BACKGROUND: Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices. OBJECTIVES: To describe the relationship between patients' characteristics, environment, and use of physical restraints in the United States and Norway. METHODS: Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients' acuity level. RESULTS: Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample. CONCLUSIONS: Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.
BACKGROUND: Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices. OBJECTIVES: To describe the relationship between patients' characteristics, environment, and use of physical restraints in the United States and Norway. METHODS: Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients' acuity level. RESULTS: Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample. CONCLUSIONS: Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.
Authors: Elizabeth Kvale; J Nicholas Dionne-Odom; David T Redden; F Amos Bailey; Marie Bakitas; Patricia S Goode; Beverly R Williams; Kathlyn Sue Haddock; Kathryn L Burgio Journal: J Palliat Med Date: 2015-04-30 Impact factor: 2.947
Authors: Bernard De Jonghe; Jean-Michel Constantin; Gerald Chanques; Xavier Capdevila; Jean-Yves Lefrant; Hervé Outin; Jean Mantz Journal: Intensive Care Med Date: 2012-10-13 Impact factor: 17.440
Authors: Elena Luk; Barbara Sneyers; Louise Rose; Marc M Perreault; David R Williamson; Sangeeta Mehta; Deborah J Cook; Stephanie C Lapinsky; Lisa Burry Journal: Crit Care Date: 2014-03-24 Impact factor: 9.097