危重症患者规范化身体约束循证护理实践  

Evidence-based nursing practice for standardized physical restraint in critically ill patients

作　　者：李欣[1] 胡慧秀[1] 孙超[1] 王霞[1] 邵欣[2] 戴雪松[1] Li Xin;Hu Huixiu;Sun Chao;Wang Xia;Shao Xin;Dai Xuesong(Department of Nursing,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Intensive Care Unit,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院护理部国家老年医学中心中国医学科学院老年医学研究院,100730 [2]北京医院重症监护室国家老年医学中心中国医学科学院老年医学研究院,100730

出　　处：《中华现代护理杂志》2020年第12期1541-1549,共9页Chinese Journal of Modern Nursing

基　　金：北京医院科技新星(BJ-2018-129);复旦循证护理中心证据转化与临床应用项目(Fudanebn2019020)。

摘　　要：目的将危重症患者规范化身体约束的最佳证据应用于临床实践并评价其效果。方法遵循澳大利亚乔安娜布里格斯研究所(JBI)的临床证据实践应用模式,根据研究获得的最佳证据制订相应的临床审查标准及审查方法,逐条进行障碍因素分析并制订行动策略。采用便利抽样法,选择2019年6-10月北京医院综合ICU和4个病房ICU的212例患者以及上述科室工作的66名护士为研究对象。比较干预前后危重症患者约束使用率及约束并发症发生率,护士对危重症患者规范化约束相关知识的认知水平,以及审查标准的执行率。结果干预前后危重症患者身体约束使用率分别为52.73%(58/110)和21.57%(22/102),干预前后比较差异有统计学意义(χ^2=21.869,P<0.05),约束并发症发生率分别为32.76%(19/58)和4.55%(1/22),干预前后比较差异有统计学意义(χ^2=6.771,P<0.05)。干预前后,ICU护士对规范化身体约束的相关知识得分分别为(41.89±15.01)、(78.18±10.66)分,干预前后比较差异有统计学意义(t=-16.017,P<0.05);干预后各审查指标的执行率均高于干预前,干预前后比较差异有统计学意义(P<0.05)。结论通过制订和应用最佳实践方案可规范ICU护士身体约束的使用,能够提高护士对最佳证据执行的依从性,降低危重症患者身体的约束使用率,促进护理质量持续改进。Objective To apply the best evidence of standardizing physical restraint in critically ill patients to clinical practice and to evaluate its clinical effects.Methods The clinical evidence practice application model of the Australia Joanna Briggs Institute(JBI)was followed,the corresponding clinical review standards and review methods was formulated according to the best evidence obtained from the research,the obstacle factors were analyzed and action strategies were formulated one by one.By convenient sampling,a total of 212 patients from the general ICU and 4 wards ICU of Beijing Hospital and 66 nurses working in the above departments from June to October 2019 were selected as research objects.The usage rate of restraint and incidence of restraint complications in critically ill patients,cognition level of nurses on the knowledge related to standardized restraint of critically ill patients and the implementation rate of review standards were compared before and after intervention.Results The usage rates of physical restraint in critically ill patients before and after intervention were respectively 52.73%(58/110)and 21.57%(22/102),and the difference between before and after intervention was statistically significant(χ^2=21.869,P<0.05).The incidence of restraint complications before and after intervention was 32.76%(19/58)and 4.55%(1/22),and the difference before and after intervention was statistically significant(χ^2=6.771,P<0.05).Before and after intervention,ICU nurses'scores on the knowledge of standardized physical restraint were respectively(41.89±15.01)and(78.18±10.66),and the difference was statistically significant before and after the intervention(t=-16.017,P<0.05).The implementation rates of review indexes were higher than those before intervention,and the differences before and after the intervention were statistically significant(P<0.05).Conclusions The development and application of best practice plan can standardize the use of physical restraint by nurses in intensive care units,improve the co

关 键 词：重症监护病房 约束 最佳证据 循证实践 

分 类 号：R473[医药卫生—护理学]