The use of physical restraint in critical care, a review

“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.

Happy Friday!