Nurses' Decision-Making Process in Cases of Physical Restraint in Intensive Care Units

Purpose: ICUs had the highest frequency of using physical restraint in hospitals. The timing of the use of physical restraint is most likely to be determined by the nursing staffs in ICUs. It is necessary to understand the motives and ideas behind the use of physical restriants in the ICUs. The purpose of this study was to explore factors influencing the concept, attitude and decision-making process of the nursing staffs when applying physical restriants. Moreover, analyzing the conflicts between the influencing factors and the nursing ethics of this behavioral decision.

Methods: In-depth interviews and observations were used to collect data in medical center in northern Taiwan. Purposive sampling was applied and 4 intensive care unit nurses who had the experience of applying physical restraints during patients’ hospitalization were interviewed using semi-structured questionnaires. The data collection period was from September 2016 to March 2017.

Results: Content analysis was used to analyze and categorize the data. It is classified into four thematic categories as followed: (1)safety factors: risk prevention strategies/tools for patient safety, (2) Environmental factors: The culture of using restraints in the ICUs and quality of control, (3)ethical impact: Patient rights, autonomy, dignity, and conflicts between caregivers when applying physical restriants. Most families do not want their love ones to be in danger, so they have more respect for the nursing staffs when it comes to the evaluation and decision making of applying physical restriants. Nursing staffs also don't want to have their patients extricating invasive lines or tubes from themselves, therefore this situation is not only a medical dispute, but also caused emotional stress for nurses, including helplessness, fear, anger and guilt.

Conclusion: This study was not only understands the views and decision-making process of nursing staffs in ICUs on the implementation of physical restraints, but also how to assist the proper assessment to carry out the appropriate physical restraints, and even the timely release from them. In conclusion, in order to achieve a restriant-free environment, we still need to have a proper policy formulation and the development of appropriate ancillary assessment tools.