Effective Factors on The Administration of Chemical Restraint Among Nurses in Intensive Care Units (ICU): An Observational Study

Chemical restraints are drugs used to restraint a patient's involuntary movements or emergency control of the patient's aggressive behavior and to cause sedation and pain relief, reduce symptoms, and reduce the likelihood of harming oneself or others. Improper use of chemical restraints can lead to complications in patients and can even delay the separation of patients under mechanical ventilation from the ventilator. The aim of this study was to investigate the effective factors in nurses' use of chemical restraints in patients admitted to intensive care units.

This was an observational study. The statistical society of the research included 160 hospitalized patients in intensive care units (ICU) at Kowsar hospital, Sanandaj, Iran. After 8 hours of hospitalization and stability of their conditions, those patients in intensive care units were assessed based on administrating of chemical restraint by nurses. Data was collected through patients’ information forms, and observational checklists, then analyzed by SPSS 21, independent t-test, Chi-2, Fisher, and Mann–Whitney. Independent risk factors for the administration of chemical restraint were investigated by using the logistic regression model.

Of the 160 patients admitted to intensive care units, 105 patients (65.62%) underwent chemical restraints. The most common time to use chemical restraints was during the night shift and then the evening shift. Comparison of patients for whom chemical restraint was used or not, showed that the two groups in terms of smoking history (P=0.037), intubation (P=0.0001), dressing (P=0.001) and drain (P=0.001) as well as NGT (P=0.010), GCS (P=0.012), FOUR score (P=0.050), type of nursing shifts (P=0.017), restlessness (P=0.004) Had a statistically significant difference. Relationship between BMI variables, alcohol addiction, drug addiction, having a catheter, fixator and traction, delirium, having a dressing, nurse to patient ratio, underlying disease and mechanical ventilation mode using limiters Chemical was not significant (P>0.05). The results of logistic regression analysis showed that between smoking (P=0.041, OR=3.232), being intubated (P=0.0001, OR=75.959), having a drain (P=0.016, OR=2.669), FOUR score (P=0.0001, OR=0.944), there was a significant relationship using chemical restraints.

Regarding the results of the study, it could be concluded that the administration of chemical restraint is increasing among nurses in intensive care units (ICU). Therefore, the necessity of the clinical guidelines and policies for the administration of chemical restraint are highlighted.