| 摘要: | 中文摘要
背景：身體約束在急性醫療機構是常見的護理措施，內科病房病人常有躁動、譫妄情形，為確保病人住院安全及維持治療品質，必要時醫護人員會對病人進行約束治療，以避免及減少自拔管路、躁動或攻擊行為發生。然其成效不明，且不當約束可能會造成不良事件發生，如自拔管路、躁動、攻擊行為，甚至使住院時間延長及死亡。若能找出影響住院病人約束後發生不良事件預測因子，將有助於制定更為個別性及有效之照護計畫，確保病人安全，降低約束後不良事件發生。
目的：探討影響內科病房病人約束後發生不良事件之預測因子，藉此分析及預測造成病人約束後發生不良事件之因素，以便即早發現並預防不良事件發生。
方法：本研究為回溯性研究(retrospective study)，採病歷資料收集方式，以卜瓦松迴歸分析探討住院病人約束後發生不良事件之預測因子。預測因子包含：人口學特性、約束前評估及約束後評估；不良事件包含：約束後拔管次數、約束後躁動次數及約束後攻擊次數進行分析。資料收集時間為111 年01 月01 日至112年02月28日入住台北市某區域教學醫院之內科病房、年齡20 歲以上、入院診斷為內科疾病、因任何因素進行身體約束治療者共100 位。
結果：內科病房病人約束後發生拔管次數不良事件達顯著之預測因子包括：陪病者為外傭、約束後病人反應：情緒欠穩、約束前有拔管次數、約束前有躁動次數；內科病房病人約束後發生躁動不良事件達顯著者包括：用藥評估：非類固醇抗發炎藥、躁動時有給予用藥、約束原因：協助治療、約束前有拔管及約束前有躁動次數。結論：本研究探索病人約束後發生不良事件的預測因子，以供臨床護理人員參考並給予病人適當處置，進而減少約束傷害發生。
英文摘要
Background: Physical restraint is a common nursing measure in acute healthcare settings, particularly in internal medicine wards where patients may exhibit restlessness and delirium. To ensure patient safety and maintain the quality of treatment, healthcare professionals may resort to restraint therapy when necessary, aiming to prevent self-extubation,agitation, or aggressive behaviors. However, the effectiveness of such measures is unclear, and improper restraint can lead to adverse events such as self-extubation, agitation, aggression, and even prolonged hospitalization or death. Identifying predictive factors for adverse events following patient restraint in hospitalization can aid in developing more individualized and effective care plans, ensuring patient safety, and reducing the occurrence of post-restraint adverse events.
Objective: To investigate predictive factors influencing the occurrence of adverse events following patient restraint in internal medicine wards. This analysis aimed to identify and predict factors contributing to adverse events after patient restraint, facilitating early detection and prevention of such events.
Methods: This study is a retrospective analysis utilizing medical record data. Poisson regression analysis will be employed to explore predictive factors for adverse events following patient restraint. Predictive factors include demographic characteristics, pre-restraint assessments, and postrestraint assessments. Adverse events analyzed include the frequency of post-restraint extubation, agitation, and aggression. Data will be collected from January 1, 2022, to February 28, 2023, for 100 patients aged 20 and above admitted to an internal medicine ward in a teaching hospital in a specific district of Taipei City.
Results: Significant predictive factors for post-restraint extubation events in internal medicine ward patients include having a foreign domestic helper as a companion, post-restraint patient reactions indicating emotional instability, pre-restraint occurrences of extubation, and prerestraint occurrences of agitation. Significant predictive factors for postrestraint agitation events include medication assessments involving nonsteroidal anti-inflammatory drugs, administration of medication during agitation, restraint reasons related to treatment assistance, pre-restraint occurrences of extubation, and pre-restraint occurrences of agitation.
Conclusion: This study explored predictive factors for adverse events following patient restraint, providing clinical nursing staff with reference points for appropriate patient management and minimizing restraintrelated injuries. |
