ICU患者身体约束缩减管理方案的构建研究

Study on the construction of constraint reduction management scheme for ICU patients

目的基于循证理论构建科学、实用的ICU患者身体约束缩减管理方案,为实施身体约束提供科学、可操作性强的理论依据。方法通过证据综合和小组讨论,初步拟定ICU患者身体约束缩减管理方案;通过德尔菲法对构建的ICU患者身体约束缩减管理方案进行2轮函询,对指标进行修改和筛选,并结合层次分析法确定各指标的权重。结果第1轮函询27名专家,问卷有效回收率为92.6%;第2轮函询25名专家,问卷有效回收率为96.0%。2轮函询专家权威系数分别为0.862和0.823,肯德尔和谐系数分别为0.371和0.418(P<0.001),最终形成ICU患者身体约束缩减方案,包括6项一级指标(组织结构、约束评估、约束替代、约束流程、约束等级、中止约束)、36项二级指标。结论基于循证理论和德尔菲法构建的ICU患者身体约束缩减管理方案科学、可靠,可以为今后的ICU患者身体约束提供参考。

Objective To construct a scientific and practical restraint reduction program for ICU patients based on evidence-based theory,and provide a scientific and operable theoretical basis for the implementation of physical restraint in clinical practice.Methods Through evidence synthesis and group discussion,the restraint reduction program of ICU patients was initially formulated.Through two rounds of Delphi expert consultation,the indicators were modified and screened,and the weights of the indicators were defined through analytic hierarchy process.Results In the first round,27 experts were consulted,and the effective recovery rate was 92.6%;in the second round,25 experts were consulted,and the effective recovery rate was 96.0%.For both rounds,the expert authority coefficient were 0.862 and 0.823,the Kendall harmony coefficient were 0.371 and 0.418(P<0.001).Finally,a constraint reduction scheme for ICU patients was formed,including 6 primary indicators(organizational structure,constraint assessment,constraint substitution,constraint process,constraint level,and termination of constraint)and 36 secondary indicators.Conclusion Based on evidence-based theory and Delphi method,the restraint reduction program for ICU patients is scientific and reliable,which can provide reference for ICU restraint in the future.