Ye Junrong, Xiao Aixiang, Yu Lin, Guo Jianxiong, Lei Huawei, Wei Hongmei, Luo Wei
Traditional Chinese Medicine Department, Affiliated Brain Hospital of Guangzhou Medical University, China.
Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China.
Arch Psychiatr Nurs. 2018 Jun;32(3):488-494. doi: 10.1016/j.apnu.2017.11.028. Epub 2017 Nov 22.
The purpose of this article was to synthesize the evidence regarding the reduction of physical restraint, and to seek some practical recommendations based on the current situation in China.
Nine databases were retrieved; these were PubMed, CINAHL, MEDLINE, Trip Database, PsysINFO, Cochrane Library, CNKI (Chinese database), Wanfang (Chinese database) and CBM (Chinese database) respectively. The selected articles were screened manually, and the identified researches were appraised through Review manager 5.3.
Eight studies (four randomized controlled trials and four quasi-experimental studies) published between June 2013 and May 2017 were selected. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. The outcome of meta-analysis suggested staff training reduced the duration (IV=-0.88; 95% CIs=-1.65 to -0.10; Z=2.22; p=0.03) and adverse effect (RR, 0.16; 95% CIs=0.09 to 0.30; Z=5.96; p<0.00001) of physical restraint, but there were no statistical change in the frequency of physical restraint (RR, 0.74; 95% CIs=0.43 to 1.28; Z=1.07; p=0.28). Noticeably, the result of pooled estimates from 3 RCTs suggested staff training had no effects on the incidence of physical restraint. (RR, 1.01; 95% CIs=0.45 to 2.24; Z=0.02; p=0.99) CONCLUSION: Staff training was an effective measure to minimize the duration and adverse effects of physical restraint. More studies are needed to examine the effectiveness of staff training in relation to reduce the prevalence of physical restraint. Furthermore, considering the nurse's education background in China, it is recommended to conduct a compulsory training program to reduce the unnecessary restraint.
本文旨在综合有关减少身体约束的证据，并根据中国现状寻求一些实用建议。
检索九个数据库，分别为PubMed、CINAHL、MEDLINE、Trip数据库、PsysINFO、Cochrane图书馆、CNKI（中文数据库）、万方（中文数据库）和CBM（中文数据库）。对所选文章进行人工筛选，并通过Review manager 5.3对纳入的研究进行评价。
选取了2013年6月至2017年5月发表的八项研究（四项随机对照试验和四项准实验研究）。二分类变量的效应指标采用风险比（RR）及95%置信区间（CI）。计算标准化均数差（SMD）及95%CI作为合并的连续性效应。Meta分析结果表明，工作人员培训可缩短身体约束的持续时间（IV=-0.88；95%CI=-1.65至-0.10；Z=2.22；p=0.03）并减少其不良影响（RR，0.16；95%CI=0.09至0.30；Z=5.96；p<0.00001），但身体约束的频率无统计学变化（RR，0.74；95%CI=0.43至1.28；Z=1.07；p=0.28）。值得注意的是，三项随机对照试验的合并估计结果表明，工作人员培训对身体约束的发生率无影响（RR，1.01；95%CI=0.45至2.24；Z=0.02；p=0.99）。结论：工作人员培训是减少身体约束持续时间和不良影响的有效措施。需要更多研究来检验工作人员培训在降低身体约束发生率方面的有效性。此外，考虑到中国护士的教育背景情况，建议开展强制性培训项目以减少不必要的约束。
