| Objective: To investigate and analyze the current status and influencing factors of physical restraint among critically ill patients,develop a standard physical restraint scoring scale for critically ill patients,and apply it to clinical work and discuss its application effect.Methods: The first part: a total of 204 patients who received a treatment in ICU of The Affiliated Hospital of Guizhou Medical University from April to September 2016 were selected by convenience sampling.The self-designed patient's general information and the related disease questionnaire were investigated and a multiple Logistic regression was used to analyze the physical restraint influencing factors.The second part: from October to November 2016,16 experts from Guizhou,Anhui,Shanghai,Jiangsu were consulted by Delphi method to develop scale assessment items.From December 2016 to January 2017,80 patients in ICU were evaluated to test the reliability and validity of the scale.And after the 273 assessments of 50 patients from February to March 2017,the score of restraint was determined.The questionnaire recovery rate,the authority coefficient(Cr),the coefficient of variation(CV)and the Kendall's W were used to evaluate the expert's positive coefficient,the degree of authority and the degree of coordination of opinions.Cronbach's alpha coefficient,inter rater reliability,content validity and construct validity were evaluated the reliability and validity.The third part: a total of 220 patients who received a treatment in ICU from April 2017 to September 2017 were selected by convenience sampling.The patients were divided into the control group and the experimental group by the admission time.The patients in the control group were restrained by the experience evaluation of the nurses;the patients in the experimental group were restrained after using the standard physical restraint scoring scale.Compared the rate of physical restraint,length of restraint time,unplanned extubation rate,the incidence of restraint complications and the rateof falling or falling out of bed between the two groups.The data were analyzed by independent sample t test,chi square test and Wilcoxon rank sum test.Results: The first part: 84 patients use physical restraints among the 204 patients,the rate of physical restraints is 41.2%.Logistic regression analysis shows that moderate pain(OR=5.757),severe pain(OR=22.125),mechanical ventilation(OR=6.690),special medicine use(OR=5.408)and tube drawing history(OR=7.512)are the risk factors;high communication skill(OR=0.036)is a protective factor.The second part: two rounds of expert consultation,the recovery rates are 100% and 94%,the enthusiasm of experts is high.The authority coefficient(Cr)is 0.87 and 0.88,and the authority of experts is high.The Kendall 's W coefficient is 0.210 and 0.513(P< 0.01).Physical restraint scoring scale consists of 3 dimensions and 8 items: attack risk assessment(sedation agitation degree,communication skills,pain,aggressive behavior),fall bed risk(activity ability,the number of special drug)and tube risk(tube risk degree,the number of tube).The correlation coefficients between each item and total score range from 0.61 to 0.83,the content validity index is 0.97.The exploratory factor analysis extract 3 common factors,and the cumulative contribution rate is 87.215%.Internal consistency reliability Cronbach's alpha coefficient is 0.889,and inter rater reliability was 0.946(P < 0.05).Conclusion: Nurses should pay attention to the assessment of the related factors of physical restraint and take pertinent nursing measures.Standard physical restraint scoring scale for critically ill patients can be used to assess patients comprehensively,and it has good reliability and validity,which can guide nurses to regularize its restraint behaviors.It can reduce the rate of physical restraint,length of restraint time,unplanned extubation rate and protect patients' safety.It is suitable for clinical promotion. |
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