Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Nurse Education regarding Agitated Patients and Its Effects on Clinical Practice

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Nurse Education regarding Agitated Patients and Its Effects on Clinical Practice

Article excerpt

INTRODUCTION

Agitation can be defined as excessive motor activity, consisting of purposeless behaviors such as pacing, fidgeting or hand-wringing, and a feeling of anxiety or tension (Mott, Poole, & Kenrick, 2005). In this sense, agitation is not a medical diagnosis but, rather, a symptom of certain diseases, disorders and conditions common in intensive care patients. Agitation might be demonstrated by physical non-aggressive behaviors, aggressive behaviors and verbal agitation (Cohen- Mansfield, 2001; Poole, 2003). More specifically, agitation can include frequent movements of the head, arms, or legs, and bucking the ventilator that persist despite attempts by staff to calm the patient down (Jaber et al., 2005). It might result from pain, the adverse effects of medications, fluid and electrolyte imbalance, and environmental or psychological factors (Poole, 2003).

Because of patients' medical conditions, medications, diagnostic procedures, invasive interventions, medical devices, noisy and crowded environments, the rate of agitated patients is very high in the ICU (Intensive Care Unit) (Cohen et al., 2002; Maccioli et al., 2003). According to Maccioli et al. (2003) more than 70% of ICU patients may experience some degree of agitation during their ICU stay. In order to decrease the number of agitated patients in the ICU, it is crucial to be able to recognize treatable and preventable causes of agitation. These include pain, sleep deprivation, unwanted noise, unnatural light, social isolation, urinary retention, inappropriate extremity positions and not turning of immobilized patients at a minimum every 2 h, hypoxia, fear, sepsis, myocardial ischemia and altered cell metabolism (Aitken, Marshall, Elliott, & McKinley, 2008; Maccioli et al., 2003).

Patient agitation should be addressed carefully as it influences a patient's medical condition adversely and causes the loss of workforce and other resources (Weir & O'Neill, 2008). The adverse outcomes of agitation such as prolonged hospital stays, nosocomial infections, pressure ulcers, increased levels of confusion, unplanned extubations and vulnerability to self-injury can be avoided (Jaber et al., 2005; Waterhouse, 2005). In order to prevent these adverse outcomes of agitation, some medical approaches can be used. The most prevalent one is restraint therapy, although evidence is lacking to support the effectiveness of physical restraints' use to prevent adverse outcomes (Martin & Mathisen, 2005). Physicians and nurses can apply restraint therapy using physical or chemical approaches. Although the ethical and medical debates continue, physical restraints are used very frequently and considered the easiest way to control patient agitation (Demir, 2007). Typical physical restraining devices include soft wrist, ankle restraints, upper body-vest, two-to-five point leather restraints and body webs. As for chemical restraints, these are medications such as analgesics, sedatives, major tranquilizers (neuroleptic agents) and dissociative agents used to control agitation (Maccioli et al., 2003; Paterson, 2006).

Since the use of physical restraints is associated with physical, psychological, ethical, and legal problems, health care providers need to be careful when deciding on restraining patients (Maccioli et al., 2003). The most reported physical problems due to use of physical restraints were agitation, pressure ulcers, contractures, infections, incontinence, functional impairment, accidental strangulation and asphyxiation, oedema, cyanosis and necrosis (Demir, 2007; Waterhouse, 2005). Along with restraint therapy, physicians and nurses should be fully knowledgeable of the other practices which exist for preventing and controlling patient agitation. Health care workers, particularly nurses, should consider that dealing with agitated patients requires specific practice, knowledge and skills, and all of which can be learned by context-specific education. …

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