Influence of a graded nursing model based on quantitative risk assessment on protective restraint of psychiatric patients

doi:10.3761/j.issn.0254-1769.2023.11.006

Abstract

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

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

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.

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.

Figures/Tables 4

References 31

[1]	蔡壮, 许冬梅, 高静, 等. 精神科保护性约束实施及解除专家共识[J]. 中华护理杂志, 2022, 57(2):146-151. DOI URL
	Cai Z, Xu DM, Gao J, et al. Expert consensus on the implementation and removal of protective restraints in psychiatry[J]. Chin J Nurs, 2022, 57(2):146-151. DOI URL
[2]	中华护理学会精神卫生专业委员会. 精神科住院抑郁症患者自杀预防及护理干预措施专家共识[J]. 中华护理杂志, 2022, 57(18):2181-2185.
	Mental Health Professional Committee of Chinese Nursing Association. Expert consensus of suicide care interventions for psychiatric inpatients with depression[J]. Chin J Nurs, 2022, 57(18):2181-2185.
[3]	Chieze M, Hurst S, Kaiser S, et al. Effects of seclusion and restraint in adult psychiatry:a systematic review[J]. Front Psychiatry, 2019, 10:491. DOI PMID
[4]	Cusack P, Cusack FP, McAndrew S, et al. An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings[J]. Int J Ment Health Nurs, 2018, 27(3):1162-1176. DOI URL
[5]	Khatib A, Ibrahim M, Roe D. Rebuilding trust after physical restraint during involuntary psychiatric hospitalization[J]. Arch Psychiatr Nurs, 2018, 32(3):457-461. DOI URL
[6]	Beghi M, Peroni F, Gabola P, et al. Prevalence and risk factors for the use of restraint in psychiatry:a systematic review[J]. Riv Psichiatr, 2013, 48(1):10-22.
[7]	Staggs VS. Trends in use of seclusion and restraint in response to injurious assault in psychiatric units in U.S. hospitals,2007-2013[J]. Psychiatr Serv, 2015, 66(12):1369-1372. DOI URL
[8]	彭建燕, 吴冬梅, 杨海军, 等. 精神疾病患者保护性约束使用的现况调查[J]. 上海护理, 2021, 21(5):43-45.
	Peng JY, Wu DM, Yang HJ, et al. Investigation on status quo of protective constraint in psychiatric patients[J]. Shanghai Nurs, 2021, 21(5):43-45.
[9]	刘风兰, 朱艳玲, 缪志梅, 等. 项目管理在住院精神疾病患者约束中的应用效果[J]. 中华现代护理杂志, 2017, 23(19):2499-2502.
	Liu FL, Zhu YL, Miao ZM, et al. Application of project management to reduce the effects of physical restraint for psychiatric inpatients[J]. Chin J Mod Nurs, 2017, 23(19):2499-2502.
[10]	马莹, 叶君荣, 黄昭君, 等. 基于循证构建精神科护理质量敏感性指标[J]. 护理学报, 2020, 27(9):27-32.
	Ma Y, Ye JR, Huang ZJ, et al. Construction of evidence-based sensitive indicators of psychiatric nursing quality[J]. J Nurs China, 2020, 27(9):27-32.
[11]	邵静, 罗薇, 耿丽弟, 等. 精神科专科护理质量敏感性指标体系的构建[J]. 中国护理管理, 2021, 21(6):931-936.
	Shao J, Luo W, Geng LD, et al. Construction of sensitive quality index system of psychiatric nursing[J]. Chin Nurs Manag, 2021, 21(6):931-936.
[12]	吴欣娟, 李玉乐, 谢瑶洁. 我国分级护理实施现状及建议[J]. 中国护理管理, 2008, 8(2):5-7.
	Wu XJ, Li YL, Xie YJ. Present situation and suggestions of graded nursing in China[J]. Chin Nurs Manag, 2008, 8(2):5-7.
[13]	Korkeila H, Koivisto AM, Paavilainen E, et al. Psychiatric nurses’ emotional and ethical experiences regarding seclusion and restraint[J]. Issues Ment Health Nurs, 2016, 37(7):464-475. DOI URL
[14]	Muir-Cochrane EC, Baird J, McCann TV. Nurses’ experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units:a qualitative study[J]. J Psychiatr Ment Health Nurs, 2015, 22(2):109-115. DOI URL
[15]	马昌凤, 钱一平, 顾康莹, 等. 基于综合量化风险评估策略的分级管理在精神科住院患者中的应用[J]. 中华现代护理杂志, 2022, 28(13):1769-1772.
	Ma CF, Qian YP, Gu KY, et al. Effects of hierarchical management based on comprehensive quantitative risk assessment in psychiatric inpatients[J]. Chin J Mod Nurs, 2022, 28(13):1769-1772.
[16]	张沥支. 精神分裂症康复期患者护理人文关怀需求现状调查及干预效果评价[D]. 青岛: 青岛大学, 2020.
	Zhang LZ. Investigation on the current sitpation of humanistic care needs of patients with schizophrenia in rehabilitation period and the evaluation of intervention effect[D]. Qingdao: Qingdao University, 2020.
[17]	Velo Higueras M, et al. Fajardo Galván D,Cruces González M, International development cooperation from the D. Orem self-care theory[J]. Rev Enferm, 2013, 36(5):48-51. PMID
[18]	王玉秀. 基于HACCP的精神科高危患者护理风险评估汇总表的设计与应用[J]. 中华现代护理杂志, 2016, 22(18):2611-2614.
	Wang YX. Design and application of the risk-assessment summary sheet based on HACCP for psychiatric high-risk patient[J]. Chin J Mod Nurs, 2016, 22(18):2611-2614.
[19]	陈月新, 叶敏捷, 季显琼, 等. 护士用自杀风险评估量表(NGASR)在住院精神分裂症患者中应用的信效度研究[J]. 中国民康医学, 2011, 23(3):271-273.
	Chen YX, Ye MJ, Ji XQ, et al. Validity and reliability of Nurses’ Global Assessment of Suicide Risk(NGASR) for schizophrenia inpatients[J]. Med J Chin People’s Health, 2011, 23(3):271-273.
[20]	吴宇飞, 孙秀丽, 李媛媛, 等. 中文版布罗塞特暴力风险评估量表的效度和信度检验[J]. 中国心理卫生杂志, 2015, 29(6):446-451.
	Wu YF, Sun XL, Li YY, et al. Validity and reliability of the Chinese-version of the Brøset Violence Checklist[J]. Chin Ment Health J, 2015, 29(6):446-451.
[21]	Cutcliffe JR, Barker P. The Nurses’ Global Assessment of Suicide Risk(NGASR):developing a tool for clinical practice[J]. J Psychiatr Ment Health Nurs, 2004, 11(4):393-400. DOI URL
[22]	Linaker OM, Busch-Iversen H. Predictors of imminent violence in psychiatric inpatients[J]. Acta Psychiatr Scand, 1995, 92(4):250-254. DOI URL
[23]	Almvik R, Woods P. The Brøset violence checklist(BVC) and the prediction of inpatient violence:some preliminary results[J]. Psychiatr Care, 1998, 5(6):208-211.
[24]	李小妹. 精神科护理学[M]. 北京: 人民卫生出版社, 2006.
	Li XM. Psychiatric nursing[M]. Beijing: People’s Medical Publishing House, 2006.
[25]	古玮娜, 张凌芳, 张冬红. 保护性约束微视频在精神科低年资护士技能培训中的应用[J]. 中华护理杂志, 2018, 53(4):477-481.
	Gu WN, Zhang LF, Zhang DH. Application of protective restrain microvideo in the skill training of psychiatric low qualification nurses[J]. Chin J Nurs, 2018, 53(4):477-481.
[26]	王菲. 基于需求导向的老年护理服务对象分级模型研究[D]. 上海: 复旦大学, 2013.
	Wang F. Long-term care needs-based hierarchical recipients model[D]. Shanghai: Fudan University, 2013.
[27]	朱伟玉, 徐美英, 范振国, 等. 精神科分级护理量化标准的探讨[J]. 中国实用护理杂志, 2012, 28(7):16-18.
	Zhu WY, Xu MY, Fan ZG, et al. Discussion of quantitative criteria of grading nursing in psychiatric department[J]. Chin J Pract Nurs, 2012, 28(7):16-18.
[28]	Xu L, Zhang Y. Grading nursing care study in integrated medical and nursing care institution based on two-stage gray synthetic clustering model under social network context[J]. Int J Environ Res Public Health, 2022, 19(17):10863. DOI URL
[29]	沈小琴, 张丞, 刘若楠. 双相情感障碍患者内分泌代谢状况与冲动攻击行为的相关性[J]. 神经疾病与精神卫生, 2021, 21(1):15-20,77.
	Shen XQ, Zhang C, Liu RN. Correlation between endocrine metabolism and impulsive aggressive behavior in patients with bipolar disorder[J]. J Neurosci Ment Health, 2021, 21(1):15-20,77.
[30]	郝军锋, 王美. 具有攻击行为的强制性住院治疗精神病患者临床特征的调查研究[J]. 广州医科大学学报, 2019, 47(1):107-111.
	Hao JF, Wang M. Investigation of clinical characteristics in psychiatric patients with aggressive behaviors requiring mandatory hospitalization[J]. Acad J Guangzhou Med Univ, 2019, 47(1):107-111.
[31]	袁水莲, 伍振红, 张倩, 等. 人类职能模式康复训练对精神分裂症患者自我效能及病耻感的干预效果[J]. 中华护理杂志, 2022, 57(2):158-164. DOI URL
	Yuan SL, Wu ZH, Zhang Q, et al. Intervention effects of rehabilitation training of mode of human occupation on self-efficacy and stigma of schizophrenia patients[J]. Chin J Nurs, 2022, 57(2):158-164. DOI URL