加護病房中化學性約束的使用與護理

Chemical Restraint and Nursing Care in the Intensive Care Unit

加護病房對病患而言是陌生又隔離的環境，加上病患疾病嚴重度高、侵入性管路多、醫療處置繁雜、護理常規頻繁，病患常出現疼痛及焦慮的問題，若未給予適當處置，則會導致病患躁動行為而影響治療計畫。研究指出加護病房病患發生躁動機率達71%，化學性約束是臨床處理病患躁動的方法之一，護理人員在加護病房擔任主要照顧角色，與病患接觸時間最多，應該即時評估病患需求，與醫師討論化學性約束的使用，以緩解病患焦慮與疼痛，而有利於治療進行。當然，化學性約束亦有其副作用，在執行前應先評估呼吸道（airway）、呼吸（breathing）、血循（circulation）情況，呼吸方面要密切監測呼吸音、呼吸型態、血氧濃度，以及早發現呼吸抑制的問題；血循方面應同時監測血壓及體液容積，若為低血容積病患，可先給予靜脈注射體液容積，避免低血壓的發生。總之，病患接受化學性約束過程唯有醫護人員密切評估與監測，才能提供病患一個安全的照護計畫。

The intensive care unit (ICU) presents patients with an environment that is unfamiliar and isolating. In addition to the relative severity of diseases treated, ICUs frequently employ tube therapy, complex medical treatments and diverse nursing routines. Such elevates the chances that patients will experience pain and anxiety, which, in turn, raise the likelihood of patient agitation and reduce ultimate treatment effectiveness. Research has shown that 71% of ICU patients experience agitation. Nurses have main caring responsibilities in such circumstances because they provide the greatest percentage of bedside care. The role of nurses is not only to assess patient needs in a timely fashion, but also to discuss with ICU physicians the level of chemical restraint needed in order to relieve patient pain and anxiety. As chemical restraints involve side effects, a study of patient airway status and breathing and circulation needs must be done prior to application. In terms of breathing, patient breathing sounds, patterns and saturation levels must be monitored regularly in order to identify airway distress preemptively. In terms of blood circulation, patients should have their blood pressure and body fluid status monitored concurrently at regular intervals. With such data, should a patient become hypovolemic, appropriate intravenous fluid support may be administered prior to chemical restraint use in order to help prevent advanced hypotension. Based on such, it is clear that ICU team members must work closely together in order to monitor and assess patients prior to administering chemical restraints and to put into place a patient-tailored safety care plan.