The prevalence and incidence of restraint use in a Canadian adult intensive care unit: A prospective cohort study.
| Autor: | Hamilton, Deborah, Griesdale, Donald, Mion, Lorraine C. |
|---|---|
| Předmět: |
ACADEMIC medical centers
CONFIDENCE intervals INTENSIVE care nursing INTENSIVE care units INTERVIEWING LONGITUDINAL method RESEARCH methodology SCIENTIFIC observation RESEARCH funding RESTRAINT of patients T-test (Statistics) DECISION making in clinical medicine LOGISTIC regression analysis DISEASE incidence DISEASE prevalence ENDOTRACHEAL tubes DATA analysis software MEDICAL coding ODDS ratio MANN Whitney U Test |
| Zdroj: | Canadian Journal of Critical Care Nursing; Fall2017, Vol. 28 Issue 3, p25-33, 9p, 1 Illustration, 3 Charts |
| Abstrakt: | Intensive care (ICU) nurses use physical restraints to prevent critically ill patients from disrupting invasive therapeutic medical equipment, but their use is not without negative consequences. How and when ICU nurses make the decision to restrain is poorly understood. Objectives: To determine the extent of physical restraint use in an urban teaching ICU, to identify patient-specific factors that may contribute to the application of physical restraints, and explore nurses' rationale for use. Method: A mixed-methods study with a prospective cohort design was used to gather patient data and semi-structured interviews were conducted to gather nurse data. Patient data collection consisted o f daily medical record abstraction and random direct observation for six weeks. ICU nurses were interviewed when they restrained the patient. The interviews were analyzed using open-coding technique. Results: Fifty-four o f 72 patients initially admitted without restraints were restrained during their ICU stay (incidence 75%) for a median o f three days (IQR 2-3) and prevalence rate of 358 restraint days/1,000 ICU days (95% Cl, 309-414). Tire presence o f the endotracheal tube and the administration o f any opioid or midazolam increased the odds of physical restraint application. Nurses did not consult with physicians before restraining the patients. The primary reason fo r restraining the patient was to preserve the patient's endotracheal tube. Lower nursing staffing was a positive predictor o f physical restraint use. Conclusion: Our study showed that endoctracheal tubes in situ increases the chances o f patients being physically restrained. Any dose o f narcotic or midazolam increases the risk o f being physically restrained. High nurse-to-patient ratios reduce physical restraint use. Measuring physical restraint prevalence rate using restraint days per 1,000 ICU days may help to standardize measurements o f restraint use among critical care units. [ABSTRACT FROM AUTHOR] |
| Databáze: | Supplemental Index |
| Externí odkaz: |
|