实用新型约束带的制作与应用

躁动是脑功能不全患者的常见表现,镇静药对这类患者作用效果不明显,超常规镇静剂的使用又会影响患者呼吸和医务人员对患者病情的判断[1]。临床上为了增加神经外科躁动患者的安全系数,避免坠床、撞伤、抓伤、拔管等意外事件的发生[2],往往需要借助约束带对患者进行保护性约束。传统常采用四肢约束或采用绳索或固定带直接缠绕在患者身上,     

两种约束方式在临床中的应用效果

目的分析两种约束方式在临床中的应用效果。方法便利抽样法选择2011年10月至2013年10月入住解放军总医院南楼心血管内科的患者72例为研究对象,按入院时间先后将其分为观察组和对照组,每组各36人。对照组患者采用传统约束带约束,观察组患者采用改良后新型约束手套约束,比较两种约束方式下患者的管道脱出率、约束带并发症发生率、家属接受度及护士的满意度。结果观察组患者的管道脱出率、约束带并发症发生率低于对照组,差异均有统计学意义(均P0.05);家属接受度、护士满意度亦明显优于对照组,差异均有统计学意义(均P0.01)。结论改良后新型约束手套较传统约束带在临床中的应用效果更好,推荐在临床广泛使用。     

基于人性关怀的新型下肢约束带在手术病人中的应用效果观察

[目的]研制新款下肢约束带,探讨基于人性关怀的新型下肢约束带在手术病人中的应用效果。[方法]研制新款下肢约束带,选取2019年1月某三级甲等医院手术部符合研究条件的手术病人386例作为研究对象,按照整群抽样法将手术病人根据手术单双日分为观察组196例和对照组190例,观察组使用新型约束带,对照组使用常规约束带。比较两组约束带松脱率、约束部位肢体皮肤压力性损伤发生率、使用约束带舒适度。[结果]观察组约束带松脱率低于对照组(P<0.05);观察组约束部位肢体皮肤压力性损伤发生率低于对照组(P<0.05);两组病人使用约束带舒适度比较差异有统计学意义(P<0.05)。[结论]手术病人应用新型约束带能减少术中约束带松脱、约束部位压力性损伤,效果优于常规约束带,同时满足人性化护理服务需求。     

The movement of physical restraint‐free care for the elderly in Japan and Japanese culture

Abstract For a long time in Japan, there was no legal control or guidelines in the use of physical restraints at both acute and long‐term care facilities. Keeping the elderly in bed or binding them in beds, wheel chairs or geriatric‐chairs was commonly done. This seems to be related to a chief characteristic of the Japanese.     

身体约束不良影响及减少约束的策略

本文通过对身体约束的不良影响和各国减少约束的措施进行综述,提出应营造减少约束的环境,制定并有效实施基于循证的指南,加强对约束执行人员的教育培训,通过影响其知识、态度和行为改进约束实践。     

Respiratory Assessment in Child and Adolescent Residential Treatment Settings: Reducing Restraint-Associated Risks

TOPIC: Crisis situations of youth in treatment settings may require restraints. Restraints should only be used in situations where there is imminent danger to the child and when there is no alternative. They are meant to maintain the child's safety, but there is risk for respiratory compromise. PURPOSE: Nursing care of children in restraints must include respiratory assessment and, when indicated, immediate intervention to prevent disastrous outcomes. SOURCES: Review using PubMed and established texts confirms that clinical skills and knowledge is essential to child and adolescent psychiatric nursing. CONCLUSIONS: Clinical assessment and awareness of risks in physical restraints is essential for the safety and well-being of the child.     

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。     

The effectiveness of chemical restraint in managing acute agitation and aggression: A systematic review of randomized controlled trials

One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast‐acting medication, called chemical restraint. Such management often needs to be delivered in crisis situations to patients who are at risk of harm to themselves or others. This paper summarizes the available evidence on the effectiveness and safety of chemical restraint from 21 randomized controlled trials (RCTs) involving 3788 patients. The RCTs were of moderate to high quality and were conducted in pre‐hospital, hospital emergency department, or ward settings. Drugs used in chemical restraint included olanzapine, haloperidol, droperidol, risperidol, flunitrazepam, midazolam, promethazine, ziprasidone, sodium valproate, or lorazepam. There was limited comparability between studies in drug choice, combination, dose, method of administration (oral, intramuscular, or intravenous drip), or timing of repeat administrations. There were 31 outcome measures, which were inconsistently reported. They included subjective measures of behaviours, direct measures of treatment effect (time to calm; time to sleep), indirect measures of agitation (staff or patient injuries, duration of agitative or aggressive episodes, subsequent violent episodes), and adverse events. The most common were time to calm and adverse events. There was little clarity about the superiority of any chemical method of managing behaviours of concern exhibited by patients in Emergency Departments or acute mental health settings. Not only is more targeted research essential, but best practice recommendations for such situations requires integrating expert input into the current evidence base.     

Medicate,restrain or seclude? Strategies for dealing with violent and threatening behaviour in a Norwegian university psychiatric hospital

The aim of this study was to examine staff strategies for applying emergency procedures with patients who were violent or threatening. The study addressed those situations where verbal intervention, voluntary medication, and other interventions had been tried unsuccessfully and where staff found it necessary to apply emergency procedures in the shape of forced emergency medication (pharmacological restraint), physical restraint, and seclusion. The study was conducted in a 100-bed Norwegian university psychiatric hospital. By retrospectively examining hospital records we found there were 797 episodes of physical restraint, 384 episodes of pharmacological restraint, and 88 episodes of seclusion during a five and a half year period. The preferred emergency procedures varied significantly with patients' sex, age, and diagnoses. Physical restraint was preferred more often with male, younger, and nonpsychotic patients. Pharmacological restraint was preferred more often with female patients and older patients with a nonorganic psychotic disorder. Seclusion was preferred more often with older male patients with an organic psychotic disorder.     

Part 2. Chemical and physical restraints in the management of mechanically ventilated patients in the ICU: A patient perspective

An important goal of the care for the mechanically ventilated patient is to minimize patient discomfort and anxiety. This is partly achieved by frequent use of chemical and physical restraints. The majority of patients in intensive care will receive some form of sedation. The goal and use of sedation has changed considerably over the past few decades with literature evidencing trends toward overall lighter sedation levels and daily interruption of sedation. Conversely, the use of physical restraint for the ventilated patient in ICU differs considerably between nations and continents. A large portion of the literature on the use of physical restraint is from general hospital wards and residential homes, and not from the ICU environment. Recent literature suggests minimal use of physical restraint in the ICU, and that reduction programmes have been initiated. However, very few papers illuminate the patient's experience of physical and chemical restraints as a treatment strategy. In Part 1 of this two-part review, the evidence on chemical and physical restraints was explored with specific focus on definitions of terms, unplanned extubation, agitation, delirium as well as the impact of nurse-patient ratios in the ICU on these issues. This paper, Part 2, examines the evidence related to chemical and physical restraints from the mechanically ventilated patient's perspective.     

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.     

ICU住院病人身体约束实施的现况调查

[目的]调查ICU住院病人身体约束的实施现况,为制定ICU身体约束实践指南提供依据。[方法]采用便利抽样法抽取国内12个省/直辖市的3055名ICU护士,采用自行编制的"临床护士对住院患者身体约束现状调查问卷"进行调查。[结果]24.3%的护士约束前不使用约束评估工具,16.0%的护士告知时未使用知情同意书,43.1%的护士实施约束后导致投诉或其他不良后果,24.9%的护士不知道具体的约束替代措施,62.5%的护士遇见被约束的病人发生过约束相关并发症,10.3%的护士实施身体约束后未进行护理记录。[结论]ICU病人身体约束评估、约束告知、约束器具使用、约束记录等存在不规范,需制定统一的身体约束标准以规范指导临床实践。     

An exploratory account of registered nurses'' experience of patient aggression in both mental health and general nursing settings

Until relatively recently, aggression and violence in nursing has been an area of little discussion (Poster & Ryan 1993). Today, concerns are rising about escalating levels of violence towards nurses (Wykes 1994, Whittington 1997). In response, this paper explores registered nurses' experiences of patient aggression encountered in the acute inpatient general and mental health settings. Critical incidents from registered nurses in both areas are examined and analyzed in relation to existing literature. The aim of the research is to ascertain if differences exist or similarities prevail. Findings reveal that the two areas have similar problems in terms of types of aggression. Verbal and 'minor' types of aggression are the most problematic. Also, the 'biomedical model' of care is evident in both settings and possibly underpins chosen approaches to aggression management. The repeated use of chemical and physical restraint is apparent. The main comparison identified between the two groups relates to nursing control over situations involving violent patients. Mental health nurses seem to consistently take control of aggressive situations whilst general nurses tend to rely more heavily upon the input of others (medical staff, mental health teams and the police) when intervening. These two nursing specialties therefore have much to learn from each other in terms of nursing experience and possible future approaches to the management of aggressive patients.     

Physical restraint reduction in the acute rehabilitation setting: a quality improvement study.

A prospective, continuous quality improvement study was implemented at a hospital on two rehabilitation units: stroke and brain injury. The purpose of the study was to decrease restraint use by 25% and to maintain fall rates no greater than 10% over baseline. A multi-component restraint reduction program was implemented that focused on administrative support, education, consultation, and feedback. Monthly restraint rates and fall rates were monitored and compared to the previous year's rates. Both units reduced restraint use. Importantly, this reduction was accomplished at the same time as a decline in fall rates.