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Journal of Nursing ›› 2024, Vol. 31 ›› Issue (10): 37-42.doi: 10.16460/j.issn1008-9969.2024.10.037

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Expert consensus on perioperative protective restraint in interventional therapy for severe stroke patients

HAN Xiao-ling1, HE Jin-ai2, GENG Bing-bing1, WANG Xue-mei3, FENG Ying-pu4, YE Qiao1, FENG Jian-yu5   

  1. 1. Dept. of Nursing Administration, Zhuhai People's Hospital (Zhuhai Clinical Medical College of Jinan University), Zhuhai 519000, China;
    2. Dept. of Nursing Administration, the First Affiliated Hospital of Jinan University, Guangzhou 510000, China;
    3. Dept. of Interventional Radiology, Jiangsu Provincial Hospital, Nanjing 210029, China;
    4. Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital, Zhengzhou 450003, China;
    5. Dept. of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510000, China
  • Received:2024-01-04 Online:2024-05-25 Published:2024-06-06

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Abstract: Objective To form a written document of "Expert consensus on perioperative protective restraint in interventional therapy for severe stroke patients", to provide clinical guidance for the implementation and removal of perioperative protective restraints in interventional therapy for severe stroke patients. Methods By conducting literature review and interviews, we extracted recommendations and research findings on the implementation and removal of protective restraints for patients undergoing interventional therapy in the perioperative period of severe ischemic stroke to form a consensus draft. Following two rounds of expert consultation, we created the final consensus after adjusting , modifying, and refining the draft in accordance with expert opinions. Results The effective recovery rate of the two-round questionnaire was 96% and 91%, respectively. The authority coefficient of the two rounds of correspondence consulting was 0.896 and 0.933, respectively. The mean value of importance assignment of each indicator was > 3.5, and the coefficient of variation was < 0.25. The Kendall harmony coefficient of experts was 0.160 and 0.299 respectively. The final consensus consisted of five parts, namely, the key point of restraint implementation evaluation, restraint prevention and alternative measures, the selection of restraint tools and their duration, the key point of restraint implementation, and the key point of restraint removal. Conclusion This consensus provides guidance for and standardize the implementation and removal of protective restraints in severe stroke patients undergoing interventional therapy.

Key words: protective restraint, severe stroke, interventional therapy, perioperative period, expert consensus

CLC Number: 

  • R471.74
[1] 袁媛, 程伟鹤. 身体约束对重症脑卒中病人的影响[J]. 护理研究, 2023,37(6):1110-1113. DOI:10.12102/j.issn.1009-6493.2023.06.035.
[2] 邢银花, 高晓琴, 雷琼. 脑卒中患者留置胃管非计划性拔管的原因分析及护理对策[J]. 甘肃科技, 2022, 38(17): 87-89;128. DOI:10.3969/j.issn.1000-0952.2022.17.025.
[3] 李艳芬. 保护性约束临床路径护理在神经外科颅脑损伤躁动患者中的应用[J]. 齐鲁护理杂志, 2017, 23(6): 76-78. DOI:10.3969/j.issn.1006-7256.2017.06.039.
[4] Salehi Z, Najafi GT, Hajibabaee F, et al.Factors behind ethical dilemmas regarding physical restraint for critical care nurses[J]. Nurs Ethics,2020,27(2): 598-608. DOI:10.1177/0969733019858711.
[5] Shields L, Edelen A, Daniels MW, et al.Decline in physical restraint use following implementation of institutional guidelines[J]. J Nurs Adm, 2021,51(6):318-323.DOI:10.1097/NNA.0000000000001020.
[6] Van de Vyvere A, Dumont C. Procédures et contention physique [Physical restraint and procedure][J]. Revue medicale de Bruxelles, 2013,34(4):368-375.
[7] 李梅. 降低脑卒中患者胃管意外脱管率的护理改进策略[J]. 湖北科技学院学报(医学版), 2019, 33(1):67-69. DOI:10.16751/j.cnki.2095-4646.2019.01.0067.
[8] 刘凡,王芳,何满兰,等. 神经外科重症患者身体约束管理的最佳证据总结[J]. 护士进修杂志,2023,38(16):1478-1483. DOI:10.16821/j.cnki.hsjx.2023.16.009.
[9] 刘海平,陆鸽,周桂英,等. “品管圈”在降低脑卒中鼻饲患者非计划胃管拔除率中的应用[J]. 实用临床护理学电子杂志,2018,3(52):149-150.DOI:10.3969/j.issn.2096-2479.2018.52.112.
[10] RANO. Promoting safety: alternative approaches to the use of restrants[EB/OL].[2022-10-04].https://rano.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints.
[11] NICE. Violence and aggression:short-term management in mental health, health and community settings[EB/OL].[2022-11-23].https://www.nice.org.uk/guidance/ngl0.
[12] 雷若冰,蒋小平,林楠,等. ICU患者身体约束替代措施的证据总结[J]. 护理学杂志,2019,34(14):101-104,108. DOI:10.3870/j.issn.1001-4152.2019.14.101.
[13] 中华护理学会精神卫生专业委员会. 精神科保护性约束实施及解除专家共识[J]. 中华护理杂志, 2022,57(2): 146-151. DOI:10.3761/j.issn.0254-1769.2022.02.003.
[14] JBI. Restraint: nursing practice[EB/OL]. [2022-10-25].http://ovidsp.dc2.ovid.com/ovid-b/ovidweb.cgi.
[15] 中华医学会精神医学分会精神分裂症协作组. 激越患者精神科处置专家共识[J].中华精神科杂志, 2017,50(6):401-410. DOI:10.3760/cma.j.issn.1006-7884.2017.06.002.
[16] Allen MH, Currier GW, Hughes DH, et al.The expert consensus guideline series. Treatment of behavioral emergencies 2005[J]. J Psychiatr Pract, 2005,11(Suppl 1):5-108. DOI:10.1097/00131746-200511001-00002.
[17] 梁欢,李炜,李凤,等. 保护性约束管理对ICU脑卒中患者的影响[J]. 齐鲁护理杂志,2020,26(17):93-95. DOI:10.3969/j.issn.1006-7256.2020.17.031.
[18] 丁彦芝,李韬锋,晋盼盼,等. 精细化护理模式在ICU患者保护性约束中的应用[J]. 河北医药,2023,45(2):305-308. DOI:10.3969/j.issn.1002-7386.2023.02.036.
[19] 李莉, 刘静, 王红娟. 保护性约束结合舒适护理在颅脑损伤躁动患者中的应用效果[J]. 当代护士(上旬刊), 2022, 29(1):68-70. DOI:10.19791/j.cnki.1006-6411.2022.01.020.
[20] Hine K.The use of physical restraint in critical care[J]. Nurs Crit Care, 2007, 12(1):6-11. DOI:10.1111/j.1478-5153.2006.00197.x.
[21] 陈伟晨,尉喜燕,杜鸿雁,等. 人性化保护性约束在ICU患者中的应用[J]. 齐鲁护理杂志,2021,27(19):5-8. DOI:10.3969/j.issn.1006-7256.2021.19.002.
[22] Haidrani L.Physical restraint in healthcare settings[J]. Nurs Manag (Harrow),2017,24(1):13. DOI:10.7748/nm.24.1.13.s19.
[23] 温春娣,罗彩花,胡杏娟,等. 约束手套在保持脑卒中患者患肢手功能位中的应用研究[J]. 临床护理杂志,2015(5):69-72. DOI:10.3969/j.issn.1671-8933.2015.05.028.
[24] 王晓静. 基于人性化护理保护性约束干预在颅脑损伤躁动患者中的初步应用[J]. 河南外科学杂志, 2023, 29(1): 170-172.
[25] 廖春丽,崔鹏宇,马祥萍,等. 肿瘤医院ICU病人身体约束评估方案的构建及应用[J]. 护理研究,2023,37(5):819-825. DOI:10.12102/j.issn.1009-6493.2023.05.010.
[26] 张敏, 周知. 约束决策轮联合床旁约束核查单在危重患者中应用效果研究[J]. 基层医学论坛, 2023, 27(6): 11-13+17. DOI:10.19435/j.1672-1721.2023.06.004.
[27] 谢红萍, 陈冬梅. 保护性约束规范管理在神经外科颅脑损伤躁动患者中的应用效果[J]. 人人健康,2023(9): 120-122.
[28] 相旭. 精神分裂症患者保护性约束分级管理指标体系的构建[D].湖州:湖州师范学院,2022. DOI:10.27946/d.cnki.ghzsf.2022.000130.
[29] 周芬, 张艳, 管义祥. 保护性约束路径干预在颅脑损伤躁动病人中的应用[J]. 循证护理, 2021, 7(16): 2221-2224. DOI:10.12102/j.issn.2095-8668.2021.16.016.
[30] 刁莎,李思雨,石雨晴,等. 指南临床适用性评价工具(2.0版)解读[J]. 中国循证医学杂志,2023,23(11):1318-1322. DOI:10.7507/1672-2531.202304080.
[31] 胡雁, 郝玉芳. 循证护理学[M]. 2 版. 北京:人民卫生出版社, 2017.
[32] Dicenso A, Bayley L, Haynes RB.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.
[33] 靳英辉,赵志慧,黄粲然,等. 临床实践指南实施性评价工具的研制和验证评价[J]. 中国循证医学杂志,2022,22(1):111-119. DOI:10.7507/1672-2531.202106002.
[34] 杨怀洁,杨成良,王青丽. Delphi法在护理研究中的应用现状[J]. 现代临床医学,2015(3):166-167,171.DOI:10.11851/j.issn.1673-1557.2015.03.002.
[35] 李晓萍,沈翠珍.德尔菲法在护理研究中的应用现状[J].中华现代护理杂志, 2012(22):2605-2607. DOI:10.3760/cma.j.issn.1674-2907.2012.22.001.
[36] Duxbury JA.The eileen skellern lecture 2014: physical restraint: in defence of the indefensible?[J]. J Psychiatr Ment Health Nurs, 2015,22(2):92-101. DOI:10.1111/jpm.12204.
[37] 吕会芬, 赵腾飞. 保护性约束护理方案对幻觉患者症状改善及生活质量的影响[J]. 健康研究, 2019, 39(6): 699-702+706. DOI:10.3969/j.issn.1674-6449.2019.06.025.
[38] 王海青,刘超越,杨富,等. ICU护士对患者实施身体约束替代措施的现况调查[J]. 上海护理,2022,22(10):35-39. DOI:10.3969/j.issn.1009-8399.2022.10.008.
[39] 杨中善,许妮娜,詹昱新,等. 住院患者规范化身体约束管理最佳证据总结[J]. 护理学报,2019,26(4):31-36. DOI:10.16460/j.issn1008-9969.2019.04.031.
[40] 许娟,莫蓓蓉,胡玉娜,等. 重症监护病房成人患者护理人文关怀专家共识[J]. 护理学杂志,2022,37(18):1-4. DOI:10.3870/j.issn.1001-4152.2022.18.001.
[41] 叶君荣,李思珏,夏志春,等. 人文关怀在保护性约束护理中的应用进展[J]. 全科护理,2021,19(5):618-621. DOI:10.12104/j.issn.1674-4748.2021.05.012.
[42] Rose L,Dale C,Smith OM,et al.A mixed-methods systematic review protocol to examine the use of physical restraint with critically ill adults and strategies for minimizing their use[J]. Syst Rev, 2016,5(1):194. DOI:10.1186/s13643-016-0372-8.
[43] 李莉, 刘静, 王红娟. 保护性约束结合舒适护理在颅脑损伤躁动患者中的应用效果[J]. 当代护士(上旬刊), 2022, 29(1):68-70.DOI:10.19791/j.cnki.1006-6411.2022.01.020.
[44] 王慧敏, 张菊. 基于CiteSpace对国内外缩减约束护理研究现状与趋势的分析[J]. 护理与康复, 2023, 22(7): 43-46. DOI:10.3969/j.issn.1671-9875.2023.07.009.
[45] 陈凤,陈香萍,劳月文,等. ICU患者身体约束共享决策模式的构建及临床应用[J]. 护理与康复,2023,22(8):32-35. DOI:10.3969/j.issn.1671-9875.2023.08.008.
[46] 张瑞芳,牟静. 重症颅脑损伤病人住院期间近亲属心理调查和全程心理干预分析[J]. 安徽医药,2019,23(5):991-994. DOI:10.3969/j.issn.1009-6469.2019.05.042.
[47] 周江玲,方萍萍,连佳,等. 身体约束信息化闭环管理系统模块构建与应用[J]. 齐鲁护理杂志, 2023, 29(1): 98-101. DOI:10.3969/j.issn.1006-7256.2023.01.030.
[48] 祝红霞,宋瑜婷,程媛媛,等. 保护性约束结合共情护理模式用于重症抑郁症住院患者中的价值分析[J]. 中国医药导报,2022,19(31):174-177.DOI:10.20047/j.issn1673-7210.2022.31.41.
[49] 朱艳, 宋瑰琦, 秦玉荣. 基于安全的成人约束工具设计与人文思考[J]. 当代护士(下旬刊), 2021, 28(4):26-30. DOI:10.19793/j.cnki.1006-6411.2021.12.009.
[50] 刘义兰,杨雪娇,胡德英,等. 护理人文关怀标准的研究进展[J]. 中华护理杂志,2014,49(12):1500-1505. DOI:10.3761/j.issn.0254-1769.2014.12.020.
[51] 赵金龙,赵莹莹,宗倩倩,等. 量化风险评估的分级护理模式对精神科患者保护性约束的影响研究[J]. 中华护理杂志,2023,58(11):1315-1322. DOI:10.3761/j.issn.0254-1769.2023.11.006.
[52] 孙聪聪. 缩减约束方案在颅脑损伤患者护理中的应用效果观察[J]. 医学理论与实践,2021, 34(23):4171-4173. DOI:10.19381/j.issn.1001-7585.2021.23.059.
[53] 张静,张忆,张永贞. 基于eCASH理念身体约束缩减方案对动脉瘤性蛛网膜下腔出血患者应用效果[J]. 社区医学杂志,2022,20(12):688-692.DOI:10.19790/j.cnki.JCM.2022.12.08.
[54] 常万琪,宋魏莹,闫婧. 分阶段约束干预在神经外科颅脑损伤躁动患者中的应用[J].护理实践与研究,2019,16(24):75-77. DOI:10.3969/j.issn.1672-9676.2019.24.030.
[55] 程婷,涂惠,熊晓云,等. 重症监护病房医生对身体约束决策认知的质性研究[J]. 全科护理,2022,20(26):3727-3730. DOI:10.12104/j.issn.1674-4748.2022.26.033.
[56] 王俊. 基于循证构建医养结合机构老年人最小化身体约束方案及效果评价[D].重庆:重庆医科大学,2021.DOI:10.27674/d.cnki.gcyku.2021.000919.
[57] 李霞,刘秀红,李改侠,等. 根因分析法在综合医院住院患者非计划拔管风险管理体系中的建立及应用[J]. 新疆医学,2021,51(4):475-478.
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