身体约束在老年病人护理中使用的研究进展

综述了老年护理中身体约束的使用情况，使用身体约束对被约束者的影响，影响老年护理中身体约束使用的因素以及减少身体约束使用的方法。     

上海市老年医疗护理机构老年人使用身体约束的现况研究

目的了解上海市老年医疗护理机构身体约束使用现况,探讨使用身体约束的影响因素,为制订适用于老年医疗护理机构的身体约束规范提供参考。方法采用自设量表,对上海市67所老年医疗护理机构及其780名老年人进行调查,并采用Logistic回归分析进行使用身体约束的影响因素分析。结果上海市67所老年医疗护理机构,签署身体约束知情同意书执行率为95.52%、身体约束前评估执行率为34.33%、身体约束护理记录执行率为79.10%;在老年医疗护理机构,影响身体约束使用的影响因素有老年人年龄(OR=2.874,95%CI:2.219～3.723)、性别(OR=4.590,95%CI:0.135～0.350)、跌倒/坠床高危(OR=13.141,95%CI:7.845～22.012)以及管道滑脱高危(OR=4.665,95%CI:2.620～8.304)。结论目前仍需规范上海市老年医疗护理机构身体约束的执行率,提升老年服务内涵质量。     

题目：老年住院患者使用身体约束的研究进展

老年患者由于器官的老化和功能衰退,以及各种疾病的影响,容易发生跌倒、坠床、误吸等护理风险。身体约束在老年住院患者护理中使用较为普遍。本文从老年住院患者存在的安全隐患、身体约束用具的种类、身体约束对老年住院患者的影响、对老年住院患者身体约束的认识及减少身体约束五个方面进行综述,旨在为临床实践提供参考。     

关于实施身体约束的护理理念进展

不论是在法律和道德领域,医疗机构中使用的约束措施,一直是个倍受争议的话题。但尽量减少使用约束,缩短约束时间,在患者接受身体约束期间提供更全面的护理评估和护理措施,尽可能降低约束给患者带来的不良后果,是国内外专家的一致共识。美国的JCAHO医疗认证组织（The Joint Commission on Accreditation of Healthcare Organizations）已经提出观点,挑战对患者实施身体约束的常规,并且支持在医疗机构中减少约束措施的使用。目前,很多国外医疗机构和老年护理机构都在逐步接受实施无约束护理的观点。     

循证护理实践推荐

正临床问题住院患者进行身体约束的最佳证据是什么?证据描述身体约束指限制个人的活动自由。尽管身体约束广泛应用于急性病和老年护理中,但它仍是一个颇具争议的话题。实践推荐·证据表明,身体约束可能不利于身体的自由发展,并能阻碍身体正常的生理功能。(Grade B)·一些干预措施有可能减少病人身体约束的使用,如以临床会诊为基础的病人与医护人员的教育,以及认知环境疗法。(Grade B)     

ICU患者身体约束使用特征及护理现状的调查分析

目的 分析ICU患者身体约束的使用特征与护理现状,探讨干预措施.方法 调查我院2009年6月至2010年3月ICU身体约束的使用率、身体约束的特征及护理措施等.结果 身体约束的使用率为35.1%;其中全麻未清醒者占48.9%,气管插管者占77.9%,神经外科患者占46.6%;身体约束平均时间为(31.2±21.1)h.约束工具较为单一,约束使用、放松及停止的时机欠妥,约束护理不够规范及约束记录不全等.结论 ICU身体约束的使用率尚需下降,应减少预防性身体约束的使用,约束护理需进一步规范.     

老年康复病房跌倒高危患者减少身体约束的临床意义

目的探讨身体约束是否降低跌倒高危老年患者的跌倒发生率，为临床身体约束措施的使用提供依据。方法采用1：2配对病例对照研究，对39例跌倒病例及78例对照病例进行分析，分析身体约束这一因素对跌倒发生的影响。结果身体约束并未降低跌倒的发生率，放弃身体约束与采取身体约束措施对跌倒的发生率的影响无统计学差异（P〉0．05）。结论对于跌倒的高危老年患者，加强宣教及看护，减少因身体约束带来的社会、心理及生理的负面影响后，放弃身体约束这一防护措施，并不增加跌倒的发生率。     

ICU患者身体约束使用特征及护理现状分析

目的 分析重症监护病房(ICU)身体约束使用特征及护理现状,探讨管理对策.方法 调查2008年3-6月我院ICU身体约束使用率、身体约束特征及已采取的护理措施等.结果 1次或1次以上身体约束的使用率为39.04%;身体约束的患者特征为全麻未清醒者占41.13%;气管插管者占73.76%;神经外科患者占46.81%.时间特征为,入院当时和术后即刻为开始使用身体约束的最长时间段,平均使用时间为(20.33±32.16)h,约束时数占住院时数的平均比例为60.80%.约束工具单一,约束使用和放松时机欠妥,约束护理不够规范和约束记录不全等.结论 综合性ICU身体约束使用率尚有下降空间,控制重点在于减少预防性身体约束的使用.约束护理有待进一步规范,关键在于提高护士关于身体约束的技能,规范身体约束告知,改进身体约束工具和流程,明确身体约束指征和护理内容.     

多元化干预策略在降低老年科失能老人身体约束率中的应用研究

目的探讨多元化干预策略在降低老年科失能老人身体约束率中的应用研究。方法选取老年科2018年3月—12月102例老年失能患者作为研究对象。其中将2018年3月—7月的52例老年失能患者为对照组,实施常规约束护理流程及病情观察;将2018年8月—12月的50例老年失能患者作为观察组,运用多元化干预策略对使用身体约束的失能老人进行全方面的护理。观察并比较两组老年失能患者的身体约束使用率、患者或家属满意度、非计划性拔管率、机械损伤(包括皮肤损伤和末梢循环障碍)、院内感染等。结果观察组的身体约束使用率、非计划性拔管、机械损伤及院内感染发生率均低于对照组(P0.05);观察组患者及家属的满意度高于对照组,差异有统计学意义(P0.05)。结论多元化干预策略的实施能够降低失能老人身体约束使用率,减少非计划性拔管、机械损伤、院内感染等不良事件的发生,提高了患者及家属的满意度,得到了医护与患者多方面的认可,实现"最小化身体约束"的管理目标,促进了护患关系的和谐。     

身体约束在儿童重症监护室使用及护理现况的调查分析

目的探讨儿科重症监护病房患儿身体约束的使用特征与护理现状,为制定儿科约束规范提供临床依据。方法调查本院2016年7月~2016年12月期间收住PICU及CCU的病例,了解PICU及CCU患儿身体约束的使用率、身体约束的特征等。结果在PICU及CCU身体约束的使用率为33.44%;其中气管插管者占44.55%,所有约束的患儿中有55例患儿使用镇静剂,占约束患儿的26.1%。结论儿科ICU使用身体约束的指证还没有明确规定,约束的使用规范有待于进一步完善,其主要在于提高护士关于身体约束的相关知识和技能,改善儿童身体约束的工具,明确儿童身体约束的指证及护理。     

The factors that influence nurses' use of physical restraint: A thematic literature review

Lane C, Harrington A. International Journal of Nursing Practice 2011; 17 : 195–204 The factors that influence nurses' use of physical restraint: A thematic literature review Difficult clinical situations in both hospitals and aged care facilities might lead to the use of physical restraint on older people. This literature reviewed aimed to identify the factors that influence nurses' use of physical restraint on people aged over 60 years. The prevalence of restraint use in aged care facilities was shown to be between 12% and 47%, with 7% to 17% for hospitalized patients. Database searches retrieved studies published after 1992 that highlighted nurses' use of physical restraint on older people in both acute and aged care settings. The analysis revealed two reasons for decisions to use physical restraint that were categorized as ‘patient safety’ and ‘nurses' workload’. It is important for nurses to understand the nursing culture that perpetuates restraint use, and to consider patient‐centred nursing as an instigator for change.     

体验式教学在ICU缩减约束行动中的应用研究

目的将体验式教学应用于ICU护士身体约束培训,探讨其在缩减约束行动中的效果。方法采取便利抽样法,选取2017年1月—2018年10月在石家庄市某三级甲等医院ICU的903例住院患者为研究对象。将2017年1—10月的491例患者设为对照组,2018年1—10月的412例患者设为试验组。对照组采用常规约束护理,试验组采取缩减约束护理,比较两组身体约束率、身体约束合格率、身体约束护理文件书写质量及患者满意度得分。结果试验组患者约束率为62.14%(256/256),低于对照组的71.69%(352/491),试验组约束合格率89.06%(228/256),高于对照组的80.68%(284/352),两组比较差异均有统计学意义(P<0.05)。试验组身体约束护理文件书写质量得分(98.32±2.22)分,患者家属满意度得分(98.11±2.53)分,均高于对照组,两组得分比较差异均有统计学意义(P<0.05)。结论基于体验式教学的缩减约束护理降低了ICU患者身体约束率,提高了身体约束质量和患者满意度,值得临床推广。     

老年肿瘤病人的心理状态及护理对策

[目的]探讨老年肿瘤病人住院治疗期间加强心理护理的重要性和必要性。[方法]对135例65岁以上的肿瘤病人不同的心理状态实施针对性的心理护理。[结果]对老年病人加强心理护理能大大缓解病人各种心理压力,并能促进健康恢复。[结论]加强对老年肿瘤病人的心理护理非常必要和重要。     

Physical restraint in mental health nursing: A concept analysis

ObjectivePhysical restraint is frequently used in medical services, such as in mental health settings, intensive care units and nursing homes, but its nature varies in different institutions. By reviewing related literature, this study aims to clarify the concept of physical restraint in mental health nursing.MethodThree databases (PubMed, PsycINFO and CINAHL) were retrieved, and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing.ResultsPhysical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement. It should be the last option used by qualified personnel. Antecedents of physical restraint are improper behavior (violence and disturbance) of patients, medical assessment prior to implementation and legislation governing clinical usage. Consequences of physical restraint are alleviation of conflict, physical injury, mental trauma and invisible impact on the institution.DiscussionThis study defined the characteristics of physical restraint in mental health nursing. The proposed concept analysis provided theoretical foundation for future studies.     

约束护理单在ICU患者约束中的应用及效果

目的探讨约束护理单在ICU患者约束中的应用效果。方法对92例ICU患者约束的同时使用约束护理单,根据约束护理单要求进行观察护理。结果使用约束护理单后约束部位皮肤异常率下降,投诉和意外拔管或脱管发生率差异无统计学意义。结论使用约束护理单能降低约束对局部皮肤的不良影响,提高护理管理。     

Intensive care psychiatric nursing--psychoanalytic perspectives

Based on unobtrusive observations, a parallel is drawn between general and psychiatric intensive care nursing. The correlation between bedside skills and the incidence of physical contact between nurse and patient in each setting is considered. The phenomenon of physical attacks by patients on carers and the process of restraint in the psychiatric intensive care unit (ICU) is then examined. It is suggested that attack by and subsequent restraint of a disturbed patient may be considered in terms of an unconscious re-enactment of an early skin-on-skin object relation. It is argued that the physical holding of a psychotic patient is functional in re-establishing their bodily ego. Some thoughts are offered on how the intensive care of psychotic patients might be carried forward in the future.     

创伤外科老年患者中人文关怀护理的结果分析

目的探讨人文关怀护理融入创伤外科老年患者中的方法,为创伤的老年患者的护理提供依据。方法分析100例老年创伤外科患者的临床资料,根据其生理及心理特点,随机分为实验组50例和对照组50例,对照组给予常规护理;实验组在常规护理的基础上增加人文关怀护理。结果实验组患者对护理工作者的满意度均较对照组高,在影响手术的因素等方面的发生率均比对照组低,但是其生活质量各方面却相反。结论合理实施人文关怀护理可以降低老年患者病死率、致残率,提高了患者的生活质量和健康水平。     

The impact of education on the use of physical restraints in the acute care setting

BACKGROUND: Physical restraints have become an acceptable standard of practice for managing safety and behavior control in acute care settings. Although the primary intent for using physical restraints is for patient protection, there are many negative outcomes related to their use. Heightened awareness by recent Joint Commission on Accreditation of Healthcare Organizations and the Center for Medicare and Medicaid Services standards for restraint use has led health care administrators and nursing staff to explore methods of reducing or eliminating the use of restraints. An educational program was planned and implemented for nursing staff emphasizing the risks of physical restraints and the benefits of innovative optional measures including nonrestraint devices. The program was tested to determine whether increased awareness through education would reduce the use of restraints. METHOD: After current practice patterns and restraint utilization were established, a comprehensive educational program was provided to all nursing personnel. Twenty-three formal classroom inservice offerings were provided with follow-up reinforcement of self-study modules. Education included nursing assessment strategies and practical restraint optional interventions for managing patients exhibiting disruptive behaviors. FINDINGS: After the educational program, the overall use of physical restraints decreased as well as the length of time patients were restrained. CONCLUSION: Results of this study reinforce the need to increase staff awareness and knowledge of nonrestraint interventions to manage disruptive behaviors in the acute care setting.