ICU患者身体约束管理系统的构建与应用

doi:10.3761/j.issn.0254-1769.2023.01.007

摘要/Abstract

摘要：

目的构建ICU患者身体约束管理系统并探讨其应用效果。方法组建研究小组，以ICU患者身体约束评估量表为基础，构建ICU患者身体约束管理系统，系统实时采集相关数据，实现患者身体约束决策动态提醒和质量控制。选取2022年1月—6月浙江省某三级甲等医院ICU收治的216例患者为应用对象，比较系统应用后（2022年4月—6月）与应用前（2022年1月—3月）患者身体约束率、约束时长、非计划拔管发生率，并收集护士对该管理系统的满意度。结果 ICU患者身体约束管理系统应用后，身体约束率（35.19%）低于应用前（49.07%），约束时长为45.71（16.41，121.31） h，显著低于对照组126.00（28.05，317.00） h，两组非计划拔管发生率的比较，差异无统计学意义；护士对约束管理系统的满意度得分为（4.56±0.48）分。结论使用ICU患者身体约束管理系统有助于降低患者身体约束使用率，减少约束时长，护士对该系统的满意度较高。

关键词: 重症监护病房, 约束, 身体的, 信息系统, 护理

Abstract:

Objective To develop a physical restraint management system for ICU patients and explore its application effect. Methods A research and development team was established to build a physical restraint management system for ICU patients based on the ICU patient physical restraint assessment scale. The system collects relevant data in real time to realize the functions of dynamic reminder and quality control of patients’ physical restraint decision-making. A total of 216 patients admitted to the ICU of a tertiary A hospital in Zhejiang Province from January 2022 to June 2022 were selected as the research subjects. The patient’s physical restraint rate，length of physical restraint and the incidence of unplanned extubation of the system were compared after application（April to June 2022） and before application（January to March 2022）. The nurses’ satisfaction with the management system was collected. Results After the application of the physical restraint management system for ICU patients，the physical restraint rate was 35.19%，which was significantly lower than 49.07% before application. After the application，the physical restraint time of the patients was 45.71（16.41，121.31） h，which was significantly shorter than 126.00（28.05，317.00） h of the control group. There was no significant difference in the incidence of unplanned extubation between 2 groups. The total average score of ICU nurses’ satisfaction with the system was （4.56±0.48） points. Conclusion The use of the physical restraint management system for ICU patients can help reduce the use rate and duration of physical restraint in patients，and nurses are more satisfied with the system.

Key words: Intensive Care Units, Restraint, Physical, Information System, Nursing Care

张帅, 陈娟红, 全殷殷, 姚惠萍. ICU患者身体约束管理系统的构建与应用[J]. 中华护理杂志, 2023, 58(1): 55-59.

ZHANG Shuai, CHEN Juanhong, QUAN Yinyin, YAO Huiping. Construction and application of a physical restraint management system for ICU patients[J]. Chinese Journal of Nursing, 2023, 58(1): 55-59.

图/表 1

参考文献 16

[1]	许来雨, 彭伶丽, 黄伟红, 等. 皮瓣移植术后血管危象识别与防控管理信息系统的开发及应用研究[J]. 中华护理杂志, 2022, 57(11):1291-1296. DOI
	Xu LY, Peng LL, Huang WH, et al. Development and applica-tion of management information system for recognition and prevention of flap vascular crisis[J]. Chin J Nurs, 2022, 57(11):1291-1296.
[2]	Gu T, Wang X, Deng N, et al. Investigating influencing factors of physical restraint use in China intensive care units:a pro-spective,cross-sectional,observational study[J]. Aust Crit Care, 2019, 32(3):193-198. DOI URL
[3]	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. DOI URL
[4]	Kim K, Han Y, Kim JS. Korean nurses’ ethical dilemmas,pro-fessional values and professional quality of life[J]. Nurs Ethics, 2015, 22(4):467-478. DOI URL
[5]	崔念奇, 甘秀妮, 金静芬, 等. 6项核心策略模型在ICU患者身体约束缩减行动中的应用研究[J]. 中华急危重症护理杂志, 2020, 1(1):24-30.
	Cui NQ, Gan XN, Jin JF, et al. Effects of physical restraint reduction interventions based on 6 core strategies among patients in ICU[J]. Chin J Emerg Crit Care Nurs, 2020, 1(1):24-30.
[6]	汪晖, 尹世玉, 王颖, 等. 保护性约束信息化管理系统的构建及应用[J]. 中华护理杂志, 2019, 54(6):850-854. DOI
	Wang H, Yin SY, Wang Y, et al. The construction and clinical application of information management system for protective restraint[J]. Chin J Nurs, 2019, 54(6):850-854. DOI
[7]	刘静, 潘尧云, 石苗苗, 等. 减少心脏外科ICU成人患者身体约束的护理实践[J]. 中华急危重症护理杂志, 2020, 1(4):323-327.
	Liu J, Pan YY, Shi MM, et al. Nursing practice of physical restraint reduction strategy among adult ICU patients after cardiac surgery[J]. Chin J Emerg Crit Care Nurs, 2020, 1(4):323-327.
[8]	de Jonghe B, Constantin JM, Chanques G, et al. Physical restraint in mechanically ventilated ICU patients:a survey of French practice[J]. Intensive Care Med, 2013, 39(1):31-37. DOI URL
[9]	Lei RB, Jiang XP, Liu Q, et al. Nurse education to reduce physical restraints use in ICU:a scoping review[J]. Nurs Crit Care, 2020:nicc.12557.
[10]	崔念奇, 甘秀妮, 周世群, 等. ICU患者身体约束评估量表的构建及信效度检测[J]. 中华危重症医学杂志(电子版), 2018, 11(2):94-99.
	Cui NQ, Gan XN, Zhou SQ, et al. Construction of physical restraint assessment scale for ICU patients and analysis of its reliability and validity[J]. Chin J Crit Care Med Electron Ed, 2018, 11(2):94-99.
[11]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[12]	罗丹丹, 李娟, 卢敏妮. 儿科护士身体约束知信行调查研究[J]. 全科护理, 2021, 19(7):983-986.
	Luo DD, Li J, Lu MN. Investigation on knowledge,attitude and practice of pediatric nurses’ physical constraints[J]. Chin Gen Pract Nurs, 2021, 19(7):983-986.
[13]	李丽景, 杨献玲. 新型医用约束带在危重症手足口病患儿中的应用效果观察[J]. 护理实践与研究, 2020, 17(12):108-110.
	Li LJ, Yang XL. Observation of the application effect of new medical restraint belt in children patients with critical hand-foot-mouth disease[J]. Nurs Pract Res, 2020, 17(12):108-110.
[14]	赵永信, 顾莺, 张晓波, 等. 基于新D&M模型的《临床护理信息系统有效性评价量表》的编制及信效度评价[J]. 中国实用护理杂志, 2020, 36(7):544-550.
	Zhao YX, Gu Y, Zhang XB, et al. The development of the clinical nursing information system effectiveness evaluation scale based on the new D & M model and the conduct of reliability and validity evaluation[J]. Chin J Pract Nurs, 2020, 36(7):544-550.
[15]	韩艳, 魏丽丽. ICU患者非计划性拔管危险因素及防范措施研究进展[J]. 中华护理杂志, 2015, 50(5):598-602.
	Han Y, Wei LL. Reseach progress on the risk factors and prevention for unplanned extubations in the intensive care unit[J]. Chin J Nurs, 2015, 50(5):598-602.
[16]	向洋, 倪崴莲. 气管插管非计划性拔管预警及决策支持系统的研发与应用[J]. 中华护理杂志, 2022, 57(1):61-65. DOI
	Xiang Y, Ni WL. Development and application of early warning and decision support system for unplanned endotracheal extubation[J]. Chin J Nurs, 2022, 57(1):61-65. DOI