Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Public Health. 2022 Sep 6;10:959016. doi: 10.3389/fpubh.2022.959016. eCollection 2022.
Physical restraint (PR) reduction interventions are currently exploring in developed regions with well-established welfare systems, whereas developing countries with fast population aging have not attracted enough attention. This China's pilot study evaluated the effects of a minimized PR program on restraint reduction and nursing assistants' knowledge, attitudes, intention, and practice toward PR and explored nursing assistants' experience of the program.
This was a one-group, pretest, and posttest pilot trial with a nested qualitative descriptive study. A minimized PR program was obtained by summarizing the best evidence and was implemented in one Chinese nursing home with 102 older adults from December 18, 2020, to March 21, 2021. An educational program including three theoretical lectures and one operation training was first conducted for nursing assistants one-month period. The primary outcome was PR rate at 3 months. The secondary outcomes contained duration of restraints, types of restraints, the rate of correct PR use, the incidence of falls and/or fall-related injuries, and antipsychotics use at 3 months. Data on PR use and older adults' characteristics were collected through physical restraints observation forms and older adults' medical records. Nursing assistants' knowledge, attitude, intention, and practice toward PR were measured using the Staff Knowledge, Attitudes, and Practices Questionnaire regarding PR at 1 month. A semi-structured interview for two administrative staff and a focus group discussion with 13 nursing assistants were analyzed using content analysis to explore perspectives of intervention implementation at 3 months.
There were a significant increase in knowledge, attitude, and practice and a decrease in intention of nursing assistants after 1-month educational intervention ( < 0.001). Furthermore, only the rate of correct PR increased and the duration of restraint in the daytime decreased significantly at 3 months ( < 0.05). There were no significant effects on PR rate and other secondary outcomes at follow-up. Qualitatively, nursing assistants demonstrated overtly supportive perspectives and that assistance from the program enhanced their knowledge and practice. They noted several challenges that impeded implementation.
The intervention has acknowledged some benefits and was valued by nursing assistants. Implementation barriers should be addressed before delivering in larger trials.
身体约束（PR）减少干预措施目前正在福利制度完善的发达国家进行探索，而人口老龄化迅速的发展中国家尚未引起足够重视。本项中国试点研究评估了最小化 PR 方案对约束减少的影响，以及对护理助理对 PR 的知识、态度、意愿和实践的影响，并探讨了护理助理对该方案的体验。
这是一项单组、预测试和后测试的试点试验，嵌套了一项定性描述性研究。通过总结最佳证据，获得了最小化 PR 方案，并于 2020 年 12 月 18 日至 2021 年 3 月 21 日在一家中国养老院对 102 名老年人实施。首先，护理助理接受为期一个月的包括三次理论讲座和一次操作培训的教育计划。主要结果是 3 个月时的 PR 率。次要结果包括约束持续时间、约束类型、正确使用 PR 的比率、跌倒和/或跌倒相关伤害的发生率以及 3 个月时抗精神病药物的使用情况。通过身体约束观察表和老年人病历收集 PR 使用情况和老年人特征数据。在 1 个月时，使用 PR 工作人员知识、态度和实践问卷测量护理助理对 PR 的知识、态度、意愿和实践。对 2 名管理人员进行半结构式访谈，并对 13 名护理助理进行焦点小组讨论，使用内容分析法分析干预实施的观点。
在 1 个月的教育干预后，护理助理的知识、态度和实践明显增加，意愿明显下降（<0.001）。此外，仅正确使用 PR 的比率和白天约束的持续时间在 3 个月时显著降低（<0.05）。在随访时，PR 率和其他次要结果均无显著影响。定性分析表明，护理助理表现出明显的支持观点，该方案增强了他们的知识和实践。他们注意到一些实施障碍。
该干预措施已被认可具有一些益处，受到护理助理的重视。在更大规模的试验中实施之前，应解决实施障碍。
