Physical restraints during mechanical ventilation in intensive care

: the experiences of patients, family members and nurses

Abstract

Background
Physical restraints are a commonly used nursing intervention in intensive care to prevent treatment interference, when patients attempt to self-remove potentially life-saving medical interventions, due to pain, discomfort, delirium, sedation, and their underlying illness. The use of physical restraints is commonly justified as a patient safety measure. However, this is problematic as it compromises patients’ dignity and autonomy and causes distress for family members. Physical restraints can also be problematic due to inconsistencies in policy, and deficits in education and training for clinicians who apply and monitor them. Restraints cause moral and ethical dilemmas for nurses who are the primary decision-makers in restraint application and management.

Aim
To explore the experience of physical restraints during mechanical ventilation in intensive care, from the perspectives of patients, family members and nurses.

Methodology and methods
A naturalistic inquiry framework underpinned this study, allowing the experiences of each participant group and each individual participant to be valued, while generating a holistic understanding of the topic under exploration. Qualitative methods were utilised to achieve the aims of the study and to collect rich, meaningful data. Five patients, six family members and 12 nurses (three also belonged to the family member group) were recruited. Braun and Clarke’s (2006) method of thematic analysis was used to analyse the data.

Findings
The findings of the participant groups were synthesised to describe the totality of the experience of physical restraints during mechanical ventilation in intensive care. There were two distinct components of the experience: the experience of physical restraints and mechanical ventilation during the intensive care admission, and life after discharge. The experience of physical restraints led to a number of negative consequences for the participants. Literal and metaphorical voicelessness, and emotional and psychological harm were experienced by patients and family members, with patients additionally experiencing physical harm. They also experienced long-term consequences, including traumatic memories and continued voicelessness. For nurses, restraint application led to moral and ethical dilemmas and conflicts with their professional nursing image.

Conclusion
The experience of physical restraints during mechanical ventilation in intensive care is complex and multifaceted. While the primary rationale for restraint application is patient safety, restraints contradictorily caused substantial harm to patients, family members, and nurses’ professional image. The practice was also found to be heavily flawed as nurses received little practice guidance in the form of policy, and education and training. The insights gained from this study have led to recommendations for practice, including the creation of the CARE: Person-centred treatment interference prevention protocol.

Date of Award	2023
Original language	English
Awarding Institution	Western Sydney University
Supervisor	Kath Peters (Supervisor)