My name is María, ICU nurse for more than 10 years.
As many of you, during this time I have had the privilege to share laughs, joys, sweating, tears, despairs with my colleagues, but especially with my loved ones critical patients (from that privileged position giving the hours at bedside).
As more time I spend with them, sharing with these people in a situation of maximum vulnerability and defencelessness, safer I am that an ICU stay can be one of the most tremendous life experiences that one can experience. Experiences that mark vital paths.
Loneliness, uncertainty, fear…Pain, devices and tubes that do not allow you even move a finger without any alarm sounds, the restrains in the hands to prevent you to do any counterproductive move…I really wouldn’t like to be in their shoes.
At some point in this process of reflective thinking, positioning of the nurses in the United Kingdom fell into my hands: the purpose of avoid mechanical restraints in the critical patients (1).
Simultaneously to this fact, I moved to another ICU to work. This circumstance encouraged me to put in place one of the cognitive mechanisms that facilitate learning and critical thinking… comparison!. Why do we work so different?.
With all this hodgepodge of ideas in my head, I began to read and reflect on the use of mechanical restraints in our ICUs and…Surprise!
While in areas like Mental health, geriatrics or hospitalization units, controversy and debate were initiated and quite advanced, the use of restraints in critical patients had not received special attention (2), rather it had gone unnoticed.
Perhaps if you’re dying, is to be fastened not important?
The variability of use of mechanical restraints in ICU is enormous, ranging from places where all intubated patients are fastened to ICUs where its use (2.3) (the minimum, unfortunately for our patients) does not arise.
In addition, this variability could be seeing accentuated by the lack of registration in the medical history (4). The use of mechanical restraints is therefore something invisible…
What does this mean? Is binding or not a patient not considered a relevant part of the treatment? Is that application not derived from a clinical trial? Does its use not require monitoring and evaluation of effectiveness?.
Even going beyond perhaps we could ask ourselves how we would feel us if during this vital experience we find attached… Would it be relevant for us?
Many unknowns to be resolved regarding the use of restraints in the critical patients. Why some ICUs considered them essential for the management of patients while others can get rid of them?. Or… Why some professionals tend more to use than others?. Or a question as simple as what is the real prevalence of restraints in ICU?.
While these issues get response, it may be time to reflect if the challenge of “Humanization” and the “care based on patient” in ICUs of the 21st century is consistent with the practice of keeping them tied without a clear rationale, relevance and proven efficiency of this measure versus other proposals.
The question is served; only dialogue, joint and sincere reflection and the use of the appropriate research tools could help us along the way to unleash critical patients and progress towards humanization.
María Acevedo Nuevo
Nurse of Medical ICU at Hospital Universitario Puerta de Hierro Majadahonda
1. Bray K, Hill K, Robson W, Leaver G, Walker N, O’ Leary M, et al. British Association on Critical Care Nurses position statement on the use of restraint in adult critical care units. Nurs Crit Care. 2004 Sept-Oct; 9(5): 199-212.
2. Martin Iglesias V, Pontón Soriano C, Quintián Guerra MT, Velasco Sanz TR, Merino Martínez MR, Simón García MJ et al. Contención mecánica: su uso en cuidados intensivos. Enferm Intensiva. 2012; 23(4): 164-70.
3. Benbenbishty J, Adam S, Endacott R. Physical restraint use in intensive care units across Europe: the PRICE study. Intensive Crit Care Nurs. 2010 Oct;26(5):241-5.
4. Hine K. The use of physical restraint in Critical Care. Nurs Crit Care. 2007 Jan-Feb;12(1):6-11.