Lai Claudia K Y
School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
BMC Nurs. 2007 Jul 17;6:5. doi: 10.1186/1472-6955-6-5.
To date, the literature has provided an abundance of evidence on the adverse outcomes of restraint use on patients. Reportedly, nurses are often the personnel who initiate restraint use and attribute its use to ensuring the safety of the restrained and the others. A clinical trial using staff education and administrative input as the key components of a restraint reduction program was conducted in a rehabilitation setting to examine whether there were any significant differences in the prevalence of restraint use pre- and post-intervention. Subsequent to the implementation of the intervention program, focus group interviews were conducted to determine the perspective of the nursing staff on the use of restraints and their opinions of appropriate means to reduce their use.
Registered nurses working in units involved in the study were invited to participate in focus group interviews on a voluntary basis. Twenty-two registered nurses (three males [13.6%] and nineteen females [86.4%]) attended the four sessions. All interviews were audio taped and transcribed verbatim. Other than the author, another member of the project team validated the findings from the data analysis.
Four themes were identified. Participants experienced internal conflicts when applying physical restraints and were ambivalent about their use, but they would use restraints nonetheless, mainly to prevent falls and injuries to patients. They felt that nurse staffing was inadequate and that they were doing the best they could. They experienced pressure from the management level and would have liked better support. Communication among the various stakeholders was a problem. Each party may have a different notion about what constitutes a restraint and how it can be safely used, adding further weight to the burden shouldered by staff.
Studies about restraints and restraint use have mostly focused on nurses' inadequate and often inaccurate knowledge about the use of restraints and its associated adverse effects. These studies, however, fail to note that nurses can also be victims of the system. Restraint use is a complex issue that needs to be understood in relation to the dynamics within an environment.
迄今为止，文献已提供了大量关于使用约束措施对患者产生不良后果的证据。据报道，护士常常是发起约束措施使用的人员，并将其使用归因于确保被约束者及其他人的安全。在一个康复机构中进行了一项临床试验，该试验将员工教育和行政投入作为约束减少计划的关键组成部分，以检验干预前后约束措施使用的发生率是否存在显著差异。在干预计划实施后，进行了焦点小组访谈，以确定护理人员对约束措施使用的看法以及他们对减少约束措施使用的适当方法的意见。
邀请参与研究科室工作的注册护士自愿参加焦点小组访谈。22名注册护士（3名男性[13.6%]和19名女性[86.4%]）参加了4次访谈。所有访谈均进行了录音并逐字转录。除作者外，项目团队的另一名成员对数据分析结果进行了验证。
确定了四个主题。参与者在应用身体约束措施时经历内心冲突，对其使用态度矛盾，但仍会使用约束措施，主要是为了防止患者跌倒和受伤。他们觉得护士人员配备不足，自己已尽力而为。他们感受到管理层的压力，希望得到更好的支持。各利益相关方之间的沟通是个问题。各方对于什么构成约束措施以及如何安全使用约束措施可能有不同的概念，这进一步加重了工作人员的负担。
关于约束措施及其使用的研究大多集中在护士对约束措施使用及其相关不良影响的知识不足且常常不准确这方面。然而，这些研究没有注意到护士也可能是该系统的受害者。约束措施的使用是一个复杂问题，需要结合环境中的动态情况来理解。
