長期照護機構的約束政策與法律議題

The Issues of Policies and Legislation on the Use of Restraints in Institutional Long-term Care

黃惠璣(Hui-Chi Huang)

《長期照護雜誌》 13卷2期 (2009/09) Pp. 121-129

https://doi.org/10.6317/LTC.200909_13(2).0001

摘要

臨床上，護理人員為避免病人因拔管、跌倒及跌倒後引發合併症的醫療疏失，導致家屬對照護人員的興訟糾紛，通常會對病人使用身體約束。依據臨床研究顯示，約束住民不僅未能預防跌倒或縮減照護人力，反易徒增住民跌倒、受傷、死亡的危險。但約束迄今仍被廣泛使用於急、慢性醫療與長期照護機構，相較於美國之約束使用率，台灣機構住民身體被約束比率明顯偏高。綜觀目前長期照護機構之教育課程，大多侷限於如何改良約束帶、強調合理約束住民、簽署家屬同意書等議題，攸關無約束照護環境的規劃與設計，則付諸闕如。事實上，美、澳各國為營造無約束的長期照護環境，分別立法由政府單位主導減少照護人員使用約束。期盼爾後國內長期照護職司部門能擬訂約束政策參考，並考量照顧制度的合理性，期冀有效降低機構住民身體約束使用率。

關鍵字

機構 ； 約束 ； 政策

並列摘要

In a clinical situation in Taiwan, in order to avoid family litigation disputes due to patients removing tubes, falling, and having complications as a result of falling, nurses will use physical restraints. Based on research, physical restraints do not prevent falls or decrease the manpower needs on an institution, but rather increase the rates among the elderly of falling, injury, and mortality. In spite of these findings, physical restraints are still used widely in acute or chronic hospitals, and long-term care facilities. Comparing with the USA, there is a higher rate of use of physical restraints in Taiwan. Reviewing educational programs on physical restraints, the results showed that most of programs focused on how to adjust the physical restraint tools to increase comfort and to stress needs of retrains to family members and asking for an agreement. Therefore, there is a failure in Taiwan to create a restrain-free environment and policies. In American and Australia, changes to the law and regulations in this area have resulted in significantly decreased physical restraint use or no physical restraint use at all. The paper suggests that Taiwan need to follow restrain-free direction and set up our own regulations and policies to approaching a restrain-free environment in long-term care facilities.

並列關鍵字

Institution ； restraints ； policy