Huizing Anna R, Hamers Jan P H, Gulpers Math J M, Berger Martijn P F
Health Care and Nursing Science, Maastricht University, Maastricht, The Netherlands.
J Am Geriatr Soc. 2009 Jul;57(7):1139-48. doi: 10.1111/j.1532-5415.2009.02309.x. Epub 2009 Jun 1.
To investigate the effects of an educational intervention on the use of physical restraints with psychogeriatric nursing home residents.
Cluster-randomized trial.
Fifteen psychogeriatric nursing home wards in the Netherlands.
In total, 432 psychogeriatric nursing home residents from 15 psychogeriatric nursing home wards in seven nursing homes were selected for participation; 404 consented, and 371 of these were available at baseline. Two hundred forty-one from 14 wards had complete data and were included in the data analyses.
The nursing home wards were assigned at random to educational intervention or control status. The educational intervention consisted of an educational program for nursing staff combined with consultation with a nurse specialist (registered nurse (RN) level).
Data were collected at baseline and 1, 4, and 8 months postintervention. At each measurement, the use of physical restraints was measured using observations of blinded, trained observers on four separate occasions over a 24-hour period. Other resident characteristics, such as cognitive status, were determined using the Minimum Data Set.
Logistic and linear regression analyses showed no treatment effect on restraint status, restraint intensity, or multiple restraint use in any of the three postintervention measurements. Furthermore, only small changes occurred in the types of restraints used with residents in the experimental group.
An educational program for nursing staff combined with consultation with a nurse specialist (RN level) had no effect on the use of physical restraints with psychogeriatric nursing home residents. In addition to restraint education and consultation, new measures to reduce the use of physical restraints with psychogeriatric nursing home residents should be developed.
探讨教育干预对老年精神病护理院患者使用身体约束的影响。
整群随机试验。
荷兰的15个老年精神病护理院病房。
总共从7家护理院的15个老年精神病护理院病房中选取了432名老年精神病护理院患者参与研究；404人同意参与，其中371人在基线时可用。来自14个病房的241人有完整数据并纳入数据分析。
护理院病房被随机分配到教育干预组或对照组。教育干预包括为护理人员开展的教育项目以及与一名专科护士（注册护士级别）的咨询。
在基线以及干预后1个月、4个月和8个月收集数据。每次测量时，由经过培训的盲法观察者在24小时内分四次观察来测量身体约束的使用情况。使用最小数据集确定其他患者特征，如认知状态。
逻辑回归和线性回归分析显示，在干预后的三次测量中，对约束状态、约束强度或多重约束使用均无治疗效果。此外，实验组中对患者使用的约束类型仅发生了微小变化。
为护理人员开展的教育项目以及与专科护士（注册护士级别）的咨询对老年精神病护理院患者使用身体约束没有影响。除了约束教育和咨询外，应制定新的措施以减少老年精神病护理院患者身体约束的使用。
