Research On Continuous Improvement Of Clinical Application Of Evidence-based Practice Program For Physical Restraint Of ICU Patient

ObjectiveUnderstand the current status of ICU patients’ physical restraint evidence-based practice project and analyze its influencing factors;Formulate the project’s continuous application action plan and carry out clinical practice to improve the nurse’s knowledge level and evidence-based nursing ability,promote the improvement of patient outcomes,and enhance organizational evidence-based nursing culture.MethodsThis study takes PDCA cycle as the action framework and combines the knowledge transformation model.Evidence-based project practice department(including nurses,patients,doctors,record sheets,department flow charts,etc.)is the research object.Firstly,understand the continuing status of the evidence-based practice project of ICU patients’ physical restraint through observation and interview.Then understand the factors that affect the sustainability of the project through a combination of interview and questionnaire.Based on the continuous influencing factors of the project,combined with the expert demonstration meeting,the"Optimized Version of the ICU Patient Physical Restraint Evidence-based Practice Project and Action Strategy" was formulated.Implement the plan and use the method of front-to-back research to comprehensively evaluate the implementation effect from the level of patients,nurses and organizations.Results1.Through a baseline survey of the ongoing status of the clinical implementation of the physical restraint evidence-based practice project of ICU patients in the pilot department,it was found that:(1)A clinical review of the 12 review indicators of the clinical implementation of the recommended items of the physical restraint evidence-based practice project was conducted.The implementation rates were between 0%～100%.The implementation rates of review standards 3,11,and 12 reached 100%;the review result of review standard 1 was 72%,which was lower than the baseline level of the previous research survey(76%);review standard 2 in this study had been maintained well;the review standards 4,5,6,7,8,9,and 10 implementation rates that are closely related to the physical restraint of ICU patients had a downward trend in the review;(2)The physical restraint rate of ICU patients was 32.27%,and the average restraint time was(90.03±95.47)h.(3)Most nurses affirmed the clinical significance of the physical restraint evidence-based practice project,but made suggestions on the feasibility of using some of its contents in the process of use,and believed that there were many obstacles in the clinical implementation process;however,the nurses believed that the attention and support of the leadership level and the relevant knowledge acquired in the previous training are helpful to the clinical nursing work;(4)The average score of the ICU nurses’ evidence-based nursing implementation belief and implementation level was(90.63±27.75)points,of which the belief level(53.20±7.62)points,implementation level(37.43±20.14)points.2.Analyzed the possible obstacles during the implementation of the guidelines’ best recommendations and formulated corresponding action strategies;through expert discussion,an optimized version of the ICU patient’s physical restraint evidence-based practice nursing plan was constructed.3.(1)Before and after the implementation of the optimized version of the plan,the difference in nurses’ general data was not statistically significant(P>0.05).ICU nurses’evidence-based nursing belief and implementation scales total score,belief scale score,and implementation scale score had improved,and the belief scale score had statistically significant differences(P<0.05);after the implementation of the plan,the implementation of each item had improved;(2)Before and after the implementation of the plan,there was no statistical difference in the general data of the two groups of patients(P>0.05).The physical restraint rate of ICU patients decreased from 34.91%before optimization to 28.57%after optimization,but the difference was not statistically significant(P>0.05).The average length of physical restraint decreased from(115.19±109.32)hours before optimization to(98.42±83.78)hours after optimization,but the difference was not statistically significant(P>0.05).(3)The implementation of the plan has improved the procedures and systems related to physical restraint in the department,education and training on physical restraint at the department level,hospital electronic system,access to resources related to physical restraint and has promoted the construction of evidence-based culture in the department.Conclusions1.The sustainability of the physical restraint evidence-based practice project for ICU patients is poor,and factors such as restraint processes,restraint tools,education and training methods,and departmental systems affect the sustainability of the project.2.The evidence-based practice project needs to be updated and optimized based on the clinical situation and new research results in the continuous process.At the same time,formulate specific action strategies to promote the continuous and efficient implementation of the project based on its influencing factors.3.Evidence-based practice project needs to be adjusted or revised for specific clinical issues during the development of the evidence-based practice project.4.The continuous quality improvement of this evidence-based practice project can promote the improvement of the patient’s physical restraint standard and improve the quality of life of patients;it can promote the improvement of nurses’ knowledge level and the improvement of evidence-based nursing ability;it can improve the organization’s evidence-based culture.