Kirkevold Øyvind
Nasjonalt kompetansesenter for aldersdemens, Postboks 64, 3107 Sem.
Tidsskr Nor Laegeforen. 2005 May 19;125(10):1346-8.
The use of restraints in care for the elderly is sparsely described, with the exception of the use of mechanical restraints.
The use of restraints was investigated by interviews with the primary nurses of 1926 patients in Norwegian nursing homes. Five categories of restraint were mapped: mechanical restraints, non-mechanical restraints, electronic surveillance, the use of force or pressure in medical treatment or examination, and the use of force or pressure in activities of daily life (ADL). In addition, assumed explanatory variables were registered.
45% of patients in sheltered units for the demented and 37% of those in regular wards were subjected to at least one type of restraint during a given week. The most common restraints were the use of force or pressure in ADL, the use of mechanical restraints, and the use of force or pressure in medical treatment or examination (particularly adding medicine to a patient's food or beverage). Cognitive decline, poor ADL performance, and the presence of aggressive behaviour were factors strongly associated with the use of restraints. In 65% of the cases, no written documentation could be found. In 44%, the nurse in charge made the decision to use restraint. In 20% of the cases in which medication was added to a patient's food or beverage, the decision was made by a physician.
Restraint is frequently used in Norwegian nursing homes. High frequency, poor documentation and the arbitrariness of decision making make it reasonable to assume that the use of restraint is more often a result of inadequate routines than carefully judgment of each case.
除了机械约束的使用外，对于老年人护理中约束措施的使用描述甚少。
通过对挪威养老院1926名患者的责任护士进行访谈，调查约束措施的使用情况。划分了五类约束：机械约束、非机械约束、电子监控、在医疗或检查中使用武力或压力，以及在日常生活活动（ADL）中使用武力或压力。此外，记录了假定的解释变量。
在某一周内，痴呆症庇护单元中45%的患者和普通病房中37%的患者至少受到一种约束。最常见的约束是在日常生活活动中使用武力或压力、使用机械约束，以及在医疗或检查中使用武力或压力（特别是在患者食物或饮料中添加药物）。认知能力下降、日常生活活动表现不佳以及攻击行为的存在是与约束使用密切相关的因素。在65%的案例中，未发现书面记录。在44%的案例中，由主管护士决定使用约束。在20%的案例中，在患者食物或饮料中添加药物的决定由医生做出。
挪威养老院经常使用约束措施。高频率、记录不佳以及决策的随意性使得有理由认为，约束措施的使用更多是由于常规流程不完善，而非对每个案例的仔细判断。
