Abstract:

Objective To form an expert consensus on the implementation and removal of psychiatric protective restraints,and to standardize the related contents of the implementation and removal of psychiatric protective restraints. Methods According to the level of evidence,the evidence-based method was used to retrieve,evaluate and summarize the evidence in the field. The recommendations and research conclusions for the implementation and removal of the psychiatric medical protective restraints were extracted,and the rough consensus was formed. Through 2 rounds of enquiry and 2 experts discussion meetings,the final version of the consensus was formed by combining with the expert opinions,adjusting,modifying and perfecting the first draft. Results The positive coefficients of experts in the 2 rounds of correspondence consultation were 100%;the degree of authority of experts was 0.90;the mean value of importance of each index was>3.5,and the coefficient of variation was less than 0.25,and the expert Kendall harmony coefficient was 0.146 and 0.166,respectively （all P<0.01）. Finally,a consensus was reached on the recommendation of 10 parts,including the application group of psychiatric restraints,premise and principle,objective,key points of assessment,basic requirements,record sheet,flow chart,intervention strategies in the implementation process,ethical issues and risks,and suggestions. Conclusion The consensus provides guidance for the practice of psychiatric protective restraints and makes psychiatric restraints more standardized.

Key words: Restraint, Psychiatry, Mental Disorders, Psychiatric Nursing, Expert Consensus

摘要：

目的 形成《精神科保护性约束实施及解除专家共识》,规范精神科保护性约束实施及解除的相关内容。方法 运用循证方法,按照证据级别高低,检索、评价和汇总该领域的证据,提取精神科保护性约束实施及解除的推荐建议和研究结论,形成共识初稿,通过2轮专家函询及2次专家论证会,结合专家意见,对初稿进行调整、修改和完善,形成共识终稿。结果 2轮函询专家积极系数均为100%,专家权威程度均为0.90,各指标重要性赋值均数均>3.5分,且变异系数均<0.25,专家肯德尔和谐系数分别为0.146和0.166（均P<0.01）。最终对精神科保护性约束应用人群、前提与原则、目的、评估要点、基本要求、记录表、流程图、实施过程中的干预策略、伦理问题及风险、建议共10个部分的推荐意见达成一致。结论 该共识为精神科保护性约束的实践提供指导依据,可使精神科保护性约束行为更规范。

关键词: 约束, 精神科, 精神障碍, 精神病护理学, 专家共识