- 期刊
- OpenAccess
機構住民使用身體約束之芻議
Physical Restraints Use among Residents Living in Organization
摘要
臨床上，護理人員為避免病人因拔管、跌倒及跌倒復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；其次，部分機構因照護人力不足，而默許身體約束為合理措施。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；但身體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28%、澳洲25.5%及挪威17%之約束使用率，台灣機構住民身體被約束比率達46.6%明顯偏高。研究文獻指出護理人員的知識、態度、工作壓力、自我效能，在在影響其照護行為。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，歐美各國為營造無約束的長期照護環境、減少照護人員使用身體約束，執行教育課程之作法已行之多年，可提供爾後國內長期照護職司部門擬訂約束政策參考，期冀有效降低機構住民身體約束使用率。
並列摘要
In clinical settings, nursing staff and other health professionals may use the physical restraints to prevent patients attempting to remove their tubes and to prevent falls. In addition, some facilities may allow caregivers to use physical restraints because of lack of manpower. They believe that their use may prevent families to sue these facilities and health professionals for injuries alleged resulting from falls. A great deal of research has shown that use of physical restraints may not only fail to prevent but actually increase the rate of falls, injuries, and even deaths., Even so, use of physical restraints continues in patient care facilities everywhere. The prevalence of physical restraint use in Taiwan is 46.6% is relatively high while compared to use rates found in the United States, Australia, and Norway with 28%, 25.5%, and 17%, respectively. Some published research has pointed out that the knowledge, attitudes, working stress, and self efficacy have had important effects on nursing staff behaviors. However, educational programs directed toward nursing home patient care in Taiwan have not promoted a restraint free environment, but rather have emphasized improving the quality of restraint materials, creating reasonable restraint protocols reasons, and for getting informed consent from families and those legally responsible. No restraint environment in many other advanced industrialized countries by giving education. The question of whether the same criteria should be applied to Taiwan's long term care facilities and this question has important policy as well as clinical implications.