保护性约束在精神科患者中的使用特征及护理分析

Protective Restraint in the Use of Psychiatric Patients with Analysis of Characteristics and Nursing

目的:分析保护性约束在精神科患者中的使用特征和临床护理措施,探讨管理对策。方法:选取2014年3月-2015年3月在本院接受治疗和保护性约束的120例精神科患者作为研究对象,对其病历资料进行回顾性分析,调查接受保护性约束患者的年龄、诊断情况、接受保护性约束的原因、持续时段、部位、时间、并发症发生情况、住院天数等信息。结果:120例患者中,114例(95.0%)使用保护性约束,其中102例(89.47%)为首次住院约束;46例(40.35%)为入院当天约束;42例(36.84%)为入院前7 d约束;26例(22.81%)入院7 d后约束。保护性约束持续时间段平均为6.2 h,其中日间约束持续时间段平均为3.69 h,夜间约束持续时间段平均为9.83 h。33例患者夜间约束持续时间>10 h,占约束总例数28.95%。约束原因包括:损物、伤人43例,治疗不配合21例,行为乱38例,意识障碍12例。约束工具为约束带,约束方式主要为床上肢体功能位的约束。结论:保护性约束的使用率仍有进一步下降的趋势。保护性约束的管理重点在于规范其使用流程,进一步控制使用率。护理人员在使用的过程中要明确掌握使用指征,提高使用技能,通过对流程和使用工具的改善来保证患者的安全,并提高舒适度。

Objective：To analyze the use of protective constraint characteristics and clinical care measures in psychiatric patients,and to probe management strategies.Method：120 cases of psychiatric in our hospital for treatment and protection of constraints from March 2014 to March 2015 were selected as research subjects.We conducted a retrospective analysis of medical records,and patient＇s age,diagnosis,reasons for accepting the constraint protection,sustained period of time,location,time,occurrence of complications,length of stay and number of days information were analyzed.Result：To 120 patients,114 cases（ 95.0%）used protective constraint,102 cases（ 89.47%）accepted the first hospitalization constraint,46 cases（ 40.35%）were constrained in the day of admission,42 cases（ 36.84%） within 7 d after admission,26 cases（ 22.81%）after 7 d after admission;The average segment duration of protective constraint was 6.2 h,where the average daytime was 3.69 h,the average nighttime was 9.83 h,33 patients＇ night constrained duration10 h, accounting for 28.95% of constraint cases.Constraint causes：damaging, wounding 43 cases,incoordination with treatment 21 cases,behavior disorder 38 cases,disturbance of consciousness 12 cases.The main constraint tool was restraint strap, constraint way for bed limb function.Conclusion：The protective restraint usage still further decline.Management focus on the protection of the constraints is to regulate the use of the process,further to control the usage.Nurses shall clearly grasp the use of indications,and improve the skills,through the improvement of processes and the use of tools to ensure patient＇s safety and comfort.