Gerace Adam, Mosel Krista, Oster Candice, Muir-Cochrane Eimear
School of Nursing and Midwifery, Flinders University of South Australia, Adelaide, South Australia, Australia.
Int J Ment Health Nurs. 2013 Dec;22(6):545-57. doi: 10.1111/j.1447-0349.2012.00872.x. Epub 2012 Sep 25.
Restraint of older persons in inpatient and residential care is used to control aggression, and prevent falls and other adverse outcomes. Initiatives to reduce these practices are being implemented worldwide. However, there has been little examination of restraint practice in psychiatric services for older persons. This paper reports a retrospective comparative analysis of restraint use in three acute and two extended care psychiatric inpatient wards in Australia. The analysis involved examination of restraint incidents and comparison of restrained and non-restrained patients. There was significant variation in restraint use between wards. On one acute ward, 12.74% of patients were restrained, although restraint use declined during the data collection period. Patients with dementia were restrained at higher rates than patients with other diagnoses, and restrained patients stayed in hospital for a longer duration. Restraint occurred early in admission, and few differences emerged between those restrained once or multiple times. Mechanical restraint was more prevalent than physical restraint, with restraint predominantly used to manage aggression and falls. Findings provide new data on restraint in older persons' psychiatric services. Greater conceptual understandings of behaviours associated with dementia and the unique needs of patients with these disorders may assist in reducing restraint use in these settings.
在住院和寄宿照护中对老年人实施约束是为了控制攻击行为、预防跌倒及其他不良后果。全球都在开展减少此类做法的举措。然而，针对老年精神科服务中的约束措施却鲜有研究。本文报告了对澳大利亚三个急性和两个延长护理精神科住院病房约束使用情况的回顾性比较分析。该分析包括对约束事件的审查以及对受约束患者和未受约束患者的比较。各病房之间的约束使用情况存在显著差异。在一个急性病房中，12.74%的患者受到约束，尽管在数据收集期间约束使用有所下降。患有痴呆症的患者受到约束的比例高于其他诊断的患者，且受约束患者住院时间更长。约束在入院早期就会发生，且单次或多次受约束的患者之间几乎没有差异。机械约束比身体约束更为普遍，约束主要用于处理攻击行为和跌倒。研究结果提供了有关老年精神科服务中约束情况的新数据。对与痴呆症相关行为以及这些疾病患者独特需求有更深入的概念理解，可能有助于减少这些环境中的约束使用。
