護理之家施行約束縮減方案之成效

The Outcomes of Restraint Reduction Program in Nursing Homes

葉淑惠(Shu-Hui Yeh) ； 林麗味(Li-Wei Lin) ； 王興耀(Shing-Yaw Wang) ； 吳淑如(Shu-Zu Wu) ； 林昭宏(Jau-Hong Lin) ； 蔡富棉(Fu-Mian Tsai)

《護理研究》 9卷2期 (2001/04) Pp. 183-193

https://doi.org/10.7081/NR.200104.0183

摘要

國內護理人家入住的老人有些被長年約束在床或輪椅上，生活品質不良，極待改善。本研究采前實驗研究法測試在護理之家施行約束縮減教育方案的成效，以高雄地區立案的護理之家，隨機抽取3家進行介入措施，介入措施期間由老人護理教師到護理之家帶領該機構行政人員、工作人員、老人及家屬進行去除老人身體約束的教導共2次，並由物理治療師及老人精神科醫師各一名，提供3次的平衡運動及老人問題行為的教導及諮商。一個月的介入措施進行的前三天、及完成的三天后進行約束教育成效包括入住老人受約束情況、跌倒、壓瘡、平衡反應、精神藥物的使用、躁動次數及護理人員約束知識之測量。研究發現施行介入措施後老人身休約束比率及躁動次數有顯著下降，老人跌倒、褥瘡及平衡反應沒有顯示改變，護理工作人員約束知識得分有顯著地增加，此結果可供國內護理之縮減約束的模式，並促進老人照護品質。

關鍵字

成效 ； 約束縮減方案 ； 護理之家

並列摘要

One of the problems in nursing home care in Taiwan is resident restraint, including physical and chemical restraints. This pre-experimental study was conducted to investigate whether a restraint reduction program could reduce the prevalence of restraint in nursing homes. Three registered nursing homes were randomly selected from nursing homes in the Kaohsiung area. Staff and residents of these nursing homes were educated in restraint alternatives, balance training and managing behavior problems in one month of interventions. Three days before and after interventions, prevalence of restraints, falls, and of pressure sores, balance reaction, frequency of agitation, use of psychotic drugs, as well as the restraint knowledge of the nursing staff, was measured. After the restraint reduction program, the prevalence of restraint and frequency of resident agitation decreased significantly. The prevalence of falls and pressure sores of residents was not changed significantly. The restraint knowledge of the nursing staff significantly increased after the restraint reduction program. The information from this study led to a better strategy to reduce restraint for the elderly in nursing homes. The results could also provide a model to improve the quality of care in nursing homes in Taiwan.

並列關鍵字

outcomes ； restraint reduction program ； nursing homes

參考文獻

Berg, K., Wood-Dauphinee, S., Williams, J. I., Gayton, D.(1989).Measuring balance in the elderly: Preliminary development of an instrument.Physiotherapy Canada.41

Berglas, C.(1993).Restraint reduction program.Nursing Update.4

Bloom, C., Braun, J. V.(1991).Restraint in the 90s, success with wanderers.Geriatric Nursing.12

Burton, L., German, P., Rovner, B., Brant, L., Clark, R. D.(1992).Mental illness and the use of restraints in nursing home.The Gerontologist.32(2)

Cali, C. M., Kiel, D. P.(1995).An epidemiological study of fall-related fractures among institutionalized older people.Journal of the American Geriatrics Society.43