Department of Nursing Education, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Gauteng 2193Johannesburg, South Africa.
Intensive Crit Care Nurs. 2011 Apr;27(2):67-75. doi: 10.1016/j.iccn.2010.12.001. Epub 2011 Feb 3.
The use of mechanical restraints is a controversial practice internationally but is common in South African Intensive Care Units (ICUs). Their use was studied in the ICUs of an academic, public hospital in Johannesburg, South Africa.
Quantitative data were collected over two months by means of a checklist and analysed by means of descriptive statistics. The patients' length of stay, type of restraint used and duration thereof, the daily nurse patient ratios, as well as information regarding sedation and analgesia were detailed. Individual interviews with twenty medical and nursing ICU clinicians elicited their stated rationale for restraint, their experiences and perceptions of the practice and recommendations for restraint.
Of a total of 219 patients in the three ICUs, 106 (48.4%) were restrained. The average number of days restrained was nine with a range of days from 1 to 53 (in one case only). In only six cases were restraints other than wrist ties used. Forty seven of the restrained patients had sedation and analgesic medication prescribed and 59 not. All participants conceded a place for physical restraint in the ICU, primarily to ensure the safety of patients but were divided as to the reason for restraining patients and disputed the benefits of restraint.
Poor communication between the team, patients and families and diminished collaboration within the multi-disciplinary team emerged as central concepts in this study and influenced care decisions and practises regarding the use of mechanical restraints in the clinical area.
在国际上，使用机械约束是一种有争议的做法，但在南非的重症监护病房（ICU）中很常见。南非约翰内斯堡一所学术性公立医院的 ICU 对其使用情况进行了研究。
通过检查表收集了两个月的定量数据，并通过描述性统计进行了分析。详细记录了患者的住院时间、使用的约束类型及其持续时间、每日护士与患者的比例，以及镇静和镇痛信息。对 20 名医疗和护理 ICU 临床医生进行了个别访谈，以了解他们使用约束的理由、他们对约束的经验和看法，以及对约束的建议。
在三个 ICU 的 219 名患者中，有 106 名（48.4%）被约束。平均约束天数为 9 天，范围为 1 至 53 天（仅 1 例）。只有 6 例使用了除腕带以外的约束。被约束的 47 名患者开了镇静和镇痛药物，59 名患者没有。所有参与者都承认 ICU 中需要使用身体约束，主要是为了确保患者的安全，但对约束患者的原因存在分歧，并对约束的好处存在争议。
研究中出现的核心概念是团队、患者和家属之间沟通不畅，以及多学科团队内部合作减弱，这影响了临床区域使用机械约束的护理决策和实践。
