降低精神科急性病房病人非自願性約束發生率

本單位自2017年起，非自願性約束發生率呈現上升的趨勢，造成病人傷害與投訴，引發執行本專案的動機。分析發現造成本單位非自願性約束發生率偏高的主要原因，包含未落實身體約束替代性措施、非自願性約束認知及勸撫技巧不足，以及暴力處置影片內容不完整等。本專案小組透過製作身體約束替代措施海報、舉辦病人情緒管理訓練、更新暴力防範與勸撫處置教學影片、舉辦在職教育及擬真情境演練等措施，成功的將單位非自願性約束發生率由（千分之13.0）降為（千分之8.0）、護理人員非自願性約束之認知正確率由78.2%提升到99.1%、護理人員勸撫技術之正確率由72.7%提升到98.0%，達成專案目的，有效降低非自願性約束發生率與提升病人照護品質。

關鍵字

勸撫；非自願性約束；擬真情境演練

並列摘要

The incidence of involuntary restraint increased in our unit in 2017, and such restraint causes injury to and complaints from patients. Consequently, the upward trend of the incidence motivated us to make improvements. Our analysis revealed that main factors for involuntary restraint were failure to implement alternatives to restraint, insufficient knowledge of how to correctly apply involuntary restraint, inadequate talk down methods, and incomplete content of training films on managing violence. The incidence of involuntary restraint decreased from (13 per mille) to (8 per mille) following the production of posters detailing alternatives to restraint, the training of patients in managing emotions, the renewing of training films on violence prevention and talk down methods, and the arrangement of on-the-job training and fidelity simulation. In addition, our nursing staff members' accuracy rate regarding the knowledge of how to correctly apply involuntary restraint increased from 78.2% to 99.1%, and the application of talk down methods increased from 72.7% to 98.8%. In summary, our intervention reduced the incidence of involuntary restraint and improved the quality of patient care.

並列關鍵字

persuasion ； involuntary restraint ； realistic situational exercise

參考文獻

謝玉萍、林青蓉、康美琦、吳志卿、邱淑娟（2018）．運用醫療團隊資源管理改善身體約束品質之專案．精神衛生護理雜誌，13（1），35-43。https://doi.org/10.6847/TJPMHN.201806_13(1).05

Kleebauer, A. (2015). New NICE guidelines recommend debriefing after violent incidents. Nursing Standard, 29(40), 11. https://doi.org/10.7748/ns.29.40.11.s12

Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Al ternatives to use of restraint: A path toward humanistic care. Indian Journal of Psychiatry, 61(Suppl 4), S693–S697. https://doi.org/10.4103/psychiatry.indianjpsychiatry_104_19

Väkiparta, L., Suominen, T., Paavilainen, E., & Kylmä, J. (2019). Using interventions to reduce seclusion and mechanical restraint use in adult psychiatric units: An integrative review. Scandinavian Journal of Caring Sciences, 33(4), 765–778. https://doi.org/10.1111/scs.12701

Al-Maraira, O., & Hayajneh, F. A. (2019). Use of restraint and seclusion in psychiatric settings: A literature review.Journal of Psychosocial Nursing & Mental Health Services, 57(4), 32-39. https://doi.org/10.3928/02793695-20181022-01

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