親人在加護病房身體約束之經驗及感受

Families’ Experiences and Feeling on the Use of Physical Restraints in Intensive Care Unit

張淑純(Shu-Chun Chang)

指導教授 ： 鄭綺

臺北醫學大學/護理學院/護理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00184

摘要

身體約束常是加護病房為考量病人安全及使治療持續之醫療輔助措施，但國內外針對加護病房受約束病人之家屬經驗的研究仍較少見。本研究目的是透過加護病房家屬的觀點及藉由觀察家屬與身體受約束病人之互動情形，來瞭解家屬對於親人身體受約束之主觀經驗及感受。本研究採質量性並行的研究方式，以立意取樣於北部某區域醫院，對於加護病房身體受約束病人之重要家庭成員進行資料收集。所得量性資料以SPSS17.0進行描述性統計分析，質性資料以內容分析法歸納並萃取其意義。
一、量性研究結果顯示：本研究共收集45份有效量表，家屬年齡介於31歲至82歲之間（mean=55.6歲）；受約束個案年齡介於49歲至97歲之間（mean=83.2歲）。在擔憂病人身體不適或安全方面，家屬常見互動行為依序為：為病人按摩；讓病人自行活動或協助病人活動；為病人解開約束棒球手套/約束帶。在安撫病人情緒反應方面，家屬常見互動行為依序為，為病人加油打氣；口頭安撫病人不安情緒；觸摸病人身體；及向病人解釋說明約束原因。在家屬情緒反應方面，家屬最常出現情緒為接受；少數會出現無奈；難過的情緒。
二、質性研究顯示：共訪談十六位個案，年齡介於31至68歲之間（mean=48.9歲）。結果共分四個主題包含次類屬為：（一）心疼病人身體不適或再次受傷害：「擔心循環不好」、「擔心活動受限」、「擔心病人拔除身上留置管路」；（二）安撫病人情緒反應：「感同身受病人被約束情緒反應」、「撫平病人情緒」、「向病人說明需要約束的原因」、「分享（照片、思念的人探視」；（三）起伏情緒：「哭和難過」、「震驚」、「無奈」、「平靜/接受」；（四）期待人性化的對待：「給予更多的約束說明」、「視情況調整約束使用」、「結合現帶代科技，改善約束用具」、「彈性探視時間」。
以上研究結果顯示家屬對於親人受約束的經驗，認為身體約束是一種暫時性的醫療輔助措施，可預防病人拔管及避免病人受二度傷害。但是，家屬內心仍有許多擔憂與期待，最主要的是期許醫護人員在約束照護上能視情況做適當之調整；及建議能結合科技來改善約束設備，讓病人約束過程更舒適，使約束照護能更加專業。

關鍵字

加護病房家屬 ； 身體約束

並列摘要

For the safety of patients and the convenience of treatment, physical restraint is often used in the Intensive Care Unit (ICU) to assist medical treatment. However, there are not many researches focusing on the experience of family members of patients subjected to physical restrain in the ICU. The objectives of this dissertation were to investigate the experience of physical restrain from family members’ perspectives, and to observe the interactions between patients and their families. Both qualitative and quantitative methods were employed in our study. Our samples were collected from a district hospital in the northern Taiwan. The data were collected from essential family members of the patients restrained in the ICU. Using SPSS 17.0, we performed a descriptive analysis for quantitative data, and employed content analysis for qualitative data.
In analysis of the quantitative data, the study collected 45 effective questionnaires. The ages of participating family members were between 31 and 82 years old with a mean equaled 55.6 years old. The patients were between 49 and 97 years old with a mean equaled 83.2. The results obtained were as follows. For considerations of patient’s physical discomfort and safety, the commonest interactive behaviors between family members and patients were giving a massage to patients, assisting or letting patients exercise on their own, and removing the restrains from the patients. For pacifying patients’ emotions, the family members often encouraged and cheered the patient up, verbally comforted the patient, physically contacted to comfort the patient, and explained the reason of using physical restrain to patients. For the observation on the family members’ emotional reaction, the commonest were acceptances; few were helplessness and frustrated feelings.
In analysis of the qualitative data, 16 cases were interviewed. The participating family members were aged between31 and 68 years old with a mean age of 48.9 years old. The results consisting of four subjects with sub-categories were as follows. (1) The concern of patients’ physical discomfort or re-victimization: ‘‘the consideration of bad circulation”, ‘‘the consideration of movement limitation” ,“the consideration of extubation of patients”(2) To pacify patients’ emotions: ‘‘empathy with the reaction of the patients due to physical restrain’’, ‘‘pacifying the patients’ emotion’’, ‘‘explaining the reason for the use of physical restrain’’ , ‘‘sharing pictures with patients or visits of relatives whom patients long for’’.(3) disturbing emotions：‘‘crying and being frustrated ”, “shock”, ‘‘having no alternative” , ‘‘calm and accepting”.(4) The expectation of more humanistic treatment：‘‘more illustrations of the restraining”, “adjusting the use of restraining depending on situations”, ‘‘combining with high technology and improving the restraining equipment ”, “flexible visit time”.
Overall, the study showed that, from family members’ experiences, physical restrain was considered as a temporary assistance to medical treatment, which prevented patients from further injury. However, families still had many worries and expectations. The main expectation was that the medical personnel could adjust the use of restraining depending on situations. We suggested resorting to technology to improve the restrict equipment for a more comfortable process of physical restrain and a more professional nursing care of the restrained patients.

並列關鍵字

The families of intensive care unit ； Physical restraint

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