Dolan Jeanne, Dolan Looby Sara E
Jeanne Dolan is a critical care nurse who was practicing in the surgical intensive care unit when the study was done (now in the postanesthesia care unit), Massachusetts General Hospital, Boston, Massachusetts. Sara E. Dolan Looby is a nurse scientist, Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital.
Am J Crit Care. 2017 Sep;26(5):373-379. doi: 10.4037/ajcc2017244.
Physical restraints are used in intensive care units, particularly among patients at risk for self-terminating necessary treatment interventions, including endotracheal tubes and invasive catheters. Assessments conducted by intensive care unit nurses often influence the collaborative decision to initiate and discontinue restraints in critical care patients. However, little is known about factors that influence the critical thought processes of intensive care unit nurses in determining use of restraints.
To describe nurses' determinants of initiation and discontinuation of restraints in surgical intensive care unit patients.
Semistructured interviews were conducted to identify and describe determinants of initiation and discontinuation of physical restraints. Demographic and employment data were collected via questionnaire. Interviews were recorded, transcribed, and analyzed by using conventional content analysis to establish categories and identify themes.
A total of 13 nurses (mean age 43 [SD, 12] years, 92% female, mean of 18 [SD, 12] years of practice as a registered nurse, 69% bachelor of science in nursing) participated in the study. Content analysis revealed 3 general categories and 8 themes that indicated the thoughtful reflection processes nurses in a surgical intensive care unit use to determine use of restraints.
Top priorities were ensuring patient safety and comfort. Nurses synthesized factors including practice experience, patient-specific behaviors and risk, and patients' need for devices in determining use of restraints.
身体约束措施在重症监护病房中被使用，尤其是在那些有自行终止必要治疗干预风险的患者中，这些干预包括气管插管和侵入性导管。重症监护病房护士进行的评估往往会影响在重症患者中开始和停止使用约束措施的共同决策。然而，对于影响重症监护病房护士在决定是否使用约束措施时的批判性思维过程的因素，我们知之甚少。
描述外科重症监护病房患者中护士开始和停止使用约束措施的决定因素。
进行半结构化访谈以识别和描述身体约束措施开始和停止使用的决定因素。通过问卷调查收集人口统计学和就业数据。访谈进行录音、转录，并使用传统内容分析法进行分析，以建立类别并识别主题。
共有13名护士（平均年龄43岁[标准差，12岁]，92%为女性，作为注册护士的平均执业年限为18年[标准差，12年]，69%拥有护理学理学学士学位）参与了该研究。内容分析揭示了3个一般类别和8个主题，这些类别和主题表明了外科重症监护病房护士在决定是否使用约束措施时所采用的深思熟虑的反思过程。
首要任务是确保患者安全和舒适。护士在决定是否使用约束措施时综合考虑了包括实践经验、患者特定行为和风险以及患者对设备的需求等因素。
