某精神科病房保護約束處置改善方案

Improvement of Restraint Intervention in A Psychiatric Ward

保護約束是用在精神科病患當有攻擊、破壞及自傷等行為及傾向時之一種行為治療的運用。然若處理不當，將造成人員（病患及工作人員）肢體損傷及病患的負面感受。本專案之目的在提昇同仁之約束護理認裀進而改善學束處置造成病患神經受損、尿滯留、壓瘡等情形。筆者利用1.同仁之保護約束認方面比改善前增加12.5分（72.9分→85.4分）。2.同仁對改善後之隔離約束加護治療紀錄單的滿意度比改善前增加8.2分（25.85分→34.05分）3.病患在整個保護過程中均未出現神經、血管、皮膚損傷。4.約束時間比改善前縮短2小時31分。5.保護約束中病患均未出現尿滯留、壓瘡之情形，足以證明本改善案值得推行。

Restraint intervention is the last reasonable way in psychiatry to prevent and handle patient's aggression, de-construction, and suicide behaviors. It will cause physical trauma and patient's negative feeling if not handled properly. The objective of this study is to enhance the nursing knowledge of restraint intervention and to improve the corresponding neural trauma, uroschesis, and pressure ulcer. Through several trainings and announcements, two ways were used to monitor and evaluate the effectiveness: creating nursing standard for restraint intervention and modifying recording sheet of intensive care of isolated-restraint intervention. The results show improvement in five areas. First, the understanding of restraint intervention by colleagues improves by 12.5 points (from 72.9 to 85.4). second, the satisfaction of modified recording sheet of intensive care of isolated-restraint intervention improves by 8.2 points (from 25.85 to 34.05). third, during the restraint intervention, neural, vascular, and skin damages were not found on patients. Forth, the restraint duration was shorten by 2 hours and 31 minutes. Last, uroschesis and pressure ulcer did not occur to patients after treating. Therefore, these methods were proved to be effective.