Quinn C A
Scripps Gerontology Center, Miami University of Chio, USA.
Clin Nurse Spec. 1996 Sep;10(5):220-5; quiz 226-7. doi: 10.1097/00002800-199609000-00004.
Regulatory changes concerning the use of physical restraints in nursing homes have stimulated an examination of restraint use practices in other care settings. Caregivers are receiving mixed messages about appropriate restraint use in the hospital. Legal decisions are ambiguous in terms of the nurse's liability for restraint decisions, and the use of restraints may create a conflict between respecting patient autonomy and acting in the patient's best interest. Recent research does not support the belief that restraint use prevents patient injuries, but continues to document the untoward effects of restraints. Restraint reduction efforts have been successful in nursing homes, and many strategies can be adapted in acute care. As the movement to integrated systems of care places increased emphasis on continuity of services across settings and improved client outcomes, restraint practice is one area where interinstitutional collaboration and coordination must occur. The advanced practice nurse is in a key role to facilitate continuity of restraint reduction efforts.
疗养院中关于使用身体约束措施的监管变化促使人们对其他护理环境中的约束措施使用情况进行审视。在医院中，护理人员对于适当使用约束措施收到的信息并不一致。在护士对约束措施决策应承担的责任方面，法律裁决并不明确，而且使用约束措施可能会在尊重患者自主权和为患者谋求最大利益之间产生冲突。近期研究并不支持使用约束措施能防止患者受伤这一观点，但仍不断记录着约束措施带来的不良影响。在疗养院中，减少约束措施的努力已取得成功，许多策略可应用于急症护理。随着向综合护理系统的转变越来越强调不同环境下服务的连续性以及改善患者结局，约束措施实践是机构间必须开展合作与协调的一个领域。高级执业护士在促进减少约束措施努力的连续性方面起着关键作用。
