Family perspectives on physical restraint practices and minimization in an adult intensive care unit: A qualitative descriptive study

Objective: To explore family perspectives on physical restraint practices and their minimization in an adult intensive care unit. Design & Methods: A qualitative descriptive study with one-on-one semi-structured interviews. A deductive content analysis approach was undertaken using the Theoretical Domains Framework. Setting: A 20-bed medical, surgical, trauma ICU in Toronto, Canada. Findings: Fifteen family members were interviewed. Three themes emerged: (i) barriers and facilitators to restraint minimization. Barriers noted by families included patient agitation posing risks of losing endotracheal tubes, nurse reluctance to remove restraints, lack of family involvement, limited knowledge of alternatives, and a noisy environment. Facilitators included family involvement in decision-making, timely extubation, use of less restrictive alternatives such as mittens, mandating shorter periods of restraints application, and environmental modifications; (ii) unilateral decision-making regarding physical restraint use, where clinicians made decisions with inadequate communication with families nor obtaining consent; and (iii) the emotional impact of physical restraint use, with families experiencing sadness and shock and believing the patient would feel similarly. Conclusion: This qualitative study highlights significant issues surrounding the use of physical restraints, particularly the lack of family involvement in decision-making, the emotional toll on families, and various barriers and facilitators to minimizing restraint use. Effective communication and collaboration between clinicians and families are crucial to addressing these issues. Implications for Clinical Practice: Our findings underscore the critical need to enhance communication between clinicians and families, alongside consent processes. Identifying barriers and facilitators at various levels can inform individualized strategies to reduce restraint use, including integrating alternatives like mittens and involving families in care. Timely introduction of alternatives and family involvement are vital to prevent further emotional distress for families. Prioritizing the reduction of restraint duration is crucial, particularly in settings emphasizing harm minimization.