Use of physical restraints in acute hospitals in Germany: A multi-centre cross-sectional study
Use of physical restraints in acute hospitals in Germany: A multi-centre cross-sectional study
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DOI：
10.1016/j.ijnurstu.2013.05.005
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发表时间：
2013-12-01
影响因子：
8.1
通讯作者：
Meyer, Gabriele
中科院分区：
文献类型：
--
作者：
Krueger, Caecilia;Mayer, Herbert;Meyer, Gabriele
背景：身体约束与患者的自主和自由背道而驰。他们控制精神运动激动和跌倒风险的理由越来越受到质疑。身体约束与许多负面结果有关。德国法律是明确的，只有在例外情况下才允许在护理中进行身体约束。关于在德国急症医院使用身体约束的数据很少。目的：调查急诊医院物理约束的流行情况及与物理约束使用相关的特点。设计：横断面研究。参与者和环境：德国北莱茵-威斯特伐利亚州四家急症医院61个病房的1276名患者（平均年龄65岁，45%为女性，50%为外科）（n = 47名普通病房；n = 14名重症监护室）。方法：一名调查人员在三个月内随机选择的日期，在随机分配的三个时间段访问每个医院病房。共收集肢体约束状态直接观察3434例。研究时间为2008年10月至2009年3月。为了进行分析，每个病房随机选择一个时间段，以避免重复分析同一患者。结果：至少有一种肢体约束的患者患病率为11.8% （95%CI 7.8 ~ 15.7）。最常使用的措施是全床栏杆（9.8%,95%CI 6.5-13.1）。各病区患病率差异明显（普通病区：0 ~ 31.3%；重症病区：0 ~ 90.0%）。医院间身体约束的患病率从6.2到16.6%不等，与医院的总体关联不显著。多因素回归分析显示，使用肢体约束的年龄80-99岁对18-54岁（校正优势比4.34,95%优势比2.18-8.64）、饲管（2.70,1.40-5.22）、留置导尿管（6.52,3.75-11.34）、入住重症监护病房（3.39,1.29-8.92）具有统计学意义。共用多床房间（0.55,0.35-0.89）和原位中心静脉线呈负相关（0.44,0.19-0.98）。结论：物理约束显然是德国急症医院的标准治疗。然而，病房之间的差异表明，只有很少的身体限制的医院护理是可行的。为了尊重病人的尊严和人格完整，有必要实施干预方案，以减少实践差异，从而普遍减少德国急症医院的人身限制。(C) 2013 Elsevier Ltd.版权所有。
Background: Physical restraints are contrary to patients' autonomy and freedom. Their justification for controlling psychomotor agitation and risk of falling is being questioned more and more often. Physical restraints are associated with many negative outcomes.The German law is explicit, allowing physical restraints in nursing only as an exception. Data on the use of physical restraints in acute hospitals in Germany are sparse. Objectives: To investigate the prevalence of physical restraints and characteristics associated with physical restraint use in acute hospitals.Design: Cross-sectional study.Participants and setting: 1276 patients (mean age 65 years, 45% women, 50% surgical) on 61 wards (n = 47 general; n = 14 intensive care) in four acute care hospitals in North Rhine-Westphalia, Germany.Methods: One investigator visited each hospital ward at three randomly allocated time slots on randomly selected days within a period of three months. A total of 3434 direct observations on physical restraint status were collected. The study period lasted from October 2008 to March 2009. For analysis, one time slot per patient room was randomly chosen in order to avoid repeated analysis of the same patient.Results: The prevalence of patients with at least one physical restraint was 11.8% (95%CI 7.8-15.7). The measures used most often were full bed rails (9.8%, 95%CI 6.5-13.1). There was pronounced prevalence variation throughout the wards (general wards: 0.0-31.3%; intensive care: 0.0-90.0%). The prevalence of physical restraints between hospitals ranged from 6.2 to 16.6%, the overall association with hospital was non-significant. Multivariate regression analysis revealed statistically significant characteristics for physical restraint use: age 80-99 years versus 18-54 years (adjusted odds ratio 4.34, 95%Cl 2.18-8.64), feeding tube (2.70, 1.40-5.22), indwelling urinary catheter (6.52,3.75-11.34), and staying in intensive care unit (3.39, 1.29-8.92). Sharing a multi-bed room (0.55,0.35-0.89) and in situ central venous line were inversely associated (0.44, 0.19-0.98).Conclusions: Physical restraints are apparently standard care in German acute hospitals. However, variation between wards indicates that hospital care with only few physical restraints is feasible. Respecting patients' dignity and integrity warrants intervention programmes aimed at decreasing practice variation towards a general reduction of physical restraints in acute hospitals in Germany. (C) 2013 Elsevier Ltd. All rights reserved.