Construction And Application Of Physical Restraint Reduction Program For Patients In ICU Based On 3D Quality-Structure Model

ObjectiveThis study is based on the"three-dimensional(3D)quality-structure model"as the theoretical basis,construct a scientific and practical Physical Restraint Reduction Scheme of ICU patient,then the constructed scheme will be verified its validity in clinical application,to provide reference for ICU nursing staff to reduce physical restraint in the future,so as to promote the continuous improvement of ICU nursing quality.Methods(1)Preliminarily draw up the Physical Restraint Reduction Scheme for patients with crtical illness in ICU,based on"3D quality-structure model"as the theoretical basis,by semi-structured interview method and literature review method.It is convenient to sampling7 medical nursing experts from the intensive care department of a tertiary and first-class general hospital in Qingdao was convenient selected to conduct interviews by semi-structured interview method,and improve the first draft of the plan.Delphi expert correspondence method was used the to conduct expert correspondence.According to the results of the letter inquiries,the scheme was revised and supplemented after group discussion,formed the finally scheme for reducing physical restraint of ICU patients.The reliability of the inquiry results was judged by using the expert’s positive coefficient,the expert’s authority coefficient,and the Kendall coordination coefficient.(2)According to the inclusion and exclusion criteria 196 ICU inpatients from a tertiary first-class general hospital in Qingdao were recruit by convenience sampling.The random number table method was used to randomly divide the research subjects into an intervention group and a control group,with 98 patients in each group.The control group adopted the routine nursing program,and the intervention group adopted the ICU patients’physical restraint reduction program.The physical restraint usage rate,restraint usage time,and the incidence of physical restraint-related complications(mainly including delirium,unplanned extubation,skin pressure injury,deep vein thrombosis,ICU-acquired weakness),the collected data were subjected to statistical analysis.Results(1)Based on literature review and semi-structured interviews,the research team preliminarily constructed the Physical Restraint Reduction Program for ICU Patients,which included 3 first-level indicators,14 second-level indicators,and 64 third-level indicators;Delphi method verified that the effective recovery rate of the two rounds of letter questionnaires were 92.6%and 96.0%,the expert authority indexes of the two rounds of letter questionnaires were 0.880 and 0.905,and the Kendall’s W were 0.302 and 0.487(P<0.01).After the letter consultation,group discussion was conducted to revise the Physical Restraint Reduction Program for ICU Patients.(2)The intervention group reduced the program by applying physical restraint for ICU patients,the constraint utilization rate of intervention group(48.0%)was significantly lower than that in the control group(69.4%),with statistical significance(χ~2=9.279,P<0.01).The constraint time of intervention group(25.49±9.61)h was significantly lower than that in control group(31.73±10.26)h,with statistical significance(t=4.893,P<0.01).The incidence of delirium of intervention group(17.3%)was significantly lower than that in control group(31.6%),and the difference was statistically significant(χ~2=5.408,P<0.05).The incidence of skin pressure injury of the intervention group(2.0%)was significantly lower than that in the control group(10.2%),and the difference was statistically significant(χ~2=5.681,P<0.05).There were no significant differences in the incidence of unplanned extubation,deep venous thrombosis and acquired weakness in ICU between intervention group and control group(P>0.05).Conclusion(1)This study is based on"three-dimensional(3D)quality-structure model".The scheme is scientific and reliable,and can be popularized and used in clinical practice.(2)The results of application of physical restraint reduction program for ICU patients showed that the research program developed in this study could significantly reduce the use of physical restraint,shorten the restraint duration of patients,and reduce the occurrence of constraint-related complications,the intervention measures were effective.