USE OF PHYSICAL RESTRAINTS FOR ELDERLY PATIENTS

对老年患者使用身体约束

• 批准号: 3427519
• 负责人: LORRAINE C MION
• 金额: $ 2.16万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1991
• 资助国家: 美国
• 起止时间: 1991-07-01 至 1992-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3427519
• 关键词: aging; decision making; disease /disorder proneness /risk; geriatric nursing; hospital patient care; human old age (65+); human subject; human very old age (85+); interview; nursing homes; nursing intervention; patient care management; questionnaires; restraint; restricted physical activity; trauma

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.

本研究是管理策略的临床决策分析 旨在降低老年患者跌倒的风险 疗养院或非精神病医院。 身体束缚是常见的 但这种做法在美国的争议越来越大。 目前，干预建议通常基于轶事 证据和护士经常被分为支持者或反对者 使用身体约束。出于道德和可行性方面的考虑， 随机对照试验无法解决争议 围绕这个临床问题。 临床决策分析是 合适，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 与患者跌倒相关，提出了三个具体阶段：(1) 召集国内专家组，形成共识 量化和评估决策分析所需的概率， (2) 评估护士和老年患者的偏好 跌倒和护理导致的潜在结果健康状况 预防跌倒的方法，以及 (3) 做出正式决定 身体约束与替代护理管理的比较分析 从护士和老年患者的角度防止跌倒 在疗养院和综合医院环境中。 七 注册护士，全国认可并在以下领域发表 老年护理，已同意参加修改后的- 专家共识意见的德尔菲流程将填补 医学和护理文献。 护士（N=126）和老年患者 (N=126)将从疗养院和综合医院招募 设置。 获得口头同意后，将询问每位患者 完成简短的人口统计调查问卷并回答问题 关于之前身体束缚和跌倒的经验。 这 参与者将被要求对他们的偏好进行排序 26 健康结果的情景，代表健康的组合 结果是管理方法和/或的结果 跌倒的后果。 临床决策分析的评估 将导致在以下方面倾向于一种管理策略而不是另一种 与健康结果的可能性以及之间的权衡有关 健康结果偏好。 从个人角度来看，分开 将利用每位护士和老年人的信息进行决策分析 患者的直接排名。 将审查社会观点 使用联合分析得出的偏好值。 结果 这些决策分析将：（1）深入了解复杂且 艰难的护理决定，是否限制老人 有跌倒风险的患者，以及 (2) 帮助指导有关使用的政策 疗养院和综合医院环境中的身体约束。