Clinical Research Directory

Care Bundle for Prevention of Skin Complications and Edema in Restrained Patients

Physical restraint (restraint) is defined as the restriction of a patient's free body movements and the prevention of the patient's ability to move easily by healthcare professionals using physical or mechanical devices to prevent the patient from harming themselves or others. Physical restraints can be used by healthcare professionals for many purposes, particularly in intensive care units, such as ensuring patient safety, controlling aggressive and disruptive behavior, continuing patient care and treatment, and preventing the removal of medical equipment attached to the patient. However, when looking at the duration of physical restraint applications, it has been determined that they vary between 3-4 days. The longer the duration of physical restraint, the greater the likelihood of complications developing. In particular, long-term physical restraint can result in neurovascular and dermatological complications such as pressure injuries, edema, ecchymosis, redness, numbness, limited movement, increased temperature, discoloration, and nerve damage. The care package application is a model that improves patient care quality by simultaneously and comprehensively implementing 3-5 applications based on strong scientific evidence, prepared for the relevant area in the specified patient group. Care package applications are created to enable evidence-based practices outlined in guidelines to be used more effectively and practically in clinical settings. Within this context, the aim of this study is to develop a care package to prevent dermatological complications and edema that may occur in the restraint area in patients undergoing physical restraint in intensive care and to evaluate the effectiveness of this care package.

Hand Massage for Physical Restraint

In this study, nurses will apply hand massage to patients who are physically restrained. It will be examined whether massage has a positive effect on patients' skin color, blood circulation, skin temperature and pain. Physical restraint will be applied to patients only in the presence of medical indications and with the decision of a physician. Research question: Does hand massage applied to patients in physical restraint have an effect on preventing complications related to restraint?

Training and Support Programme on Data-driven Quality Development for Swiss Long-Term Care Facilities (NIP-Q-UPGRADE Subaim 2.6)

Since 2019, long-term care facilities (LTCFs) in Switzerland have been required by the Federal Insurance Law (KVG, Art. 59a) to report data for the calculation and public reporting of medical quality indicators (MQIs) in four clinical domains: polypharmacy, pain, malnutrition, and physical restraints. This data serves both for monitoring care quality at the national level through public reporting and for internal quality development. Contextual analysis showed that various quality development methods are already known and used in Swiss LTCFs. However, significant challenges remain: limited resources, time constraints, and restricted access to MQI data hinder effective use. Facilities reported a greater need for support in using MQI data. They also expressed interest in peer networking, structured support for applying quality methods (such as Plan Do Check Act cycles (PDCA)), and practical tools such as training, best-practice examples, and additional resources. Residents and relatives also expressed a strong interest in being more involved in decision-making and care quality discussions. The overall aim of the current study is to test a quality development training programme that supports LTCFs in using MQI data for continuous data-driven care quality development. The study is structured into three thematic areas: 1. MQI Results Literacy - Supporting LTCFs in interpreting MQI reports and benchmarks. 2. Impactful Actions - Supporting LTCFs to translate MQI results into concrete quality development actions using PDCA cycles. 3. Sparking Culture - Integrating data-driven quality development into everyday practice and fostering a culture of continuous development, with a strong emphasis on strengthening the involvement of residents, relatives, and leadership. The study follows a train-the-trainer strategy. Trainers instructed by the NIP-Q-UPGRADE research team provide structured training and coaching to Quality Leaders and management representatives of LTCFs. Quality Leaders then support their co-workers in quality development. The training programme consists of online and in-person trainings, training materials, practical tools, a website, guided tasks for facilities, and an email helpdesk for ongoing support. Study outcomes: This sub-study of the NIP-Q-UPGRADE programme aims to assess the acceptability, feasibility, fidelity, and costs related to the training programme, both at the facility level and at the trainer level.

Usage and Adverse Events of Physical Restraints in an Intensive Care Unit

The aim of this retrospective observational single-center cohort study is to (1) examine the frequency of physical restraint use in a Swiss intensive care unit, (2) identify related adverse events, and (3) determine risk factors associated with their use and complications in critically ill adult patients.