规范化使用精神科改良约束用具对约束相关并发症的影响
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摘要
目的探索规范化使用精神科改良保护约束用具对约束相关并发症的影响。方法选取2015年7月至2017年8月在上海交通大学医学院附属精神卫生中心闵行院区住院治疗并采用保护性约束的精神分裂症患者240例,采用随机数表法随机分为常规组、改良组和对照组,每组80例。对照组在常规流程下使用传统保护约束用具,常规组在常规流程下使用改良保护约束用具,改良组在规范流程下使用改良保护约束用具。比较三组患者约束并发症发生率,同时对比家属和护士对使用保护性约束用具的满意度。结果改良组患者的皮肤破损、皮肤压疮、皮肤水泡、四肢肿胀并发症发生率分别为1.25%、2.50%、0、5.00%,明显低于对照组的20.00%、32.50%、7.50%、42.50%,差异均具有统计学意义(P<0.05);改良组患者皮肤破损、皮肤压疮、四肢肿胀并发症发生率也明显低于常规组的6.25%、13.75%、21.25%,差异均具有统计学意义(P<0.05);改良组和常规组患者皮肤水泡发生率均为0,明显低于对照组的7.50%,差异具有统计学意义(P<0.05);常规组、改良组和对照组皮肤淤青、局部骨折、神经损伤并发症发生率比较差异均无统计学意义(P>0.05);家属护理满意度调查显示,改良组满意度为(97.36±4.78)分,明显优于常规组和对照组的(87.25±5.27)分、(82.88±5.72)分,差异均具有统计学意义(P<0.05),而常规组和对照组满意度比较,差异无统计学意义(P>0.05);护士满意度调查显示,改良组和常规组满意度分别为(99.13±2.36)分、(94.81±2.57)分,明显优于对照组的(88.25±4.51)分,差异均具有统计学意义(P<0.05),而常规组和对照组满意度比较,差异无统计学意义(P>0.05)。结论规范化使用精神科改良保护约束用具可显著降低约束相关并发症,降低约束用具使用风险,并有助于提高家属和护士的满意度,临床应用价值较高。
Objective To explore the influence of standardized use of modified restraint instrument on restraint-related complications in psychiatry departmenty. Methods A total of 240 schizophrenic patients with protective restraint who were hospitalized in the Affilintel Mental Health Center of Shanghai Jiao Tong University School of Medicine from July 2015 to August 2017 were randomly selected and divided into the conventional group, improved group and control group according to random number table method, with 80 cases in each group. The control group and the conventional group used the traditional protective restraint device and the improved protective restraint device respectively under the conventional process, while the improved group used the improved protective restraint device under the standard process. The incidence of constrained complications and satisfaction of family members and nurses with the use of protective restraint devices were compared among the three groups. Results The incidence of complications of skin damage, skin pressure sore, skin blisters, and limb swelling in the improved group was 1.25%, 2.50%, 0, and 5.00%, respectively, which was significantly lower than corresponding 20.00%, 32.50%, 7.50%, 42.50% in the control group(P<0.05) and also significantly lower than corresponding 6.25%, 13.75%, 21.25% in the conventional group(P<0.05); the incidence of skin blisters in the improved group and the conventional group was 0, which was significantly lower than7.50% in the control group(P<0.05). There was no significant difference in the incidence of complications of skin bruising, local fracture, and nerve injury between the conventional group, the improved group and the control group(P>0.05).The survey of satisfaction of family members showed that the satisfaction of the improved group was 97.36±4.78, which was significantly better than corresponding 87.25±5.27 of the conventional group and 82.88±5.72 of the control group(P<0.05); while there was no significant difference between the conventional group and the control group in that satisfaction(P>0.05). The nurse satisfaction survey showed that the satisfaction of the improved group and conventional group were 99.13±2.36 and 94.81±2.57, respectively, which were significantly better than 88.25±4.51 of the control group(P<0.05); while there was no significant difference between the conventional group and control group in that satisfaction(P>0.05). Conclusion Standardized use of improved protective restraint devices in psychiatry department can significantly reduce the complications related to restraint and the risk of using restraint devices, and help to improve the satisfaction of family members and nurses, which has a high clinical value.
Objective To explore the influence of standardized use of modified restraint instrument on restraint-related complications in psychiatry departmenty. Methods A total of 240 schizophrenic patients with protective restraint who were hospitalized in the Affilintel Mental Health Center of Shanghai Jiao Tong University School of Medicine from July 2015 to August 2017 were randomly selected and divided into the conventional group, improved group and control group according to random number table method, with 80 cases in each group. The control group and the conventional group used the traditional protective restraint device and the improved protective restraint device respectively under the conventional process, while the improved group used the improved protective restraint device under the standard process. The incidence of constrained complications and satisfaction of family members and nurses with the use of protective restraint devices were compared among the three groups. Results The incidence of complications of skin damage, skin pressure sore, skin blisters, and limb swelling in the improved group was 1.25%, 2.50%, 0, and 5.00%, respectively, which was significantly lower than corresponding 20.00%, 32.50%, 7.50%, 42.50% in the control group(P<0.05) and also significantly lower than corresponding 6.25%, 13.75%, 21.25% in the conventional group(P<0.05); the incidence of skin blisters in the improved group and the conventional group was 0, which was significantly lower than7.50% in the control group(P<0.05). There was no significant difference in the incidence of complications of skin bruising, local fracture, and nerve injury between the conventional group, the improved group and the control group(P>0.05).The survey of satisfaction of family members showed that the satisfaction of the improved group was 97.36±4.78, which was significantly better than corresponding 87.25±5.27 of the conventional group and 82.88±5.72 of the control group(P<0.05); while there was no significant difference between the conventional group and the control group in that satisfaction(P>0.05). The nurse satisfaction survey showed that the satisfaction of the improved group and conventional group were 99.13±2.36 and 94.81±2.57, respectively, which were significantly better than 88.25±4.51 of the control group(P<0.05); while there was no significant difference between the conventional group and control group in that satisfaction(P>0.05). Conclusion Standardized use of improved protective restraint devices in psychiatry department can significantly reduce the complications related to restraint and the risk of using restraint devices, and help to improve the satisfaction of family members and nurses, which has a high clinical value.
引文
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[13]徐英,张建惠,邢强.精神科实施保护性约束规范化流程的临床意义[J].新疆医科大学学报, 2016, 39(10):1326-1328.
[2]尹华华,胡雁.身体约束的循证护理实践[J].上海护理, 2013, 13(5):89-92.
[3]黄凌.精神科保护性约束患者的心理护理[J].中国民康医学, 2011,23(5):652.
[4]施忠英,陆惠,李萍,等.住院精神病患者保护性约束现状及其相关因素调查[J].护理研究, 2009, 23(35):3212-3215.
[5]陈兆红,张燕红,宗薇,等.优化保护性约束流程对精神分裂症患者约束率的影响[J].中华现代护理杂志, 2014, 20(33):4225-4227.
[6]信春鹰,黄薇.中华人民共和国精神卫生法[M].北京:中国法制出版社, 2012:1198-1202.
[7]杨惠青,王锋锐,李伟丽,等.护士用住院患者观察量表在精神科的应用价值[J].中国医学创新, 2012, 19(9):129-130.
[8]熊玉芳,邓克琴,张仁刚,等.磁扣式约束带在精神科保护性约束中的应用效果分析[J].当代护士, 2018, 25(6):147-150.
[9] HEINZE C, DASSEN T, GRITTNER U. Use of physical restraints in nursing homes and hospitals and related factors:a cross-sectional study[J]. J Clin Nurs, 2012, 21(7/8):1033-1040.
[10] STEINERT T, MARTIN V, BAUR M, et al. Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics[J]. Soc Psychiatry Psychiatr Epidemiol, 2007, 42(2):140-145.
[11]何永芳.精神科保护性约束对患者和家属心理影响及改进措施[J].中国民康医学, 2014, 26(1):61-63.
[12]张靖.精神科护士对住院患者实施保护性约束体验的质性研究[J].天津护理, 2017, 25(2):108-110.
[13]徐英,张建惠,邢强.精神科实施保护性约束规范化流程的临床意义[J].新疆医科大学学报, 2016, 39(10):1326-1328.