Purpose: The aim of this study was to illuminate the connotation of “dilemma” regarding the use of physical restraint on elderly patients as represented by female nurses working in general wards at community hospita...Purpose: The aim of this study was to illuminate the connotation of “dilemma” regarding the use of physical restraint on elderly patients as represented by female nurses working in general wards at community hospitals who also live with elderly adults at home. Method: The study used the questionnaire method with an independently prepared questionnaire. Participants: The objective of the study was explained to the persons in charge of nursing in the selected 17 hospitals, and 1929. Finally, this study of participants were 524 female nurses working in general 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units) at community hospitals who also live with elderly adults at home. Results and conclusions: Cronbach’s overall coefficient for the 20 items of dilemma was high (0.78) and the factor analysis extracted four dilemma factors as having a characteristic value of 1 (Kaiser-Meyer-Olkin measure value = 0.81) with a cumulative contribution ratio of 64.5%. The high Cronbach’s for these items (0.86, 0.88, 0.87 and 0.81) confirmed the internal consistencies. With respect to the dilemma where nurses working in general wards at community hospitals who also live with elderly adults at home are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: accomplishment of medical-treatment and accident prevention, characteristic features in nursing for elderly patients with dementia, healthcare professional relationship in nursing for elderly patients with dementia, and priorities on the accident prevention for elderly patients with dementia. Therefore, the construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to: (i) institution of policies to encourage discussion between nurses and other medical staff to reach consensus on treatment;(ii) allocating elderly care specialists to wards to promote alternatives to restraints;(iii) establishment of safety standards to define nurses’ responsibilities;and (iv) institution of continuous ethical education for nurses.展开更多
目的通过系统评价和Meta分析明确ICU患者使用身体约束的影响因素。方法计算机检索PubMed、EmBase、The Cochrane Library、Web of Science、CINAHL、中国知网、万方、维普、中国生物医学文献数据库,检索时限均为建库至2022年5月。由2名...目的通过系统评价和Meta分析明确ICU患者使用身体约束的影响因素。方法计算机检索PubMed、EmBase、The Cochrane Library、Web of Science、CINAHL、中国知网、万方、维普、中国生物医学文献数据库,检索时限均为建库至2022年5月。由2名研究人员独立筛选文献、提取资料及评价偏倚风险后,对ICU患者身体约束的影响因素进行描述性分析,并采用RevMan 5.3软件进行Meta分析。结果共纳入17篇文献,样本量合计6090例。描述性分析结果显示:共发现31项与ICU患者使用身体约束相关的影响因素;Meta分析结果显示:轻度意识障碍(OR=3.31,95%CI:1.84~5.97)、中度意识障碍(OR=13.10,95%CI:6.55~26.18)、谵妄(OR=6.50,95%CI:4.19~10.08)、使用镇静药物(OR=2.39,95%CI:1.40~4.09)、机械通气(OR=5.48,95%CI:2.62~11.44)是ICU患者身体约束的危险因素。结论轻度意识障碍、中度意识障碍、谵妄、使用镇静药物、机械通气是ICU患者使用身体约束的独立危险因素。受纳入研究数量和质量的限制,其他影响因素仍需高质量的研究予以验证。展开更多
文摘Purpose: The aim of this study was to illuminate the connotation of “dilemma” regarding the use of physical restraint on elderly patients as represented by female nurses working in general wards at community hospitals who also live with elderly adults at home. Method: The study used the questionnaire method with an independently prepared questionnaire. Participants: The objective of the study was explained to the persons in charge of nursing in the selected 17 hospitals, and 1929. Finally, this study of participants were 524 female nurses working in general 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units) at community hospitals who also live with elderly adults at home. Results and conclusions: Cronbach’s overall coefficient for the 20 items of dilemma was high (0.78) and the factor analysis extracted four dilemma factors as having a characteristic value of 1 (Kaiser-Meyer-Olkin measure value = 0.81) with a cumulative contribution ratio of 64.5%. The high Cronbach’s for these items (0.86, 0.88, 0.87 and 0.81) confirmed the internal consistencies. With respect to the dilemma where nurses working in general wards at community hospitals who also live with elderly adults at home are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: accomplishment of medical-treatment and accident prevention, characteristic features in nursing for elderly patients with dementia, healthcare professional relationship in nursing for elderly patients with dementia, and priorities on the accident prevention for elderly patients with dementia. Therefore, the construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to: (i) institution of policies to encourage discussion between nurses and other medical staff to reach consensus on treatment;(ii) allocating elderly care specialists to wards to promote alternatives to restraints;(iii) establishment of safety standards to define nurses’ responsibilities;and (iv) institution of continuous ethical education for nurses.
