A Comparison of Restraint Decision Tools in Intensive Care Unit: An Observational Cross-Sectional Study

Abstract

Background: The use of structured decision-making tools is highly important in reducing subjectivity in physical restraint decisions. Aim: The aim of this study was to observationally compare the effectiveness of two decision-making tools in making physical restraint decisions. Study Design: This descriptive, cross-sectional and observational comparative study. The study included patients hospitalised in the intensive care unit (ICU). Each included patient was assessed twice-daily (morning and evening) by one observer using the Restraint Decision Tree (RDT) and another observer using the Restraint Decision Wheel (RDW). Between-group differences were examined using Mann–Whitney U and Kruskal–Wallis H tests, with post hoc comparisons presented through letter-based notations adjacent to medians. Results: In total, 105 patients were included. In the morning, patients were assessed with RDT vs. RDW as not restraint: 71% vs. 72.4%, as mitted/alternative: 20% vs. 21.9% and restraint: 9% vs. 5.7%. In the evening, patients were assessed with RDT vs. RDW as not restraint: 68.6% vs. 72.4%, as mitted/alternative: 18.1% vs. 22.9%, and restraint: 13.3% vs. 4.8%. Significant differences in total Glasgow Coma Scale scores were observed in both morning and evening assessments of the RDT and in the evening assessment of the RDW (p < 0.05). Moreover, a highly significant difference was found between prior restraint history and both morning and evening assessments of the RDT and the RDW (p < 0.001). Conclusions: Both decision-making tools can be implemented by nurses in ICUs. The patient's level of consciousness and previous history of physical restraint are critical parameters affecting the restraint situation. Relevance to Clinical Practice: The widespread use of evidence-based, validated and objective decision-making tools can support restraint decisions in ICUs. Considering factors such as delirium and level of consciousness in physical restraint decisions may promote patient-centred clinical practice. © 2026 British Association of Critical Care Nurses.