Hola a tod@s, my dear Friends.

Today ends the week of #UciSinSujecciones and I didn’t want to finish it without bringing you a review article on the subject.

Published in 2007 in Nursing in Critical Care,  the journal of the British Association of Critical Care Nurses , the article The use of physical restraint in critical care talks about this ítem.
The abstract begins: “Critically ill patients are at high risk for the development of delirium and agitation, resulting in non-compliance with life-saving treatment. The use of physical restraint appears to be a useful and simple solution to prevent this treatment interference. In reality, restraint is a complex topic, encompassing physical, psychological, legal and ethical issues.”

“Restrain, in broad terms, means restricting the freedom of someone or prevent them doing something they want to” according to the Royal College of Nursing in 2004. The Joint Comission on Accreditation of Health-care Organization defines restraint as any method that limits the freedom of movement, physical activity or normal access to one’s body.

Historically, the restrictions give an image of security and were initially used at home and in psychiatric hospitals to avoid falls and disoriented patients might self-harm (Sullivan-Marx and Strumpf, 1996; Martin, 2002). In the ICU, its use began to prevent interference with the treatments of the patients with psychosis.

Already in 2004, Nirmalan believed that “physical restraints are unacceptable in the United Kingdom and are frequently associated with imprisonment”.

Studies carried out on physical restraint always talk about the reason to use them to keep the patient’s safety and prevent falls, but the real reason is to avoid removal of tubes or catheters and thus prevent the treatment non-compliance. Few studies talk about who decides to use, and they pointed  mainly towards nursing. And when: more at night than during the day.

20% of nurses noted in an American study (Maruschock 1996), that their use was acceptable if they could not closely monitor the patient. But 60% decreased use after expanding their knowledge on the subject and receive education.

From IC-HU Project we wanted to start a dialogue and discussion to generate a first action of change. From the utmost respect, and the evidence also. In the discussions: improve nursing Ratios, facilitate the family presence, adapt the sedoanalgesia and promoting team work as the #UciSinSujecciones ways.

Many thanks to everybody  for sending your photos, and by each restraint that were removed this week. By most “likes” on Facebook, today presides the post  the photo of Ramón Santos, nurse of the ICU of the MD Anderson in Madrid.

Only depends on everybody of us to follow this way and apply non-maleficence and beneficence as t point to our moral and professional obligations. And learn of the mates who already do not use them because they don’t even have them.

Happy Friday!