Gerontological Nursing, Department of Clinical Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Division of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, japan.
Jpn J Nurs Sci. 2024 Oct;21(4):e12620. doi: 10.1111/jjns.12620. Epub 2024 Sep 10.
Dementia affects more than 55 million people worldwide. Use of restraints for hospitalized older adults with dementia is a social issue that should be addressed systematically and should not depend on the characteristics of nurses. This study reviewed the literature on organizational factors associated with reducing use of restraints in older adults with dementia admitted to acute care hospitals.
A scoping review was performed. Three databases were searched for papers that met our eligibility criteria. Factors related to restraint reduction were extracted, and results were deduced. Through inductive analysis, subthemes were categorized according to similarities and differences, which were then integrated into broader themes.
Sixteen studies were eligible for inclusion. The prevalence of restraints ranged from 5.1% to 80.0% depending on how the meaning of restraint was interpreted. The most common indications for restraints were history of falls and fall risk. Interdisciplinary screening for restraints was associated with reduced prevalence of restraints, with a 0.18-fold (confidence interval [CI]: 0.12-0.24) reduction through use of a restraint decision flowchart and a 0.76-fold (CI: 0.63-0.92) reduction through consultation with a psychiatrist. Interdisciplinary members included nurses, physicians, clinical psychologists, pharmacists, respiratory therapists, and therapists.
Research is needed to introduce and develop an interdisciplinary restraint decision-making system and to test its effectiveness. Important factors in implementing alternatives to restraints are the harmful effects of restraints, expertise in dementia, regular education on alternative methods, an inpatient environment that ensures patient safety, and the development of human resources.
痴呆影响着全球超过 5500 万人。在住院的老年痴呆症患者中使用约束具是一个社会问题，应该系统地解决，而不应依赖护士的特点。本研究综述了与减少急性护理医院老年痴呆症住院患者使用约束具相关的组织因素的文献。
进行了范围界定审查。在三个数据库中搜索符合我们入选标准的论文。提取与减少约束相关的因素，并推断结果。通过归纳分析，根据相似性和差异性对亚主题进行分类，然后将其整合为更广泛的主题。
有 16 项研究符合入选标准。根据对约束具含义的不同解释，约束具的使用比例从 5.1%到 80.0%不等。约束具最常见的指征是跌倒史和跌倒风险。跨学科的约束具筛查与约束具使用比例降低有关，使用约束具决策流程图可将约束具使用比例降低 0.18 倍（置信区间[CI]：0.12-0.24），通过与精神科医生咨询可降低 0.76 倍（CI：0.63-0.92）。跨学科成员包括护士、医生、临床心理学家、药剂师、呼吸治疗师和治疗师。
需要研究引入和开发跨学科的约束具决策系统，并测试其有效性。实施约束具替代方法的重要因素包括约束具的有害影响、痴呆症专业知识、替代方法的定期教育、确保患者安全的住院环境以及人力资源的发展。
