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。
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.
[1] 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.
[2] 李静逸,洪洋,宋春梅, 等.ICU护士对患者身体约束体验的Meta整合[J].中华护理杂志,2018,53(10):1249-1255.
[3] Wilson C, Rouse L, Rae S, et al.Is Restraint A ‘Necessary Evil’ in Mental Health Care? Mental Health Inpatients’ and Staff Members’ Experience of Physical Restraint[J].Int J Ment Health Nurs, 2017, 26(5):500-512.DOI:10.1111/inm.12382.
[4] Bellenger E, Ibrahim JE, Bugeja L, et al.Physical Restraint Deaths in a 13-year National Cohort of Nursing Home Residents[J].Age Ageing,2017,46(4):688-693.DOI:10.1093/ageing/afw246.
[5] 丁艳.自制约束手套在神经外科躁动患者中的应用[J].现代临床护理,2012,11(3):82-83.
[6] 吴孟航,刘帆,王琼.神经ICU意外拔管护理风险防范策略[J].现代预防医学,2014, 41(11):2110-2112.
[7] Eskandari F, Abdullah KL, Zainal NZ, et al.Incidence Rate and Patterns of Physical Restraint Use Among Adult Patients in Malaysia[J].Clin Nurs Res,2018, 27(3):278-295.DOI:10.1177/1054773816677807.
[8] 庄晓艳,许勤,朱妹芹,等.神经外科ICU患者身体约束相关非计划拔管影响因素研究[J].护理学杂志,2014, 29(2):15-17.DOI:10.3870/hlxzz.2014.02.015.
[9] Lach HW, Leach KM, Butcher HK.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.
[10] 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.
[11] 王季芳,洪怡莉,周行涛,等.眼科日间手术术前管理的循证实践[J].中华护理杂志,2018, 53(3):276-271.DOI:10.3761/j.issn.0254-1769.2018.03.002.
[12] 张晓静,张会芝,李葆华.非计划性拔管信息化管理系统的建立及应用研究[J].中华护理杂志,2018, 53(11):1360-1362.DOI:10.3761/j.issn.0254-1769.2018.11.016.
[13] 谭媛,白建萍,王海英.神经外科患者留置管道的风险分级管理体会[J].护理学报, 2014, 21(3):28-30.
[14] Scheepmans K, Dierckx de Casterlé, Bernadette, Paquay L, et al.Restraint Use in Older Adults in Home Care: A Systematic Review[J].Int J Nurs Stud,2018, 79(3):122-136.DOI:10.1016/j.ijnurstu.2017.11.008.
[15] 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.
[16] 李佳星,任之珺,张紫君,等.缩减约束方案对预ICU气管插管非计划性拔管的效果研究[J].中华护理杂志,2017,52(5):549-553.DOI:10.3761/j.issn.0254-1769.2017.05.008.
[17] 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.
[18] Ertugrul B, Ozden D.The Effect of Physical Restraint on Neurovascular Complications in Intensive Care Units[J].Aust Crit Care,2019,9(5):98-101.DOI:10.1016/j.aucc.2019.03.002.
[19] 邹丽燕,曹梅娟.国内外灵性健康测评工具的研究进展[J].护理学杂志,2017, 32(9):98-101.DOI:10.3870/1.issn.1001-4152.2017.09.098.
[20] Fariña-López E, Estévez-Guerra GJ, Polo-Luque ML, et al.Physical Restraint Use with Elderly Patients: Perceptions of Nurses and Nursing Assistants in Spanish Acute Care Hospitals[J].Nurs Res,2018, 67(1):55-59.DOI:10.1097/NNR.0000000000000252.
[21] 孙龙凤,周冬洁,王爱平.身体约束规范化培训在内科重症监护病房中的应用与效果[J].中华护理教育, 2014,11(9):694-696.DOI:10.3761/j.issn.1672-9234.2014.09.015.
