A Study On The Clinical Applicability Of The Recommendations In The Clinical Practice Guidelines For Physical Restraint In ICU Patients

Objective:To assess the quality of the clinical practice guidelines for ICU patients' physical restraints at home and abroad.To synthesize the main recommendations of the recommendations of high quality guidelines.Through expert meeting method,questionnaire survey method and interview method to investigate the applicability of the recommendations,understand the development of the recommendations,determine recommendations can be carried out in clinical,recognition to carry out the possible obstacles in the process.Thus to reduce the ICU patients' physical restraints,norm restraints measures,provide a reference basis in evidence in clinical.Methods:(1)The research problems were raised from the literature review combined with the clinical status,the domestic and foreign guidance network,the related organization website and the database were retrieved,and the guidelines were evaluated by the clinical research and evaluation tool(AGREE II)and the high quality guide was determined by the inclusion and exclusion criteria.(2)Based on the principles of translation and integration,the recommendations of comprehensive guidelines are sorted out as the items required for this research.(3)Through the expert meeting method,questionnaire survey method and interview method recommend the application opinions of nursing managers,nurses,doctors and patients.Results:(1)This study was included in 4 clinical practice guidelines,including 3 in the United States and 1 in Canada.By something II standardized evaluation score high three areas for the scope and purpose(84.26 + 16.15)%,the second was(76.50 + 12.97)%of clarity and rigour(66.97 + 21.14)%,scoring three areas for the application of low(62.15 + 26.34)%,independence(63.54 + 34.21)%,participants(63.54 + 20.36)%,four guide mean overall score is 4.94 1.30 mm,2 class A guide,2 B guide,determinating two grade A guidcline.(2)There are 13 recommendations synthesizing from 18 recommendations,which are about practice,education,organization policy recommends three topics,mainly involves the treatment of the relations between nurses and patients,timing restraints evaluation,evaluation methods,restraints alternative plan of care,many kinds of prevention measures,de-escalation technology and crisis management strategies,restrai1nts nursing education training ancd the related resources,policy content and so on.(3)The nursing manager approved 12 recommendations for clinical application,1 for non-recommendation,and for the recommendation implementation,Nurses should be paid attention to in the implementation of clinical acceptance,knowledge,skills,evidence content influence factors such as the detail.In terms of nurses,32.08%of the nurses don't know the recommendations,and the main ways are experience summary and peer communication,and 48.77%of the recommendations are not use in clinical.8 recommendations can be applied in clinical practice.Nurses believe that the main influencing factors in the application are shortage of manpower,large workload,lack of knowledge,shortage of materials and the expected effect of the application of evidence.Doctor agreed to implement 2 recommendations,and believe in practice nursing working pressure,preventing measures,lack of resources,the feasibility and nursing inertia,adverse events held accountable and managers attitude may affect the hindering factors of implementation.Patients,they agree 7 recommendations,the major effect of restraints on the patients including psychological and physical aspects,treatment of the relations between nurses and patients,focus on restraints during nursing demand satisfaction,recognition to carry out the recommendations.Comprehensive information on the development of the opinions of the stakeholders entry for guidelines recommend comments total of 11 can be carried out in clinical,1 no,1 is not carried out.Conclusions:(1)Currently,the number of clinical practice guidelines for patients with ICU is small,and the overall quality is good,but the application,independence and participation in the guidelies need to be improved.However,there are no guidelines for physical restraint in our country,and we can consider introducing the mature foreign guidelines into clinical application.(2)Evidences synthesis including practice,education,the organization policy three aspects of a total of 13 of the recommendations,involved include treatment of the relationship between nurses and patients,evaluation,prevention,and other aspects are presented.(3)The suitability evaluation of stakeholders,determined to carry out 11 recommendations,temporarily not in ues 1,don't carry out 1.Administrators,nurses,doctors and patients pay more attention to restraints problems.At present the main factors affecting recommended are nurses self ability insufficiency,the working pressure,the evidence effect of questioning,department lack of resources and the problem of insufficient management emphasis,in the future to reduce the ICU patients physical restraints should be focused on the practice,actively promote the practice.