A Diagnostic Evaluation of Physical Restraint Practices in An Adult Intensive Care Unit: A Mixed Method Study
Bibliographic record
Abstract
Background: Evidence indicates that physical restraints (PR) are associated with adverse physical, emotional and psychological sequelae and do not consistently prevent intensive care unit (ICU) patients from removing medical devices. Guidelines advocate for minimization of PR use in ICUs. Nevertheless, PRs continue to be used extensively in ICUs both in Canada and internationally. Aim: To identify the baseline (i.e., pre-implementation) factors that could influence the successful implementation of PR minimization interventions using the integrated–Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Design: A convergent parallel mixed qualitative and quantitative methods study in a 20-bed mixed medical, surgical and trauma ICU in Toronto, Canada Methods: The qualitative component comprised one-on-one semi structured interviews with fourteen ICU staff. The quantitative component comprised a 12-week prospective observational study of 102 restrained patients. Results: The integration of findings revealed a risk-averse culture where prophylactic application of PR for intubated patients was used to prevent unplanned extubation, thereby avoiding blame from colleagues. Interviewees shared a perception of a lack of routine communication about PR from intensivists in daily team discussions. Similarly, the quantitative data showed that in only 10% (3/30) of interprofessional rounds was PR use discussed by the ICU team. The interviewed participants demonstrated poor awareness of current local PR rates of use, which echoes the observation that PR was poorly documented in medical records. While most interviewees recommended nurse facilitation to minimize PR use, nurse leaders were not actively involved in PR discussion during the interprofessional team rounds. Interviewees recommendations regarding strategies to minimize restraint use included availability of restraint alternatives and guidance on situations for applying and removing restraints. Conclusion: This analysis of contextual influences on PR practices and minimization using the i-PARIHS framework revealed potentially modifiable barriers to successful PR minimization, including a lack of leadership involvement, gaps in practice monitoring and collaborative decision-making processes, and sometimes conflicting priorities in terms of patient safety. The establishment of an interprofessional facilitation team that addresses risk-averse culture and promotes collaboration among ICU stakeholders will be crucial to the success of any approach to restraint minimization in this context.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".