神经外科患者规范化身体约束管理的循证护理实践

目的 制定神经外科患者规范化身体约束策略并应用于我院神经外科,以规范身体约束策略,提高身体约束护理质量。方法 遵循JBI临床证据实践应用模式,包括证据应用前基线审查、证据应用实践变革及证据应用后效果再审查3个阶段。将最佳证据转化为12条审查指标,应用于神经外科病房。比较证据应用前后患者身体约束率、非计划性拔管率、患者身体约束体验、护士对患者身体约束知信行水平及最佳证据执行率。结果 证据应用后,神经外科患者身体约束率从证据应用前的7.69%下降至2.91%;证据应用前后患者非计划性拔管发生率比较差异无统计学意义（P>0.05）;证据应用后患者约束体验优于证据应用前,差异有统计学意义（P<0.05）;证据应用后神经外科护士对患者身体约束知信行水平高于证据应用前（P<0.05）。12项审查标准执行情况,除审查指标10证据应用前后差异无统计学意义（P>0.05）外,其余各项审查标准证据应用后执行情况均优于证据应用前（P<0.05）。结论 基于最佳证据的规范化身体约束管理策略应用于神经外科患者后,可降低患者身体约束率,同时不增加患者非计划性拔管发生,改善患者约束体验,提高护士对患者身体约束知识信念行为水平,从而改善患者结局,提高护理质量。

Evidence-based Nursing Practice of Physical Restraint Standardized Management in Neurosurgery Department

Objective To develop the standardized physical restraint strategy for neurosurgery department, to promote the application of the best evidence of physical restraint and improve the quality of physical restraint nursing.Methods We conducted the study based on JBI clinical evidence practice application model and there were three stages: baseline review before evidence application, change of evidence application, and effect review after evidence application. The best evidence was converted into 12 audit criteria through structural discussion then the criteria were applied in neurosurgical ward. Physical restraint rate, complication rate, nurses’ KAP (knowledge, attitude, practice) regarding physical restraint and audit criteria execution rate were compared before and after evidence application.Results After the application of evidence, the physical restraint rate decreased from 7.69% to 2.91%. The incidence of unplanned extubation showed no statistical significance (P>0.05).Patients’ experience on physical restraint was improved, which was statistically significantly (P<0.05) nurses’ KAP regarding physical restraint was enhanced (P<0.05). Of the audit criteria execution rate of the 12 audit criteria,the execution rate of all the criteria except that of NO.10 was improved(P<0.05).Conclusion Evidence-based standardized physical restraint management strategy can lower the rate of physical constraint in neurosurgery, improve the level of physical restraint knowledge of nurses and regulate their behaviors, so as to improve the outcome of patients and improve the quality of nursing.