小儿身体约束工具使用的研究进展

通过阅读大量文献和结合临床实际经验,列举许多新型的小儿身体约束工具。认为新型身体约束工具比传统约束工具更符合患儿的病情需要,方便临床上使用;新型约束工具能够提高患儿舒适度,减少约束并发症的发生。     

澳大利亚循证卫生保健中心身体约束标准介绍

本文对2013年7月澳大利亚循证卫生保健中心（JBI）在其网站公布的身体约束标准中对身体约束的定义、护士的责任、实施身体约束的原则及管理、身体约束的原因、减少身体约束的措施及对老年人的约束7个方面进行了介绍,以期为我国身体约束的使用提供参考。     

护理院老年人身体约束的护理研究进展

介绍身体约束的定义,综述国内外护理院身体约束使用现状,对老年人、家属和护理人员的影响及减少身体约束使用的策略,为实现身体约束最小化及提高护理院服务质量提供参考依据。     

优化保护性约束流程对精神分裂症患者约束率的影响

目的：探讨优化保护性约束流程对精神分裂症患者约束率的影响。方法采用传统保护性约束流程护理的患者纳入对照组,采用优化后的精神科保护性约束流程护理的患者纳入研究组。比较两组患者运用保护性约束使用率、约束使用频次率以及患者对约束的满意度。结果研究组同期157例住院精神分裂症患者中被约束35例（22．29％）,被约束的频次是49次（31．21％）,对保护性约束的满意度为100．0％;而对照组同期202例住院精神分裂症患者中被约束98例（48．51％）,被约束的频次是116次（57．43％）,满意度为87．75％;两组比较,差异均有统计学意义（χ2分别为26．04,24．44,4．71;P＜0．05）。结论优化保护性约束流程实现了精神科保护性约束工作的科学性、标准化和规范化,减少并发症和医患矛盾,值得在精神科中推广使用。     

ICU护士实施身体约束替代的现况调查

目的 了解ICU护士实施身体约束替代的现状,为今后优化ICU身体约束管理提供依据。方法 采用自行设计的ICU护士身体约束替代现状调查表,通过现场调研方式对上海市某三甲综合医院228名ICU护士进行调查。结果 142名护士(62.3%)对身体约束替代知识有所了解,110名ICU护士(48.2%)在临床实践中实施身体约束替代,主要的身体约束替代类别为治疗设施管理(91.7%)、管道管理(90.4%),其次是环境控制(82.0%)。约束替代主要用于烦躁或攻击性,意识模糊、定向力障碍、单纯烦躁的患者(>50%),以实施身体约束后较为多见(74.1%)。结论 ICU护士实施身体约束替代整体水平偏低,以生理因素身体约束替代为主而心理因素为主的患者注意力转移身体约束替代实施较少,身体约束替代在实施约束前使用率不高。应加强身体约束替代相关培训,促进身体约束替代的实施,优化ICU患者的身体约束管理,减少不必要的身体约束。     

住院患者身体约束方法的研究进展

本文对身体约束的分类、器械约束装置的改良、患者活动监管装置以及约束的辅助方法进行综述,以期为身体约束的合理使用提供参考,从而降低住院患者身体约束的使用率和使用时间,减少伤害的发生。     

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。     

保护性约束在ICU患者使用中的问题和对策

目的探讨对进入ICU患者和家属接受保护性约束的态度和问题,分析原因,给予相应的护理对策。方法选择2014年1月到10月外科手术后需进入ICU监护的676名患者和其家属随机分为研究组和对照组,对照组采用常规的约束方法,研究组采用预先心理干预,告知患者和家属保护性约束的相关知识。结果研究表明,研究组的患者和家属对保护性约束的接受和合作明显高于对照组。结论改变保护性约束的实施方法能提高患者和家属的接受度,以及减少保护性约束的负性影响,提高患者的舒适度和满意度,降低护患矛盾的发生率。     

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。     

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。     

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses’ perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma‐informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use.     

Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint

Restraint in mental health care has negative consequences, and guidelines/policies calling for its reduction have emerged internationally. However, there is tension between reducing restraint and maintaining safety. In order to reduce restraint, it is important to gain an understanding of the experience for all involved. The aim of the present study was to improve understanding of the experience of restraint for patients and staff with direct experience and witnesses. Interviews were conducted with 13 patients and 22 staff members from one UK National Health Service trust. The overarching theme, ‘is restraint a necessary evil?’, contained subthemes fitting into two ideas represented in the quote: ‘it never is very nice but…it's a necessary evil’. It ‘never is very nice’ was demonstrated by the predominantly negative emotional and relational outcomes reported (distress, fear, dehumanizing, negative impact on staff/patient relationships, decreased job satisfaction). However, a common theme from both staff and patients was that, while restraint is ‘never very nice’, it is a ‘necessary evil’ when used as a last resort due to safety concerns. Mental health‐care providers are under political pressure from national governments to reduce restraint, which is important in terms of reducing its negative outcomes for patients and staff; however, more research is needed into alternatives to restraint, while addressing the safety concerns of all parties. We need to ensure that by reducing or eliminating restraint, mental health wards neither become, nor feel, unsafe to patients or staff.     

Perspectives on the experience of being physically restrained: an integrative review of the qualitative literature

Publications providing information on the safe use of physical restraints, guidelines for restraint use, and journal articles on the care of mental health patients are frequently devoid of information regarding patients' perspectives on physical restraint. As physical restraint is a common procedure in many settings, the purpose of this review is to examine and summarize the qualitative literature on patients' perspectives on being physically restrained, from 1966 through to 2009. A formal integrative review of existing qualitative literature on patients' perspectives of physical restraint was conducted. Studies were critiqued, evaluated for their strength, and analysed for key themes and meanings. Twelve studies were ultimately identified and included in the review. Four themes emerged from the review, including negative psychological impact, retraumatization, perceptions of unethical practices, and the broken spirit. While little qualitative research on patients' perceptions of physical restraint exists, findings within the current literature reveal serious implications for patients and nurses alike. Additional research into physical restraint implications for the patient-nurse dyad is needed, and nurses should approach the use of physical restraint with caution and awareness of their potential psychological impact.     

降低ICU患者约束缺陷发生率的品管圈实践

目的探讨品管圈对降低ICU患者约束缺陷发生率的作用。方法成立品管圈活动小组,确立活动主题,回顾性分析湖南省人民医院ICU品管圈活动开展前2013年1—5月患者身体约束缺陷的发生情况,分析发生的原因,设立目标及制定整改措施,与2013年6—12月开展品管圈活动后ICU患者约束缺陷的发生情况进行比较。结果实施品管圈后,约束缺陷事件从活动前的24.7%降低至活动后的10.1%,差异具有统计学意义(P0.05)。结论开展品管圈活动降低了ICU约束缺陷的发生率,促进护理质量持续改进。     

Manual restraint and shows of force: the City-128 study

Manual restraint is used to manage disturbed behaviour by patients. This study aimed to assess the relationship of manual restraint and show of force to conflict behaviours, the use of containment methods, service environment, physical environment, patient routines, staff characteristics, and staff group variables. Data from a multivariate, cross-sectional study of 136 acute psychiatric wards in England were used to conduct this analysis. Manual restraint was used less frequently on English acute psychiatric wards (0.20 incidents per day) than show of force (0.28 incidents per day). Both were strongly associated with the proportion of patients subject to legal detention, aggressive behaviours, and the enforcement of treatment and detention. Medical, nursing, and security guard staff provision were associated in different ways with variations in the use of these coercive interventions. An effective ward structure of rules and routines was associated with less dependence on these control methods. Training for manual restraint should incorporate the scenarios of attempted absconding and enforcement of treatment, as well as violent behaviour. Attempts to lessen usage of these interventions could usefully focus on increasing the availability of medical staff to patients, reducing reliance on security guards and establishing a good ward structure.     

Reducing Use of Physical Restraint: A Pilot Study Investigating a Relationship-Based Crisis Prevention Curriculum

The use of physical restraint in residential treatment programs continues to be a topic of debate. Yet, there is a scarcity of empirical research on effective methods for reducing both the need and the use of physical restraint. Without such evidence, there is no clear direction on how to improve staff practices when working with students experiencing emotional and behavioral challenges. Consequently, it has been difficult for programs to develop clear, consistent, and definitive efforts to reduce restraint practices and eliminate unnecessary restraint. In an effort to improve program practices, we designed and piloted a relationship-based crisis prevention curriculum. In this article we discuss the pilot study and briefly outline curriculum features. Pilot study results reveal a statistically significant reduction in restraint, a shift in attitudes about prevention and need for restraint, and a positive trend in staff preparation. Additionally, the social validity of the curriculum and future directions for practice and research are discussed.     

Using interventions to reduce seclusion and mechanical restraint use in adult psychiatric units: an integrative review

The aim of this integrative review was to describe interventions aimed at reducing seclusion and mechanical restraint use in adult psychiatric inpatient units and their possible outcomes. CINAHL, MEDLINE, PsycINFO and Medic databases were searched for studies published between 2008 and 2017. Based on electronic and manual searches, 28 studies were included, and quality appraisal was carried out. Data were analysed using inductive content analysis. Interventions to proactively address seclusion were environmental interventions, staff training, treatment planning, use of information and risk assessment. Interventions to respond to seclusion risk were patient involvement, family involvement, meaningful activities, sensory modulation and interventions to manage patient agitation. Interventions to proactively address mechanical restraint were mechanical restraint regulations, a therapeutic atmosphere, staff training, treatment planning and review of mechanical restraint risks. Interventions to respond to mechanical restraint risks included patient involvement, therapeutic activities, sensory modulation and interventions to manage agitation. Outcomes related to both seclusion and mechanical restraint reduction interventions were varied, with several interventions resulting in both reduced and unchanged or increased use. Outcomes were also reported for combinations of several interventions in the form of reduction programmes for both seclusion and mechanical restraint. Much of the research focused on implementing several interventions simultaneously, making it difficult to distinguish outcomes. Further research is suggested on the effectiveness of interventions and the contexts they are implemented in.