| Background:Physical restraint has long been widely used as a protective nursing measure in ICU patients.With the development of whole-person holistic care model,increase number of scholars begin to pay attention to the adverse effects of excessive restraint on patients,especially the long-term harm caused by immature children.At home and abroad,the nursing consensus of "reduce the physical restraint rate,rational use of physical restraint" has been gradually reached.Since 2016,China has taken "the physical restraint rate of patients" as a sensitive indicator to evaluate the quality of nursing.Nurses as policy makers and practitioners of physical restraints,the cognition and attitude has a direct influence to the physical restraint,but the pediatric ICU nurses knowledge about physical restraints reserves is not yet clear,under the information age how to utilize the existing evidence in pediatric ICU nurses physical restraints,lack of targeted training,which can be reference for strategy.Objectives:1.To investigate the cognition,attitude and practice of physical restraint of pediatric ICU nurses,and to provide practical basis for program construction and training implementation.2.Based on evidence-based evidence,the physical restraint training program for pediatric ICU nurses is constructed,which provides theoretical basis for updating the knowledge of physical restraint of nurses,establishing the correct attitude of physical restraint,and finally making rational use of physical restraint.3.Carry out training and effect evaluation,realize the dissemination of evidence,and provide knowledge reserve for the follow-up research to standardize the physical restraint behavior of nurses.Methods:1.Study on the cognition,attitude and practice of physical restraint in ICU nursesUsing a convenient sampling method,109 nurses were enrolled in the ICU of a children's hospital in Chongqing in February 2018.The general information questionnaire and the " Questionnaire of knowledge,attitude and practice of stuff towards physical restraint " were used to investigate the cognition,attitude and behavior of physical restraint in pediatric ICU nurses.2.Study on the construction of physical restraint training program for nurses in pediatric ICU(1)Adopt the method of evidence summary,retrieve the Up To Date,U.S National Guideline Clearinghouse(NGC),Joanna Briggs Institute,(JBI),Cochrane,PubMed,EMbase,CINAHL,CNKI,Wanfang.The retrieval time until January 2019.After summarizing the evidence,each piece of evidence was pre-graded to form the first draft of the training content.(2)The expert group meeting is adopted to demonstrate and revise the evidence and make recommendations.Finally,integrate the evidence content and expert recommendations to form the final version of the training content.(3)With the method of scoping review,retrieves in Joanna Briggs Institute(JBI),Cochrane,PubMed,EMbase,CINAHL,CNKI,Wanfang,VIP,CBM,retrieval time until June 2019.Summed up the training mode,training methods,the content of the training time,training target,etc,formed the draft training framework.3.Experimental study to verify the training effect109 nurses who participated in part 1 were selected as training objects to spread the evidence.The training methods of offline centralized guidance,online video learning and online platform Q&A were applied for 8 weeks.After the training,the results were evaluated with the " Questionnaire of knowledge,attitude and practice of stuff towards physical restraint ","trainee response evaluation form" and the physical restraint test for pediatric ICU patients.Results:1.Cross-sectional investigation and study: The overall average accuracy of the physical restraint knowledge questionnaire of the pediatric ICU nurses was 60.88%,which was at a low level.The average score of the attitude questionnaire was 33.49±5.14.The negative degree of the attitude towards physical restraint was relatively high,and the tendency to use physical restraint was relatively high.The average score of the behavioral questionnaire was 22.61±2.72,which showed a low level.2.Training content:(1)This study summarized 35 pieces of evidence in the seven categories of organizational management,patient factor management,treatment facility management,bed fall prevention,environmental control,nurse-patient relationship establishment,and restraint process.After being proved by experts in the field of pediatric critical care and evidence-based medicine,it can be applied to the pediatric ICU clinic.There were 20 A recommendations and 15 B recommendations.(2)The final training plan adopts the training methods of offline centralized guidance,online course learning and online platform communication and Q&A.As well as the modular training content,including 5 modules: 1)basic knowledge of physical restraint: adverse effects of physical restraint,application principles of physical restraint;2)normative procedures of physical restraints: multidisciplinary team work,restraints on the initiation of doctor's orders,informed consent of children and their families,assessment of physical restraints,monitoring of the use of physical restraints,and nursing records;3)alternative intervention measures for physical restraint: patient factor management,treatment equipment management,falling bed prevention,environmental management,and nurse-patient relationship establishment.3.Quasi-experiment study:(1)The overall average accuracy rate of the ICU children's physical restraint knowledge questionnaire after training was 80.23%,higher than that before training,and the average accuracy rate reported in China was 73.97%.The knowledge level was higher than before,and the difference was statistically significant.The average score of physical restraint attitude after training was 31.98±4.49,which was lower than the average score before training,and the tendency to use physical restraint was reduced,and the difference was statistically significant.The average score of physical restraint behavior questionnaire after training was 37.28±2.45,which was higher than the average score before training,and the behavioral level was improved,with statistically significant difference.(2)The trainees' response scores on the training topic,training lecturer,training facilities,training time and training effect are all higher than 4 points,indicating that the research object is relatively satisfied with the training;(3)The average score of physical restraint test for pediatric ICU nurses after training was 75.36 points,indicating a good grasp of the training content.Conclusion:1.The pediatric ICU nurses involved in the survey had insufficient knowledge reserve of physical restraint,and lacked understanding of basic knowledge such as the concept,classification and adverse effects of physical restraint.They tend to use physical restraint,and they pay less attention to the informed consent of the children and their families,and the starting restraint of the doctor's advice,with a negative attitude.The normative behavior of physical restraint is poor,and the understanding and application of restraint alternative interventions are less,lacking evidence-based decision-making basis.2.In this study,35 pieces of evidence in 7 categories were collected,covering various aspects such as the normative process of physical restraint and alternative intervention measures.The evidence was abundant and highly recognized by experts.The variety of training strategies summarized through the scope review provides a reliable basis for the construction of the training program in this study.3.The physical restraint training program for pediatric ICU nurses constructed in this study can effectively improve the knowledge and attitude of pediatric ICU nurses,but the change of physical restraint behavior still needs clinical management and guidance.The training has positive evaluation and feedback,but the difficulty of the course and the training time need to be further adjusted and improved. |
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