精神专科医院保护性约束的使用及护理策略

The Use of Protective Restraint in Psychiatric Hospital and Nursing Strategy

目的调查保护性约束在精神专科医院中的使用特点及其相关影响因素,探讨有效的护理策略。方法对连续入院的260名精神障碍患者进行问卷调查,内容包括社会人口学和保护性约束相关问题等。结果保护性约束使用率31.9%,其中39.8%为首次住院患者,79.5%为入院当天被约束。因攻击、外跑及拒绝治疗而被保护性约束的占总体被约束患者的91.5%,出院时92.7%被约束隔离过的患者认为当时的处置是必要的。被保护性约束的患者诊断集中分布于重性精神障碍。被保护性约束持续时间平均为(6.6±5.3)h,其中日间约束持续时间平均为(3.7±3.6)h,夜间约束持续时间平均为(10.3±1.4)h。32.9%被保护性约束患者夜间约束持续时间大于10 h。结论我国精神科病房保护性约束使用率仍有下降空间,需重视规范流程。护理人员应加强培训,在使用过程中更要严把使用指征,熟练使用技巧,通过对流程和使用工具的改进来保证患者安全的同时提高患者舒适度,降低护理风险。

Objective To investigate the characteristics of protective constraint, and make out its usage and relevant factors in the psychiatric wards. And discuss the nursing strategy. Methods The study included a＇consecutively assessed sample of 260 psychiatric inpatients. Social demographic, clinical data, PR-related problems and so on were collected from the medical records using a form designed for thisstudy and confirmed via interview. Results The frequency of PR was 31.9% in the whole sample. 39.8% accepted the first hospitalization constraint, 79.5% were constrained in the day of admission. 91.5% of PR was due to aggressive behavior, escape behavior and refusal of treatment. 92.7% considered PR was appropriate on discharge. The average segment duration of protective constraint was （6.6±5.3） h, where the average day-time was （3.7±3.6） h, the average night-time was （10.3±1.4） h, 32.9% patients night constrained duration〉10 h. Conclusion The use of protective restraint may still further decline. Management should focus on regulating the process of protective restraint, further to control the usage. Nurses shall clearly grasp the use of indications,and improve the skills, through the improvement of processes and the tools to ensure patient safety and comfort.