降低外科加護病房連續性約束之專案

身體約束在重症單位常被運用於維護病患安全及預防異常事件。本專案旨為降低連續約束率，從現況分析中發現原因有護理人員認知不足、採工作取向的價值觀、擔心管路自拔遭到懲處、缺乏與病患有效溝通的方法、缺乏提醒機制。故採取解決方案包括舉辦在職教育、約束體驗營、溝通技巧課程、分享異常事件處理經驗並邀請醫師一同參與約束照護計畫、創新製作溝通圖卡、鼓勵家屬參與照護計畫、運用提醒機制，最後不僅成功將單位病患連續約束率由56.2%降低至9.2%，期間亦無自拔管路事件發生。建議醫院及護理行政主管應加強醫護同仁約束相關的在職教育，並製造安全的環境，以減少使用約束及確保病人的安全。

關鍵字

約束；知識；態度；溝通

並列摘要

Physical restraints are often used to ensure patients' safety and to prevent unexpected accidents in clinical practice. This project aimed to reduce the rate of continuous use of restraints. An analysis of use of restraints that reason of the high rate of continuous restraint, including the lack of nurses' knowledge, mining work-oriented values, fear of being punished due to accidental tubing removal, the lack of effective communication with patients, and lack of reminding mechanism. Therefore, several strategies were implemented, including in-service education, experiencing of being restraint, communication skill training, experience sharing of incident event, inviting doctors to join restraint care plan, innovation of communication cards, encouraging family to participate care plan, and application of reminding mechanism. The rate of continuous restraint was reduced from 56.3% to 9.2%, and no unplanned tubing removal occurred. It was recommended that hospitals and nursing administration should einforce in-service education and provide a secure environment in order to reduce the use of physical restraint and to ensure patients' safety at the same time.

並列關鍵字

restraint ； knowledge ； attitude ； communication

參考文獻

吳純怡、陳明怡、賴寶琴、林鎭均(2016) •降低加護病房病人身體約束時間大於24小時之比率成效•台灣醫學、20(2)，189-194• Doi: 10.6320/FJM.2016.20(2).8

歐羽珊、康云、蔣立琦(2014) •重症病人及家屬創傷後壓力症之照護策略•源遠護理，8(3)，75-80。Doi: 10.6530/YYN/2014.B.09

謝佳容、盧美秀、林秋芬(2014) •身體約束教育方案對護理人員的知識、態度與行為成效之探討•護理暨健康照護研究• 10(4)，265-274。Doi: 10.6225/JNHR.10.4.265

Chang, Y. Y., Yu, H. H., Loh, E. W.,& Chang, L. Y. (2016). The efficacy of an in-service education program designed to enhance the effectiveness of physical restraints. The journal of nursing research, 24(1), 79-86. Doi:10.1097/jnr.0000000000000092

Sokol, D. K. (2010). When is restraint appropriate? All practicable and less invasive alternatives, such as persuasion and de-escalation techniques, must first have been exhausted. British Medical Journal, 341, c4147. Doi:10.1136/bmj.C4147

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降低外科加護病房連續性約束之專案

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