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  

Influence of a graded nursing model based on quantitative risk assessment on protective restraint of psychiatric patients

作　　者：赵金龙 赵莹莹 宗倩倩 贾琼 许伟 吴航 安凤荣[2] ZHAO Jinlong;ZHAO Yingying;ZONG Qianqian;JIA Qiong;XU Wei;WU Hang;AN Fengrong

机构地区：[1]首都医科大学附属北京安定医院12病区/国家精神疾病医学中心/国家精神心理疾病临床医学研究中心/精神疾病诊断与治疗北京市重点实验室,北京市100088 [2]首都医科大学附属北京安定医院护理部/国家精神疾病医学中心/国家精神心理疾病临床医学研究中心/精神疾病诊断与治疗北京市重点实验室,北京市100088

出　　处：《中华护理杂志》2023年第11期1315-1322,共8页Chinese Journal of Nursing

基　　金：首都医科大学附属北京安定医院2021年院级科研课题(YJ2021-07)。

摘　　要：目的探讨基于量化风险评估的分级护理模式对精神科住院患者保护性约束的影响。方法2015年4月—2020年1月连续选取北京市某三级甲等精神专科医院抑郁症治疗中心男、女两个病区收治的住院患者为研究对象,其中男病区2016年10月—2018年3月和女病区2018年8月—2020年1月收治的1891例住院患者为试验组,男病区2015年4月—2016年9月和女病区2017年2月—2018年7月收治的1712例住院患者为对照组。试验组实施基于量化风险评估的分级护理模式,对照组给予常规风险管理及护理。统计两组住院患者总例数、保护性约束患者的例数及接受约束患者的保护性约束次数,以保护性约束的次数为主要观察指标,观察护理模式、疾病诊断及性别对保护性约束次数的影响。结果试验组保护性约束率(23.22%)低于对照组(26.16%)(P=0.018),试验组的保护性约束次数[3(1,6)次]低于对照组[4(1,8)次](P=0.024);不同性别和诊断比较,男性保护性约束次数[4(2,9)次]高于女性[3(1,6)次](P<0.001),双相情感障碍患者的保护性约束次数[4(2,8)次]高于抑郁症患者[2(1,5)次](P<0.001)和精神分裂症患者[3(1,6)次](P=0.018)。结论基于量化风险评估的分级护理模式能降低精神科患者的保护性约束率及次数,保护性约束的使用受到性别与诊断的影响。Objective To explore the effect of a graded nursing model based on quantitative risk assessment and multidimensional needs on protective restraint of psychiatric inpatients.Methods This study was a retrospective study.We chose inpatients admitted to the depression treatment center of a psychiatric hospital in Beijing from April 2015 to January 2020 as the research subjects.The experimental group was given the graded nursing model based on quantitative risk assessment and multidimensional needs,with a total of 1891 cases,while the control group was given routine risk management and nursing,with a total of 1712 cases.We counted the total number of inpatients in the 2 groups,the number of people receiving protective restraint and the number of times each person received protective restraint during hospitalization.Taking the number of protective restraints as the main observation index,we observed the impact of nursing model,disease diagnosis and gender on the number of protective restraints.Results The number and frequency of protective restraints in the experimental group was significantly lower than that in the control group(P=0.018).In the control group,the number of protective restraints in males was significantly higher than that in females(P=0.005),and the number of protective restraints in patients with bipolar disorder was significantly higher than that in patients with depression and schizophrenia(P<0.001,P=0.018).Conclusion The graded nursing model based on quantitative risk assessment and multi-dimensional needs can significantly reduce the number and frequency of protective constraints for psychiatric patients,improve the quality and efficiency of clinical nursing in psychiatric departments,and it is worthy of clinical promotion and application.

关 键 词：风险评估与减低 精神病护理学 护理评估 约束 身体的 

分 类 号：R473.74[医药卫生—护理学]