量化风险评估的分级护理模式对精神科患者保护性约束的影响研究

doi:10.3761/j.issn.0254-1769.2023.11.006

摘要/Abstract

摘要：

目的探讨基于量化风险评估的分级护理模式对精神科住院患者保护性约束的影响。方法 2015年4月—2020年1月连续选取北京市某三级甲等精神专科医院抑郁症治疗中心男、女两个病区收治的住院患者为研究对象，其中男病区2016年10月—2018年3月和女病区2018年8月—2020年1月收治的1 891例住院患者为试验组，男病区2015年4月—2016年9月和女病区2017年2月—2018年7月收治的1 712例住院患者为对照组。试验组实施基于量化风险评估的分级护理模式，对照组给予常规风险管理及护理。统计两组住院患者总例数、保护性约束患者的例数及接受约束患者的保护性约束次数，以保护性约束的次数为主要观察指标，观察护理模式、疾病诊断及性别对保护性约束次数的影响。结果试验组保护性约束率（23.22%）低于对照组（26.16%）（P=0.018），试验组的保护性约束次数[3（1，6）次]低于对照组[4（1，8）次]（P=0.024）；不同性别和诊断比较，男性保护性约束次数[4（2，9）次]高于女性[3（1，6）次]（P<0.001），双相情感障碍患者的保护性约束次数[4（2，8）次]高于抑郁症患者[2（1，5）次]（P<0.001）和精神分裂症患者[3（1，6）次]（P=0.018）。结论基于量化风险评估的分级护理模式能降低精神科患者的保护性约束率及次数，保护性约束的使用受到性别与诊断的影响。

关键词: 风险评估与减低, 精神病护理学, 护理评估, 约束, 身体的

Abstract:

Objective To explore the effect of a graded nursing model based on quantitative risk assessment and multidimensional needs on protective restraint of psychiatric inpatients. Methods This study was a retrospective study. We chose inpatients admitted to the depression treatment center of a psychiatric hospital in Beijing from April 2015 to January 2020 as the research subjects. The experimental group was given the graded nursing model based on quantitative risk assessment and multidimensional needs，with a total of 1 891 cases，while the control group was given routine risk management and nursing，with a total of 1 712 cases. We counted the total number of inpatients in the 2 groups，the number of people receiving protective restraint and the number of times each person received protective restraint during hospitalization. Taking the number of protective restraints as the main observation index，we observed the impact of nursing model，disease diagnosis and gender on the number of protective restraints. Results The number and frequency of protective restraints in the experimental group was significantly lower than that in the control group（P=0.018）. In the control group，the number of protective restraints in males was significantly higher than that in females（P=0.005），and the number of protective restraints in patients with bipolar disorder was significantly higher than that in patients with depression and schizophrenia（P<0.001，P=0.018）. Conclusion The graded nursing model based on quantitative risk assessment and multi-dimensional needs can significantly reduce the number and frequency of protective constraints for psychiatric patients，improve the quality and efficiency of clinical nursing in psychiatric departments，and it is worthy of clinical promotion and application.

Key words: Risk Evaluation and Mitigation, Psychiatric Nursing, Nursing Assessment, Restraint, Physical

赵金龙, 赵莹莹, 宗倩倩, 贾琼, 许伟, 吴航, 安凤荣. 量化风险评估的分级护理模式对精神科患者保护性约束的影响研究[J]. 中华护理杂志, 2023, 58(11): 1315-1321.

ZHAO Jinlong, ZHAO Yingying, ZONG Qianqian, JIA Qiong, XU Wei, WU Hang, AN Fengrong. Influence of a graded nursing model based on quantitative risk assessment on protective restraint of psychiatric patients[J]. Chinese Journal of Nursing, 2023, 58(11): 1315-1321.

图/表 4

表1 两组护理分级标准比较

Table 1 Comparison of nursing grading standards of 2 groups

表2 两组干预方法比较

Table 2 Comparison of the 2 nursing models

表3 两组保护性约束患者一般资料比较

Table 3 Statistical analysis of general information of patients

表4 护理模式、性别及诊断对患者保护性约束次数的影响

Table 4 Effects of nursing model, gender, and diagnosis on the number of protective restraints

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