精神科保护性约束实施及解除专家共识的临床适用性及实施情况调查分析

doi:10.3761/j.issn.0254-1769.2025.11.012

中华护理杂志 ›› 2025, Vol. 60 ›› Issue (11): 1359-1365.DOI: 10.3761/j.issn.0254-1769.2025.11.012

精神科保护性约束实施及解除专家共识的临床适用性及实施情况调查分析

谷嘉宁(), 许冬梅, 邵静(), 高静, 蔡壮, 屈燕花, 叶晓露, 张梦倩, 梅冬里, 张燕红, 杨波, 程艮, 王丽娜, 叶君荣, 林瑞月, 周永玲, 马润娟

100096 北京市北京回龙观医院临床心理科（谷嘉宁，张梦倩），护理部（许冬梅，邵静，屈燕花，叶晓露），康复科（高静），临床五科（蔡壮），临床四科（梅冬里）；南京医科大学附属脑科医院护理部（张燕红）；重庆市精神卫生中心护理部（杨波）；首都医科大学附属北京安定医院护理部（程艮）；河北省精神卫生中心护理部（王丽娜）；广州医科大学附属脑科医院护理部（叶君荣）；厦门市仙岳医院急性病房（林瑞月）；宁夏回族自治区宁安医院护理部（周永玲）；云南省精神病医院护理部（马润娟）

收稿日期:2024-10-08 出版日期:2025-06-10 发布日期:2025-06-03
通讯作者: 邵静，E-mail：shaojing0901@163.com
作者简介:谷嘉宁：女，硕士，主管护师，E-mail：gjn0805@163.com
基金资助:
北京市医院管理中心“培育计划”(PX2022078);北京市卫健委高层次公共卫生技术人才项目(学科骨干-02-08)

Analysis of clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry

GU Jianing(), XU Dongmei, SHAO Jing(), GAO Jing, CAI Zhuang, QU Yanhua, YE Xiaolu, ZHANG Mengqian, MEI Dongli, ZHANG Yanhong, YANG Bo, CHENG Gen, WANG Lina, YE Junrong, LIN Ruiyue, ZHOU Yongling, MA Runjuan

Received:2024-10-08 Online:2025-06-10 Published:2025-06-03

摘要/Abstract

摘要：

目的了解“精神科保护性约束实施及解除专家共识”（简称“约束共识”）的临床适用性及实施情况，为促进精神科保护性约束规范化及更新共识内容提供参考。方法 2024年6月15日—7月15日，采用便利抽样法，对30个省份480所医院的8 364名护士进行问卷调查，采用指南临床适用性评价工具（2.0版）及自行编制的约束共识临床实施情况调查问卷进行调查。结果共回收有效问卷7 844份，有效问卷回收率为93.78%。临床适用性评分结果显示，约束共识可获得性评分最低（64.72%），可接受性评分最高（76.74%），是否接受过培训及所在医院等级是各维度评分的主要影响因素（P<0.05）。4 774名（87.42%）护士认为应用约束共识有助于提升约束操作的规范性。约束共识的安全率为79.51%，经济比率为76.87%。1 739名（22.17%）护士认为约束共识存在实施障碍。结论约束共识临床适用性整体较好，其应用有助于提高护士临床操作的规范性。未来应提高约束共识的推广及培训力度，根据医疗机构特点制订分层推广策略，并不断提高约束共识的证据质量，从而改善其临床应用效果。

关键词: 约束, 专家共识, 临床适用性, 问卷调查, 精神科护理

Abstract:

Objective To understand the clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry，and to provide references for promoting the standardized practice of psychiatric protective restraints and updating the consensus. Methods By the convenience sampling method，a questionnaire survey was conducted among nurses from 480 hospitals in 30 provinces from June 15 to July 15，2024. The survey was conducted using the instrument for evaluating clinical applicability of guide-lines（version 2.0） and a self-compiled questionnaire on the clinical implementation of the restraint consensus. Results A total of 7，844 valid questionnaires were collected，with a valid questionnaire recovery rate of 93.78%. The results of clinical applicability scoring showed that the consensus had the lowest availability score（64.72%） and the highest acceptability score（76.74%）. The results showed that nurses’ receiving training and the level of their hospitals were the main influencing factors for scores in various dimensions（P<0.05）. 4，774 participants（87.42%） believed that the application of consensus could enhance the standardization of nurses’ restraint operations. The safety rate of the restraint consensus was 79.51%，and the economic ratio was 76.87%. Among the evaluators，1，739 （22.17%） believed that there were implementation obstacles in the consensus. Conclusion The clinical applicability of the consensus is relatively good，and the application of the consensus helps to improve the standardization of clinical operations. In the future，efforts should be made to strengthen the promotion and training of the consensus，develop hierarchical promotion strategies according to the characteristics of medical institutions，and improve the quality of evidence for the consensus，so as to further enhance the clinical application effect of the consensus.

Key words: Restraint, Expert Consensus, Clinical Applicability, Questionnaire, Psychiatric Nursing

谷嘉宁, 许冬梅, 邵静, 高静, 蔡壮, 屈燕花, 叶晓露, 张梦倩, 梅冬里, 张燕红, 杨波, 程艮, 王丽娜, 叶君荣, 林瑞月, 周永玲, 马润娟. 精神科保护性约束实施及解除专家共识的临床适用性及实施情况调查分析[J]. 中华护理杂志, 2025, 60(11): 1359-1365.

GU Jianing, XU Dongmei, SHAO Jing, GAO Jing, CAI Zhuang, QU Yanhua, YE Xiaolu, ZHANG Mengqian, MEI Dongli, ZHANG Yanhong, YANG Bo, CHENG Gen, WANG Lina, YE Junrong, LIN Ruiyue, ZHOU Yongling, MA Runjuan. Analysis of clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry[J]. Chinese Journal of Nursing, 2025, 60(11): 1359-1365.

图/表 3

表1 调查对象的一般资料（n=7 844）

Table 1 General information on participants（n=7 844）

表2 自变量赋值方式

Table 2 Assignment methods of independent variables

表3 约束共识临床适用性多元线性回归分析（n=7 844）

Table 3 Multiple liner regression analysis of clinical applicability evaluation ofrestraint consensus（n=7 844）

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精神科保护性约束实施及解除专家共识的临床适用性及实施情况调查分析

Analysis of clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry

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