Factors associated with mechanical restraint in the hospital environment: a cross-sectional study

Souza, Lívia Maria da Silva; Santana, Rosimere Ferreira; Capeletto, Cristiane da Silva Gabriel; Menezes, Arianna Kassiadou; Delvalle, Romulo

doi:10.1590/S1980-220X2018007303473

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 53 • 2019 • https://doi.org/10.1590/S1980-220X2018007303473 copy

Factors associated with mechanical restraint in the hospital environment: a cross-sectional study^* * Extracted from the dissertation: “Contenção mecânica no ambiente hospitalar: estudo transversal”, Mestrado Profissional em Enfermagem Assistencial, Universidade Federal Fluminense, 2018.

Factores asociados con la contención mecánica en el entorno hospitalario: estudio transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To estimate the prevalence of mechanical restraint in the hospital environment and the factors associated with its performance.

Method:

A cross-sectional, observational study with patients from a public hospital from the medical clinic, surgical clinic and intensive care unit evaluated by descriptive, univariate and multivariate analyses.

Results:

One hundred eleven (111) patients participated in the study. The prevalence of mechanical restraint was 51.4%; bilateral rails on the bed were used in 100% of the restraints, and bilateral wrist restraints were also observed in 29.8%. The most common justifications were the risk of falls (100.0%) and the risk of non-scheduled removal of invasive devices (57.9%). The restrained patients differ significantly from those not restrained by the following associated factors: male gender; age; stroke diagnosis; the hospitalization unit; ambulation capacity; the use of sedative medication; and the use of invasive devices.

Conclusion:

This study estimated a high mechanical restraint prevalence in the hospital environment and determined factors associated with the risk of a patient being restrained. A medical restraint evaluation team is recommended for an in-depth analysis of indication and therapy.

DESCRIPTORS:
Restraint, Physical; Hospital Care; Nursing Care; Humanization of Assistance; Patient Safety

Restraint characteristics	f	(%)
Type of restraint
Lateral rails on the bed	40	70.2
Lateral rails and wrist restraints	17	29.8
Justification for restraint
Agitation	7	19.3
Use of Invasive Devices	33	57.9
Risk of falls	57	100.0
Other reasons	1	1.8

Variable	Unrestrained		Restrained		Overall		p-Value
	n=54		n=57		n=111
	F	%	F	%	F	%
Gender
Female	33	61.1	20	35.1	53	47.7	0.006
Male	21	38.9	37	64.9	58	52.3	0.006
Age (years)
18├ 28	8	14.8	1	1.8	9	8.1	0.000 ^(a)
28├ 38	10	18.5	1	1.8	11	9.9
38├ 48	2	3.7	5	8.8	7	6.3
48├ 58	4	7.4	5	8.8	9	8.1
58├ 68	16	29.6	17	29.8	33	29.7
68├ 78	9	16.7	18	31.6	27	24.3
78├ 88	4	7.4	9	15.8	13	11.7
88├ 98	1	1.9	1	1.8	2	1.8
Hospitalization unit
Intensive Care Unit	2	3.7	28	49.1	30	27.0	0.000
Medical clinic	27	50.0	28	49.1	55	49.5
Surgical clinic	25	46.3	1	1.8	26	23.4
Comorbidities
Stroke	3	5.6	15	26.3	18	16.2	0.003
Neoplasm	3	5.6	5	8.8	8	7.2	0.717^(b)
Kidney disease	4	7.4	10	17.5	14	12.6	0.108
Respiratory disease	4	7.4	13	22.8	17	15.3	0.024
Cardiac diseases	4	7.4	5	8.8	9	8.1	1.000^(b)
Senile Dementia/Alzheimer’s	0	0.0	5	8.8	5	4.5	0.057^(b)
Diabetes Mellitus	4	7.4	3	5.3	7	6.3	0.712^(b)
Systemic Arterial Hypertension	1	1.9	7	12.3	8	7.2	0.061^(b)
Patient conditions
Ambulation	48	88.9	13	22.8	61	55.0	0.000
Sedative Medication	9	16.7	30	52.6	39	35.1	0.000
Mechanical ventilation	0	0.0	15	26.3	15	13.5	0.000
Use of invasive devices
Peripheral Venous Catheter	39	72.2	33	57.9	72	64.9	0.114
Nasoenteric tube	0	0.0	6	10.5	6	5.4	0.027 ^(b)
Urinary Catheter	5	9.3	32	56.1	37	33.3	0.000
Central Venous Catheter	1	1.9	18	31.6	19	17.1	0.000
Orotracheal tube	0	0.0	12	21.1	12	10.8	0.000
Tracheostomy	1	1.9	5	8.8	6	5.4	0.207^(b)
Gastrostomy	0	0.0	3	5.3	3	2.7	0.244^(b)
RAAS score
-4 - Combative	0	0.0	1	1.8	1	0.9	0.415
-3 - Moderate sedation	0	0.0	1	1.8	1	0.9
-1 - Torpor	0	0.0	1	1.8	1	0.9
0 - Alert and Calm	54	100.0	53	93.0	107	96.4
1 - Restless	0	0.0	1	1.8	1	0.9

Number of professionals/bed	Unrestrained		Restrained		Overall		χ² test p-value
	n=54		n=57		n=111
	F	%	F	%	F	%
0.25 = 1 professional for each 4 beds	35	64.80	12	21.10	47	42.30	0.000
0.33 = 1 professional for each 3 beds	14	25.90	15	26.30	29	26.10
0.42 = 5 professionals for each 12 beds	3	5.60	2	3.50	5	4.50
0.5 = 1 professional for each 2 beds	0	0.00	2	3.50	2	1.80
0.67 = 2 professionals for each 3 beds	2	3.70	26	45.60	28	25.20

Factor	Prevalence of restraint when factor is NOT present		Prevalence of restraint when factor IS present		χ² test p-value	OR	CI of the OR
Factor	F	%	F	%	χ² test p-value	OR	CI of the OR
Male	20/53	37.70	37/58	63.80	0.006	2.9	1.3-6.3
Intensive Care Unit	30/82	36.60	27/29	93.10	0	23.4	5.2-105.4
Stroke	42/93	45.20	15/18	83.30	0.003	6.1	1.7-22.4
Ambulation	44/50	88.00	13/61	21.30	0	0.037	0.01-0.11
Sedative Medication	27/72	37.50	30/39	76.90	0	5.6	2.3-13.5
Mechanical Ventilation	42/96	43.80	15/15	100.00	0	nc	Nc
Nasoenteric tube	51/105	48.60	06/06	100.00	0.027^(b)	nc	Nc
Urinary catheter	25/74	33.80	32/37	86.50	0	12.5	4.4-36.2
Central Venous Catheter	39/82	42.40	18/19	94.70	0	24.5	3.1-191.1
Orotracheal tube	45/99	45.50	12/12	100.00	0	nc	Nc

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Rosimere Ferreira Santana Rua Dr. Celestino, 74 - Centro CEP 24020-091 - Niterói, RJ, Brasil rosifesa@gmail.com

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Factors associated with mechanical restraint in the hospital environment: a cross-sectional study* * Extracted from the dissertation: “Contenção mecânica no ambiente hospitalar: estudo transversal”, Mestrado Profissional em Enfermagem Assistencial, Universidade Federal Fluminense, 2018.

Factores asociados con la contención mecánica en el entorno hospitalario: estudio transversal

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Factors associated with mechanical restraint in the hospital environment: a cross-sectional study^* * Extracted from the dissertation: “Contenção mecânica no ambiente hospitalar: estudo transversal”, Mestrado Profissional em Enfermagem Assistencial, Universidade Federal Fluminense, 2018.