降低兒童加護病房四歲以下非氣管內管留置病童約束率

Reduce the Use of Physical Restraint in Children without Endotracheal Tube under the Age of Four Years in Pediatric Intensive Care Units

張雲英(Yun-Ying Chang) ； 郭純芳(Chun-Fang Guo) ； 林欣儀(Shin-Yi Lin) ； 蔡妃荏(Fei-Jen Tsai) ； 陳永娟(Yong-Chuan Chen)

《榮總護理》 36卷3期 (2019/09) Pp. 237-245

https://doi.org/10.6142/VGHN.201909_36(3).0003

摘要

兒童加護病房之病童因置入侵入性管路、住院壓力、分離焦慮及害怕身體受到傷害，無法遵從醫療處置並出現反抗行為，護理人員常需要採取身體約束預防非氣管內管留置病童自拔管路、跌倒或自傷行為。然四歲以下病童遭受約束時，會增加其焦慮情緒，引發身體躁動及反抗，進而增加管路滑脫及約束損傷之風險。於2015年6月1日至30日調查本單位四歲以下非氣管內管留置病童約束率高達2.44%，分析原因包括：限制性探訪政策造成護理人員或家屬無法持續床旁安撫病童、缺乏導管隱藏策略、約束替代物品及兒科保護性約束之標準流程，因此，專案目的為降低四歲以下病童約束率。透過改善對策：舉辦在職教育、制訂兒童加護病房約束流程、發展簡易型兒童保護衣褲及導管隱藏策略，與規範彈性會客等措施，將約束率降低至0.28%，且未發生約束造成之損傷。本專案除建立兒童加護病房約束流程及研發簡易型兒童保護衣褲外，並提升病童管路照護品質。

關鍵字

兒科 ； 身體約束 ； 約束替代方案

並列摘要

In the pediatric intensive care unit, due to invasive tube placement, hospitalization stress, separation anxiety, and fear of physical injury, young children find it difficult to cooperate with medical treatment and often appear to have rebellious behavior. To prevent the risk of removing their endotracheal tube, falling down, or hurting themselves, physical restraint is usually needed in the PICU. However, when a child under the age of four years is restrained, it increases their anxiety, causes physical agitation and resistance, and therefore increases the occurrence of unplanned extubation and restraint-related injuries. Therefore, the purpose of this project was to reduce the use of restraints in sick children under the age of four years. The restraint rate of nontracheal indwelling children under the age of four years is as high as 2.44%. The reasons for the analysis include restrictive visitation policies and factors of care ratio, resulting in comforting of sick children by non-nurses or their families, lack of catheter concealment strategies, constraining alternatives, and pediatric protective standard procedures. Through education, establishment of physical restraint standards, the development of simple child protection underwear, a catheter concealment strategy and flexible visiting, the physical restraint rate was reduced to 0.28%, with no restraint-related injuries. In addition to establishing a pediatric intensive care unit restraint process and developing simple child protection underwear during the project period, the quality of tubing care for sick children was improved.

並列關鍵字

pediatric ； physical restraint ； alternative methods of restraint

參考文獻

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