Physical restraints in intensive care-An integrative review.

Background: Physical restraints (PRs) are commonly used in intensive care units (ICUs) worldwide for the prevention of treatment interference. While PRs are fundamentally used to maintain patient safety, they can negatively impact the experiences of patients and their families and cause moral and ethical dilemmas for ICU nurses.

Objectives: The aim of this integrative review was to explore the current literature on the use of PR in intensive care.

Methods: This article used an integrative review framework to explore the current literature available on the experiences of PR in ICU. Research published between January 2007 and July 2016 was considered. Databases searched included CINAHL, Proquest, Medline, PubMed, and Cochrane. Inclusion/exclusion criteria were used to screen for eligibility. Methodological quality was evaluated using a quality assessment checklist, adapted from Walsh and Downe, and based on the Critical Appraisal Skills Programme tool. The findings were analysed and synthesised into major themes.

Results: Seventeen articles from Europe, Asia, and the United States of America were included. Five major themes emerged: (i) prevention of treatment interference; (ii) nurses' role as primary decision-makers PR application and removal; (iii) adherence to PR protocols; (iv) moral and ethical dilemmas faced by nurses; and (v) experiences of patients and families. The literature identified the prevalence of PR in today's ICUs, the drawbacks of current practice, and the paucity of knowledge of the lived experiences of PR.

Conclusion: PR is the first choice in preventing of treatment interference, and most clinicians believe there is a valid place for them in ICU. However, its effectiveness in preventing self-extubation is questionable, and there are obvious flaws within this practice including inconsistencies surrounding PR protocols and the shortage of education and training provided to nurses. Further research into lived experiences of PR to gain deeper insights may lead to possible solutions and improve current practice.