Improving Nursing Quality of Use of Physical Restraints in ICU Through Shared Decision Making

^{Purpose: Employing physical restraints over a prolonged period imperceptibly causes adverse physical and mental impacts on the patient and it has become a considerably controversial issue in terms of nursing care.The purpose of this study is to reduce the rate of continuous restraint in the ICU and to improve patient safety and nursing quality.}

^{Methods: An empirical study was conducted through systematic literature review and analysis. A cross-sectional study was used to collect individual cases of using innovative restraint alternatives in a total of 19 patients in an ICU in a medical center in southern Taiwan during the period from April 1, 2018 to September 30, 2018.This is achieved by adopting the shared decision making approach for patients and the medical staff to collaborate in the restraint care program through mutual respect and effective communication in combination with use of innovative alternatives to replace traditional physical restraints. Data of the rate of continuous physical restraint, patient physical comfort levels, the incidence rate of unplanned self-extubation due to agitated behavior were collected.}

^{Results: The results show that (1) through the effective shared decision making approach, patient and family satisfaction levels towards employing restraints reached 100%; (2) the rate of continuous physical restraint was reduced from 31.2% to 1.54%; (3) the incidence rate of unplanned self-extubation in the ICU during the period was 0; (4) the number of incidents of medical device-related injuries was 0.}

^{Conclusion: In addition to improving the collaborative relationship between the medical staff and patients through effective physician-patient communication, establishing patient decision aid tools and providing on-the-job training for medical staff in combination with use of innovative restraint alternatives can also improve patient adherence and comfort levels, thereby reducing the rate of continuous physical restraint and risks of self-extubation. We advise medical institutions not to overlook the effects that restraint issues may have on nursing care quality.}