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Restraints in intensive care units--a mixed method study.

Gayle Langley1, Shelley Schmollgruber, Anthony Egan

  • 1Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Gauteng 2193Johannesburg, South Africa. Gayle.langley@wits.ac.za

Intensive & Critical Care Nursing
|February 8, 2011
PubMed
Summary

Mechanical restraints are common in South African Intensive Care Units (ICUs), with nearly half of patients restrained. Clinicians acknowledged their use for safety but disputed benefits, citing poor communication and team collaboration as key issues.

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Area of Science:

  • Critical Care Medicine
  • Patient Safety
  • Healthcare Practices

Background:

  • Mechanical restraints are internationally controversial yet frequently used in South African Intensive Care Units (ICUs).
  • This study investigated the practice of mechanical restraint use in a Johannesburg academic hospital's ICUs.

Purpose of the Study:

  • To examine the prevalence, duration, and types of mechanical restraints used in South African ICUs.
  • To explore clinicians' rationale, experiences, and perceptions regarding mechanical restraint practices.
  • To identify factors influencing care decisions and practices related to mechanical restraints.

Main Methods:

  • Quantitative data collected via checklist over two months.
  • Analysis included patient demographics, restraint details, nurse-patient ratios, and sedation/analgesia use.
  • Qualitative data from interviews with 20 ICU clinicians provided insights into rationale and perceptions.

Main Results:

  • 48.4% of 219 ICU patients were restrained, with an average duration of nine days.
  • Wrist ties were the predominant restraint type; other types were rarely used.
  • Clinicians agreed on restraint for patient safety but disagreed on reasons and benefits, with mixed use of sedation/analgesia.

Conclusions:

  • Poor interdisciplinary communication and diminished collaboration significantly influenced mechanical restraint decisions and practices.
  • Effective communication and enhanced teamwork are crucial for optimizing patient care and restraint management in ICUs.