Determining Best Practice through Research of the Lived Experience of Intubated/Restrained ICU Patients/Families

Purpose:
This is a phenomenological qualitative study to assess the experience of the patient/family in the intensive care when the patient is physically restrained for intubation/mechanical ventilation and to use this information to help decrease restraint use in this population.

Background/Significance:
A review of the literature revealed a gap in the evidence for intensive care unit use of physical restraint. The literature that describes the ICU environment offers two alternatives to restraint: chemical restraint or 1:1 nursing care. Neither of these options is viable in our organization. Chemical restraint is an unacceptable care alternative for our patients due to the complications of sedation and financially 1:1 cares for every mechanically ventilated patient is not feasible.

Methods:
This is an IRB approved research study using a convenience sample from a cardiovascular intensive care unit (CICU). The study population (n=14) was divided into two groups: planned and unplanned intubation/mechanical ventilation. The planned group had education prior to intubation. The unplanned group had no education and were emergent intubations. The sample size was determined by saturation. Once written consents were obtained, interviews were conducted with patients and families using a semi-structured interview tool consisting of 5 questions. Audiotaped interviews were obtained after the patients were transferred out of ICU. Recordings were transcribed for common themes.

Results:
Themes identified from patients: lack of memory regarding restraints; perception of being ”heavily sedated”; the lived experience is intense and profound (“painful”, “horrific”) but it is the experience of being intubated that is described not being restrained; and several noted without restraints they would have pulled the tube out. Themes identified from families: knowledge of restraint use/purpose decreased anxiety; difficult to see the patient struggle against the restraint; and felt reassured the patient could not pull the tube out. Nursing caring behaviors were identified by both patients and families as providing comfort and helping them through the experience.

Conclusions and Implications for Practice:
Understanding the patient/family experience through their stories and words can help nurses provide better care for their ICU patients. Pain is the cause of the patient's agitation, controlling pain allows the patient the opportunity to be more alert, participate in their care and be unrestrained.