Thomann Silvia, Barbezat Isabelle, Thomas Karin, Siegrist-Dreier Sandra, Britt Chantal, Molls Sabine, Hahn Sabine, Richter Dirk, Schmitt Kai-Uwe
School of Health Professions, Bern University of Applied Sciences, Applied Research & Development in Nursing, Murtenstrasse 10, Bern, 3008, Switzerland.
Department of Nursing, Bern University Hospital (Insel Gruppe), Freiburgstrasse 38, Bern, 3010, Switzerland.
BMC Geriatr. 2025 May 20;25(1):358. doi: 10.1186/s12877-025-06015-3.
For general hospital settings, effective restraint reduction strategies are lacking. Patient involvement is proven to be useful in restraint reduction in mental healthcare and in long-term care settings. Since such an approach has never been investigated in a general hospital setting, we investigated whether and how patient involvement regarding restraint reduction is feasible in such a setting.
A pilot study following a participatory action research design was conducted. Qualitative and quantitative approaches were applied to develop and pilot an intervention to reduce restraint by preventive involvement of patients (aged 65+) in Switzerland. The intervention entailed reflecting on the potential risk of restraint use together with the patient within 24 h of admission and jointly defining possible prevention measures. The intervention was piloted for one month on one ward. Data collection for the qualitative evaluation included interviews with eight patients, five nurses, two ward managers and one clinical nurse specialist. These data were analysed by means of content analysis. Data collection for the quantitative evaluation consisted of a survey of nurses and an extraction of data from the electronic patient files. These data were descriptively analysed.
The evaluation comprised the files of 177 patients (pre to post pilot). It was found that that prevalence of restraint was lower during the pilot phase than before (4.8% vs. 10.2%), although a similar number of patients were found to be at a potential risk of restraint use (51.6% vs. 53.3%). In addition, considerably more patients with a potential restraint risk had restraint prevention measures documented (53.1% vs. 10.2%). From the perspective of the nursing staff, feasibility and acceptability of the intervention was not provided. The intervention was considered to be too time-consuming and the target group too unspecific.
The proactive and structured involvement of patients (aged 65+) in the prevention of restraint use might be an approach to reduce restraint use in a general hospital. Patients were positive about being addressed on the topic during the nursing admission interview. However, the effort was regarded to be high. Limiting the intervention to electively admitted patients should be considered to lower the burden.
在综合医院环境中，缺乏有效的减少约束措施的策略。在精神卫生保健和长期护理环境中，患者参与已被证明对减少约束是有用的。由于这种方法从未在综合医院环境中进行过研究，我们调查了在这种环境中患者参与减少约束是否可行以及如何可行。
进行了一项遵循参与式行动研究设计的试点研究。采用定性和定量方法来开发和试点一项干预措施，通过瑞士65岁及以上患者的预防性参与来减少约束。该干预措施包括在入院后24小时内与患者一起反思使用约束的潜在风险，并共同确定可能的预防措施。该干预措施在一个病房进行了为期一个月的试点。定性评估的数据收集包括对8名患者、5名护士、2名病房管理人员和1名临床护理专家的访谈。这些数据通过内容分析进行分析。定量评估的数据收集包括对护士的调查和从电子患者档案中提取数据。这些数据进行了描述性分析。
评估包括177名患者（试点前到试点后）的档案。结果发现，试点阶段的约束发生率低于之前（4.8%对10.2%），尽管发现有类似数量的患者存在使用约束的潜在风险（51.6%对53.3%）。此外，有潜在约束风险的患者中记录有约束预防措施的比例要高得多（53.1%对10.2%）。从护理人员的角度来看，该干预措施的可行性和可接受性未得到证实。该干预措施被认为过于耗时，目标群体过于不明确。
65岁及以上患者积极主动且结构化地参与预防约束使用可能是综合医院减少约束使用的一种方法。患者对在护理入院访谈中讨论该话题持积极态度。然而，人们认为工作量很大。应考虑将干预措施限制在择期入院患者中，以减轻负担。
