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Construction and Multidimensional Verification of Clinical Practice Standards for Physical Restraint: A Four-Year
Yan Xu1, Luman Zheng2, Lixia Chen3
1Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.
Introduction:
Physical restraint (PR) is widely used in inpatient clinical nursing. Unplanned extubation (UE) events among restrained patients account for nearly half of all hospital UE cases, leading to an increased risk of medical disputes. It is imperative to establish a standardized nursing quality evaluation system and optimize PR-related nursing practices to lower the incidence of UE.
Methods:
This was a single-center retrospective longitudinal quality improvement study conducted based on inpatient data of a tertiary Grade A hospital in Zhejiang Province from 2018 to 2021. The PDCA cycle and multi-dimensional intervention strategies were adopted for practice optimization. A series of measures including setting up management teams, carrying out systematic training and applying the innovative hand-shake restraint technique were implemented. The PR utilization rate and relevant indicators were dynamically monitored, and independent influencing factors of UE were analyzed. This study was designed in compliance with the SQUIRE 2.0 standards.
Results:
After intervention, the PR utilization rate decreased from 4.29% to 2.77%, and the daily incidence of PR-related UE fell from 0.89% to 0.24%. Advanced age, consciousness disorder, neurological diseases and catheter indwelling duration of 1-5 days were independent risk factors for UE, whereas female gender and family accompaniment were protective factors. The interventions effectively corrected the disconnection between nurses' knowledge, attitude and practice, and improved patients' mental state and treatment compliance.
Conclusion:
This study established a standardized evaluation system for PR nursing quality. Innovative techniques and multi-dimensional interventions effectively optimized clinical nursing practices, reduced PR utilization and the occurrence of PR-related UE events. The results provide scientific evidence for clinical nursing management and promote the application of humanistic care philosophy in nursing practice.
