Organización Nacional de Trasplantes, Madrid, España; Grupo de Trabajo Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería de Intensivos y Unidades Coronarias, Madrid, España; Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España.
Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana (IDIPHISA), Majadahonda, Madrid, España; Universidad Autónoma de Madrid, Madrid, España.
Enferm Intensiva (Engl Ed). 2020 Jan-Mar;31(1):19-34. doi: 10.1016/j.enfi.2019.01.004. Epub 2019 Jun 26.
The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units.
A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive.
thematic content analysis. Data saturation was achieved.
Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used).
The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.
本研究旨在探讨医生和护理助理在重症监护病房（CCU）管理身体约束（PR）方面的经验。
这是一项多中心现象学研究，包括马德里（西班牙）的 14 个 CCU。根据其身体约束的使用情况对 CCU 进行分层：“经常使用”与“很少使用”。成立了三个焦点小组：第一组由经常使用身体约束的 CCU 的护理助理组成，第二组由很少使用身体约束的 CCU 的护理助理组成，最后一组由两种 CCU 类型的医生组成。抽样方法：目的性。
主题内容分析。达到数据饱和。
出现了四个主要主题：1）安全和风险的概念（患者安全与专业人员安全），2）约束类型，3）专业责任（处方、记录和专业角色）和 4）“零约束”范式。身体约束使用的概念化在某些主要主题上存在差异，这取决于 CCU 的类型，包括政策、身体约束的使用和管理（经常使用与很少使用）。
要真正减少 CCU 中身体约束的使用，必须基于一个关键点：接受现象的复杂性。不同 CCU 中观察到的身体约束的使用受到个人、群体和组织因素的影响。这些因素将决定医生和护理助理如何解释安全和风险、护理中心（以患者为中心还是以专业人员为中心）、约束概念、专业责任和干预措施、团队互动和领导力。
