Huang Hui Chi, Huang Yu Tai, Lin Kuan Chia, Kuo Yong Fang
Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
Information Science and Applications Alumni Association, Asia University, Taichung, Taiwan.
J Adv Nurs. 2014 Jan;70(1):130-43. doi: 10.1111/jan.12176. Epub 2013 Jun 4.
To identify the rate and risk factors of physical restraint in residential aged care facilities in Taiwan.
In Taiwan, physical restraint is commonly used in aged care facilities to prevent accidents. Many are unaware of the associated risks. Restrained residents cannot move freely, increasing the risk of atrophy and leading to reduced physical functioning.
A community-based epidemiological survey.
Data were collected from June-December 2007 across 178 residential aged care facilities with 5,173 residential beds in the target city of Taiwan. Twenty facilities were sampled using probability proportional to size by beds and accreditation ranking. In all, 256 primary caregivers (78 nurses and 178 care aides) and 847 residents completed the study questionnaires and tests. A multilevel analysis approach was used to identify individual- and facility-level risk factors for physical restraint and assess the variation in physical restraint at the individual- and facility-level.
Of 847 residents, 62% (527) were restrained during the study period. The main reasons for restraint use were fall prevention and prevention of tube removal. Resident level risk factors for physical restraint included lower Barthel Index scores (more dependent) and an agreement allowing the use of physical restraint to avoid injury signed by a family member or social worker. A facility-level risk factor for physical restraint was younger primary caregivers.
To reduce the incidence of physical restraint in residential aged care facilities in Taiwan, educational programmes should target primary caregivers and families in facilities.
确定台湾地区安养机构中身体约束的发生率及危险因素。
在台湾，安养机构中常用身体约束来预防事故。许多人并未意识到其中的相关风险。被约束的居民无法自由活动，增加了萎缩风险并导致身体机能下降。
一项基于社区的流行病学调查。
于2007年6月至12月间，在台湾目标城市的178家设有5173张床位的安养机构收集数据。采用按床位数量和认证等级与规模成比例的概率抽样方法选取20家机构。共有256名主要照顾者（78名护士和178名护理员）以及847名居民完成了研究问卷和测试。采用多水平分析方法来确定身体约束的个体和机构层面危险因素，并评估个体和机构层面身体约束情况的差异。
在847名居民中，62%（527名）在研究期间受到约束。使用约束的主要原因是预防跌倒和防止管道脱落。身体约束的居民层面危险因素包括巴氏指数得分较低（依赖性更强）以及有家庭成员或社会工作者签署的允许使用身体约束以避免受伤的协议。身体约束的机构层面危险因素是较年轻的主要照顾者。
为降低台湾地区安养机构中身体约束的发生率，应针对机构中的主要照顾者和家属开展教育项目。
