Establishment Of Index System For Graded Management Of Physical Restraint In Patients With Schizophrenia

Research Purpose:This study constructs the hierarchical management index system of physical restraint for schizophrenic patients through evidence summary,case data,focus group interview and Delphi method,and uses analytic hierarchy process to calculate the weight coefficient of each index.Clarify the restraint level according to the restraint strength,restraint belt function and dangerous risk,and provide the reference basis for the rational selection of staffing,restraint parts and restraint appliances for clinical nurses.Research Methods:1.Evidence-based nursing method was adopted to systematically search domestic and foreign the research related to the restraint,independently screen and evaluate the literature,and collect relevant evidence.2.The case data of schizophrenic patients with protective restraint were reviewed,and the patients with different restraint parts and restraint appliances were compared.3.Objective sampling method was used to select relevant insiders from a third class a psychiatric hospital in Huzhou city for focus interview.4.Delphi method was used to assign importance values to each item and put forward suggestions and suggestions.5.The hierarchical structure model of constraint hierarchical management index system was established by Yaahp software,and the judgment matrix was constructed to calculate the weight coefficient and percentage of each item.According to the percentage of each item,the hierarchical management of protective restraints is classified.Research Results:1.4046 literatures were preliminarily searched and 13 were finally included.The included studies were medium or high-quality literature,and 35 pieces of evidence related to restraint parts,restraint appliances,joint assistance to restraint personnel and related factors were summarized.2.A total of 196 patients with restraint in a third class psychiatric hospital of Huzhou were reviewed.There were statistically significant differences in the degree of cooperation,agitation and sensory and perceptual disturbance in patients with different restraint parts（P<0.05）,and there were statistically significant differences in the disease types,previous restraint history,degree of cooperation and agitation in patients with different restraint devices（P<0.05）.3.A focus interview was conducted with 24 clinical insiders from the Psychiatric Department of a Third Class A psychiatric hospital in Huzhou city.The interview results are summarized into three topics: Determination of restraint parts,selection of restraint appliances and joint assistance to restraint personnel.4.Seventeen experts from the third class psychiatric hospitals in different regions of Zhejiang Province were selected for two letter consultations,and finally a hierarchical management index system of protective constraints for schizophrenic patients was constructed,including three first-class indexes,24 second-class indexes and 52 third-class indexes.The questionnaire recovery rates of the two rounds of expert correspondence were 94.44% and 100% respectively,the proposal rates were 64.71% and 11.76% respectively,and the authority coefficients were 0.896 and 0.903 respectively.After two rounds of correspondence,the mean value of importance assigned to each item ranged from 3.76 to 5.00,the coefficient of variation ranged from 0 to 0.23,the full score ratio is between 0.24 and 1.00,and the Kendall harmony coefficient is 0.330.5.The consistency ratios of all indicators in the hierarchical management index system of protective restraint for schizophrenics were all <0.1.In this index system,the weight of the three first-level indexes is 0.5396 for effective determination of restraint position,0.2970 for joint assistance of restraint personnel,and 0.1634 for rational selection of restraint tools.In the grading management index system,the effective determination of restraint parts accounted for 54%,which was divided into double upper limbs <18%,extremities 18%～36%,limbs and shoulders >36%.The reasonable selection of restraint appliances accounted for 16%,which was divided into cotton restraint belt ≤5.33%,magnetic buckle restraint belt >5.33%.The joint assistance of restraint personnel accounted for 30%,divided into 2-3 nurses <10%,2-3 nurses and 2 security guards10%～20%,and 2-3 nurses and 3-4 security guards >20%.Research Conclusion:This study constructs the hierarchical management index system of protective constraints for schizophrenic patients through evidence summary,data review and focus interview,and the construction process was relatively scientific.The index system includes three dimensions:determination of restraint position,selection of restraint appliance and joint assistance of restraint personnel,and the content covered is relatively comprehensive.The selected experts have certain enthusiasm and authority,the consistency of indicators at all levels is good,and the weight distribution is reasonable.The restraint level of the three dimensions in this index system is reasonable,which can provide reference for the minimum degree of restraint,avoiding the injury caused by restraint belt,and avoiding the physical injury of patients and staff.