ETHICAL AND CLINICAL CONSIDERATIONS IN THE USE OF RESTRAINTS FOR PATIENT SAFETY IN INTENSIVE CARE UNITS
Keywords:
Ethics, Patient Safety, Restraint, Intensive Care
Abstract
The use of physical restraints on patients in intensive care units (ICUs) is a common intervention aimed at ensuring patient safety, particularly in preventing the dislodgement of vital invasive devices. However, this practice raises ethical and clinical dilemmas due to the complex considerations involved. The aim of this study was to explore the ethical and clinical considerations in the use of restraints for patient safety in the intensive care setting. This research employed a qualitative phenomenological design, with data collected through in-depth interviews involving eight participants in the intensive care unit. Data were analyzed using the Colaizzi method. The study identified three major themes: considering the patient's needs, preventing the dislodgement of invasive devices, and experiencing contradictory feelings. The findings highlight the need for clearer, standardized policies on the use of restraints in intensive care units that incorporate both ethical and clinical perspectives.
References
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Bassi, E & Ceresola M. (2011). Use of physical restraints in adult ICU patients to prevent patient-initiated device removal: a systematic review. JBI Libr. Syst. Rev, 9 (Suppl. 32), 1-14. https://doi.org/10.11124/01938924-201109321-00015.
Chapman, R., Ogle, K. R., Martin, C., Rahman, A., Mckenna, B., & Barnfield, J. (2016). Australian nurses' perceptions of the use of manual restraint in the Emergency Department: A qualitative perspective. Journal of Clinical Nursing, 25(9-10), 1273-1281. https://doi.org/10.1111/jocn.13159.
Fithria, F., Adlim, M., Jannah, S. R., & Tahlil, T. (2021). Indonesian adolescents' perspectives on smoking habits: a qualitative study. BMC Public Health, 21(1), 1-8. https://doi.org/10.1186/s12889-020-10090-z.
Fitri, F., Asniar, A., & Fithria, F. 2022. Function of Directing in Performing Physical Restrain in Intensive Care Wards: A Phenomenological Study. International Journal of Nursing Education Volume, 14(4), 1-6. https://doi.org/10.37506/ijone.v14i4.18674
Guenna Holmgren, A., Juth, N., Lindblad, A., & von Vogelsang, A. C. (2021). Nurses' experiences of using restraint in neurosurgical care - A qualitative interview study. Journal of Clinical Nursing, August, 1-12. https://doi.org/10.1111/jocn.16044.
Goethals, S., Dierckx de Casterlé, B., & Gastmans, C. (2013). Nurses' decision-making process in cases of physical restraint in acute elderly care: A qualitative study. International Journal of Nursing Studies, 50(5), 603-612. https://doi.org/10.1016/j.ijnurstu.2012.10.006.
Kandeel, N. A., & Attia, A. K. (2013). Physical restraints practice in adult intensive care units in Egypt. Nursing and Health Sciences, 15(1), 79-85. https://doi.org/10.1111/nhs.12000.
Kassew, T., Dejen Tilahun, A., & Liyew, B. (2020). Nurses' knowledge, attitude, and influencing factors regarding physical restraint use in the intensive care unit: A multicenter cross-sectional study. Critical Care Research and Practice, 1-10. https://doi.org/10.1155/2020/4235683.
Li, X., & Fawcett, T. N. (2014). Clinical decision making on the use of physical restraint in intensive care units. International Journal of Nursing Sciences, 1(4), 446-450. https://doi.org/10.1016/j.ijnss.2014.09.003.
Luk, E., Sneyers, B., Rose, L., Perreault, M. M., Williamson, D. R., Mehta, S., Cook, D. J., Lapinsky, S. C., & Burry, L. (2014). Predictors of physical restraint use in Canadian intensive care units. Critical Care, 18(2), 1-8. https://doi.org/10.1186/cc13789.
Perez, D., Murphy, G., Wilkes, L., & Peters, K. (2021). Understanding nurses' perspectives of physical restraints during mechanical ventilation in intensive care: A qualitative study. Journal of Clinical Nursing, 30(11-12), 1706-1718. https://doi.org/10.1111/jocn.15726.
Riahi, S., Thomson, G., & Duxbury, J. (2016). An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint. Journal of Psychiatric and Mental Health Nursing, 23(2), 116-128. https://doi.org/10.1111/jpm.12285
Salehi, Z., Najafi Ghezeljeh, T., Hajibabaee, F., & Joolaee, S. (2020). Factors behind ethical dilemmas regarding physical restraint for critical care nurses. Nursing Ethics, 27(2), 598-608. https://doi.org/10.1177/0969733019858711.
Teece, A., Baker, J., & Smith, H. (2022). Understanding the decision-making of critical care nurses when restraining a patient with psychomotor agitation secondary to hyperactive delirium: a 'think aloud' study. Journal of Clinical Nursing, 31(1-2), 121-133. https://doi.org/10.1111/jocn.15889.
Unoki, T., Sakuramoto, H., Ouchi, A., & Fujitani, S. (2019). Physical restraints in intensive care units: a national questionnaire survey of physical restraint use for critically ill patients undergoing invasive mechanical ventilation in Japan. Acute Medicine & Surgery, 6(1), 68-72. https://doi.org/10.1002/ams2.380.
Via-Clavero, G., Guàrdia-Olmos, J., Falcó-Pegueroles, A., Gil-Castillejos, D., Lobo-Cívico, A., De La Cueva-Ariza, L., Romero-García, M., & Delgado-Hito, P. (2020). Factors influencing critical care nurses' intentions to use physical restraints adopting the theory of planned behavior: A cross-sectional multicentre study. Australian Critical Care, 33(5), 426-435. https://doi.org/10.1016/j.aucc.2019.09.003.
Vieta, E., Garriga, M., Cardete, L., Bernardo, M., Lombraña, M., Blanch, J., Catalán, R., Vázquez, M., Soler, V., Ortuño, N., & Martínez-Arán, A. (2017). Protocol for the management of psychiatric patients with psychomotor agitation. BMC Psychiatry, 17(1). https://doi.org/10.1186/s12888-017-1490-0.
Bassi, E & Ceresola M. (2011). Use of physical restraints in adult ICU patients to prevent patient-initiated device removal: a systematic review. JBI Libr. Syst. Rev, 9 (Suppl. 32), 1-14. https://doi.org/10.11124/01938924-201109321-00015.
Chapman, R., Ogle, K. R., Martin, C., Rahman, A., Mckenna, B., & Barnfield, J. (2016). Australian nurses' perceptions of the use of manual restraint in the Emergency Department: A qualitative perspective. Journal of Clinical Nursing, 25(9-10), 1273-1281. https://doi.org/10.1111/jocn.13159.
Fithria, F., Adlim, M., Jannah, S. R., & Tahlil, T. (2021). Indonesian adolescents' perspectives on smoking habits: a qualitative study. BMC Public Health, 21(1), 1-8. https://doi.org/10.1186/s12889-020-10090-z.
Fitri, F., Asniar, A., & Fithria, F. 2022. Function of Directing in Performing Physical Restrain in Intensive Care Wards: A Phenomenological Study. International Journal of Nursing Education Volume, 14(4), 1-6. https://doi.org/10.37506/ijone.v14i4.18674
Guenna Holmgren, A., Juth, N., Lindblad, A., & von Vogelsang, A. C. (2021). Nurses' experiences of using restraint in neurosurgical care - A qualitative interview study. Journal of Clinical Nursing, August, 1-12. https://doi.org/10.1111/jocn.16044.
Goethals, S., Dierckx de Casterlé, B., & Gastmans, C. (2013). Nurses' decision-making process in cases of physical restraint in acute elderly care: A qualitative study. International Journal of Nursing Studies, 50(5), 603-612. https://doi.org/10.1016/j.ijnurstu.2012.10.006.
Kandeel, N. A., & Attia, A. K. (2013). Physical restraints practice in adult intensive care units in Egypt. Nursing and Health Sciences, 15(1), 79-85. https://doi.org/10.1111/nhs.12000.
Kassew, T., Dejen Tilahun, A., & Liyew, B. (2020). Nurses' knowledge, attitude, and influencing factors regarding physical restraint use in the intensive care unit: A multicenter cross-sectional study. Critical Care Research and Practice, 1-10. https://doi.org/10.1155/2020/4235683.
Li, X., & Fawcett, T. N. (2014). Clinical decision making on the use of physical restraint in intensive care units. International Journal of Nursing Sciences, 1(4), 446-450. https://doi.org/10.1016/j.ijnss.2014.09.003.
Luk, E., Sneyers, B., Rose, L., Perreault, M. M., Williamson, D. R., Mehta, S., Cook, D. J., Lapinsky, S. C., & Burry, L. (2014). Predictors of physical restraint use in Canadian intensive care units. Critical Care, 18(2), 1-8. https://doi.org/10.1186/cc13789.
Perez, D., Murphy, G., Wilkes, L., & Peters, K. (2021). Understanding nurses' perspectives of physical restraints during mechanical ventilation in intensive care: A qualitative study. Journal of Clinical Nursing, 30(11-12), 1706-1718. https://doi.org/10.1111/jocn.15726.
Riahi, S., Thomson, G., & Duxbury, J. (2016). An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint. Journal of Psychiatric and Mental Health Nursing, 23(2), 116-128. https://doi.org/10.1111/jpm.12285
Salehi, Z., Najafi Ghezeljeh, T., Hajibabaee, F., & Joolaee, S. (2020). Factors behind ethical dilemmas regarding physical restraint for critical care nurses. Nursing Ethics, 27(2), 598-608. https://doi.org/10.1177/0969733019858711.
Teece, A., Baker, J., & Smith, H. (2022). Understanding the decision-making of critical care nurses when restraining a patient with psychomotor agitation secondary to hyperactive delirium: a 'think aloud' study. Journal of Clinical Nursing, 31(1-2), 121-133. https://doi.org/10.1111/jocn.15889.
Unoki, T., Sakuramoto, H., Ouchi, A., & Fujitani, S. (2019). Physical restraints in intensive care units: a national questionnaire survey of physical restraint use for critically ill patients undergoing invasive mechanical ventilation in Japan. Acute Medicine & Surgery, 6(1), 68-72. https://doi.org/10.1002/ams2.380.
Via-Clavero, G., Guàrdia-Olmos, J., Falcó-Pegueroles, A., Gil-Castillejos, D., Lobo-Cívico, A., De La Cueva-Ariza, L., Romero-García, M., & Delgado-Hito, P. (2020). Factors influencing critical care nurses' intentions to use physical restraints adopting the theory of planned behavior: A cross-sectional multicentre study. Australian Critical Care, 33(5), 426-435. https://doi.org/10.1016/j.aucc.2019.09.003.
Vieta, E., Garriga, M., Cardete, L., Bernardo, M., Lombraña, M., Blanch, J., Catalán, R., Vázquez, M., Soler, V., Ortuño, N., & Martínez-Arán, A. (2017). Protocol for the management of psychiatric patients with psychomotor agitation. BMC Psychiatry, 17(1). https://doi.org/10.1186/s12888-017-1490-0.
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2025-06-14
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