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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.

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.

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.

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 determine the intention to use physical restraint (PR) and the relationship with sociodemographic and professional variables of the Paediatric Intensive Care Unit (PICU) nurses. A multicentre and correlational study was carried out from October 2021 to December 2023 in five paediatric intensive care units from five maternal and child hospitals in Spain. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire was provided. Moreover, sociodemographic and employment variables were registered. A total of 230 paediatric nurses participated in the study. A total of 87.7 % were females with an average age of 35.5 ± 9.7 years and working experience of 10.5 ± 8.4 years. The mean scores obtained were 21.1 ± 3.8 for attitude, 13.1 ± 5.0 for subjective norms, 14.4 ± 4.3 for perceived behavioural control and 28.0 ± 6.0 for intention. The nurses apply more physical restraint to anxious patients, with scarce analgesics and sedation, those affected with pharmacological withdrawal symptoms and those with a high risk of accidental removal of vital support devices or fall from bed. The sex (p = 0.007) and type of employment contract (p = 0.01) are the variables that are significantly correlated with the intention to use of PR. The paediatric nurses analysed had a moderate attitude, social pressure and perceived behavioural control towards the use of PR. It is important to know the factors that influence the intention to use physical restraint in order to standardise safe practice for critically ill paediatric and to ensure that patients' rights are respected by obtaining informed consent and assessing the prescription, continuation and removal of physical restraint.

Aims. To identify the factors influencing critical care nurses’ intention of physical restraint in intubated patients. Background. Physical restraint reduction has been advocated by many international institutions, nurses are the main physical restraint decision-makers, and it is critical to identify the factors influencing physical restraint intention from nurses’ perspective. Methods. A cross-sectional study was conducted among critical care nurses in China from February 2022 to March 2022. Results. The model showed a good model fit (χ2/df = 2.57, RMSEA = 0.07, GFI = 0.94, CFI = 0.89, and AGFI = 0.90). Attitude (β = 0.29, p<0.05), subjective norm (β = 0.25, p<0.05), and perceived behavioral control (β = 0.32, p<0.001) directly influenced the intention to use physical restraint in intubated patients. Ethical conflict (β = 0.04, p<0.05) indirectly influenced the intention. Conclusions. The study revealed that ethical conflict, attitude, subjective norm, and perceived behavioral control were positive predictors of physical restraint intention among intubated patients from nurses’ perspectives. Implications for Nursing Management. This provides a theoretical perspective to develop effective interventions to reduce physical restraints in critical care settings. Nursing managers should enhance ethical education and physical restraint knowledge and skill training.

Physical Restraint (PR) is a coercive procedure used in emergency psychiatric care to ensure safety in life-threatening situations. Because of its traumatic nature, studies emphasize the importance of considering the patient’s subjective experience. We pursued this aim by overcoming classic qualitative approaches and innovatively applying a multilayered semiautomated language analysis to a corpus of narratives about PR collected from 99 individuals across seven mental health services in Italy. Compared to a reference corpus, PR narratives were characterized by reduced fluency and lexical density, yet a greater use of emotional and cognitive terms, verbs, and first-person singular pronouns. Sadness was the most represented emotion, followed by anger and fear. One-third of the PR narratives contained at least one metaphor, with Animals and War/Prison as the most distinctive source domains. The quality and length of the PR experience impacted both the structure and the sentiment of the narratives. Findings confirm the distressful nature of PR but also point to the use of various linguistic mechanisms which might serve as an early adaptive response toward healing from the traumatic experience. Overall, the study highlights the importance of Natural Language Processing as an unobtrusive window into subjective experience, offering insights for therapeutic choices.

Background Although many countries have implemented strict legal rules, the prevalence of physical restraints in nursing homes seems to remain high. In Switzerland, data related to the frequency of physical restraints are scarce and little is known about associations with resident and nursing home characteristics. The aim of this study was to investigate the prevalence and types of physical restraints in nursing homes in two Swiss cantons and to explore whether resident-related and organisational factors are associated with the use of physical restraints. Methods We conducted a multicentre cross-sectional study. Twenty nursing homes with 1362 residents from two culturally different cantons were included. Data on physical restraints and residents’ characteristics were extracted from residents’ records (11/2013 to 2/2014). Organisational data were collected by questionnaires addressing nursing home directors or nursing managers. Sample size calculation and outcome analysis took cluster-adjustment into account. Descriptive statistics and multiple logistic regression analysis with nursing homes as random effect were used for investigation. Results The prevalence of residents with at least one physical restraint was 26.8 % (95 % confidence interval [CI] 19.8–33.8). Centre prevalence ranged from 2.6 to 61.2 %. Bilateral bedrails were most frequently used (20.3 %, 95 % CI 13.5–27.1). Length of residence, degrees of care dependency and mobility limitation were significantly positively associated with the use of physical restraint, but none of the organisational characteristics was significantly associated. Conclusion Approximately a quarter of the nursing home residents included in our study experienced physical restraints. Since variation between nursing homes was pronounced, it seems to be worthwhile to explore nursing homes with particularly low and high use of physical restraints in future research, especially by using qualitative methods. There is a need for effective interventions aiming at restraint-free nursing care. Development of interventional approaches should consider specific residents’ characteristics associated with restraint use.

BackgroundRestrictive practices (ie, physical restraint, rapid tranquilisation and seclusion) are used to manage risk of harm to self and/or others during inpatient psychiatric admissions. Restrictive practices can be physically and psychologically hazardous for both patients and staff, but there have been few well-controlled evaluations of interventions to reduce restrictive practices.ObjectiveTo conduct a controlled evaluation of the implementation of a culture change intervention on a psychiatric intensive care unit (PICU) compared with a control PICU on use of restraint.MethodsA new staff role was created on the intervention PICU (ie, the reducing restrictive interventions advocate; RRIA). The RRIA met with patients/carers and advised, trained, supervised and debriefed the multidisciplinary team concerning restraint. Mixed methods evaluated the effectiveness of the RRIA role. Restraint outcomes on the intervention and the control PICU were compared pre (19 months) and post intervention (19 months). Qualitative interviews were conducted with the RRIA, the PICU ward manager and the RRI organisational lead.ResultsOn the intervention PICU, there were significant reductions in the use of seclusion, full restraint and use of standing holds. Qualitatively, positive changes to the safety culture of the intervention PICU were reported, and these were consistently rated as important, impactful and unlikely without the RRIA role.ConclusionsPICU safety culture can improve when specific roles focused on changing ward practices around restraints are implemented. More controlled evaluations of reducing restraint interventions on PICUs are needed.