ICU护士实施患者身体约束决策过程的质性研究
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摘要
目的探讨ICU护士对患者实施身体约束的决策过程。方法对12名ICU护士进行半结构式深度访谈,对资料进行整理与分析,提取主题。结果析出身体约束决策过程主题的11个类属,包括风险预见、替代方案选择、身体约束意向、身体约束实施、身体约束反思、身体约束合理化6个决策阶段,患者、护士、家属、管理4个原因要素,安全1个结果目标。结论身体约束的实施是一系列复杂的决策过程,受多种因素共同影响。本研究结果可供制定患者身体约束干预措施和相关管理参考。
Objective To explore nurses' decision-making process in physical restraint use for ICU patients.Methods In-depth semi-structured interviews were conducted on 12 ICU nurses,then data were transcribed and analyzed to identify themes.Results Eleven categories reflecting decision-making process in physical restraint use were identified,including 6 decision-making stages of risk prediction,alternative selection,physical restraint intention,implementation,reflection and rationalization,4 influencing factors of patients,nurses,family members and management,and 1 outcome objective of safety.Conclusion Nurses' decision-making in physical restraint use is complicated and affected by multiple factors.The study results provide references for targeted intervention and management.
Objective To explore nurses' decision-making process in physical restraint use for ICU patients.Methods In-depth semi-structured interviews were conducted on 12 ICU nurses,then data were transcribed and analyzed to identify themes.Results Eleven categories reflecting decision-making process in physical restraint use were identified,including 6 decision-making stages of risk prediction,alternative selection,physical restraint intention,implementation,reflection and rationalization,4 influencing factors of patients,nurses,family members and management,and 1 outcome objective of safety.Conclusion Nurses' decision-making in physical restraint use is complicated and affected by multiple factors.The study results provide references for targeted intervention and management.
引文
[1]Kandeel N A,Attia A K.Physical restraints practice in adult intensive care units in Egypt[J].Nurs Health Sci,2013,15(1):79-85.
[2]潘燕彬,江智霞,张晶晶,等.身体约束护患体验的研究进展[J].护理学杂志,2017,32(20):104-106.
[3]Bellenger E,Ibrahim J E,Bugeja L,et al.Physical restraint deaths in a 13-year national cohort of nursing home residents[J].Age Ageing,2017,46(4):688-693.
[4]Berzlanovich A M,Sch9pfer J,Keil W.Deaths due to physical restraint[J].Deutschrztebl Int,2012,109(3):27-32.
[5]Rakhmatullina M,Taub A,Jacob T.Morbidity and mortality associated with the utilization of restraints[J].Psychiatr Q,2013,84(4):499-512.
[6]Bellenger E N,Ibrahim J E,Lovell J J,et al.The nature and extent of physical restraint-related deaths in nursing homes:a systematic review[J].J Aging Health,2018,30(7):1042-1061.
[7]Gallinagh R,Slevin E,McCormack B.Side rails as physical restraints in the care of older people:a management issue[J].J Nurs Manag,2002,10(5):299-306.
[8]崔金锐,陈英.护理敏感性质量指标研究进展[J].护理学杂志,2014,29(12):88-91.
[9]Hurlock-Chorostecki C,Kielb C.Knot-So-Fast:a lear-ning plan to minimize patient restraint in critical care[J].Dynamics,2006,17(3):12-18.
[10]李黎明,宋葆云,吕欢,等.国外住院患者身体约束使用指征的研究进展[J].中国护理管理,2014,14(10):1016-1018.
[11]凯西·卡麦兹.建构扎根理论:质性研究实践指南[M].边国英,译.重庆:重庆大学出版社,2016:55-154.
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[13]彭茜,庄贵军.行为合理化对销售人员灰色营销行为倾向的影响[J].管理科学,2012,25(1):55-65.
[14]孙璇,王荣,代秀珍,等.两种类型ICU谵妄老年患者的护理[J].护理学杂志,2012,27(22):36-37.
[15]Rose L,Burry L,Mallick R,et al.Prevalence,risk factors,and outcomes associated with physical restraint use in mechanically ventilated adults[J].J Crit Care,2016,31(1):31-35.
[16]Barr J,Fraser G L,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.
[17]Goethals S,Dierckx De CasterléB,Gastmans C.Nurses'decision-making process in cases of physical restraint in acute elderly care:a qualitative study[J].Int J Nurs Stud,2013,50(5):603-612.
[18]Li X,Fawcett T N.Clinical decision making on the use of physical restraint in intensive care units[J].Int J Nurs Sci,2014,1(4):446-450.
[19]李广海,陈通.现代决策的基石:理性与有限理性研究述评[J].统计与决策,2008(3):49-52.
[20]李佳星,任之珺,张紫君,等.缩减约束方案对预防ICU气管插管非计划性拔管的效果研究[J].中华护理杂志,2017,52(5):549-553.
[21]姚秋近,张一,张瑜,等.定向力评定在神经外科重症监护病房患者解除身体约束中的应用[J].中华护理杂志,2017,52(11):1327-1329.
[2]潘燕彬,江智霞,张晶晶,等.身体约束护患体验的研究进展[J].护理学杂志,2017,32(20):104-106.
[3]Bellenger E,Ibrahim J E,Bugeja L,et al.Physical restraint deaths in a 13-year national cohort of nursing home residents[J].Age Ageing,2017,46(4):688-693.
[4]Berzlanovich A M,Sch9pfer J,Keil W.Deaths due to physical restraint[J].Deutschrztebl Int,2012,109(3):27-32.
[5]Rakhmatullina M,Taub A,Jacob T.Morbidity and mortality associated with the utilization of restraints[J].Psychiatr Q,2013,84(4):499-512.
[6]Bellenger E N,Ibrahim J E,Lovell J J,et al.The nature and extent of physical restraint-related deaths in nursing homes:a systematic review[J].J Aging Health,2018,30(7):1042-1061.
[7]Gallinagh R,Slevin E,McCormack B.Side rails as physical restraints in the care of older people:a management issue[J].J Nurs Manag,2002,10(5):299-306.
[8]崔金锐,陈英.护理敏感性质量指标研究进展[J].护理学杂志,2014,29(12):88-91.
[9]Hurlock-Chorostecki C,Kielb C.Knot-So-Fast:a lear-ning plan to minimize patient restraint in critical care[J].Dynamics,2006,17(3):12-18.
[10]李黎明,宋葆云,吕欢,等.国外住院患者身体约束使用指征的研究进展[J].中国护理管理,2014,14(10):1016-1018.
[11]凯西·卡麦兹.建构扎根理论:质性研究实践指南[M].边国英,译.重庆:重庆大学出版社,2016:55-154.
[12]巴尼G·格拉泽.扎根理论研究概论:自然呈现与生硬促成[M].费小冬,译.Mill Valley:Sociology Press,2009:5-108.
[13]彭茜,庄贵军.行为合理化对销售人员灰色营销行为倾向的影响[J].管理科学,2012,25(1):55-65.
[14]孙璇,王荣,代秀珍,等.两种类型ICU谵妄老年患者的护理[J].护理学杂志,2012,27(22):36-37.
[15]Rose L,Burry L,Mallick R,et al.Prevalence,risk factors,and outcomes associated with physical restraint use in mechanically ventilated adults[J].J Crit Care,2016,31(1):31-35.
[16]Barr J,Fraser G L,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.
[17]Goethals S,Dierckx De CasterléB,Gastmans C.Nurses'decision-making process in cases of physical restraint in acute elderly care:a qualitative study[J].Int J Nurs Stud,2013,50(5):603-612.
[18]Li X,Fawcett T N.Clinical decision making on the use of physical restraint in intensive care units[J].Int J Nurs Sci,2014,1(4):446-450.
[19]李广海,陈通.现代决策的基石:理性与有限理性研究述评[J].统计与决策,2008(3):49-52.
[20]李佳星,任之珺,张紫君,等.缩减约束方案对预防ICU气管插管非计划性拔管的效果研究[J].中华护理杂志,2017,52(5):549-553.
[21]姚秋近,张一,张瑜,等.定向力评定在神经外科重症监护病房患者解除身体约束中的应用[J].中华护理杂志,2017,52(11):1327-1329.