"Patient Comfort Can Be Sacrificed for Patient Safety"-Perception and Practice Reported by Critical Care Nurses Toward Physical Restraints: A Qualitative Descriptive Study.

Ruolin Qiu,Nianqi Cui,Yuping Zhang,Jingfen Jin

doi:10.3389/fmed.2021.573601

Abstract

Aim: The aim of the study was to explore the perception and practice of physical restraints used by critical care nurses.Design: A qualitative descriptive design was used.Method: From December 2019 to May 2020, a one-to-one, semi-structured in-depth interview with 10 critical care nurses from two intensive care units in a tertiary general hospital with 3,200 beds in China was conducted using the method of purposeful sampling. The data were analyzed using inductive thematic analysis.Findings: The perception of physical restraints among critical care nurses was that patient comfort can be sacrificed for patient safety. Physical restraints protected patient safety by preventing patients from unplanned extubation but influenced patient comfort. Physical restraints were common practice of critical care nurses. Relative physical restraints provided patients with more freedom of movement and rationalization of physical restraints which were the practical strategies.Conclusion: The study identified problems in critical care nurses' perception and practice on physical restraints. Critical care nurses are confident that physical restraints can protect patient safety, and the influence of physical restraints on patient comfort is just like the side effect. Although physical restraints were common practice, critical care nurses still faced dilemmas in the implementation of physical restraints. Relative physical restraints and rationalization of physical restraints help critical care nurses cope with the “bad feelings,” which may also be the cause of unplanned extubation. It is necessary for the adaptation of clinical practice guidelines about physical restraints for critically ill patients in the Chinese context, to change the perception and practice of critical care nurses and deliver safe and high-quality patient care.

Highlights

Patient safety has been a global health priority, while 134 million adverse events occur each year due to unsafe care in hospitals in low- and middle-income countries, contributing to 2.6 million deaths annually [1]
Rationalization of physical restraints (PR) might help critical care nurses cope with the “bad feelings” during PR practice
As clinical practice guidelines (CPGs) may be a convenient way of packaging evidence and presenting recommendations for critical care nurses’ decision-making about PR, and high requirements of resource about the development of high-quality CPGs, it is necessary for the adaptation of CPGs about PR for critically ill patients in Chinese context

Summary

Introduction

Patient safety has been a global health priority, while 134 million adverse events occur each year due to unsafe care in hospitals in low- and middle-income countries, contributing to 2.6 million deaths annually [1]. Unplanned extubation (UE) is a serious adverse event that threatens the safety of critically ill patients because it is associated with a higher risk for mortality, morbidity, and resource utilization [3]. Prevention of UE has been the reason for the use of physical restraints (PR) by critical care nurses, there is no evidence to establish that it is effectual and it is associated with a higher risk for mortality and morbidity. When we understand the perception and practice in which critical care nurses use PR on patients, we will provide more targeted measures to reduce the rate of PR on critically ill patients, thereby delivering safe, high-quality patient care. The main reason for the use of PR around ICU is to prevent patients from accidentally removing the catheters or devices needed to protect their safety [7]. PR is widely used in ICU around the world [14]

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