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护理学报 ›› 2019, Vol. 26 ›› Issue (4): 31-36.doi: 10.16460/j.issn1008-9969.2019.04.031

• 循证护理 • 上一篇    下一篇

住院患者规范化身体约束管理最佳证据总结

杨中善1, 许妮娜1, 詹昱新1, 刘宁2, 李昭慧1, 乐格芬1   

  1. 1.华中科技大学同济医学院附属协和医院,湖北 武汉 430022;
    2.遵义医学院珠海校区,广东 珠海 519041
  • 收稿日期:2018-12-23 出版日期:2019-02-25 发布日期:2020-07-08
  • 通讯作者: 许妮娜（1977-）,女,湖北武汉人,硕士研究生学历,主管护师,护士长。
  • 作者简介:杨中善（1990-）,女,湖北仙桃人,本科学历,护师。

Summary of Best Evidence for Standardized Management of Physical Restraint in Inpatients

YANG Zhong-shan1, XU Ni-na1, ZHAN Yu-xin1, LIU Ning2, LI Zhao-hui1, LE Ge-fen1   

  1. 1. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China;
    2. Zhuhai Campus, Zunyi Medical College, Zhuhai 519041, China
  • Received:2018-12-23 Online:2019-02-25 Published:2020-07-08

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摘要： 目的 检索并获取符合住院患者身体约束管理的最佳证据,为医务人员、管理者、患者及家属临床实践提供参考。方法 用PIPOST确定科学问题,制定合适的检索策略和纳排标准,检索JBI、RNAO、CINAHL等数据库,由2名有资质的研究员对不同的文献类型采用对应的评价工具独立进行评价、证据提取与综合。结果 纳入11篇有关身体约束的文献,其中1篇临床决策、3篇证据总结、3篇指南、3篇系统评价、1篇专家共识。从11篇文献中共提取了50条证据,综合成5个维度22条最佳证据,分别是组织政策、培训教育、约束评估、替代方案和实施监测。结论 临床管理者应根据专科特色制定合适的约束制度,对员工定期培训,促进零约束的组织文化。对实施约束的患者进行人文关怀,充分尊重患者的人权与尊严。

关键词: 身体约束, 证据总结, 循证护理

Abstract: Objective To summarize the best evidence for physical restraint management in inpatients and to provide reference for medical staff, managers, patients and families. Methods We employed PIPOST to identify scientific problems, then formulated appropriate retrieval strategies and criteria. We searched the JBI, RNAO and CINAHL, etc. and 2 qualified researchers independently evaluated articles using different tools according different types of the articles. We used The Joanna Briggs Institute Levels of Evidence and Grades of Recommendation to assess the evidence classification and recommendation level. Two researchers synthesized the best evidence. Results Totally 11 articles were enrolled, including 1 clinical decision, 3 evidence summaries, 3 guidelines, 3 systematic reviews and 1 expert consensus. A total of 50 evidences were extracted which were integrated into 22 best evidences in 5 dimensions. There were organizational policy, training education, restraint evaluation, alternative methods and implementation monitoring. Conclusion Clinical managers should establish appropriate restraint system according to specialty characteristics, regular training for medical staff, and promote the free-restraint culture. Humanistic care is recommended for patients with physical restraints to fully respect the human rights and dignity of the patients.

Key words: physical restraints, evidence summary, evidence-based nursing

中图分类号: 

  • R197.323.2
[1] Dikiciyan J, Sabangan B, Katz B,et al.Australian and New Zealand Society for Geriatric Medicine Position Statement - Physical Restraint Use in Older People[J].Australas J Ageing, 2016, 35(3):225. DOI:10.1111/ajag.12224.
[2] 纪媛媛,王军,马春梅,等.神经外科ICU患者谵妄特点分析[J].中华现代护理杂志,2018,24(25):2982-2986. DOI:10.3760/cma.j.issn.1674-2907.2018.25.002.
[3] Lan S H, Lu L C, Lan S J, et al.Educational Intervention on Physical Restraint Use in Long-term Care Facilities-systematic Review and Meta-analysis[J]. Kaohsiung J Med Sci 2017, 33(8):411-421. DOI:10.1016/j.kjms.2017.05.012.
[4] Government of Ontario: Patient Restraints Minimization Act,2001.[EB/OL](2017-12-12)[2018-11-22].https://www.ontario.ca/laws/statute/01p16.
[5] Maccioli G A, Dorman T, Brown B R, et al.Clinical Practice Guidelines for the Maintenance of Patient Physical Safety in the Intensive Care Unit: Use of Restraining Therapies American College of Critical Care Medicine Task Force 2001-2002[J].Crit Care Med, 2003, 31(11):2665-2676.
[6] Bray K, Hill K, Robson, et al.British Association of Critical Care Nurses Position Statement on the Use of Restraint in Adult Critical Care Units[J].Nurs Crit Care,2004,9(5):199-212.
[7] 马慧,程云,薛一帆,等.神经外科使用身体约束预防患者自我拔管的最佳证据应用[J].护理学杂志,2015,30(20):5-8. DOI:10.3870/J.ISSN.1001-4152.2015.20.005.
[8] Aromataris E, Fernandez R, Godfrey C M, et al.Summarizing Systematic Reviews: Methodological Development, Conduct and Reporting of an Umbrella Review Approach[J].Int J Evid Based Healthc, 2015,13(3):132-140. DOI:10.1097/XEB.0000000000000055.
[9] Dicenso A, Bayley L, Haynes R B.Accessing Pre-appraised Evidence: Fine-tuning the 5S Model into a 6S Model[J].Evid Based Nurs,2009,12(4):99-101. DOI:10.1136/ebn.12.4.99-b.
[10] Allen M H, Currier G W, Hughes D H, et al.The Expert Consensus Guideline Series. Treatment of Behavioral Emergencies 2005[J]. J Psychiatr Pract, 2005,11(Suppl 1):5-108.
[11] Parkes J, Carson R.Sudden Death during Restraint_ Do Some Positions Affect Lung Function[J]. Med Sci Law,2008,48(2):137-141.
[12] Smith N H, Timms J, Parker V G, et al.The Impact of Education on the Use of Physical Restraints in the Acute Care Setting[J].J Contin Educ Nurs,2003,34(1):26-33.
[13] Office of the Public Advocate. Position Statement: Protecting the Human Rights of Adults with Decision-making Disabilities[EB/OL].[2018-11-22]. https://www.publicadvocate.wa.gov.au/_files/position_statement_2.pdf.2013/2018-11-22.
[14] Australian Government Department of Health and Ageing. How to Support A Restraint-free Environment in Community Aged Care[J]. Australian Government Department of Health and Ageing,2012(20122012. How to Support A Restraint-free Environment in Community Aged Care[J]. Australian Government Department of Health and Ageing,2012(11):1. DOI:http://www.health.gov.au/internet/main/publishing.nsf/Content/ag.
[15] The Joanna Briggs Institute. Critical Appraisal Checklist for Text and Opinion[EB/OL]. [2018-11-22]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[16] The Joanna Briggs Institute. Critical Appraisal Checklist for Randomized Controlled Trials[EB/OL]. [2018-11-22]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[17] The Joanna Briggs Institute. Critical Appraisal Checklist for Quasi-Experimental Studies[EB/OL]. [2018-11-22]. http://joannabriggs.org/research/critical-appraisal-tools.html.
[18] Brouwers M C, Kho M E, Browman G P, et al.AGREE II: Advancing Guideline Development, Reporting, and Evaluation in Health Care[J]. Prev Med, 2010, 51(5):421-424.
[19] The Joanna Briggs Institute. Critical Appraisal Checklist for Systematic Reviews and Research Syntheses[EB/OL]. [2018-11-22].http://joannabriggs.org/research/critical-appraisal-tools.html.
[20] 王青春,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J].护士进修杂志, 2015,30(11):964-967. DOI:10.16821/j.cnki.hsjx.2015.11.002.
[21] 曹秋君,吴燕. 预防静脉血液标本溶血的最佳证据总结[J].中华护理杂志,2018,53(8):1000-1004. DOI:10.3761/j.issn.0254-1769.2018.08.020.
[22] Moore G, Pfaff J A.Assessment and Emergency Management of the Acutely Agitated or Violent Adult[EB/OL]. [2018-11-22].https://so.uptodate.cn/contents/assessment-and-emergency-management-of-the-acutely-agitated-or-violent-adult?
[23] Jayasekara R. Evidence Summary.Physical Restraint: Prone Position[J]. The Joanna Briggs Institute EBP Database, JBI@Ovid,2018:JBI1024.
[24] Mann E.Restraint: Clinician Information[Z].Australia: The Joanna Briggs Institute,2016.
[25] Bellman S.Residential Aged Care: Physical Restraint[Z].Australia: The Joanna Briggs Institute,2016.
[26] Gillings M, Grundlingh G, Meng A Y. Guidelines for the Management of Excited Delirium / Acute Behavioural Disturbance (ABD)[EB/OL].(2016-05-01)[2018-11-22]. https://www.rcem.ac.uk/docs/College%20Guidelines/5p.%20RCEM%20guidelines%20for%20management%20of%20Acute%20Behavioural%20Disturbance%20(May%202016).pdf.
[27] Registered Nurses' Association of Ontario. Promoting Safety: Alternative Approaches to the Use of Restraints[EB/OL].[2018-11-22]. https://rnao.ca/sites/rnao-ca/files/Promoting_Safety_-_Alternative_Approaches_to_the_Use_of_Restrain28ts_0.pdf.
[28] Lach H W, Leach K M.Evidence-based Practice Guideline Changing the Practice of Physical Restraint Use in Acute Care[J]. J Gerontol Nurs,2016,42(2):17-26. DOI:10.3928/00989134-20160113-04.
[29] Luaute J, Plantier D, Wiart L, et al.Care Management of the Agitation or Aggressiveness Crisis in Patients with TBI. Systematic Review of the Literature and Practice Recommendations[J].Ann Phys Rehabil Med,2016, 59(1):58-67. DOI:10.1016/j.rehab.2015.11.001. Epub 2015 Dec 14.
[30] 葛向煜,胡雁,徐建呜,等.身体约束在重症监护室应用的系统评价[J].护理学杂志,2015, 30(14):94-99.DOI:10.3870/hlxzz.2015.14.094.
[31] 潘燕彬,郝巍巍,张晶晶,等.住院患者身体约束真实体验研究的系统评价[J].中国护理管理,2016,16(8):1033-1040. DOI:10.3969/j.issn.1672-1756.2016.08.007.
[32] 国家卫生计生委医院管理研究所护理中心.护理敏感质量指标实用手册(2016版)[M].北京:人民卫生出版社,2016:138-139.
[33] 陈巧玲,金爽,柳芳登,等.ICU护士实施身体约束知信行评估量表的构建[J].中华护理杂志,2016,51(6):742-748. DOI:10.3761/j.issn.0254-1769.2016.06.023.
[34] 石泽亚,杨丹,秦月兰,等.降低ICU患者约束缺陷发生率的品管圈实践[J].护理学报,2014,21(15):13-16.
[35] Vance D L.Effect of A Treatment Interference Protocol on Clinical Decision Making for Restraint Use in the Intensive Care Unit: A Pilot Study[J]. Aacn Clinical Issues, 2003, 14(1):82-91.
[36] Hurlock-Chorostecki C, Kielb C.Knot-so-fast: A Learning Plan to Minimize Patient Restraint in Critical Care[J]. Dynamics, 2006, 17(3):12-18.
[37] 宋秀婵,徐红,萧佩多,等.约束决策轮及等级在重症监护室危重症意识障碍患者中的应用[J]. 现代临床护理,2015,14(10):33-36. DOI:10.3969/j.issn.1671-8283.2015.10.009.
[38] 杨晶,杨露,郑晓娜.ICU住院患者身体约束量表的设计与应用[J].护理学杂志,2015,30(11):15-17. DOI:10.3870/hlxzz.2015.11.015.
[39] 崔念奇,甘秀妮,张传来,等.基于德尔菲法构建ICU患者身体约束评估量表[J].护理学杂志,2018, 33(2):62-64. DOI:10.3870/j.issn.1001-4152.2018.02.062.
[40] Richmond J S, Berlin J S, Fishkind A B, et al.Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup[J]. West J Emerg Med,2012,13(1):17-25.
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