Thomann Silvia, Hahn Sabine, Bauer Silvia, Richter Dirk, Zwakhalen Sandra
Department of Health Professions, Applied Research & Development in Nursing, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
Department of Nursing Science, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria.
BMC Health Serv Res. 2021 Apr 20;21(1):367. doi: 10.1186/s12913-021-06362-y.
In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects).
A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016-2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed.
The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%.
The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible.
在躯体急症医院环境中使用约束措施时，常规做法和机构文化似乎起着重要作用。这意味着，在一家医院，类似的患者情况可能会使用约束措施来处理，而在另一家医院，同样的情况可能不会使用约束措施。这种做法差异在伦理和法律上似乎存在问题。文中讨论了诸如指南可用性等特定组织因素的影响。然而，迄今为止，此类因素在医院层面的相关性很少得到研究。因此，本研究的目的是：a）确定在医院层面（医院总体效应）可以解释多少约束措施使用的差异，以及b）研究组织因素对约束措施使用的影响（特定背景效应）。
对横断面多中心数据进行二次数据分析。数据收集于瑞士和奥地利急症医院的三次质量评估期间（2016 - 2018年）。纳入年龄在18岁及以上、签署知情同意书的不同医学专科的住院患者。进行了描述性分析和多水平逻辑回归分析。
该研究纳入了来自140家医院的29477名患者。至少使用过一次约束措施的患者的30天患病率为8.7%（n = 2577）。约束措施使用指南的可用性以及护理人员的进修课程与约束措施使用减少相关（优势比分别为0.60和0.75）。通过将医院作为随机效应纳入，模型的解释方差从24%增加到55%。
即使考虑患者特征，不同医院之间约束措施的使用差异仍然很大。识别因常规做法或机构文化而使用约束措施的情况似乎是减少约束措施使用的重要方法。对适当结构和员工知识的投入有助于尽可能提供无约束护理。
