title: Use of physical restraints in adult critical care: a bicultural study.
abstract: BACKGROUND
  Although controversial, physical restraints are commonly used in adult critical care units in the United States to prevent treatment interference and self-inflicted harm. Use of physical restraints in Norwegian hospitals is very limited. In the United States, an experimental design for research on use of restraints has not seemed feasible. However, international research provides an opportunity to compare and contrast practices.
  
  
  OBJECTIVE
  To describe the relationship between patients' characteristics, environment, and use of physical restraints in the United States and Norway.
  
  
  METHODS
  Observations of patients and chart data were collected from 2 intensive care units (n = 50 patients) in Norway and 3 (n = 50 patients) in the United States. Sedation was measured by using the Sedation-Agitation Scale. The Nine Equivalents of Nursing Manpower Use Score was used to indicate patients' acuity level.
  
  
  RESULTS
  Restraints were in use in 39 of 100 observations in the United States and not at all in Norway (P = .001). Categories of patients were balanced. In the Norwegian sample, the median Nine Equivalents of Nursing Manpower Use Score was higher (37 vs 27 points, P < .001), patients were more sedated (P < .001), and nurse-to-patient ratios were higher (1.05:1 vs 0.65:1, P < .001). Seven incidents of unplanned device removal were reported in the US sample.
  
  
  CONCLUSIONS
  Critical care units with similar technology and characteristics of patients vary between nations in restraint practices, levels of sedation, and nurse-to-patient ratios. Restraint-free care was, in this sample, safe in terms of treatment interference.
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Martin
authors.forename: Lars
authors.initials: L
authors.lastname: Mathisen
mesh_terms: D000328:Adult; D003422:Critical Care; D018864:Cultural Diversity; D006801:Humans; D007362:Intensive Care Units; D009664:Norway; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D014481:United States