EBSCOhost), Nursing and Allied Health Collection: Comprehensive and Cochrane Database of Systematic Reviews (by Cochrane Library, RCAAP and Google Scholar. All articles were analysed by two independent reviewers; (3) results: according to the inclusion criteria, 18 articles were included. The categories that influence ethical decision in nursing are: consequence of the decision, the context, the nature of the decision in terms of its complexity, the principles of the ethical decision in nursing, ethical issues and universal values; (4) conclusions: the findings of this review provide evidence that there is extensive knowledge regarding nursing ethical decision making in adult physical restriction, also, it is considered an ethical issue with many associated assumptions. In this article we aim to confront all these issues from a legal perspective.

Objective To explore the impact of physical restraint (PR) on the occurrence of venous thromboembolism (VTE) in stroke patients. Methods Totally 321 stroke patients were randomly enrolled and categorized into 2 groups according to whether PR was used or not. Moreover, the effect of PR on VTE in stroke patients was explored, and the independent influencing factors for the occurrence of VTE in stroke patients were also identified. Results Among the enrolled patients, 68 cases (21.18%) developed VTE, including 60 with muscular calf vein thrombosis, 6 with great saphenous vein thrombosis, and 2 with deep vein thrombosis (DVT). Of these 68 patients, 49 had cerebral infarction and 19 had intracerebral hemorrhage (ICH). Also, there were 39 patients (39/96) developing VTE with PR, and 29 (29/225) developing VTE without PR. Through analyzing the relationship between the incidence of VTE in stroke patients and clinicopathological parameters, it was discovered that diagnose (χ2 = 33.058 P = 0.000), history of diabetes (χ2 = 12.80 P = 0.000), muscle strength (χ2 = 21.608 P = 0.000), activity of daily living (ADL) (χ2 = 41.952 P = 0.000), and PR (χ2 = 31.004 P = 0.000) were significantly correlated with the occurrence of VTE. Moreover, as revealed by multivariate analysis of variance ICH (OR 4.485 (1.653–12.169), P = 0.003), previous history of diabetes (OR 2.511 (1.257–5.018), P = 0.009), low ADL (OR 0.208 (0.109–0.397), P = 0.000), and PR (OR 5.048 (2.520–10.113), P = 0.000) were the independent risk factors for VTE in stroke patients, while muscle strength (OR 0.679 (0.366–1.259), P = 0.219) had an impact on the occurrence of VTE, but was not an independent risk factor. Conclusion This treatment center can lower the occurrence of VTE by standardizing the use of PR. Meanwhile, for the patients with ICH who have a history of diabetes and poor ADL, more education and care should be provided to minimize the occurrence of VTE.

This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices. Prospective multi-centre follow-up study out to 3 months after ICU discharge. Two district general hospitals and three teaching hospitals across Europe. Two hundred and thirty-eight recovering, post-ventilated ICU patients. None. Assessment of patients' memories of ICU was undertaken at 1-2 weeks post ICU discharge. Patients' psychological recovery was assessed by examining the level of PTSD-related symptoms and rate of PTSD by 3 months post ICU. The rate of defined PTSD was 9.2%, ranging from 3.2% to 14.8% in the different study ICUs. Independent of case mix and illness severity, the factors found to be related to the development of PTSD were recall of delusional memories, prolonged sedation, and physical restraint with no sedation. The development of PTSD following critical illness is associated with a number of different precipitating factors that are in part related to how patients are cared for within intensive care. This study raises the hypothesis that the impact of care within the ICU has an impact on subsequent psychological morbidity and therefore must be assessed in future studies looking at the way patients are sedated in the ICU and how physical restraint is used.

ABSTRACTBackgroundIn April 2016, the Japanese government introduced an additional benefit for dementia care in acute care hospitals (dementia care benefit) into the universal benefit schedule of public healthcare insurance program. The benefit includes a financial disincentive to use physical restraint. The present study investigated the association between the dementia care benefit and the use of physical restraint among inpatients with dementia in general acute care settings. MethodsA national cross-sectional study design was used. Eight types of care units from acute care hospitals under the public healthcare insurance program were invited to participate in this study. A total of 23,539 inpatients with dementia from 2,355 care units in 937 hospitals were included for the analysis. Dementia diagnosis or symptoms included any signs of cognitive impairment. The primary outcome measure was “use of physical restraint.” ResultsAmong patients, the point prevalence of physical restraint was 44.5% ( n = 10,480). Controlling for patient, unit, and hospital characteristics, patients in units with dementia care benefit had significantly lower percentage of physical restraint than those in any other units (42.0% vs. 47.1%; adjusted odds ratio, 0.76; 95% confident interval [0.63, 0.92]). ConclusionsThe financial incentive may have reduced the risk of physical restraint among patients with dementia in acute care hospitals. However, use of physical restraint was still common among patients with dementia in units with the dementia care benefit. An educational package to guide dementia care approach including the avoidance of physical restraint by healthcare professionals in acute care hospitals is recommended.

IntroductionPhysical restraint is a therapeutic procedure allowing to immobilize an agitated patient.Although it is an effective method especially in the states of psychomotor instability, its practice is not devoid of risks which imposes a codified technique with particular monitoring.ObjectivesThe aim of this work was to evaluate the knowledge of nurses and nursing assistants in the practice and monitoring of physical restraint and to establish a suitble protocol codifing it.MethodsOur study was a descriptive cross-sectional study based on a questionnaire grouping together a set of questions on general and professional characteristics, the decision of physical restraint, its prescription, its means, its monitoring, informing the patient and his relatives, physical restraint’s risks, the patient’s experience, the caregiver’s experience as well as the relationship between caregiver and patient. Our target population was composed of nurses and orderlies of the psychiatry department <> of the Razi hospital in Manouba.ResultsWe collected 30 professinals.90% of them were women. 30% of our sample had less than five years of experience. Only 23.30% of caregivers had mental health training at the beginning of their professional career. 50% of them received training focused on physical restraint.83.30% reported using physical restraint for psychomotor agitation.56.6% ignored the psychological effects of the physical straint on patients. 73.3% of caregivers informed patients before straint.ConclusionsA physical restraint protocol, codifying the technique of implementation and monitoring parameters is needed in order to improve the relation patient-cargiver and ensure an optimal care .DisclosureNo significant relationships.

Healthcare staff use coercive measures to manage patients at acute risk of harm to self or others, but their effect on patients' mental health is underexplored. This nationwide Swiss study emulated a trial to investigate the effects of coercive measures on the mental health of psychiatric inpatients at discharge. We analysed retrospective longitudinal data from all Swiss adult psychiatric hospitals that provided acute care (2019-2021). The primary exposure was any coercive measure during hospitalization; secondary exposures were seclusion, restraint and forced medication. Our primary outcome was Health of the Nations Outcome Scale (HoNOS) score at discharge. We used inverse probability of treatment weighting to emulate random assignment to the exposure. Of 178,369 hospitalizations, 9.2% (  = 18,800) included at least one coercive measure. In patients exposed to coercive measures, mental health worsened a small but statistically significant amount more than in non-exposed patients. Those who experienced at least one coercive measure during hospitalization had a significantly higher HoNOS score (1.91-point,  < .001, 95% confidence interval [CI]: 1.73; 2.09) than those who did not experience any coercive measure. Results were similar for seclusion (1.60-point higher score,  < .001, 95% CI: 1.40; 1.79) and forced medication (1.97-point higher score,  < .001, 95% CI: 1.65; 2.30). Restraint had the strongest effect (2.83-point higher score,  < .001, 95% CI: 2.38; 3.28). Our study presents robust empirical evidence highlighting the detrimental impact of coercive measures on the mental health of psychiatric inpatients. It underscores the importance of avoiding these measures in psychiatric hospitals and emphasized the urgent need for implementing alternatives in clinical practice.