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重症监护病房中身体约束的道德困境:理解身体约束使用中的自主性、善意、不伤害和公正原则

Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence and Justice in the Use of Physical Restraints.

作者信息

Zhou Junya, Qin Qingzhu, Chen Songge, Zhang Hongmei

机构信息

Department of Cardiology, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, People's Republic of China.

Department of Nursing, Henan Provincial Key Medicine Laboratory of Nursing, Henan Provincial People's Hospital; Zhengzhou University People's Hospital, Zhengzhou, Henan, 450003, People's Republic of China.

出版信息

J Multidiscip Healthc. 2024 Apr 12;17:1619-1627. doi: 10.2147/JMDH.S455910. eCollection 2024.

DOI:10.2147/JMDH.S455910
PMID:38628615
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11020279/
Abstract

In intensive care units, patients are often restrained to ensure their safety, with physical restraints being the most commonly used method. However, physical restraints compromises the patient's freedom, health and comfort, and nurses often face moral dilemmas when deciding whether to use physical restraints. This article examines physical restraints through the four universal principles of autonomy, beneficence, non-maleficence and justice. Through these principles, the authors will critically explore whether the physical restraints of patients by nurses is ethical in practice and what moral issues exist. This paper also explores conflicts and moral dilemmas for nurses in this context. Finally, suggestions are made on changes to education and clinical practice.

摘要

在重症监护病房,患者常被约束以确保安全,身体约束是最常用的方法。然而,身体约束会损害患者的自由、健康和舒适度,护士在决定是否使用身体约束时常常面临道德困境。本文通过自主、行善、不伤害和公正这四项普遍原则来审视身体约束。通过这些原则,作者将批判性地探讨护士对患者进行身体约束在实践中是否符合伦理以及存在哪些道德问题。本文还探讨了在此背景下护士面临的冲突和道德困境。最后,针对教育和临床实践的变革提出了建议。

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本文引用的文献

1
Healthcare staff's experiences of using manual physical restraint: A meta-synthesis review.医护人员使用手动身体约束的体验:元综合评价。
Nurs Health Sci. 2023 Sep;25(3):271-289. doi: 10.1111/nhs.13045. Epub 2023 Aug 10.
2
Restraining patients in acute care hospitals-A qualitative study on the experiences of healthcare staff.约束急性医疗机构中的患者:医护人员的经验定性研究。
Nurs Open. 2022 Mar;9(2):1311-1321. doi: 10.1002/nop2.1175. Epub 2022 Jan 28.
3
Physical Restraint in the Critical Care Unit: A Narrative Review.重症监护病房中的身体约束:一项叙述性综述。
New Bioeth. 2022 Mar;28(1):68-82. doi: 10.1080/20502877.2021.2019979. Epub 2022 Jan 27.
4
Physical Restraint Use in Intensive Care Units: Exploring the Decision-Making Process and New Proposals. A Multimethod Study.重症监护病房中的身体约束使用:探索决策过程和新提案。一项多方法研究。
Int J Environ Res Public Health. 2021 Nov 11;18(22):11826. doi: 10.3390/ijerph182211826.
5
Why are physical restraints still in use? A qualitative descriptive study from Chinese critical care clinicians' perspectives.为什么物理约束仍在使用?来自中国重症监护临床医生视角的定性描述性研究。
BMJ Open. 2021 Nov 3;11(11):e055073. doi: 10.1136/bmjopen-2021-055073.
6
Nurses' Views on the Use of Physical Restraints in Intensive Care: A Qualitative Study.护士对重症监护中使用身体约束的看法:一项定性研究。
Int J Environ Res Public Health. 2021 Sep 13;18(18):9646. doi: 10.3390/ijerph18189646.
7
Good practices for physical restraint in intensive care units: integrative review.重症监护病房身体约束的良好实践:综合评论。
Rev Bras Enferm. 2021 Jul 9;74(3):e20201166. doi: 10.1590/0034-7167-2020-1166. eCollection 2021.
8
Prevalence of and factors associated with physical restraint use in the intensive care unit: a multicenter prospective observational study in Japan.在重症监护病房使用身体约束的流行情况及相关因素:日本多中心前瞻性观察研究。
Intern Emerg Med. 2022 Jan;17(1):37-42. doi: 10.1007/s11739-021-02737-5. Epub 2021 Apr 14.
9
Physical restraints: An ethical dilemma in mental health services in China.身体约束:中国精神卫生服务中的伦理困境
Int J Nurs Sci. 2017 Dec 7;5(1):68-71. doi: 10.1016/j.ijnss.2017.12.001. eCollection 2018 Jan 10.
10
Factors behind ethical dilemmas regarding physical restraint for critical care nurses.关于重症监护护士实施身体约束的伦理困境的背后因素。
Nurs Ethics. 2020 Mar;27(2):598-608. doi: 10.1177/0969733019858711. Epub 2019 Jul 18.