Transplant National Organization, Health Ministry, 28029 Madrid, Spain.
Nursing Department, Faculty of Medicine, Autonomous University of Madrid, 28029 Madrid, Spain.
Int J Environ Res Public Health. 2021 Nov 11;18(22):11826. doi: 10.3390/ijerph182211826.
The general aim of this study was to explore the decision-making process followed by Intensive Care Unit (ICU) health professionals with respect to physical restraint (PR) administration and management, along with the factors that influence it.
A qual-quant multimethod design was sequenced in two stages: an initial stage following a qualitative methodology; and second, quantitative with a predominant descriptive approach. The multicenter study was undertaken at 17 ICUs belonging to 11 public hospitals in the Madrid region (Spain) across the period 2015 through 2019. The qualitative stage was performed from an interpretative phenomenological perspective. A total of eight discussion groups (DG) were held, with the participation of 23 nurses, 12 patient care nursing assistants, and seven physicians. Intentional purposive sampling was carried out. DG were tape-recorded and transcribed. A thematic analysis of the latent content was performed. In the quantitative stage, we maintained a 96-h observation period at each ICU. Variables pertaining to general descriptive elements of each ICU, institutional pain-agitation/sedation-delirium (PAD) monitoring policies and elements linked to quality of PR use were recorded. A descriptive analysis was performed, and the relationship between the variables was analyzed. The level of significance was set at ≤ 0.05.
A total of 1070 patients were observed, amounting to a median prevalence of PR use of 19.11% (min: 0%-max: 44.44%). The differences observed between ICUs could be explained by a difference in restraint conceptualization. The various actors involved jointly build up a health care culture and a conceptualization of the terms "safety-risk", which determine decision-making about the use of restraints at each ICU. These shared meanings are the germ of beliefs, values, and rituals which, in this case, determine the greater or lesser use of restraints. There were different profiles of PR use among the units studied: preventive restraints versus "Zero" restraints. The differences corresponded to aspects such as: systematic use of tools for assessment of PAD; interpretation of patient behavior; the decision-making process, the significance attributed to patient safety and restraints; and the feelings generated by PR use. The restraint-free model requires an approach to safety from a holistic perspective, with the involvement of all team members and the family.
本研究的总体目的是探讨重症监护病房（ICU）卫生专业人员在实施和管理身体约束（PR）方面的决策过程，以及影响该过程的因素。
采用定性-定量混合方法设计，分两个阶段进行：第一阶段采用定性方法，第二阶段采用以描述性为主的定量方法。该多中心研究于 2015 年至 2019 年在马德里地区 11 家公立医院的 17 个 ICU 进行。定性阶段采用解释现象学的视角。共进行了 8 个讨论小组（DG），共有 23 名护士、12 名患者护理助理和 7 名医生参与。采用有意的目的性抽样。DG 进行了录音和转录。对潜在内容进行了主题分析。在定量阶段，我们在每个 ICU 保持了 96 小时的观察期。记录了每个 ICU 的一般描述性元素、机构疼痛-激动/镇静-昏迷（PAD）监测政策以及与 PR 使用质量相关的元素。进行了描述性分析，并分析了变量之间的关系。显著性水平设置为 ≤ 0.05。
共观察了 1070 名患者，PR 使用的中位数患病率为 19.11%（最小：0%-最大：44.44%）。观察到的 ICU 之间的差异可以用约束概念的差异来解释。参与的各个角色共同建立了一种医疗保健文化和对“安全风险”的概念化，这决定了每个 ICU 对约束使用的决策。这些共同的意义是信念、价值观和仪式的萌芽，在这种情况下，决定了约束的使用程度。在所研究的单位中，PR 使用存在不同的模式：预防约束与“零”约束。差异对应于以下方面：系统使用评估 PAD 的工具；对患者行为的解释；决策过程、对患者安全和约束的重视、PR 使用产生的感觉。无约束模型需要从整体的角度看待安全问题，需要所有团队成员和家属的参与。
