Construction Of A Minimal Physical Restraint Scheme For Adult ICU Patients Based On System Management Theory

Objective: Based on system management theory and following the principle of minimal physical restraint,this study systematically and comprehensively constructed an implementation scheme covering the whole process of physical restraint in adult ICU patients by literature research,qualitative interview,Delphi method and analytic hierarchy process,so as to provide a basis for the management and implementation of minimal physical restraint in clinical work.To provide theoretical guidance to realize the concept of "patient-centered" quality nursing service.Methods: Combined with literature research,qualitative interview,Delphi method and analytic hierarchy process,the minimal physical restraint program for adult ICU patients was constructed.1.Literature research and qualitative interviews were conducted.Firstly,BMJ,Up to Date,NGC,SIGN,JBI evidence-based health care database,NZGG,GMS,Dingxiang Yuan and Yimai Tong were searched.Secondly,literatures were screened according to inclusion and exclusion criteria by searching various Chinese and English databases:CNKI,China Biomedical Literature Database,Wanfang Database,VIP Chinese Science and Technology Journal Database,Pub Med,OVID,Cochrane Library,CINAHL,Web of Science and Embase.On the basis of literature research,combined with semi-structured interviews,and based on system management theory,the contents related to the minimum physical constraints of adult ICU patients were sorted out to form an index item pool.After group discussion,a draft of minimum physical restraint program for adult ICU patients was formed..2.Delphi method was applied to 18 experts from 12 provinces for two rounds of questionnaire consultation.By analyzing the reliability of the results of the letter consultation,the initial draft of the minimal physical restraint program for adult ICU patients was revised and improved,and the minimal physical restraint program for adult ICU patients was initially established.3.Use analytic hierarchy process(AHP)to determine the weight of each indicator,conduct consistency test,and form the final scheme.Results: 1.A total of 34 literatures were included in the final study,including 10 systematic evaluations,4 practice guidelines,2 clinical practice standards,3 evidence summaries and 15 original studies.Based on the results of semi-structured interview and group discussion,the preliminary draft of the plan for minimizing physical restraint in adult ICU patients includes three aspects: decision preparation,refinement and grading,and concrete implementation.2.The effective recovery rate of the questionnaires in the two rounds of correspondence was 100%;The authority coefficients of the two rounds of consultation were 0.90 and 0.94 respectively.The coordination coefficient of expert letter consultation was 0.184-0.252(P<0.01).In the results of the second round of letter consultation,the coefficient of variation of importance and operability of each index were 0.00-0.14 and 0.00-0.21 respectively.The finally established program contains 3 dimensions and 31 specific indicators,covers the whole process of physical restraint.3.On the basis of the mean value of expert importance assignment,analytic hierarchy process(AHP)was used to determine the weight of each index of the minimum physical restraint program for adult ICU patients,and the logical consistency test of the program was conducted.The results show that the consistency ratio of single ranking and total ranking is less than 0.1,indicating that the consistency test result is acceptable.The weight value of the first-level indicators is 0.4286 for decision preparation,0.1429 for decision classification and 0.4286 for specific measures.Among the second-level indicators,the combination weight is higher: assessment of risk factors,early intervention and prevention,and system improvement,etc.Among the three-level indicators,the combination weights are higher: Based on clinical judgment and effective assessment tools to evaluate the necessity of the patients with physical constraints(assessing patients’ level of consciousness: directional force assess,calm restless level,strength grade,catheter dangerous degree,etc.),constraints in the process of timely assess the usage and effects,once every 2 hours to observe physical constraints possible complications,and make records,if the patient is agitated,the frequency should be increased,and the physical restraint should be evaluated every 4 hours during the restraint period.Research Conclusions: This study based on the theory of system management,integrity,and build feedback guidelines,combined with literature research,qualitative interviews,Delphi method and chromatography analysis method to construct the adult ICU patients to minimize the physical constraints scheme,this scheme has high scientific nature,reliability and rationality,and the level of clear,reasonable weight,the maneuverability is strong,The results of this study have certain guiding significance for the clinical nursing work of adult ICU.