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探讨约束使用中的偏见:减轻急诊科躁动患者护理中偏见的四种策略。

Exploring bias in restraint use: Four strategies to mitigate bias in care of the agitated patient in the emergency department.

机构信息

Department of Emergency Medicine, LAC+USC Medical Center, Los Angeles, California, USA.

Special Projects and Innovation, Emergency Medicine Residency Program, Dignity Health-St. Joseph's Medical Center, Stockton, California, USA.

出版信息

Acad Emerg Med. 2021 Sep;28(9):1061-1066. doi: 10.1111/acem.14277. Epub 2021 Jun 11.

DOI:10.1111/acem.14277
PMID:33977591
Abstract

Agitation is a routine and increasingly common presentation to the emergency department (ED). In the wake of a national examination into racism and police use of force, this article aims to extend that reflection into emergency medicine in the management of patients presenting with acute agitation. Through an overview of ethicolegal considerations in restraint use and current literature on implicit bias in medicine, this article provides a discussion on how bias may impact care of the agitated patient. Concrete strategies are offered at an individual, institutional, and health system level to help mitigate bias and improve care.

摘要

激动是急诊部(ED)常见的常规表现。在全国范围内对种族主义和警察使用武力进行审查后,本文旨在将这种反思扩展到急诊医学中,以管理出现急性激动的患者。通过概述约束使用中的伦理法律考虑因素和医学中隐性偏见的现有文献,本文讨论了偏见如何影响激动患者的护理。本文还提供了个体、机构和卫生系统层面的具体策略,以帮助减轻偏见并改善护理。

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Exploring bias in restraint use: Four strategies to mitigate bias in care of the agitated patient in the emergency department.探讨约束使用中的偏见:减轻急诊科躁动患者护理中偏见的四种策略。
Acad Emerg Med. 2021 Sep;28(9):1061-1066. doi: 10.1111/acem.14277. Epub 2021 Jun 11.
2
Exploring Bias in Restraint Use: Four Strategies to Mitigate Bias in Care of the Agitated Patient in the Emergency Department.探索约束使用中的偏见:减轻急诊科躁动患者护理中偏见的四种策略。
Focus (Am Psychiatr Publ). 2023 Jan;21(1):100-105. doi: 10.1176/appi.focus.23022007. Epub 2023 Jan 16.
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"The Coats That We Can Take Off and the Ones We Can't": The Role of Trauma-Informed Care on Race and Bias During Agitation in the Emergency Department.“我们能脱下的外套和不能脱下的外套”:创伤知情护理在急诊科躁动期间对种族和偏见的作用
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Qualitative study of patient experiences and care observations during agitation events in the emergency department: implications for systems-based practice.急诊科激越事件中患者体验和护理观察的定性研究:对基于系统的实践的启示。
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Approach to the Agitated Emergency Department Patient.急诊室躁动患者的处理方法
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引用本文的文献

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Peer support enhanced behavioural crisis response teams in the emergency department: protocol for a stepped-wedge cluster-randomised controlled trial.急诊科同伴支持强化行为危机应对团队:阶梯式楔形整群随机对照试验方案
BMJ Open. 2025 Jun 8;15(6):e103775. doi: 10.1136/bmjopen-2025-103775.
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Predicting Agitation Events in the Emergency Department Through Artificial Intelligence.
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JAMA Netw Open. 2025 May 1;8(5):e258927. doi: 10.1001/jamanetworkopen.2025.8927.
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Racial and Ethnic Disparities in EMS Use of Restraints and Sedation for Patients With Behavioral Health Emergencies.紧急医疗服务(EMS)在行为健康紧急情况中对患者使用约束措施和镇静剂方面的种族和族裔差异。
JAMA Netw Open. 2025 Mar 3;8(3):e251281. doi: 10.1001/jamanetworkopen.2025.1281.
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Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol.急诊科针对激越症状的临床决策支持系统的形成性评估:一项研究方案。
BMJ Open. 2024 Feb 19;14(2):e082834. doi: 10.1136/bmjopen-2023-082834.
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Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments.身体约束是否不道德且违法?:对韩国书面判决的定性分析
BMC Nurs. 2024 Feb 4;23(1):94. doi: 10.1186/s12912-024-01781-8.
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Focus (Am Psychiatr Publ). 2023 Jan;21(1):70-71. doi: 10.1176/appi.focus.23022003. Epub 2023 Jan 16.
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Updates in the Assessment and Management of Agitation.躁动评估与管理的进展
Focus (Am Psychiatr Publ). 2023 Jan;21(1):35-45. doi: 10.1176/appi.focus.20220064. Epub 2023 Jan 16.
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BMJ Open. 2022 May 11;12(5):e059876. doi: 10.1136/bmjopen-2021-059876.