A Comparison of Restraint Decision Tools in Intensive Care Unit: An Observational Cross-Sectional Study

Area of Science:

• Critical Care Medicine
• Nursing Practice
• Clinical Decision Support

Background:

• Subjectivity in physical restraint decisions necessitates structured tools.
• Effective decision-making tools are crucial in intensive care units (ICUs).

Purpose of the Study:

• To observationally compare the effectiveness of the Restraint Decision Tree (RDT) and Restraint Decision Wheel (RDW).
• To evaluate two structured decision-making tools for physical restraint decisions in the ICU.

Main Methods:

• A descriptive, cross-sectional, observational comparative study.
• 105 ICU patients were assessed twice daily using RDT and RDW by separate observers.
• Statistical analysis included Mann-Whitney U and Kruskal-Wallis H tests.

Main Results:

• Morning assessments showed RDT vs. RDW: 71% vs. 72.4% not restraint, 20% vs. 21.9% alternative, 9% vs. 5.7% restraint.
• Evening assessments showed RDT vs. RDW: 68.6% vs. 72.4% not restraint, 18.1% vs. 22.9% alternative, 13.3% vs. 4.8% restraint.
• Significant differences in Glasgow Coma Scale scores and prior restraint history were noted for both tools (p < 0.05 and p < 0.001, respectively).

Conclusions:

• Both RDT and RDW are implementable by ICU nurses.
• Patient consciousness level and prior restraint history are key factors in restraint decisions.
• Objective tools support patient-centered care by considering factors like delirium and consciousness.