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， 疗养院或非精神病医院。 身体约束是一种常见的 但在美国却越来越引起争议 目前，干预建议通常基于轶事 证据和护士往往分为支持者或反对者 使用身体限制。出于道德和可行性考虑， 随机对照试验并不能解决这一争议 围绕这个临床问题。 临床决策分析， 适用，因为它是一种制定和定量评价 相互冲突的护理方式。 为了评估身体约束问题 与患者福尔斯跌倒相关，提出了三个具体阶段：（1） 召集一个国家专家小组，就下列问题形成共识： 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 跌倒和护理导致的潜在结局健康状态 防止福尔斯跌倒的方法，以及（3）进行正式决策 肢体约束与替代护理管理的比较分析 防止护士和老年患者跌倒 在疗养院和综合医院的环境中。 七 注册护士，国家承认，并在该地区公布， 老年护理，已同意参加修改- 德尔菲过程中的专家共识意见，将填补=空白， 医学和护理文献。 护士（N=126）和老年患者 （N=126）将从nirsing家庭和综合医院招募 设置. 在获得口头同意后，每位患者将被处死 完成简短的人口统计学问卷并回答问题 有过身体约束和福尔斯摔倒的经历。 的 参与者将被要求对他们的偏好进行排序， 健康结果的情景，代表健康 作为管理方法后果的结果，和/或 福尔斯的后果 临床决策分析的评价 将导致一种管理策略优于另一种管理策略， 与健康结果的可能性以及之间的权衡的关系 健康结果偏好。 从个人角度来看， 决策分析将使用每个护士和老年人进行， 患者的直接排名。 将从社会角度进行审查 使用从联合分析导出的偏好值。 的结果 这些决策分析将：（1）提供对复杂的洞察力， 护理决策困难，是否限制老年人 患者有跌倒的风险，（2）帮助指导有关使用 在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.