Clinical application of evidence for reduced physical restraint with ICU adult catheterized patients: a stepped-wedge randomized controlled trial

Background: In recent years, there have been many disputes about the validity and rationality of physical restraint. More and more nurses are beginning to pay attention to the pros and cons of restraint use, and rebal-ance the priority of restraint use. Aim: This study was performed to guide and standardize the practice of physi-cal restraint by nurses and evaluate the effects of application. Methods: The trial was a stepped-wedge, cluster, randomized controlled trial. Four ICUs in the Affiliated Hospital of Nantong University were recruited, including the general ICU, Neurosurgery ICU, Neurology ICU and Cardiac Surgery ICU. Catheterized patients aged 18 years or older who were admitted to ICU and were willing to participate in the study were included. During the control phase, each ICU implemented nursing procedures and the management model as usual, and during the intervention phase implemented practical reform. Results: Compared with pre-implementation and post-implementation, the patient restraint time was shortened (682.16 +/- 370.81 vs 467.41 +/- 406.37; P=0.000) and the restraint rate was decreased (91.2% vs 73.7%; P=0.000). In the general ICU, the restraint time gradually decreased (P > 0.05). The restraint rate gradually decreased, but slightly increased in the fourth stage (P < 0.05). In the Neurosurgery ICU, restraint time was shortened in the fourth stage (P=0.000), and the restraint rate of the fourth stage was also decreased (P=0.000). In the Neurology ICU, the restraint time was extended during post-implementation (P=0.000) and the restraint rate increased during post-implementation (P < 0.05). In the Cardiac Surgery ICU, there was no significant difference of restraint time and rate in different implementation stages (P > 0.05). Linking evidence to action: The best evidence of reasonable physical restraint with ICU adult catheterized patients was transformed and applied to clinical practice. We believe that this study has evidence-based potential to help healthcare providers reduce the restraint rate and shorten the restraint time of ICU patients.