Application Of Physical Restraints Research Articles

Factors affecting nursing practice of patient physical restraint among nurses

BackgroundThis study was aimed to identify perception, knowledge, attitude and nursing practice toward use of physical restraints among clinical nurses.MethodsThe research participants were 180 nurses from general hospitals located in Korea. Data were collected using self-report questionnaires regarding perception, attitude, knowledge, and nursing practice on application of physical restraints and analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression.ResultsThere were significant negative relationships attitudes towards the use of physical restraints with knowledge (r = -.32, p < .001). Knowledge showed a positive correlation with nursing practice (r = .28, p < .001). Factors affecting nursing practice of clinical nurses were identified as knowledge (β = .23), education experiences on physical restraints (Yes) (β = .18), and work unit (ICU) (β = .43). The explanation power of this regression model was 22% and it was statistically significant (F = 7.45, p < .001).ConclusionThis study suggests that knowledge, education experiences on physical restraints, and work unit were the strongest predictor on nursing practice toward use of patient physical restraints. Therefore, developing and applying evidence-based educational intervention programs by work unit to reduce the inappropriate use of physical restraints in hospitals are required.

Factors Associated With Physical Restraint in an Urban Emergency Department

To determine what patient characteristics were associated with the application of physical restraints in our emergency department (ED). This was a retrospective analysis of encounters in the ED of an urban, Level I academic trauma center. We included ED encounters of adult patients (aged ≥18 years) during a 5-year period starting in 2017. We evaluated the independent association of restraint application during an encounter using a generalized estimating equation model. There were 464,031 ED encounters during the time period from 162,244 unique patients, including 34,798 (7.5%) with restraint application, comprising 18,166 unique patients. Several variables were associated with an increased likelihood of restraint use during an encounter. The variable with the highest odds ratio was intoxication with drugs or alcohol (adjusted odds ratio [aOR] 8.29; 95% confidence interval (CI) 7.94 to 8.65). American Indian race was associated with increased odds of restraint application (aOR 1.42; 95% CI 1.31 to 1.54) compared to the reference value of White race. Black race (aOR 0.58; 95% CI 0.55 to 0.61) and Hispanic ethnicity (aOR 0.42; 95% CI 0.37 to 0.48) were associated with lower odds of restraint application. Drug and alcohol intoxication were most closely associated with restraint. Encounters in which the patient was American Indian had higher odds of restraint, but this study does not replicate prior findings regarding other racial disparities in restraint.

Hand and Wrist Injuries Associated With Application of Physical Restraints: A Systematic Review.

While handcuffs and zip ties are common methods of physical restraint used by law enforcement, they have been noted to damage soft tissue and bony structures of the hand and wrist. This paper seeks to characterize the safety of physical restraints by summarizing its effects on hand and wrist function and disability. Relevant studies were gathered through an independent double selection and extraction process using 3 electronic databases (EMBASE, MEDLINE, and CINAHL) from database inception to June 19, 2020. A total of 16 studies involving 807 participants were included. Lesion to the superficial branch of the radial nerve was the most commonly reported injury noted in 82% (42/55) of hands examined. A total of 6% (5/77) of examined hands had bony injury, including 3 radial styloid fractures and 2 scaphoid fractures. Both studies on zip ties noted presence of handcuff neuropathy, with 1 case report documenting severe rapidly progressing ischemic monomelic neuropathy. Overall, the use of handcuffs and zip ties is associated with entrapment neuropathies and bony injury to the hand and wrist. Further studies of higher quality evidence are necessary to understand the effects of physical restraint on hand function and disability.

Nurses' attitudes towards the use of physical restraint in psychiatric care: A systematic review of qualitative and quantitative studies.

WHAT IS KNOWN ON THE SUBJECT?: Application of physical restraint is a common practice to protect service users and staff in psychiatric care. Nurses' attitudes towards physical restraint and its influencing factors in psychiatric settings in different countries are variable. Previous reviews include studies on different coercive methods, making it difficult to differentiate attitudes specific to physical restraint. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Nurses' attitudes were marked by negative feelings and moral conflict towards the use of physical restraint and consider it a necessary nursing intervention and a last resort. The barriers for restraint-free environment practice included contextual demand, lack of knowledge on restraint and lack of alternatives to restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurse educators should develop and evaluate related educational training programmes to promote the development of alternative effective skills in handling violence instead of physical restraint. Policy makers should develop strategies to remove the barriers to a restraint-free environments. ABSTRACT: Introduction Physical restraint is common in psychiatric care; nurses' attitudes are crucial as nurses often implement the procedure. Previous reviews include studies exploring coercive methods but do not specifically focus on physical restraint. Aims This integrated mixed-method systematic review aimed to examine nurses' attitudes towards the use of physical restraint in psychiatric care and the factors influencing these attitudes. Methods Six databases were searched from 2000 to 2021. Thematic integrative analysis was used to synthesize the data. Results Ten studies were included. Five themes encapsulate nurses' attitudes towards physical restraint: "emotional responses," "moral conflicts," "ensuring safety for all," "a necessary nursing intervention" and "a last resort." Three themes were identified for factors influencing attitudes: "contextual demands," "level of knowledge" and "alternatives to restraint." Discussion Nurses' attitudes were marked by negative feelings and moral conflict towards the use of physical restraint. However, nurses applied physical restraint as an ordinary nursing intervention. Educational interventions and the leadership role may facilitate the change of current practice to a restraint-free environment. Implications for Practice Mental health nurses should work to remove the barriers to restraint-free environment and develop effective skills that can be used as alternatives to physical restraint.

Risk factors, time to onset and recurrence of delirium in a mixed medical-surgical ICU population: A secondary analysis using Cox and CHAID decision tree modeling.

A retrospective secondary analysis of 4,200 patients was collected from two academic medical centers. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) in all patients. Univariate and multivariate Cox models, logistic regression analysis, and Chi-square Automatic Interaction Detector (CHAID) decision tree modeling were used to explore delirium risk factors. Increased delirium risk was associated with exposed only to artificial light (AL) hazard ratio (HR) 1.84 (95 % CI: 1.66-2.044, P<0.001), physical restraint application 1.11 (95 % CI: 1.001-1.226, P=0.049), and high nursing care requirements (>8 hours per 8-hour shift) 1.18 (95 % CI: 1.048-1.338, P=0.007). Delirium incidence was inversely associated with greater family engagement 0.092 (95 % CI: 0.014-0.596, P=0.012), low staff burnout and anticipated turnover scores 0.093 (95 % CI: 0.014-0.600, P=0.013), non-ICU length-of-stay (LOS)<15 days 0.725 (95 % CI: 0.655-0.804, P<0.001), and ICU LOS ≤15 days 0.509 (95 % CI: 0.456-0.567, P<0.001). CHAID modeling indicated that AL exposure and age <65 years were associated with a high risk of delirium incidence, whereas SOFA score ≤11, APACHE IV score >15 and natural light (NL) exposure were associated with moderate risk, and female sex was associated with low risk. More rapid time to delirium onset correlated with baseline sleep disturbance (P=0.049), high nursing care requirements (P=0.019), and prolonged ICU and non-ICU hospital LOS (P<0.001). Delirium recurrence correlated with age >65 years (HR 2.198; 95 % CI: 1.101-4.388, P=0.026) and high nursing care requirements (HR 1.978, 95 % CI: 1.096-3.569), with CHAID modeling identifying AL exposure (P<0.001) and age >65 years (P=0.032) as predictive variables. Development of ICU delirium correlated with application of physical restraints, high nursing care requirements, prolonged ICU and non-ICU LOS, exposure exclusively to AL (rather than natural), less family engagement, and greater staff burnout and anticipated turnover scores. ICU delirium occurred more rapidly in patients with baseline sleep disturbance, and recurrence correlated with the presence of delirium on ICU admission, exclusive AL exposure, and high nursing care requirements.

Nurses' Views on the Use of Physical Restraints in Intensive Care: A Qualitative Study.

Despite the worldwide promotion of a “restraint-free” model of care due to the questionable ethical and legal issues and the many adverse physical and psychosocial effects of physical restraints, their use remains relatively high, especially in the intensive care setting. Therefore, the aim of the present study was to explore the experiences of nurses using physical restraints in the intensive care setting. Semi-structured interviews with 20 nurses working in intensive care units for at least three years, were conducted, recorded, and transcribed verbatim. Then, the transcripts were analyzed according to the qualitative descriptive approach by Sandelowsky and Barroso (2002). Six main themes emerged: (1) definition of restraint, (2) who decides to restrain? (3) reasons behind the restraint use, (4) physical restraint used as the last option (5) family involvement, (6) nurses’ feelings about restraint. Physical restraint evokes different thoughts and feelings. Nurses, which are the professionals most present at the patient’s bedside, have been shown to be the main decision-makers regarding the application of physical restraints. Nurses need to balance the ethical principle of beneficence through this practice, ensuring the safety of the patient, and the principle of autonomy of the person.

Racial and ethnic disparities in emergency department restraint use: A multicenter retrospective analysis.

Research regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation. We identified all ED patient encounters with a section 12(a) order across a large integrated 11-hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in-network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed-effect logistic regression with random-intercept model. We identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR]= 1.44, 95% confidence interval [CI]= 1.28 to 1.63), Black/African American race (aOR= 1.22, 95% CI= 1.01 to 1.48), Hispanic ethnicity (aOR= 1.45, 95% CI= 1.22 to 1.73), Medicaid insurance (aOR= 1.21, 95% CI= 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR= 1.51, 95% CI= 1.31 to 1.74). Across all age groups, patients who were 25 to 34years of age were at highest risk of restraint (aOR= 2.01, 95% CI= 1.69 to 2.39). Patients with a primary care provider within our network (aOR= 0.81, 95% CI= 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness. Black/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation.

Preventing Self-Extubation Without Using Restraints.

Preventing Self-Extubation Without Using Restraints.

Knowledge, Attitude, and Practice of Nurses Working in the Adult Intensive-Care Unit and Associated Factors towards the Use of Physical Restraint in Federally Administered Hospitals in Addis Ababa, Ethiopia: A Multicenter Cross-Sectional Study.

Background Physical restraint is any chemical or physical involuntary method restricting an individual's movement, physical activity, or normal access to the body. Physical restraints are prescribed by the physician, but the ICU nurse remains the decision maker responsible in assessing the need, application, and removal of PR on patients in the ICU setting. Objectives This cross-sectional descriptive study was carried out to determine the knowledge, attitudes, and practices of nurses working in adult ICU and associated factors towards the use of physical restraints in federally administered hospitals in Addis Ababa, Ethiopia, 2019. Methods The study was conducted in ICUs of Federal Hospitals in Addis Ababa, Ethiopia, 2019. A hospital-based descriptive cross-sectional study design was carried out. By census, a total of 126 nurses were included. The data were checked for their completeness and were entered to EpiData version 4.2 and analyzed using SPSS version 25 software with 95% CI. Also, the Pearson correlation coefficient and binary logistic regression analysis were used to find an association. Result Majority of nurses was found to be aged between 21 and 30 years, (62.5%) have worked 2–5 years, and (83%) were degree graduates. The nurses' knowledge score was 6.1 ± 2.6 (50.8%) with possible range 0–11, the attitude score was 14.1 ± 3.1 (64%) with possible range 0–22, and the practice score was 13.9 ± 3.8 (63.18%) with possible range 0–22. Their demographical characteristics such as gender, working year, and education levels were not significantly associated with knowledge, attitudes, and practices (P > 0.05). Only age significantly associated with practice. Lack of a written policy or guideline and not being trained on application of physical restraint were significantly associated with knowledge. Also, practice was associated with knowledge and attitude. Conclusion According to the study, there was a poor level of nurses' knowledge, proper attitude, and satisfactory practice toward the use of physical restraints.

Care challenges in older general hospital patients : Impact of cognitive impairment and other patient-related factors.

BackgroundOlder general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment).MethodsA cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients’ cognitive status.ResultsCare challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations.ConclusionThe findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.

Factors Affecting Nurses’ Performance Regarding Use of Physical Restraints in Critical Care Unit

Background: Physical restraints are any devices or materials attached to patients’ bodyprevent the patient from pulling the connected devices. Aim: assess factors affecting nurses’ performance regarding use of physical restraint in critical care unit. Design:Descriptive exploratory designs were used. Setting: The study was conducted in Medical Intensive Care Unit at Ain Shams University Hospital, Egypt. Subjects: A convenient sample of 36 nurses was recruited from the previously mentioned setting. Tools: A structured interview questionnaire to assess nurses'demographic data and nurses’ knowledge about physical restraint, use of physical restraint observational for assessing nurses’ practice and questionnaire for assessing factors affecting nurses’ performance regarding use of physical restraint. Results: Half of the studied nurse had satisfactory knowledge level. All the studied nurses had unsatisfactory level of practice. The majority of the studied nurses reported that the degree of experience is one of the most important factor affecting use of physical restraints properly,less than two third of the studied nurses reported that, separation of ICU patients' in a private room affects their ability to monitor the patients. No statistically significant relation between nurses’ level of knowledge and their demographics data. Conclusion: most common factors affecting use of physical restraint is absence of clear policies to conduct physical restraint, no written consent for patient’s approval on application of physical restraint and in addition to absence of continuous education about use of physical restraint. Recommendations: Developing hospital policy and procedure for physical restraints to be available for all nurses and physicians. A hospital consent policy for obligating doctor and nurses to get approval from patient or his / her family before application of physical restraint.

Physical Restraint Use With Elderly Patients: Perceptions of Nurses and Nursing Assistants in Spanish Acute Care Hospitals.

Physical restraint is often used during the hospitalization of elderly people. However, this procedure is associated with adverse outcomes; therefore, it is necessary to be aware of the circumstances that promote restraint use, such as the perceptions of professionals who use it. The purpose of the research was to determine the situations in which nursing staff considered the use of physical restraint as most important and to evaluate the possible associations with the sociodemographic and professional variables. A descriptive cross-sectional multicenter study was carried out in 52 units of eight Spanish acute hospitals. A survey of registered nurses and nursing assistants was used to collect data related to sociodemographic characteristics, experience, training in restraint use, and the Perception of Restraint Use Questionnaire (PRUQ)-which assesses the perceived importance of reasons frequently given for the use of physical restraint. The sample comprised 508 registered nurses and 347 nursing assistants. Almost all (98%) had used physical restraint, and 82% thought their training in the use of physical restraint was insufficient. Nursing assistants scored higher than registered nurses (p < .005, d = .68) on PRUQ total score and individual item scores, suggesting they thought the factors were more important in restraint use. Both registered nurses and nursing assistants considered restraint as most important in the prevention of falls and in the removal of medical devices such as intravenous lines and urinary catheters. Associations between PRUQ total score and other variables (unit type, sociodemographic factors, hospital) were nonsignificant. The professionals considered restraint as very important in preventing safety problems. In order to improve the quality of care, it is essential to identify the factors that can have an effect on the application of physical restraint. Educational programs are of fundamental importance, but to be more effective in reducing the use of physical restraint, they should address commonly held views on rationale for restraint use and be accompanied by institutional policies promoting a restraint-free environment.

신경계 병동에서 억제대를 적용 중인 환자가족의 억제대 적용에 대한 인식과 태도

This study was conducted to identify families' perception and attitude toward application of physical restraint(PR) in general neurological wards. The study is based on subjects from 70 family members who have cared patients applying PR. Data was collected using self-report questionnaires and reviewing of patients' medical records. 68.6% of subjects were female and the mean age was 47.9 years old. Family members were either sons, daughters or spouses. The questionnaires analyzed families' perceptions based on a score of 5, the results showed a mean score of 4.2, and items related to maintaining therapeutic tools scored the highest. The application of PR with two hands was perceived by families as more important than PR applied with one hand. In families' attitude toward PR, there was general agreement that families had the right to decide to apply and remove PR. Continuous education and information regarding PR is required to support families.

Contextual influences on nurses' decision-making in cases of physical restraint.

In order to fully understand nurses' ethical decision-making in cases of physical restraint in acute older people care, contextual influences on the process of decision-making should be clarified. What is the influence of context on nurses' decision-making process in cases of physical restraint, and what is the impact of context on the prioritizing of ethical values when making a decision on physical restraint? A qualitative descriptive study inspired by the Grounded Theory approach was carried out. In total, 21 in-depth interviews were carried out with nurses working on acute geriatric wards in Flanders, Belgium. The research protocol was approved by the Ethics Committee of the Faculty of Medicine, Leuven. Relationships with nursing colleagues and the patient's family form an inter-personal network. Nurses also point to the importance of the procedural-legal context as expressed in an institutional ethics policy and procedures, or through legal requirements concerning physical restraint. Furthermore, the architectural structure of a ward, the availability of materials and alternatives for restraint use can be decisive in nurses' decision-making. All interviewed nurses highlighted the unquestionable role of the practical context of care. Context can have a guiding, supportive, or decisive role in decision-making concerning the application of physical restraint. The discussion focuses on the role of the inter-personal network of nurses on the process of decision-making. An institutional ethics policy and a value-supportive care environment can support nurses in their challenge to take ethically sound decisions.

Examination of Ethical Dilemmas Experienced by Adult Intensive Care Unit Nurses in Physical Restraint Practices

Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.

EPA-1251 – Physical restraint of patients: therapeutic necessity or abuse of psychiatry

Physical restraint of patients is applied when a patient is aggressive and violent, after application of medicaments and verbal therapy have failed to produce the expected results. One of the strongest arguments for using physical restraint is the potential harm the patient can cause to himself, others or both. The objective of the study was to find which psychopathological manifestations required physical restraint, what diagnostic entities were related with application of physical restraint and how long the physical restraint lasted. The retrospective study covered 84 patients who were treated in our institution in the period between 2011 and 2012 and were physically restrained at some point during that period. Additional parameters were used in the study: 1/ diagnosis, 2/ patient's age, 3/ sex, 4/ previous application of pharmacotherapy, 5/ number of instances of physical restraint. Out of the total number of patients who were physically restrained, 52.4% (n=44) of them were diagnosed with schizophrenia. Average age of the patients was 28.2. The men (92.8%, n=78) outnumbered the women. 73.8% (n=62) of them received medication prior to being physically restrained. 5.9% (n=5) of the patients were physically restrained at least twice. If applied in the presence of precisely defined indications and after other therapeutic modalities have been exhausted, physical restraint is a therapeutic intervention. In all other cases, and particularly if used for longer than is necessary, physical restraint is a form of punishment of the patient and abuse of psychiatry.

Characteristics of nursing home residents and physical restraint: a systematic literature review

To analyse and to summarise factors associated with nursing home residents' characteristics which could lead to physical restraint, and to investigate the consequences of physical restraint use for this population. Even though the application of physical restraint is highly controversial, prevalence rates show that it is a common intervention in nursing homes. Residents' characteristics seem to be important to predict the use of physical restraint. Evidence suggests that restrained nursing home residents may have physical and psychological disadvantages as a consequence of being restrained. A systematic literature research involving the databases PubMed, Cumulative Index to Nursing and Allied Health Literature, ISI Web of Science and Cochrane Library was carried out for articles published from January 2005-November 2011. Nine Studies fulfilled the inclusion criteria and the quality assessment. Restrained residents had low activities of daily living (ADL) scores and severe cognitive impairment. Residents with low cognitive status and serious mobility impairments were at high risk to be restrained, as well as residents with previous fall and/or fracture. Repeated verbal and physical agitation was found to be positively associated with restraint use. Possible consequences of physical restraint were as follows: lower cognitive and ADL performance, higher walking dependence, furthermore falls, pressure ulcers, urinary and faecal incontinence. This systematic literature review reveals notable resident-related factors for physical restraint use. The consequences of restraint seem to negatively influence residents' physical and psychological well-being. Physical restraint seems to be an important risk factor for residents' further health problems. Resident's characteristics appear to be decisive factors for the use of physical restraint. Nurses need a high level of expertise and competence in evaluating the individual residents' situation and deciding further steps, with respect for the autonomy and dignity of the person.

Perceptions of Family Care-givers toward Use of Physical Restraints: An Application of Q-methodology

Purpose: The purpose of this study was to identify on the perceptions of family care-givers toward use of physical restraints according to their values, beliefs, and perceptions using Q methodology. Methods: Thirty-three family care-givers classified 41 selected Q-statements into 9 points standard. The obtained data were analyzed by using a pc QUANL program. Results: Principal component analysis identified 4types of the perceptions of family care-givers toward the use of physical restraints. Type I is `Rational accepted`, which means that they perceived the restraints are essential therapeutic devices and had cooperative attitude to use of medical staffs` restraints. Type II is `Sardonic sensibility`, which means that they have a negative and a cynical attitude to use of physical restraints. Type III is `Ambivalent`, which means that they have conflicts between rationality and emotion, and type IV is `Practical claim of a right`, which means they insist that patients and their family members must be provided with a detailed explanation regarding the application of physical restraints. Conclusion: The findings of this study suggest that perceptions toward the use of physical restraints among family care-givers should be understood for patients` safety and dignity in medical circumstance. Based on the results, this study will be useful in developing the customized nursing intervention for supporting family care-givers` subjectivity considering the Korean context.

Comparison of Oxygen Saturation Values Obtained From Fingers on Physically Restrained or Unrestrained Sides of the Body

The aim of this study was to compare semiexperimentally the pulse oximetry values obtained from a finger on restrained or unrestrained sides of the body. The pulse oximeter provides a noninvasive measurement of the oxygen saturation of hemoglobin in arterial blood. One of the procedures most frequently applied to patients in intensive care units is the application of physical restraint. Circulation problems are the most important complication in patients who are physically restrained. Evaluation of oxygen saturation from body parts in which circulation is impeded or has deteriorated can cause false results. The research sample consisted of 30 hospitalized patients who participated in the study voluntarily and who were concordant with the inclusion criteria of the study. Patient information and patient follow-up forms were used for data collection. Pulse oximetry values were measured simultaneously using OxiMax Nellcor finger sensors from fingers on the restrained and unrestrained sides of the body. Numeric and percentile distributions were used in evaluating the sociodemographic properties of patients. A significant difference was found between the oxygen saturation values obtained from a finger of an arm that had been physically restrained and a finger of an arm that had not been physically restrained. The mean oxygen saturation value measured from a finger of an arm that had been physically restrained was found to be 93.40 (SD, 2.97), and the mean oxygen saturation value measured from a finger of an arm that had not been physically restrained was found to be 95.53 (SD, 2.38). The results of this study indicate that nurses should use a finger of an arm that is not physically restrained when evaluating oxygen saturation values to evaluate them correctly.

Unplanned Extubation Study Leaves Questions Unanswered

With respect to the article by Chang and colleagues1 in the September 2008 issue, I applaud the authors for attempting to address the difficult issue of preventing unplanned extubations in the intensive care unit (ICU). However, I believe that additional information was required to support the authors’ conclusion that the application of physical restraint is on its own a risk factor for self-extubation.The authors provide little information about the decision-making process for application of restraint in the study ICU. They do state that an “evaluation of the risk of unplanned extubation and/or fall”1(p410) was performed, but they provide no details of the content of this evaluation or of the potential differences in risk category among the patient groups that it might reveal. Did the patients who were included in the unplanned extubation group score at higher risk than those who did not or higher than the control group? Why weren’t the members of the control group restrained? What factors were involved in the decision-making process that might also be related to unplanned extubation?Also, the authors state that “[a]mong the 191 patients who were physically restrained, 82 had an unplanned extubation.”1(p411) What about the 109 patients who were restrained but did not have an unplanned extubation? What differences exist among that group, the unplanned extubation group, and the control group? Were they monitored more frequently? Were different forms of physical restraint used?The authors claim, “Currently, use of a wrist belt tied to the bedside railing is the most common method of restraining patients.”1(p413) Were all of the patients in the study restrained this way? Given that the assessment described seems to be both for unplanned extubation and/or for fall, it seems reasonable to ask whether other methods that would be unsuccessful in preventing unplanned extubation (such as use of a vest restraint) were the kind actually used on some proportion of patients in the study.Preventing unplanned extubation in the ICU is a very important topic that deserves further study to promote the most effective and informed practice. In my judgment, though, additional information about the method used to decide to restrain patients, the specific monitoring that was performed, and the type of restraint that was used would have made this study more informative and more valuable.