TY - JOUR
T1 - Implementation of nonpharmacologic physical restraint minimization interventions in the adult intensive care unit
T2 - A scoping review
AU - Alostaz, Ziad
AU - Rose, Louise
AU - Mehta, Sangeeta
AU - Johnston, Linda
AU - Dale, Craig
N1 - Funding Information:
This scoping review was funded through graduate awards provided by Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada.
Publisher Copyright:
© 2021 The Authors
PY - 2021
Y1 - 2021
N2 - Objective: To identify the elements informing the successful implementation of nonpharmacologic physical restraint minimization interventions in adult intensive care unit patients. To map those elements to innovation, context, recipients and facilitation domains of the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and to describe the outcomes of those interventions. Methodology: A scoping review of studies published in English reporting on restraint minimization interventions in adult intensive care units. We searched seven databases (MEDLINE, CIHAHL, Embase, Web of Science, Cochrane Library, PROSPERO and Joanna Briggs) from inception to 2021. Two authors independently screened articles for inclusion, extracted study characteristics and mapped intervention data to the i-PARIHS domains. Results: Seven studies met inclusion criteria. Innovations comprised multicomponent interventions including education, decision aids/protocols and restraint alternatives. No studies utilised an implementation science framework to diagnose the baseline practice context. A commonly reported barrier to restraint minimization was a risk averse culture. Change was mostly driven by the external context (i.e. national regulations). Overall, nurses were the primary facilitators and recipients of practice change. Outcomes were changes in restraint incidence and prevalence abstracted from the medical record. However, no study validated the accuracy of restraint documentation. All studies documented an initial decrease in physical restraint use, but no long-term results were reported. Conclusion: Restraint minimization intervention studies report nurse-facilitated multicomponent interventions and short-term practice change. Future restraint minimization research incorporating implementation science frameworks, interprofessional teams and patient/family perspectives is warranted.
AB - Objective: To identify the elements informing the successful implementation of nonpharmacologic physical restraint minimization interventions in adult intensive care unit patients. To map those elements to innovation, context, recipients and facilitation domains of the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and to describe the outcomes of those interventions. Methodology: A scoping review of studies published in English reporting on restraint minimization interventions in adult intensive care units. We searched seven databases (MEDLINE, CIHAHL, Embase, Web of Science, Cochrane Library, PROSPERO and Joanna Briggs) from inception to 2021. Two authors independently screened articles for inclusion, extracted study characteristics and mapped intervention data to the i-PARIHS domains. Results: Seven studies met inclusion criteria. Innovations comprised multicomponent interventions including education, decision aids/protocols and restraint alternatives. No studies utilised an implementation science framework to diagnose the baseline practice context. A commonly reported barrier to restraint minimization was a risk averse culture. Change was mostly driven by the external context (i.e. national regulations). Overall, nurses were the primary facilitators and recipients of practice change. Outcomes were changes in restraint incidence and prevalence abstracted from the medical record. However, no study validated the accuracy of restraint documentation. All studies documented an initial decrease in physical restraint use, but no long-term results were reported. Conclusion: Restraint minimization intervention studies report nurse-facilitated multicomponent interventions and short-term practice change. Future restraint minimization research incorporating implementation science frameworks, interprofessional teams and patient/family perspectives is warranted.
KW - Implementation
KW - Intensive care unit
KW - Physical restraint
KW - Practice change
KW - Scoping review
UR - http://www.scopus.com/inward/record.url?scp=85121790810&partnerID=8YFLogxK
U2 - 10.1016/j.iccn.2021.103153
DO - 10.1016/j.iccn.2021.103153
M3 - Review article
AN - SCOPUS:85121790810
SN - 0964-3397
JO - Intensive and Critical Care Nursing
JF - Intensive and Critical Care Nursing
M1 - 103153
ER -