| Objective:To investigate the basic situation of the implementation of physical restraint in the geriatric medical care institutions,analyze the influencing factors of physical restraint in the geriatric medical care institutions,develop and verify the evaluation form of physical restraint in the geriatric medical care institutions,and construct the physical restraint management protocol suitable for the geriatric medical care institutions.Method:1.Construction of the questionnaire on the implementation of physical restraint for the elderly in the geriatric medical care institutionsThrough literature review and expert meeting method,the questionnaire on the basic situation of the implementation of physical restraint for the elderly in the geriatric medical care institutions was constructed.Three sub-questionnaires were included: questionnaire on the status quo of physical restraint management in the geriatric medical care institutions,questionnaire on knowledge-attitudes-behavior of medical staff in the geriatric medical care institutions and questionnaire on the status quo of physical restraint use in the geriatric medical care institutions.2.Investigation and research on the basic situation of physical restraint in the geriatric medical care institutionsFrom March 18,2019 to October 25,2020,66 geriatric medical care institutions under the jurisdiction of Shanghai Geriatric Care Management and Quality Control Center were investigated by using the questionnaire on the basic situation of physical restraint implementation in the geriatric medical care institutions.The present situation of physical restraint management,knowledge,attitude and behavior of medical staff and the use of physical restraint were analyzed.3.Development of physical restraint assessment form for the elderly in the geriatric medical care institutionsThe elderly in the cross-sectional survey were included in the study group,and the chi-square test was used for single-factor analysis to obtain the influencing factors of physical restraints of the elderly in the geriatric medical care institutions,which were put into the Logistic regression equation.The variables of the evaluation model were screened out according to the variables entered into the regression equation,and the variable score was determined by referring to the OR value.The predictive value of the screened variables was verified by ROC curve.According to the Youden index,sensitivity and specificity,the optimal diagnostic threshold of the evaluation model was determined and verified,so as to establish the physical restraints evaluation table for the elderly in the geriatric medical care institutions.4.Construction of physical restraints management scheme for the elderly in the geriatric medical care institutionsBased on the preliminary investigation results of the implementation of physical restraints for the elderly in the geriatric medical care institutions,relevant guidelines,norms,consensus and standards of physical restraints were retrieved,evidence of physical restraints was screened and integrated,and the physical restraints management plan for the elderly in geriatric medical care institutions was initially prepared.The final draft of the physical restraints management plan for the elderly in the geriatric medical care institutions was formed through expert meeting,which can be used for reference by medical staff and managers in the geriatric medical care institutions.Results:1.Investigation and research on the basic situation of physical restraints in the geriatric medical care institutions(1)Investigation on the current situation of the management of physical restraint for the elderly in the geriatric medical care institutions: 66 geriatric medical care institutions were investigated in this study.Among them,64 institutions(96.97%)signed informed consent before using physical restraints.44 institutions(66.67%)were not evaluated before using physical restraints,and 22 institutions(33.33%)were only evaluated before using physical restraints.55 institutions(83.33%)were observed and recorded in the process of physical restraints,including the location of restraint,skin temperature,color,blood flow,tightness of restraint,restraint time,and restraint relaxation time.(2)Investigation of knowledge,attitude and behavior of medical staff in the geriatric medical care institutions on physical restraints: A total of 334 health care workers in the geriatric health care institutions,(33.41±8.10)years old,had been engaged in the geriatric care/nursing for(9.77±7.45)years.233(69.76%)had received training in physical restraints,and 101(30.24%)had not.The score of knowledge,attitude and behavior of medical staff on physical restraints was(4.92±1.02),(21.59±3.80)and(58.52±5.79).There was no statistically significant difference in the scores of knowledge,attitude and behavior on physical restraints among medical staff of different age,gender,working years,educational background and professional title(P > 0.05),while there was statistically significant difference between whether medical staff had received training related to physical restraints and the scores of physical restraints behavior(P < 0.05).(3)A survey on the status of physical restraints in the elderly in the geriatric medical care institutions: a total of 3662 elderly were investigated,(82.97±8.64)years old,the youngest age was 60 years old,the oldest age was 105 years old.Physical restraints were used in 1447 elderly,and the utilization rate of physical restraints was 39.51%.Among them,a total of 2512 elderly were investigated in the nursing homes,931 elderly using physical restraints,the utilization rate of physical restraints was 37.06%;A total of 688 elderly were investigated in the community health service centers,341 elderly using physical restraints,and the utilization rate of physical restraints was 49.56%.A total of462 elderly were investigated in hospitals with geriatric care units.175 elderly using physical restraints,and the utilization rate of physical restraints was 37.88%.The restraint tools include restraint belt,restraint gloves,restraint vest,restraint clothing;Reasons for physical restraints include prevention of falling from beds,scratches,falls,tube off,aggressive behavior,and ensuring smooth treatment.2.Development of the assessment form of physical restraints for the elderly in geriatric medical care institutions(1)Analysis results of influencing factors of physical restraints for the elderly in the geriatric medical care institutions: The results showed that there were statistically significant differences in 11 factors,including age,gender,consciousness,muscle strength,behavior,treatment/equipment,ADL grade,cognitive function,long-term bedridden or not,falling history or not,and tube off history(P < 0.05).The above 11 influencing factors were put into the Logistic regression equation,and 10 variables with statistically significant differences were obtained,including age,gender,consciousness,muscle strength,behavior,treatment/equipment,cognitive function,ADL grade,fall history,and history of tube off.(2)Results of construction and verification of the assessment model of physical restraints for the elderly in the geriatric medical care institutions: The Logistic model of the assessment on physical restraints for the elderly is as follows: Logistic(Y)=-4.122+0.181 gender +0.224 age +0.525 consciousness 1+0.732 consciousness 2+0.809 consciousness3+0.586 muscle strength 1+0.967 muscle strength 2-0.178 behavior 1+1.366 behavior2+1.688 behavior 3+1.371 treatment/equipment 1+0.417 Treatment/device2+0.813ADL1+1.242ADL2+0.609 cognitive function 1+1.049 cognitive function 2+1.103 cognitive function 3+0.758 fall history +0.792 pipeline slip history.Reference OR value will assign points into the Logistic regression equation 10 variables,the evaluation model is divided into 25 points,the lowest was divided into 0,according to Youden index,the degree of sensitivity,specific and about clinical experience,determine the boundary values of the evaluation model of 12.According to the behavioral score,3662 elderly were divided into agitation group(n=1050)and calm group(n=2612)for verification of boundary value selection.The sensitivity and specificity of agitation group were 97.33%and 10.26%,and the sensitivity and specificity of calm group were 50.79% and81.08%.The sensitivity of the evaluation model is high.When the elderly are in a calm and sedative state,the specificity of the evaluation model is high considering the minimization of physical restraints.3.Construction of management protocol of physical restraints for the elderly in the geriatric medical care institutionsA total of 6 guidelines that met the inclusion criteria were retrieved,and 3 were expert consensus.Finally,4 guidelines and 3 expert consensus were included through literature quality evaluation.The guidelines and expert consensus evidence were extracted and summarized,and the preliminary draft of the management protocol of physical restraints for the elderly in the geriatric medical care institutions was constructed based on the investigation of the basic situation of the implementation of physical restraints in the elderly and the analysis of influencing factors.Organize 12 experts to hold program discussion meeting,revise the protocol,and finally establish the management protocol of physical restraints for the elderly in the geriatric medical care institutions,including clinical practice(evaluation,planning,implementation)and management(quality control management,training),with a total of 35 recommendations.Conclusion:1.The elderly in the geriatric medical care institutions have a high utilization rate of physical restraints.Community health service centers are the highest,followed by nursing homes,and hospitals with geriatric care units are the lowest.The use of physical restraints in the geriatric medical care institutions is not standardized,and there is a lack of assessment tools for physical restraints in the geriatric medical care institutions.2.Due to the lack of knowledge about alternative measures of physical restraints for medical staff in the geriatric medical care institutions,it is necessary to strengthen the knowledge training of system of physical restraints for medical staff,correct their attitude towards the use of physical restraints,change their behavior of physical restraints,and standardize the use of physical restraints.3.There are 10 influencing factors of physical constraints for the elderly in the geriatric medical care institutions,including age,gender,consciousness,behavior,muscle strength,treatment/equipment,cognitive function,ADL grading,history of fall and history of tube off.4.Developed the assessment form of physical restraints for the elderly in the geriatric medical care institutions,containing 10 assessment items,including age,gender,consciousness,behavior,muscle strength,treatment/equipment,cognitive function,ADL grading,fall history,and tube off history.The lowest score in the evaluation form is 0,and the highest score is 25.If the score is < 12,physical restraint is not required.If the score is≥12,physical restraint is required(the principle of minimizing physical restraint is given priority).5.The management protocol of physical restraints for the elderly in the geriatric medical care institutions includes clinical practice and management.After expert demonstration,the framework is clear,the content is complete and scientific,and the process is simple and clear,which is worthy of clinical recommendation and application. |
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