The Anxiety of Patients with Hand Fixation (Restrain) in Intensive Care Unit
DOI:
https://doi.org/10.31674/mjn.2025.v16i03.005Abstract
Background: Treatment of patients with agitation and attempts to remove IV tubes, mechanical ventilators, nasogastric tubes, and catheter urine, the health worker will perform fixation on the hand, often called restraint. This action needs attention because it has several impacts on the patient, one of which is anxiety. Objective: The purpose of this study was to analyse differences in anxiety in patients with restraint or conventional hand fixation with hand fixation or modified restraints. Methods: The research method uses a quasi-experimental post-test design by comparing the final results of anxiety. The population is patients who are hospitalised in the Intensive Care Unit (ICU) at Kediri Baptist Hospital. The research sample was 54 respondents using a purposive sampling technique. The inclusion criteria were total care patients, patients who received restraints and had a RASS value > +1, and patient exclusions were patients receiving care less than twice in 24 hours. The independent variable is conventional restraint and modified restraints. Control group with restraint or conventional hand fixation with the intervention group using hand fixation or modified restraints. The dependent variable is anxiety using FAS (Face Anxiety Scale). Research has obtained ethical clearance. Statistical test using Mann Whitney (a < 0.05). Results: The experimental group had 22.2% not anxious, 33.3% mildly anxious, 44.4% moderately anxious, and no severe cases, while the control group had 3.7%, 48.1%, 11.1%, and 37.0%, respectively, showing the intervention use modified restraints reduced severe anxiety. The results of statistical tests were found that the Z value was -1.976 (> ± 1.96). It indicates that there was a difference in anxiety between the patient with hand fixation experimental group and the control group. The p-value, which was obtained, was 0.039, indicating that the difference between the experimental group and the control group was significant. Conclusion: There is a significant difference in the use of hand fixation or conventional restraints with modifications, it is necessary to continue to develop restraint devices that are safe and can reduce patient anxiety in the inpatient room.
Keywords:
Anxiety, Hand Fixation, Inpatient Room, RestrainDownloads
References
Abraham, J., Hirt, J., Richter, C., Köpke, S., Meyer, G., & Möhler, R. (2022). Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings. The Cochrane Database of Systematic Reviews, 8(8). https://doi.org/10.1002/14651858.CD012476.pub2
Agraharkar, S., Horwitz, S., Lewis, K., Goldstein, G., Havens, J., & Gerson, R. (2021). Agitation and Restraint in a Pediatric Psychiatric Emergency Program: Clinical Characteristics and Diagnostic Correlates. Pediatric Emergency Care, 37(12), e836–e840. https://doi.org/10.1097/PEC.0000000000002385
Ain, I. (2021). Health Education On Anxiety Levels In Projective Surgery Patients In Mokoyurli Buol Hospital. Journal of Applied Nursing and Health, 3(1), 15–21. https://doi.org/10.55018/janh.v3i1.20
Anasulfalah, H., Faozi, E., & Mulyantini, A. (2020). Manset restraint sebagai evidence-based nursing untuk mengurangi resiko luka ekstremitas pada pasien yang mengalami penurunan kesadaran. Prosiding Seminar Nasional Keperawatan Universitas Muhammadiyah Surakarta 2020 [Proceedings of the 2020 National Nursing Seminar of Muhammadiyah University of Surakarta]. Retrieved from: https://stikeselisabethmedan.ac.id/wp-content/uploads/2022/02/Prosiding-Seminar-Nasional-Keperawatan-Universitas-Muhammadiyah-Surakarta-2020-Profesi-Ners-XXI-2.pdf#page=45. Accessed on: 12th June, 2024.
Burry, L. D., Cheng, W., Williamson, D. R., Adhikari, N. K., Egerod, I., Kanji, S., Martin, C. M., Hutton, B., & Rose, L. (2021). Pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a systematic review and network meta-analysis. Intensive Care Medicine, 47(9), 943–960. https://doi.org/10.1007/s00134-021-06490-3
Chieze, M., Hurst, S., Kaiser, S., & Sentissi, O. (2019). Effects of seclusion and restraint in adult psychiatry: a systematic review. Frontiers in Psychiatry, 10. https://doi.org/10.3389/fpsyt.2019.00491
Cusack, P., Cusack, F. P., McAndrew, S., McKeown, M., & Duxbury, J. (2018). An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings. International Journal of Mental Health Nursing, 27(3), 1162–1176. https://doi.org/10.1111/inm.12432
Dodok, Y., Guntur, A., Indriyawati, & Wicaksono, K. E. (2022). Behavioral differences in seeking help for mental health among generation z from the Kodi people group and the Madurese ethnic group. Journal of Applied Nursing and Health, 4(1), 78–85. https://doi.org/10.55018/janh.v4i1.57
Ely, E. W., Truman, B., Shintani, A., Thomason, J. W., Wheeler, A. P., Gordon, S., Francis, J., Speroff, T., Gautam, S., Margolin, R., Sessler, C. N., Dittus, R. S., & Bernard, G. R. (2003). Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA, 289(22), 2983–2991. https://doi.org/10.1001/jama.289.22.2983
Hall-Melnychuk, E. L., Hopkins, R. O., & Deffner, T.-M. (2025). Post-Intensive Care Syndrome-Mental Health. Critical Care Clinics, 41(1), 21–39. https://doi.org/10.1016/j.ccc.2024.08.005
Hammervold, U. E., Norvoll, R., Aas, R. W., & Sagvaag, H. (2019). Post-incident review after restraint in mental health care-a potential for knowledge development, recovery promotion and restraint prevention. A scoping review. BMC Health Services Research, 19(1), 1–13. https://doi.org/10.1186/s12913-019-4060-y
Hubaybah, H., Siregar, S. A., Putri, F. E., Fitri, A., & Rahayu, F. S. (2022). Factors Related To Anxiety Level Of Public Health Employees During COVID-19. Journal of Applied Nursing and Health, 4(1), 23–32. https://doi.org/10.55018/janh.v4i1.31
Khanafi, K., Ismail, S., & Erawati, M. (2019). Studi Explorasi Pengalaman Perawat dalam Pengkajian Delirium (Exploratory study of nurses' experiences in delirium assessment), Jurnal Perawat Indonesia, 3(3), 237–242. https://doi.org/10.32584/jpi.v3i3.413
Latronico, N., Eikermann, M., Ely, E. W., & Needham, D. M. (2024). Improving management of ARDS: uniting acute management and long-term recovery. Critical Care, 28(1). https://doi.org/10.1186/s13054-024-04810-9
McKinley, S., & Madronio, C. (2008). Validity of the Faces Anxiety Scale for the assessment of state anxiety in intensive care patients not receiving mechanical ventilation. Journal of Psychosomatic Research, 64(5), 503–507. https://doi.org/10.1016/j.jpsychores.2008.02.002
Murali, K. P., Fonseca, L. D., Blinderman, C. D., White, D. B., & Hua, M. (2022). Clinicians’ views on the use of triggers for specialist palliative care in the ICU: A qualitative secondary analysis. Journal of Critical Care, 71. https://doi.org/10.1016/j.jcrc.2022.154054
Muslimah, N., Awaludin, S., & Kurniawan, A. (2019). Implementasi terapi pijat swedia untuk menurunkan tingkat kecemasan dan menstabilkan tanda-tanda vital pada pasien di ruang Intensive Care Unit (ICU) Rumah Sakit Prof. Dr. Margono Soekarjo: Case Study. Journal of Bionursing, 1(2), 216–224. https://doi.org/10.20884/1.bion.2019.1.2.25
Musslifah, A. R. (2022). Optimization of Islamic counselling and understanding of wellbeing in reducing anxiety and stress in face-to-face learning after the covid-19 pandemic. Journal of Applied Nursing and Health, 4(1), 103–109. https://doi.org/10.55018/janh.v4i1.60
Newton, N. D. (2020). Implementation of a violence checklist to reduce seclusion/restraint on inpatient psychiatry [Doctoral dissertation, University of Maryland, Baltimore]. UMB Digital Archive. Retrieved from: https://archive.hshsl.umaryland.edu/entities/publication/bcdc7946-93ec-4dbf-9e20-f7c683b7f281. Accessed on 10th June, 2024.
Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care, 25(3), 342–367. https://doi.org/10.1177/1367493520937152
Perers, C., Bäckström, B., Johansson, B. A., & Rask, O. (2021). Methods and strategies for reducing seclusion and restraint in child and adolescent psychiatric inpatient care. Psychiatric Quarterly, 1–30. https://doi.org/10.1007/s11126-021-09887-x
Roppolo, L. P., Morris, D. W., Khan, F., Downs, R., Metzger, J., Carder, T., Wong, A. H., & Wilson, M. P. (2020). Improving the management of acutely agitated patients in the emergency department through implementation of Project BETA (Best Practices in the Evaluation and Treatment of Agitation). Journal of the American College of Emergency Physicians Open, 1(5), 898–907. https://doi.org/10.1002/emp2.12138
Scarneo-Miller, S. E., Kerr, Z. Y., Adams, W. M., Belval, L. N., & Casa, D. J. (2020). Influence of State-Level Emergency Planning Policy Requirements on Secondary School Adoption. Journal of Athletic Training, 55(10), 1062–1069. https://doi.org/10.4085/1062-6050-118-19
Sessler, C. N., Gosnell, M. S., Grap, M. J., Brophy, G. M., O'Neal, P. V., Keane, K. A., Tesoro, E. P., & Elswick, R. K. (2002). The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. American Journal of Respiratory and Critical Care Medicine, 166(10), 1338–1344. https://doi.org/10.1164/rccm.2107138
Sher, Y., Desai, N., Sole, J., & D’souza, M. P. (2024). Dyspnea and Dyspnea-Associated Anxiety in the ICU Patient Population: A Narrative Review for CL Psychiatrists. Journal of the Academy of Consultation-Liaison Psychiatry, 65(1), 54–65. https://doi.org/10.1016/j.jaclp.2023.11.001
Shirasaki, K., Hifumi, T., Nakanishi, N., Nosaka, N., Miyamoto, K., Komachi, M. H., Haruna, J., Inoue, S., & Otani, N. (2024). Postintensive care syndrome family: A comprehensive review. Acute Medicine & Surgery, 11(1). https://doi.org/10.1002/ams2.939
Sriwana. (2019). Health education about stroke patient treatment of knowledge and family anxiety. Journal of Applied Nursing and Health, 1(1), 19–23. https://doi.org/10.55018/janh.v1i1.78
Suhandoko, Pradian, E., & Maskoen, T. (2014). Reliabilitas dan validitas penilaian skala sedasi richmond agitation sedation scale (RASS) dan ramsay pada pasien kritis dengan ventilasi mekanik di ruang perawatan intensif (Reliability and validity of the Richmond Agitation Sedation Scale (Rass) and Ramsay sedation assessment in critically ventilated patients in the Intensive Care Room). Jurnal Anasteri Periioperatif, 2(3), 186–193. https://doi.org/10.15851/jap.v2n3.330
Sunaringtyas, W., Sulistyorini, A., & Fernanda, F. (2023). Application of the Defense Style Questionnaire (DSQ) model of self defense mechanism in post stroke patients. Journal of Applied Nursing and Health, 5(1), 112–118. https://doi.org/10.55018/janh.v5i1.141
Suwardianto, H. (2021). Physical and Cognitive Therapy (PCT) in Critically Ill Patient. Connectivity and Functional Specialization in the Brain, 47. https://doi.org/10.5772/intechopen.94154
Suwardianto, H., & Sari, D. A. K. W. (2019). Pain level in critical patients with sleep hygiene care in Intensive Care Unit. Journal of Nursing Practice, 3(1). https://doi.org/10.30994/jnp.v3i1.61
Teece, A., Baker, J., & Smith, H. (2020). Identifying determinants for the application of physical or chemical restraint in the management of psychomotor agitation on the critical care unit. Journal of Clinical Nursing, 29(1–2), 5–19. https://doi.org/10.1111/jocn.15052
Välimäki, M., Lam, Y. T. J., Hipp, K., Cheng, P. Y. I., Ng, T., Ip, G., Lee, P., Cheung, T., Bressington, D., & Lantta, T. (2022). Physical restraint events in psychiatric hospitals in Hong Kong: a cohort register study. International Journal of Environmental Research and Public Health, 19(10). https://doi.org/10.3390/ijerph19106032
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