A Study on the Application of Physical Restraints in Intensive Care Units

일 대학병원 중환자실의 억제대 사용실태

  • 김미연 (계명대학교 동산의료원 신경외과 중환자실) ;
  • 박정숙 (계명대학교 간호대학)
  • Received : 2010.01.20
  • Accepted : 2010.04.02
  • Published : 2010.05.31

Abstract

Purpose: The purpose of this descriptive study was to investigate the application of physical restraints in ICUs of a university hospital. Method: Data were collected from August 1 to October 1 2009, using a recording tool from Electric Nursing Records and an observation tool for physical restraints and related factors. Frequency, percentage, and paired t-test with the SPSS/WIN 16.0 program were used to analyze the data. Results: The application rate for physical restraints in 5 ICUs was 34.3%, the highest application rate was 48.4% in the neurosurgical ICU. The mean frequency for physical restraint application per patient was 1.14, and the mean hours of restraint application per incident was 113.01 hours. The most common complications of physical restraints were bruising and edema. Conclusion: Many ICU nurses use physical restraints when caring for patients who are at high risk for falls, including patients have high levels of acuity, decreased level of consciousness or increased irritability. When physical restraints are applied, patients show resistance against the use resulting in side effects of bruising and edema. Therefore, nurses should observe changes in restrain sites, perform nursing interventions to prevent complications, and minimize the use of physical restraints.

Keywords

References

  1. Akansel, N. (2007). Physical restraint practices among ICU nurses in one university hospital in western Turkey. Health Science Journal, 1(4), Retrieved November 30, 2009, fromhttp://www.hsj.gr/volumellissue4/turkey(o).pdf
  2. Cho, Y. A., Kim, J. S., Kim, N. R., Choi, H. J., Cho, J. G., Lee, H. J., et al. (2006). A Study on the use of physical restraints in ICDs. Journal of Korean Academy of Adult Nursing, 18(4), 543-552.
  3. Choi, E. H. (1999). A study on the use of physical restraint in an ICU. Unpublished master's thesis, Seoul National University, Seoul.
  4. Choi, E., & Song, M. (2003). Physical restraint use in Korean ICU. Journal of Clinical Nursing, 12(5), 651-659. https://doi.org/10.1046/j.1365-2702.2003.00789.x
  5. Craven, R. F., & Hirnle, C. J.. (2008). Fundamentals of nursing. Philadelphia: Lippincott Williams & Wilkins.
  6. Demir, A. (2007). Nurses' use of physical restraints in four Turkish hospitals. Journal of Nursing Scholarship, 39(1), 38-45. https://doi.org/10.1111/j.1547-5069.2007.00141.x
  7. Evans, D., & FitzGerald, M. (2002). Reasons for physically restraining patients and residents: a systematic review and content analysis. International Journal of Nursing Studies. 39(7). 735-743. https://doi.org/10.1016/S0020-7489(02)00015-9
  8. Hamers, J. P., & Huizing, A. R. (2005). Why do we use physical restraints in the elderly. Zeitschrift fur Gerontologie und Geriatrie, 38(1), 19-25. https://doi.org/10.1007/s00391-005-0286-x
  9. Hamers, J. P., Meyer, G., Kopke, S., Lindenmann, R., Groven, R., & Huizing, A. R. (2009). Attitudes of dutch, german and swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study. International Journal of Nursing studies, 46(2), 248-255. https://doi.org/10.1016/j.ijnurstu.2008.06.007
  10. Health Care Financing Administration. (2001). Rules and regulation: Federal Register, 66(14), 7148-7164.
  11. Hospital Nurses Association. (2005). Fall prevention guideline and summary. Retrieved November 13, 2009, from http://www.khna.or.kr/bbs/datalresource/khna_Fcare.pdf
  12. Janeli, L. M., Stamps, D., & Delles, L. (2006). Physical restraint use: A nursing perspective. Journal of the Academy of Medical-Surgical Nurses, 15(3). 163-167.
  13. Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). (2000). Automated comprehensive accreditation manual for behavioral health care. Oakbrook Terrace, IL: Author.
  14. Kim, J. S., & Oh, H. Y. (2006). Perceptions and attitude on use of physical restraints among caregivers in long term care facilities. Journal of Korea Gerontological Nursing, 26(2), 347-360.
  15. Kim, K. S., Kim, J. H., Lee, S. H., Cha, H. K., Shin, S. J., & Chi, S. A. (2000). The physical restraint use in hospital nursing situation. Journal of Korean Academy of Nursing, 30(1), 60-71.
  16. Kim, S., Lee, Y., Kim, D., Kim, S. Y., Ahn, H. Y., & Yu, S. J. (2009). Perception, attitude, and knowledge about physical restraints among nursing personnel in long term care facilities. The Journal of Korean Academic Society of Nursing Education, 15(1), 62-71. https://doi.org/10.5977/JKASNE.2009.15.1.062
  17. Korean Neurological Association. (2007), Neurology, Seoul:Koonja.
  18. Korean Association of Critical Care Nurse. (2005). Development and application of serious patient classification. KACN publication resource room No.1, Retrieved December 2, 2009, from http://www.kacn.or.kr/publicationlresource.php
  19. Lee, S. H. (2006). Useful characteristic evaluation of the serious case classification tool which it applies in ICU patients. Unpublished master's thesis, Kyungpook National University, Daegu.
  20. Lee, Y. G., Cho, Y. H., Kim, S. A., Kim, J. K., Kim, H. M., Kim, H. E., et al. (2003). The study on physical restraint use in intensive care unit, Journal of Korean Clinical Nursing Reserch, 8(2), 117-130.
  21. Lofgren, R. P., Macpherson, D. S., Granieri, R., Myllenbeck, S., & Sprafka, J. M. (1989). Mechanical restraints on the medical wards: Are protective devices safe? American Journal of Public Health, 79(6), 735-738. https://doi.org/10.2105/AJPH.79.6.735
  22. Minnick, A. F., Mion, L. C., Johnson, M. E., Catrambone, C., & Leipzig, R. (2007). Prevalence and variation of physical restraint use in acute care settings in the US. Journal of Nursing Scholarship, 39(1), 30-37. https://doi.org/10.1111/j.1547-5069.2007.00140.x
  23. Minnick, A. F., Mion, L. C., Leipzig, R., Lamb, K., & Palmer, R. M. (1998). Prevalence and patterns of physical restraint use in the acute care setting. The Journal of Nursing Administration, 28(11), 19-24. https://doi.org/10.1097/00005110-199811000-00007
  24. 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. https://doi.org/10.1111/j.1365-2648.2007.04298.x
  25. Park, M. H. (1997). Study on the ICU nurses' intention to use restraints and related factors. Unpublished master's thesis, Keimyung University, Daegu.
  26. Park, M. H., & Lee, B. S. (1998). Study on the ICU nurses' intention to use restraints and related factors. Korean lournal of Health Policy and Administration, 8(2). 191-215.
  27. Parkes, J. (2002). A review of the literature on positional asphyxia as a possible cause of sudden death during restraint. British Journal of Forensic Practice, 4(1), 24-30. https://doi.org/10.1108/14636646200200005
  28. Sullivan-Marx, E. M. (2001). Achieving restraint-free care of acutely confused older adults. Journal of Gerontological Nursing, 27(4), 56-61.