以质量求发展，以服务铸品牌

护理学报 ›› 2024, Vol. 31 ›› Issue (13): 56-61.doi: 10.16460/j.issn1008-9969.2024.13.056

• 循证护理 • 上一篇    下一篇

预防老年患者跌倒住院环境管理的最佳证据总结

刘璇1a, 王小惠1b, 张凌1c, 杨楠1a, 魏婷2, 焦昊然2, 黄峰1a, 蓝玉清1a   

  1. 1.赣州市人民医院 a.全科医学科;b.胃肠疝外科;c.护理部,江西 赣州 341000;
    2.赣南医科大学 护理学院,江西 赣州 341000
  • 收稿日期:2024-02-22 出版日期:2024-07-10 发布日期:2024-08-05
  • 通讯作者: 蓝玉清（1969-）,女,江西赣州人,本科学历,主任护师。E-mail：gzszk909@163.com
  • 作者简介:刘璇（1989-）,女,江西赣州人,硕士,主管护师。
  • 基金资助:
    2020年赣州市科技局科技计划项目（2020601006）; 2022年度江西省卫生健康委科技计划项目（202212433）; 2023年度江西省卫生健康委科技计划项目（202311946）

Best evidence summary for environmental management for fall prevention in hospitalized elderly patients

LIU Xuan1a, WANG Xiao-hui1b, ZHANG Ling1c, YANG Nan1a, WEI Ting2, JIAO Hao-ran2, HUANG Feng1a, LAN Yu-qing1a   

  1. 1a. Dept. of General Medicine; b. Dept. of Gastroenterology and Coloproctology; c. Dept. of Nursing Administration, Ganzhou People's Hospital, Ganzhou 341000, China;
    2. School of Nursing, Ganzhou Medical University, Ganzhou 341000, China
  • Received:2024-02-22 Online:2024-07-10 Published:2024-08-05

PDF (PC)

147

赞

摘要： 目的 老年患者跌倒是常见的临床问题,一旦发生会严重威胁患者的身心健康。本研究旨在总结有效预防老年住院患者跌倒发生环境管理的最佳证据,以提高临床护理安全质量。方法 计算机系统检索中英文相关数据库及学科专业网站中有关老年住院患者跌倒预防的系统评价、证据总结、专家共识、指南、临床决策支持系统,检索时间为建库至2023年11月16日。结果 最终共纳入14篇文献,其中7篇指南、4篇专家共识、1篇系统评价、1篇证据总结、1篇临床决策。最终从适老化安全环境、辅助器具/设备、无障碍环境与标识3个方面汇总了29条最佳证据。结论 本研究全面系统地检索总结了预防老年患者跌倒住院环境管理的最佳证据,在使用证据时应根据临床情境进行选择、合理转化,从而制定出更具临床专业化和针对性的预防老年住院患者跌倒的环境管理措施,更好地保障老年患者住院安全性。

关键词: 环境管理, 老年患者, 跌倒, 最佳证据, 证据总结, 循证护理

Abstract: Objective Fall is a common clinical problem for elderly patients and can seriously threaten their physical and mental health once it occurs. This study aims to systematically summarize the best evidence for effective environmental management to prevent falls among hospitalized elderly patients, and to improve clinical nursing safety quality. Methods Relevant databases and professional websites in Chinese and English were retrieved using a computer system for systematic evaluation, evidence summary, expert consensus, guideline, and clinical decision support system related to fall prevention for hospitalized elderly patients from the inception to November 16, 2023. Results A total of 14 articles were finally collected, including 7 guidelines, 4 expert consensuses, 1 systematic review, 1 evidence summary, and 1 clinical decision. Totally 29 pieces of best evidence were summarized from 3 aspects of age-friendly safety environment, assistive devices/equipment, barrier-free environment and markings, and appropriate footwear. Conclusion This study comprehensively and systematically retrieves and summarizes the best evidence for environmental management to prevent fall in hospitalized elderly patients. The evidence should be selected and reasonably transformed according to the clinical context to develop more clinically specialized and targeted measures to prevent fall in hospitalized elderly patients and better protect their safety during hospitalization.

Key words: environmental management, elderly patient, fall, best evidence, evidence summary, evidence-based nursing

中图分类号: 

  • R473.59
[1] Pitchai P, Dedhia HB, Bhandari N, et al.Prevalence, risk factors, circumsta-nces for falls and level of functional independence among geriatric population-adescriptive study[J].Indian J Public Health,2019,63(1):21-26. DOI:10.4103/ijph.IJPH_332_17.
[2] James SL, Lucchesi LR, Bisignano C, et al.The global burden of falls: gl-obal, regional and national estimates of morbidity and mortality from The Global Burden of Disease Study(GBDS) 2017[J].Inj Prev,2020,26(1):i3-i11. DOI:10.1136/injuryprev-2019-043286.
[3] 中国老年保健医学研究会老龄健康服务与标准化分会,《中国老年保健医学》杂志编辑委员会.中国老年人跌倒风险评估专家共识[J].中国老年保健医学,2019,17(4):47-48,50. DOI:10.3969/j.issn.1672-2671.2019.04.013.
[4] Pati D, Lee J, Mihandoust S, et al.Top five physical design factors contributing to fall initiation[J]. HERD,2018,11(4):50-64. DOI:10.1177/1937586718763798.
[5] Pati D, Valipoor S, Cloutier A, et al.Physical design factors contributing to patient falls[J]. J Patient Saf, 2021, 17(3):e135-e142.DOI:10.1097/PTS.0000000000000339.
[6] 胡雁,郝玉芳.循证护理学[M].北京:人民卫生出版社,2018.
[7] 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.
[8] 周芬,郝玉芳,丛雪等.指南研究与评价工具AGREE Ⅱ及各领域分值的补充解释及思考[J].护理学报,2018,25(18):56-58.DOI:10.16460/j.issn1008-9969.2018.18.056.
[9] Foster MJ, Shurtz S.Making the Critical Appraisal for Summaries of Evid-ence (CASE) for Evidence-Based Medicine (EBM): critical appraisal of summaries of evidence[J].J Med Libr Assoc,2013,101(3):192-198. DOI:10.3163/1536-5050.101.3.008.
[10] 王春青,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.
[11] Sarah B,Douglas PK. Falls: Prevention in nursing care facilities and the hospital setting[EB/OL].(2022-07-01)[2023-10-30].https://www.uptodate.cn/
[12] Bellman S. Evidence Summary. Falls (older adults): prevention (hospital settings)[EB/OL].(2023-05-08)[2023-11-17].https://ovidsp-dc2-ovid-com.kean.idm.oclc.org/ovid-new-a/ovidweb.cgi?&S=MBHOFPBMCHEBAEICIPKJFHLEAEKBAA00&Link+Set=S.sh.21%7c1%7csl_190.
[13] Montero-Odasso M,van der Velde N,Martin FC,et al. World guidelines for falls prevention and management for older adults:a global initiative[J].Age Ageing,2022,51(9):afac205. DOI:10.1093/ageing/afac205.
[14] Schoberer D,Breimaier HE,Zuschnegg J,et al.Fall prevention in hospitals and nursing homes:clinical practice guideline[J]. Worldviews Evid Based Nurs,2022,19(2):86-93. DOI:10.1111/wvn.12571.
[15] Ontario RNAO. Preventing falls and reducing injury from falls fourth edition[EB/OL]. (2017-01-01)[2022-09-23]. https://rnao.ca/bpg/guidelines/prevention-falls-and-fall-injuries.
[16] Jung D, Shin S,Kim H.A fall prevention guideline for older adults living in long-term care facilities[J]. Int Nurs Rev, 2014,61(4):525-533.DOI:10.1111/inr.12131.
[17] National Institute for Health and Clinical Excellence. Falls in older people:assessing risk and prevention[EB/OL].(2013-06-07)[2018-12-29]. http://www.nice.org.uk/guidance.
[18] 中华人民共和国国家卫生健康委.老年人跌倒干预技术[EB/OL].(2011-08-26)[2011-09-06].http://www.nhc.gov.cn/wjw/gfxwj/201304/729e74b51ab5434c965ec03164eca46d.shtml.
[19] Hospital Bed Safety Workgroup. Clinical guidance for the assessment and implementation of bed rails in hospitals, long term care facilities, and home care settings[J]. Crit Care Nurs Q,2003,26(3):244-262.DOI:10.1097/00002727-200307000-00010.
[20] Valipoor S, Pati D, Kazem-Zadeh M,et al.Falls in older adults: a systematic review of literature on interior-scale elements of the built environment[J]. Journal of Aging and Environment,2020,34(4):351-374. DOI:10.1080/02763893.2019.1683672.
[21] 北京市卫生健康委员会.老年友善医疗机构评定技术规范[EB/OL].(2022-03-24)[2022-07-01].https://wjw.beijing.gov.cn/zwgk_20040/zcwj2022/dfbz/202304/t20230408_2992960.html.
[22] 皮红英,高远,候惠如,等.老年人跌倒风险综合管理专家共识[J].中华保健医学杂志,2022, 24(6):439-441.DOI:10.3969/j.issn.1674-3245.2022.06.001.
[23] 杨泽,唐振兴,苏志刚,等.老年健康生活环境的宜居(适老)性评估标准(草案)[J].中国老年保健医学,2018,16(5):12-18.DOI:10.3969/j.issn.1672-2671.2018.05.002.
[24] 中国康复医学会老年康复专业委员会专家共识组,上海市康复医学会专家共识组.预防老年人跌倒康复综合干预专家共识[J].老年医学与保健, 2017, 23(5):349-352.DOI:10.3969/j.issn.1008-8296.2017.05.001.
[25] 国家卫生健康委,国家中医药管理局.关于开展建设老年友善医疗机构工作的通知[EB/OL].[2020-12-01].http://www.nhc.gov.cn/lljks/pqt/202012/03cdf0773f0c42fe86e577f2143f6721.shtml.
[26] Berry S, Kiel MP. Falls:prevention in nursing care facilities and the hospitalsetting[EB/OL].(2022-05-08)[2023-07-29].http://49.234.226.30:8091/contents/falls-prevention-in-nursing-care-facilities-and-the-hospital-setting.
[27] 陈春丽,张建凤,任俊翠,等.护理敏感质量指标在不良事件管理持续改进中应用的效果评价[J].护理研究,2019,33(14):2503-2506.DOI:10.12102/j.issn.1009-6493.2019.14.033.
[28] 刘小红,谢志洁,张晨晨,等.肿瘤患者护理风险共享治理实践[J].护理学杂志,2022,37(3):56-58. DOI:10.3870/j.issn.1001-4152.2022.03.056.
[29] World Health Organization. Assistive technology[EB/OL].(2018-05-18)[2022-07-08].https://www.who.int/news-room/fact-sheets/detail/assistive-technology.
[30] Rice LA, Fliflet A, Frechette M, et al.Insights on an automated fall dete-ction device designed for older adult wheelchair and scooter users: a qualitative study[J]. Disabil Health J, 2022, 15(1S):101207.DOI: 10.1016/j.dhjo.2021.101207.
[31] 施雯,黄天翊,肖悦,等.基于人-环境-作业模式的轮椅使用者跌倒干预研究进展[J].护理学报,2023,30(16):41-47.DOI:10.16460/j.issn1008-9969.2023.16.041.
[32] Singh H, Scovil CY, Yoshida K, et al.Factors that influence the risk of falling after spinal cord injury:a qualitative photo-elicitation study with individuals that use a wheelchair as their primary means of mobility[J].BMJ Open, 2020, 10(2): e34279.DOI: 10.1136/bmjopen-2019-034279.
[1] 张静, 彭焕椽, 陈佳, 鲁永锦, 刘克玄, 侯晓敏. 成人体外循环心脏手术患者预防手术部位感染的最佳证据总结[J]. 护理学报, 2025, 32(4): 41-47.
[2] 李若雨, 刘鑫, 林萍, 陈丹, 林桦. 出院患者用药安全管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 50-55.
[3] 杨小娟, 毛孝容, 王静, 江华, 李蓉, 樊宇, 文青, 李林章, 陈晓容. 成人重度烧伤患者早期肠内营养管理的最佳证据总结[J]. 护理学报, 2025, 32(3): 56-61.
[4] 刘硕怡, 熊莉娟, 李凌, 王玉梅, 何嘉, 李鑫, 袁淑蕾, 郭雪琴, 王暘婧, 张慧娟. 老年住院患者衰弱预防及管理临床实践指南的质量评价及内容分析[J]. 护理学报, 2025, 32(2): 50-55.
[5] 闫亚铃, 乐美妮, 姚桃琴, 王雪莲, 姜建玲, 辛艺. 老年胃肠肿瘤患者围手术期衰弱管理方案的构建[J]. 护理学报, 2025, 32(2): 74-78.
[6] 毕雅昕, 端烨, 何丽君, 徐秒, 龚荣花. 减重代谢术后骨质疏松症预防与管理的最佳证据总结[J]. 护理学报, 2025, 32(1): 44-49.
[7] 李珂, 贺雨琼, 李雨蔚, 常颖. 脑卒中患者跌倒恐惧干预研究的范围综述[J]. 护理学报, 2025, 32(1): 50-55.
[8] 陈洁, 孟庆童, 刘惊今, 吴艳妮. 基于指南的慢性心力衰竭患者运动康复科普手册研制[J]. 护理学报, 2024, 31(9): 36-41.
[9] 符路路, 解艺璇, 王玥, 魏巍, 张传英, 朱宇. 新生儿操作性疼痛听觉刺激干预的证据总结[J]. 护理学报, 2024, 31(9): 42-47.
[10] 纪锐婷, 林丹娜, 刘小成, 李婷婷, 谢映梅, 胡冰, 应文娟. 早产儿初乳口腔免疫疗法的最佳证据总结[J]. 护理学报, 2024, 31(8): 37-42.
[11] 张小莉, 杨鑫玉, 肖宇, 刘春燕, 张璐, 伍晓琴, 黄月霖, 傅静. 晚期癌症患者代理决策者安宁疗护决策后悔研究的范围综述[J]. 护理学报, 2024, 31(8): 49-54.
[12] 周毅峰, 杨继平, 胡正中, 袁浩. 肝癌切除手术患者目标导向性血糖监测的证据总结[J]. 护理学报, 2024, 31(7): 46-50.
[13] 蔡立柏, 梁郝, 刘延锦, 魏苗, 郭玉茹, 李英, 崔妙然, 秦俊美. 跌倒恐惧在全膝关节置换术后患者疼痛灾难化与恐动症的中介效应[J]. 护理学报, 2024, 31(7): 63-67.
[14] 姚晨晨, 陈娟, 杨雷. 老年衰弱患者基于埃德蒙顿衰弱量表评估分层抗阻运动的效果观察[J]. 护理学报, 2024, 31(7): 73-78.
[15] 王灵, 秦芳, 高钰琳, 甄莉, 冯日宣, 刘兵, 马正文, 许笑宇, 李国新. 经皮穴位电刺激治疗术后疼痛的最佳证据总结[J]. 护理学报, 2024, 31(6): 51-55.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!