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Introduction
The use of physical restraints in acute and intensive care began ages ago. Although physical restraints have attracted much negative attention and criticism from both the health care sector and the human rights organizations, they continue to be used to a certain extent in countries across the globe. In the United States, for instance, acute and intensive care units use restraints as a therapeutic and moral method of minimizing accidents and injuries to both the patients and healthcare providers (Hamers, Gulpers & Strik, 2004).
This is because majority of patients in acute and intensive care settings may be emotionally, psychologically, or mentally unstable and are therefore in a position to inflict harm not only on themselves but also on others. Restraints have turned into a legal concern and some countries like the United States and England have laws that govern their extent and circumstances of their use. For instance, the Mental Health Act of 1983 identifies five circumstances under which restraints can be used. These circumstances include: noncompliance with treatment, self-harm, and risk of a physical injury by an accident were the most relevant in critical care settings.
Problem Statement
A considerable number of patients in acute and intensive care settings are normally subjected to physical restraints. This number is said to range between 7% and 17% according to a research study done by Akansel (2007). Common types of physical restraints include: wrist restraint, ankle restraint, chest restraint, chest and leg restraint, and whole body restraints. Materials used to physically restrain patients include sheets, belts, and gloves. The use of physical restraint on patients is associated with harm not only on the patients but also on their families. The harm done is not only physical, but also emotional and psychological in nature. The Food and Drug Administration estimates that the number of deaths resulting from physical restraints is at least 100.
Description of the Problem and its Significance to Nursing
Complications resulting from physical restraints have been widely reported by various researchers. Cheney, Gossett, Fullerton-Gleason, Weiss, Ernst and Sklar (2006) found that limb and vest restraints used on elderly patients caused atrioventricular irregularities. In addition, prolonged agitation resulted in tachycardia and deaths among patients. Mott, Poole and Kenrick (2005) also found that physical restraints fail to completely play their purpose but instead enhance the risk of agitation.
Physically restrained patients are more likely than non-restrained patients to suffer from falls and strangulation. They are more likely to spend more time in hospitals, less likely to be discharged, and have higher risks of complications and death. Zun and Downey (2008) also found that patients who are physically restrained are normally agitated, acquire more complications and fall down more often as they try to free themselves from the restraints.
Most of the studies above also found that hospitals and healthcare units that physically restrain patients lack standard material that is distinctively designed for physical restraint. In the study by Demir (2007), the materials used for wrist and ankle restraints were produced by nurses themselves by making use of a roll of gauze directly or after placing some cotton in between the layers of the gauze. Only a handful of intensive care units studied used standard restraint materials.
The complications resulting from physical restraints are also linked to the lack of adequate care of the patients by the nurses. The maximum number of hours that a restrained patient should go unobserved is two hours (Moore & Haralambous, 2007). Restrained patients should not be left for more than two hours without being reassessed or observed. Unfortunately, most acute and intensive care settings do not comply with this rule.
Majority of the studies mentioned above showed that restrained patients go for more than three hours and in some extreme cases for days without being reexamined and reevaluated. It is therefore important for nurses to continually observe and monitor physically restrained patients to ensure that self-inflicted harm and complications arising from the restraints are minimized as much as possible.
Purpose Statement
The purpose of this study is to examine the extent of self-inflicted injuries in physically restrained and non-restrained patients in intensive care units.
The Research Question
In intensive care patients, do physical restraints compared to lack of restraints lead to more self-inflicted injuries?
Conclusion
The use of physical restraints on patients is a highly controversial topic in the nursing field. While some experts are of the opinion that physical restraints are a necessity to manage some patients, others believe that physical restraints cause more harm than good and affect not only the patients but also the nursing professionals. This study will examine this topic further and will provide evidence that either supports or opposes the use of physical restraints on ICU patients.
Reference List
Akansel, N. (2007). Physical restraint practices among ICU nurses in one university hospital in Western Turkey. Health Science Journal, 4, 1-8.
Cheney, P., Gossett, L., Fullerton-Gleason, L., Weiss, S., Ernst, A., & Sklar, D. (2006). Relationship of restraint use, patient injury, and assaults on EMS personnel. Pre-hospital Emergency Care, 10(2), 207-212.
Demir, A. (2007). Nurses use of physical restraints in four Turkish hospitals. Journal of Nursing Scholarship, 39(1), 38-45.
Hamers, J., Gulpers, M., & Strik, W. (2004). Use of physical restraints with cognitively impaired nursing home residents. Journal of Advanced Nursing, 45(3), 246-251.
Moore, K., & Haralambous, B. (2007). Barriers to reducing the use of restraints in residential elder care facilities. Journal of Advanced Nursing, 58(6), 532-540.
Mott, S., Poole, J., &. Kenrick, M. (2005). Physical and chemical restraints in acute care: Their potential impact on the rehabilitation of older people. International Journal of Nursing Practice, 11, 95-101.
Zun, L., & Downey, L. (2008). Level of agitation of psychiatric patients presenting to an Emergency Department. Primary Psychiatry, 15(2), 59-65.
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