ICU患者身体约束替代措施的证据总结
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摘要
目的检索、评价和总结ICU患者身体约束替代措施的最佳证据,为护士减少约束使用提供参考。方法计算机检索国内外数据库、相关网站,检索时限均从建库截至2019年1月,纳入已发布的ICU相关身体约束指南、证据总结、最佳实践信息册、专家共识、推荐实践、系统评价。结果最终纳入6篇文献,其中4篇指南,1篇最佳实践信息册,1篇专家共识。汇总了患者因素管理、治疗设施管理、坠床预防、环境控制、护患关系建立5个大类证据,最终总结出13项最佳证据。结论身体约束替代措施对减少身体约束使用有着重要作用。建议护士在应用证据时,结合多学科团队建议,考虑患者文化背景、临床情景以及国内政策,为患者提供个性化约束护理,达到最大化减少约束,保护患者安全的目的。
Objective To retrieve, evaluate and summarize best evidence on alternatives to physical restraint in ICU patients, and to provide reference for reducing restraint use. Methods Related websites and electronic databases were searched from inception to January 2019 to collect guidelines, evidence summary, best practice, expert consensus, recommended practice, and systematic review regarding physical restraint use in ICU. Results Four guidelines, 1 best practice information sheet, and 1 expert consensus were included. Five categories including patient management, equipment management, prevention of falls from bed, environmental control, and establishment of nurse-patient relationship, totaling to 13 items, were summarized as best evidence. Conclusion Use of restraint alternatives plays an important role in reducing restraint use. It is suggested that nurses should consider multidisciplinary team′s advices, patient′s cultural background, clinical situation and domestic policies when applying evidence, thus to provide personalized physical restraint, reduce restraint use and ensure patient safety.
Objective To retrieve, evaluate and summarize best evidence on alternatives to physical restraint in ICU patients, and to provide reference for reducing restraint use. Methods Related websites and electronic databases were searched from inception to January 2019 to collect guidelines, evidence summary, best practice, expert consensus, recommended practice, and systematic review regarding physical restraint use in ICU. Results Four guidelines, 1 best practice information sheet, and 1 expert consensus were included. Five categories including patient management, equipment management, prevention of falls from bed, environmental control, and establishment of nurse-patient relationship, totaling to 13 items, were summarized as best evidence. Conclusion Use of restraint alternatives plays an important role in reducing restraint use. It is suggested that nurses should consider multidisciplinary team′s advices, patient′s cultural background, clinical situation and domestic policies when applying evidence, thus to provide personalized physical restraint, reduce restraint use and ensure patient safety.
引文
[1] Benbenbishty J,Adam S,Endacott R.Physical restraint use in intensive care units across Europe:the PRICE study[J].Intensive Crit Care Nurs,2010,26(5):241-245.
[2] Tolson D,Morley J E.Physical restraints:abusive and harmful[J].J Am Med Dir Assoc,2012,13(4):311-313.
[3] Said A A,Kautz D D.Reducing restraint use for older adults in acute care[J].Nursing,2013,43(12):59-61.
[4] Evans D,Wood J,Lambert L.Patient injury and physical restraint devices:a systematic review[J].J Adv Nurs,2010,41(3):274-282.
[5] Jones C,B?ckman C,Capuzzo M,et al.Precipitants of post-traumatic stress disorder following intensive care:a hypothesis generating study of diversity in care[J].Intensive Care Med,2007,33(6):978-985.
[6] European Association for Children in Hospital.2010 resolution on restraint[EB/OL].(2010-06-19)[2018-07-01].https://www.each-for-sick-children.org/?view=article&id=114:2010-resolution-on-restraint&catid=16&highlight=WyJyZXN0cmFpbnQiLCIncmVzdHJhaW50JyIsIidy ZXN0cmFpbnQnLiJd.
[7] Royal College of Nursing.Restrictive physical intervention and therapeutic holding for children and young people[EB/OL].(2010-06-19)[2018-07-01].https://www.rcn.org.uk/professional-development/publications/pub-003573.
[8] 么莉,冯志仙,朱宗蓝,等.护理敏感质量指标实用手册(2016版)[M].北京:人民卫生出版社,2016:138-156.
[9] 曹锐,朱小平,靳英辉,等.ICU成人患者规范化身体约束证据总结[J].中国护理管理,2018,18(12):1600-1607.
[10] The Joanna Briggs Institute.Restraint standards[EB/OL].[2019-01-14].http://connect.jbiconnectplus.org/Search.aspx#.
[11] Maccioli G A,Dorman T,Brown B R,et al.Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit:use of restraining therapies-American College of Critical Care Medicine Task Force 2001-2002[J].Crit Care Med,2003,31(11):2665-2676.
[12] Lach H W,Leach K M,Butcher H K.Evidence-based practice guideline:changing the practice of physical restraint use in acute care[J].J Gerontol Nurs,2016,42(2):17-26.
[13] Registered Nurses′ Association of Ontario(RNAO).Promoting safety:alternative approaches to the use of restraints[EB/OL].(2016-05-04)[2018-12-01].http://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints.
[14] Hartford Institute for Geriatric Nursing.Physical restraints and side rails in acute and critical care settings.Evidence-based geriatric nursing protocols for best practice[EB/OL].(2012-07-01)[2018-12-01].https://consultgeri.org/geriatric-topics/physical-restraints#deeper-reading.
[15] The Joanna Briggs Institute.Best practice evidence based practice information sheets for health professionals physical restraint[EB/OL].(2002-06-03)[2018-12-01].http://ovidsp.tx.ovid.com.lib.ym.edu.tw/sp3.31.1b/ovidweb.cgi?&S=OPEJFPIAEEDDJJAFNCEKHDLBEAGCAA00&Link+Set=.
[16] Bray K,Hill K,Robson W,et al.British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units[J].Nurs Crit Care,2004,9(5):199-212.
[17] Conn D K,Gibson M,Feldman S,et al.National guidelines for seniors′ mental health:the assessment and treatment of mental health issues in long-term care homes (focus on mood and behaviour symptoms)[J].Can J Geriatr,2006,9(S2):S59-S64.
[18] de Silva P S,Fonseca M C.Unplanned endotracheal extubations in the intensive care unit:systematic review,critical appraisal,and evidence-based recommendations[J].Anesth Analg,2012,114(5):1003-1014.
[19] Martin B,Mathisen L.Use of physical restraints in adult critical care:a bicultural study[J].Am J Crit Care,2005,14(2):133-142.
[20] 葛向煜,胡雁,徐建鸣,等.身体约束在重症监护室应用的系统评价[J].护理学杂志,2015,30(14):94-99.
[21] 庄晓艳.运用医疗失效模式与效应分析降低约束患者非计划性拔管率的研究[D].南京:南京医科大学,2014.
[22] Sze T W,Leng C Y,Lin S K.The effectiveness of phy-sical restraints in reducing falls among adults in acute care hospitals and nursing homes:a systematic review[J].JBI Libr Syst Rev,2012,10(5):307-351.
[23] Ofoegbu B N,Playfor S D.The use of physical restraints on paediatric intensive care units[J].Paediatr Anaesth,2005,15(5):407-411.
[24] 雷若冰,蒋小平,许颖,等.住院儿童身体约束应用的研究进展[J].护理学杂志,2018,33(21):105-108.
[2] Tolson D,Morley J E.Physical restraints:abusive and harmful[J].J Am Med Dir Assoc,2012,13(4):311-313.
[3] Said A A,Kautz D D.Reducing restraint use for older adults in acute care[J].Nursing,2013,43(12):59-61.
[4] Evans D,Wood J,Lambert L.Patient injury and physical restraint devices:a systematic review[J].J Adv Nurs,2010,41(3):274-282.
[5] Jones C,B?ckman C,Capuzzo M,et al.Precipitants of post-traumatic stress disorder following intensive care:a hypothesis generating study of diversity in care[J].Intensive Care Med,2007,33(6):978-985.
[6] European Association for Children in Hospital.2010 resolution on restraint[EB/OL].(2010-06-19)[2018-07-01].https://www.each-for-sick-children.org/?view=article&id=114:2010-resolution-on-restraint&catid=16&highlight=WyJyZXN0cmFpbnQiLCIncmVzdHJhaW50JyIsIidy ZXN0cmFpbnQnLiJd.
[7] Royal College of Nursing.Restrictive physical intervention and therapeutic holding for children and young people[EB/OL].(2010-06-19)[2018-07-01].https://www.rcn.org.uk/professional-development/publications/pub-003573.
[8] 么莉,冯志仙,朱宗蓝,等.护理敏感质量指标实用手册(2016版)[M].北京:人民卫生出版社,2016:138-156.
[9] 曹锐,朱小平,靳英辉,等.ICU成人患者规范化身体约束证据总结[J].中国护理管理,2018,18(12):1600-1607.
[10] The Joanna Briggs Institute.Restraint standards[EB/OL].[2019-01-14].http://connect.jbiconnectplus.org/Search.aspx#.
[11] Maccioli G A,Dorman T,Brown B R,et al.Clinical practice guidelines for the maintenance of patient physical safety in the intensive care unit:use of restraining therapies-American College of Critical Care Medicine Task Force 2001-2002[J].Crit Care Med,2003,31(11):2665-2676.
[12] Lach H W,Leach K M,Butcher H K.Evidence-based practice guideline:changing the practice of physical restraint use in acute care[J].J Gerontol Nurs,2016,42(2):17-26.
[13] Registered Nurses′ Association of Ontario(RNAO).Promoting safety:alternative approaches to the use of restraints[EB/OL].(2016-05-04)[2018-12-01].http://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints.
[14] Hartford Institute for Geriatric Nursing.Physical restraints and side rails in acute and critical care settings.Evidence-based geriatric nursing protocols for best practice[EB/OL].(2012-07-01)[2018-12-01].https://consultgeri.org/geriatric-topics/physical-restraints#deeper-reading.
[15] The Joanna Briggs Institute.Best practice evidence based practice information sheets for health professionals physical restraint[EB/OL].(2002-06-03)[2018-12-01].http://ovidsp.tx.ovid.com.lib.ym.edu.tw/sp3.31.1b/ovidweb.cgi?&S=OPEJFPIAEEDDJJAFNCEKHDLBEAGCAA00&Link+Set=.
[16] Bray K,Hill K,Robson W,et al.British Association of Critical Care Nurses position statement on the use of restraint in adult critical care units[J].Nurs Crit Care,2004,9(5):199-212.
[17] Conn D K,Gibson M,Feldman S,et al.National guidelines for seniors′ mental health:the assessment and treatment of mental health issues in long-term care homes (focus on mood and behaviour symptoms)[J].Can J Geriatr,2006,9(S2):S59-S64.
[18] de Silva P S,Fonseca M C.Unplanned endotracheal extubations in the intensive care unit:systematic review,critical appraisal,and evidence-based recommendations[J].Anesth Analg,2012,114(5):1003-1014.
[19] Martin B,Mathisen L.Use of physical restraints in adult critical care:a bicultural study[J].Am J Crit Care,2005,14(2):133-142.
[20] 葛向煜,胡雁,徐建鸣,等.身体约束在重症监护室应用的系统评价[J].护理学杂志,2015,30(14):94-99.
[21] 庄晓艳.运用医疗失效模式与效应分析降低约束患者非计划性拔管率的研究[D].南京:南京医科大学,2014.
[22] Sze T W,Leng C Y,Lin S K.The effectiveness of phy-sical restraints in reducing falls among adults in acute care hospitals and nursing homes:a systematic review[J].JBI Libr Syst Rev,2012,10(5):307-351.
[23] Ofoegbu B N,Playfor S D.The use of physical restraints on paediatric intensive care units[J].Paediatr Anaesth,2005,15(5):407-411.
[24] 雷若冰,蒋小平,许颖,等.住院儿童身体约束应用的研究进展[J].护理学杂志,2018,33(21):105-108.
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