重症监护病房机械约束的使用:特征、应用标准和相关因素。多中心研究结果

IF 1.1 Q3 NURSING
M. Acevedo-Nuevo RN, MsC, PhD , M.C. Martín-Arribas RN, MsC, PhD , M.T. González-Gil RN, PhD , M. Solís-Muñoz RN, MsC, PhD , S. Arias-Rivera RN, MsC , A. Royuela-Vicente PhD
{"title":"重症监护病房机械约束的使用:特征、应用标准和相关因素。多中心研究结果","authors":"M. Acevedo-Nuevo RN, MsC, PhD ,&nbsp;M.C. Martín-Arribas RN, MsC, PhD ,&nbsp;M.T. González-Gil RN, PhD ,&nbsp;M. Solís-Muñoz RN, MsC, PhD ,&nbsp;S. Arias-Rivera RN, MsC ,&nbsp;A. Royuela-Vicente PhD","doi":"10.1016/j.enfi.2021.12.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><p>To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement.</p></div><div><h3>Method</h3><p>Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96<!--> <!-->h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals).</p></div><div><h3>Results</h3><p>A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (<em>P</em> <!-->&lt;<!--> <!-->.001) and with the provision of training for professionals (<em>P</em> <!-->=<!--> <!-->.020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r<!--> <!-->=<!--> <!-->−.431) and in the subgroup of patients with ETT (r<!--> <!-->=<!--> <!-->−.521).</p></div><div><h3>Conclusions</h3><p>Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who <em>may</em> not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.</p></div>","PeriodicalId":43993,"journal":{"name":"Enfermeria Intensiva","volume":"33 4","pages":"Pages 212-224"},"PeriodicalIF":1.1000,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Uso de contenciones mecánicas en unidades de cuidados críticos: caracterización, estándares de aplicación y factores relacionados. Resultados de un estudio multicéntrico\",\"authors\":\"M. Acevedo-Nuevo RN, MsC, PhD ,&nbsp;M.C. Martín-Arribas RN, MsC, PhD ,&nbsp;M.T. González-Gil RN, PhD ,&nbsp;M. Solís-Muñoz RN, MsC, PhD ,&nbsp;S. Arias-Rivera RN, MsC ,&nbsp;A. Royuela-Vicente PhD\",\"doi\":\"10.1016/j.enfi.2021.12.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><p>To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement.</p></div><div><h3>Method</h3><p>Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96<!--> <!-->h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals).</p></div><div><h3>Results</h3><p>A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (<em>P</em> <!-->&lt;<!--> <!-->.001) and with the provision of training for professionals (<em>P</em> <!-->=<!--> <!-->.020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r<!--> <!-->=<!--> <!-->−.431) and in the subgroup of patients with ETT (r<!--> <!-->=<!--> <!-->−.521).</p></div><div><h3>Conclusions</h3><p>Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who <em>may</em> not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.</p></div>\",\"PeriodicalId\":43993,\"journal\":{\"name\":\"Enfermeria Intensiva\",\"volume\":\"33 4\",\"pages\":\"Pages 212-224\"},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2022-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Enfermeria Intensiva\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1130239922000232\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Enfermeria Intensiva","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1130239922000232","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 0

摘要

目的从应用频率和质量方面描述和描述重症监护病房(CCU)机械约束(MR)的使用情况,并研究其与疼痛/激动-镇静/谵妄、护患比例和机构参与的关系。方法2016年2 - 5月在17个CCUs进行多中心观察研究。每个CCU的观察时间为96小时。主要变量为约束的流行程度、MR建议的遵守程度、疼痛/激动-镇静/谵妄监测和机构参与(方案和专业人员培训)。结果共纳入1070例患者。约束的总体患病率为19.11%,气管内插管组为42.10%,无气管内插管或人工气道组为13.92%。与非药物管理相关的建议依从率在0%至40%之间,与伦理-法律方面的监测相关的建议依从率在0%至100%之间。在非交流患者中,较低的约束发生率与适当的疼痛监测相关(P <.001),以及为专业人士提供培训(P = .020)。在CCU的普通患者组(r = - 0.431)和ETT患者亚组(r = - 0.521)中,MR的使用质量与其患病率呈负相关。结论约束在全气管插管/人工气道患者中应用尤为频繁,但在其他不符合使用要求的患者中也有应用。在使用MC的非药物替代品、伦理和法律警惕性以及机构参与方面有很大的改进空间。用有效的工具更好地解释患者行为可能有助于限制核磁共振的使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Uso de contenciones mecánicas en unidades de cuidados críticos: caracterización, estándares de aplicación y factores relacionados. Resultados de un estudio multicéntrico

Objectives

To describe and characterise the use of mechanical restraint (MR) in critical care units (CCU) in terms of frequency and quality of application and to study its relationship with pain/agitation-sedation/delirium, nurse:patient ratio and institutional involvement.

Method

Multicentre observational study conducted in 17 CCUs between February and May 2016. The observation time per CCU was 96 h. The main variables were the prevalence of restraint, the degree of adherence to MR recommendations, pain/agitation-sedation/delirium monitoring and institutional involvement (protocols and training of professionals).

Results

A total of 1070 patients were included. The overall prevalence of restraint was 19.11%, in patients with endotracheal tube (ETT) 42.10% and in patients without ETT or artificial airway it was 13.92%. Adherence rates between 0% and 40% were obtained for recommendations related to non-pharmacological management and between 0% and 100% for those related to monitoring of ethical-legal aspects. The lower prevalence of restraint was correlated with adequate pain monitoring in non-communicative patients (P < .001) and with the provision of training for professionals (P = .020). An inverse correlation was found between the quality of the use of MR and its prevalence, both in the general group of patients admitted to CCU (r = −.431) and in the subgroup of patients with ETT (r = −.521).

Conclusions

Restraint is especially frequently used in patients with ETT/artificial airway, but is also used in other patients who may not meet the use profile. There is wide room for improvement in non-pharmacological alternatives to the use of MC, ethical and legal vigilance, and institutional involvement. Better interpretation of patient behaviour with validated tools may help limit use of MR.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
2.50
自引率
23.10%
发文量
48
期刊介绍: Enfermería Intensiva es el medio de comunicación por antonomasia para todos los profesionales de enfermería españoles que desarrollan su actividad profesional en las unidades de cuidados intensivos o en cualquier otro lugar donde se atiende al paciente crítico. Enfermería Intensiva publica cuatro números al año, cuyos temas son específicos para la enfermería de cuidados intensivos. Es la única publicación en español con carácter nacional y está indexada en prestigiosas bases de datos como International Nursing Index, MEDLINE, Índice de Enfermería, Cuiden, Índice Médico Español, Toxline, etc.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信