Tomoe Yoshimochi
Japan
physical restraint, critical care, guideline, ICU
''5. Međunarodni kongres HDMSARIST-a'' i ''8. Međunarodni kongres WfCCN-a''
Šibenik, 12.-15. travnja 2012. godine
[Aim] Physical restraint was, in principle, prohibited in a nursing-care setting by the Nursing Care Insurance Law on April, 2000 in Japan, which had partly been in response to some sensational mass media reports on restraint cases and the public mood at that time. Since then, there has been a growing trend, even in a hospital setting, to avoid any physical restraint. However in critical care, minimal physical restraint is inevitable to avoid self-extubation of the tubes for life-support. To provide a clear implementation guideline for this dilemma, the task force conducted a nation-wide survey in Japan and presented a guideline based on the survey data.
[Subjects & Methods] A questionnaire regarding physical restraint was sent to nursing directors of all the hospitals with ICU facilities in 2007. Four hundred and ninety three replies out of 1,188 hospitals surveyed (41.5%) were obtained.
[Results] The percentages of the hospital employing / not employing physical restraint were 94.7 / 1.4 %, respectively. In total, 84.2 % of the hospitals surveyed had handling guidelines in any form for physical restraint, which mostly included ‘starting criteria’ and ‘methods to obtain informed consent’. Fifty percent had ‘criteria to discontinue physical restraint’ and 24.3 % had ‘methods to avoid unnecessary physical restraint’ as well.
[Discussion] An ethically-acceptable consensus has been built in Japan to draft a guideline for physical restraint in the ICU setting. The followings are the contents of the guideline currently posted at the web site of the society. 1. Basic concept of physical restraint, 2. Criteria to place, 3. Methods to place, 4. Practical tube management including removal. The guideline should be further evaluated for the utilization in hospital care.