Giving Voice to Patients on Ventilators: Perceptions of the Restraint Experience

Thursday, 15 July 2010: 8:30 AM

Sandra S. Dodd, MSN, CCRN
Nursing Administration, Martin Memorial Medical Center, Stuart, FL
Suzanne J. Crouch, EdD, MSN, ARNP, RN-BC
School of Nursing, Palm Beach Atlantic University, West Palm Beach, FL

Learning Objective 1: identify potential situations which may increase the level of anxiety of a patient who is physically restrained.

Learning Objective 2: create a plan of care for the restrained patient which includes maintaining patient safety while recognizing patient autonomy.

Purpose: Patients who are on ventilators and physical restraints often have little or no ”voice” to express their physical, emotional, or spiritual concerns. Even though the use of physical restraints is a standard of practice, physical restraints have been shown to cause psychological, physical, legal, and ethical problems (Mott, Poole. & Kenrick, 2005). While there is significant published work on restraints in regards to safety, ethical, and family concerns, there is little nursing research on patients' perceptions of the physical restraint experience (Happ, Tuite, Dobbin, Di-Virgilio-Thomas, & Kitutu, 2004). The purpose of this nursing research study was to view restraint experiences through the lens of patients' eyes and listen to their voices regarding their experiences.

Methods: Fifty patients who had been admitted to one of four Intensive Care Units at two medical centers in southeastern Florida participated in the study. After the patient was weaned from the ventilator and removed from restraints, the nurse researcher contacted the patient to conduct an interview with the intent of listening to the patients' perceptions of the restraint experience.

Results: Qualitative analysis revealed recurring themes of anxiety and helplessness related to loss of autonomy. “I felt bad. I felt like an animal tied down.” “Frightened, I was unable to complete my prayer with making the sign of the cross.”  “Even though my arms were exercised periodically by the nurse, I could not move them very well for days after I was released.” “I felt like I was drowning from reflux.”

Conclusion: The information gathered may shed new light on patients’ anxieties and perceptions of the ventilator and restraint experience. Additionally, findings may aid healthcare workers in actively listening to patients' voices. Implications for nursing practice may include an improvement in patient autonomy and an enhancement in overall quality of care and patient satisfaction.