Treatment interference in acutely and critically ill adults

Abstract

OBJECTIVES: To examine the state of knowledge of treatment interference, the self-removal of technological devices, in acutely or critically ill adults and to propose a multidisciplinary research agenda to further understanding of this clinical problem. METHOD: A combined computerized and hand search of the nursing and medical literature (MEDLINE, 1966 to June 1996; Cumulative Index to Nursing and Allied Health Literature, 1985 to June 1996; and holdings at the Center for the Study of Nursing History at the University of Pennsylvania) was conducted. Literature on specific technological devices and articles that contained the terms self-removal, withdrawal, devices, self-extubation, unplanned extubation, and involuntary treatment were searched. RESULTS: Literature on treatment interference was found in four main topic areas: (1) maintaining treatment, (2) unplanned extubation, (3) disruption or manipulation of a medical device, and (4) involuntary treatment. CONCLUSIONS: The results clearly establish the clinical importance of treatment interference and underscore the multidisciplinary and multifactorial nature of this perplexing, life-threatening clinical problem. Future research on treatment interference should emphasize systematically building an understanding of the processes involved, including patients' attributes, behavioral cues, and consequences, to develop appropriate multidisciplinary strategies to prevent patients' self-removal of technological devices.