Clinical Pearls

Use of physical restraints is an established practice in intensive care units, yet it can contribute to adverse effects such as delirium, agitation, and longer mechanical ventilation times. It is unclear whether restraint use increases during times of health care emergencies, such as the COVID-19 pandemic.Kumar and colleagues explored trends associated with restraint use during the COVID-19 pandemic, including its use among racial and ethnic minorities. They found Restraint use significantly increased from 29.4% in the pre-COVID period to 32.5% during the COVID-19 pandemic.Factors associated with higher risk for restraint use during COVID-19 included Hispanic ethnicity, non–English-speaking status, male sex, receipt of mechanical ventilation, use of antipsychotic medication, and neurologic illness.Although further research is needed to understand restraint use during times of hospital system stress, the authors recommend immediate implementation of quality improvement measures to address racial and ethnic disparities.See Article, pp 145–149Venous thromboembolism (VTE) occurs more often in critically ill patients than in patients in general care areas. Although anticoagulant therapy is effective in preventing VTE, there are risks associated with its use.Zeng and colleagues tested the efficacy and safety of an intermittent pneumatic compression (IPC) pump as a stand-alone VTE prevention measure in intensive care unit patients with a high risk of bleeding. They found that Study findings support the use of IPC as a preventive measure for VTE when pharmacological interventions are contraindicated.See Article, pp 100–107Moral injury occurs when nurses face injurious events that contribute to psychological, emotional, or spiritual suffering. The risk of moral injury is routinely present in everyday practice in the intensive care unit (ICU); however, not all nurses who face moral adversity develop moral injury.Sumner and colleagues explored the prevalence of moral injury among ICU nurses and the relationship among moral injury, moral resilience, and a healthy work environment. They found The authors recommend interventions that promote moral resilience and healthy work environment standards to support the retention of a resilient nursing workforce.See Article, pp 118–126The United States is the only industrialized country without a nationally mandated paid family leave system. Nurses in the United States must piece together time off and job protection status from numerous programs. As such, maternity leave is often short, may lead to nurses’ poor mental health and delayed postpartum recovery, and may contribute to the increasing turnover in the nursing workforce.Watson and colleagues explored the lived experience of critical care nurses with maternity leave policies. They identified 4 themes: Study findings show that nurse-mothers often exhaust paid time off or return too early from maternity leave. The authors suggest various policy and organizational evidence-based strategies to enhance work flexibility and nurses’ support.See Article, pp 128–144