USE OF PHYSICAL RESTRAINTS FOR ELDERLY PATIENTS

本研究是一项临床决策分析的管理策略 旨在降低老年患者跌倒的风险 疗养院或非精神病院。身体上的克制是一种常见的 但在美国，这种做法越来越有争议。 目前，干预建议通常基于轶事。 证据和护士通常被分为支持者和反对者。 使用身体的束缚。出于伦理和可行性方面的考虑， 随机对照试验不会解决这一争议 围绕着这个临床问题。临床决策分析是 适合，因为它是一种制定和定量评估的方法 相互冲突的护理方式。评估身体约束问题 与患者跌倒有关的三个具体阶段被提出：(1) 召集一个国家专家小组就以下问题达成共识 量化和评估决策分析所需的概率， (2)评估护士和老年病人对医疗服务的偏好 跌倒可能导致的健康状况及护理 预防跌倒的方法，以及(3)进行正式决定 体力约束与交替护理管理的对比分析 防止从护士和老年病人的预感中跌落 在疗养院和普通医院的环境中。七 注册护士，国家认可并在以下领域出版 老年护理，已同意参加一项修改- 专家共识意见的德尔菲法，将填补 医学和护理文献。护士(N=126)和老年患者 (n=126)将从尼尔辛之家和综合医院恢复 设置。在获得口头同意后，每个患者都将被 填写简短的人口统计调查问卷并回答问题 关于先前的身体束缚和摔倒经验。这个 参与者将被要求对26个项目的偏好进行排序 健康结果的情景，代表健康的组合 结果是管理方法和/或 跌倒的后果。临床决策分析的评价 将导致在以下情况下偏袒一种管理战略 与健康结果的可能性的关系以及以下各项的权衡 健康结果偏好。从个人的角度来看，分开 决策分析将使用每个护士和老年人的 患者的直接排名。我们将考察社会视角。 使用从联合分析中得出的偏好值。结果是 这些决策分析将：(1)提供对复杂和 艰难的护理决定，是否要约束老年人 有跌倒风险的患者，以及(2)帮助指导有关使用 疗养院和综合医院环境中的身体限制。

This study is a clinical decision analysis of management strategies aimed at reducing the risk of falling among elderly patients in a nursing home or nonpsychiatric hospital. Physical restraint is a common but increasingly controversial practice in the United States. Currently, intervention recommendations are typically based on anecdotal evidence and nurses are often divided as either proponents or opponents to use of physical restraints. Due to ethical and feasibility concerns, randomized controlled trials will not resolve the controversy surrounding this clinical problem. a clinical decision analysis is suitable because it is a method to formulate and quantitatively evaluate conflicting styles of care. To assess the physical restraint issue related to patient falls, three specific phases are proposed: (1) to convene a panel of national experts to form a consensus opinion on probabilities needed to quantitate and evaluate the decision analysis, (2) to assess nurses' and elderly patients's preferences of the potential outcome health states resulting from falling and the nursing approaches to prevent falls, and (3) to conduct a formal decision analysis on physical restraint versus alternative nursing management for preventing a fall from the prespectives of nurses and elderly patients in both the nursing home and general hospital settings. Seven registered nurses, nationally recognized and published in the area of gerontological nursing care, have agreed to participate in a modified- Delphi process for expert consensus opinion that will fill=gaps in the medical and nursing literature. Nurses (N=126) and elderly patients (N=126) will be recuited from the nirsing home and general hospital settings. After obtaining verbal consent, each patients will be aksed to complete short demographic questionnaire and to answer questions regarding prior experience with physical restraint and falls. The participants will be asked to rank order their preferences for 26 scenarios of health outcomes, representing combinations of health outcomes that are consequences of the management approach and/or consequences of falls. Evaluation of the clinical decision analysis will result in favoring one management strategy over the other in relation to the likelihood of health outcomes and the trade-offs among health outcome preferences. From an individual perspective, separate decision analyses will be conducted using each nurses's and elderly patient's direct rankings. The societal perspective will be examined using preference values derived from conjoint analysis. The results of these decision analyses will: (1) provide insight into the complex and difficult nursing decision, whether or not to restrain an elderly patient at risk of falling, and (2) help guide policy regarding use of physical restraints in the nursing home and general hospital setting.