ICU患儿最小化身体约束证据转化的促进和障碍因素分析

doi:10.3761/j.issn.2096-7446.2025.12.014

摘要/Abstract

摘要：

目的探讨ICU患儿最小化身体约束的相关证据在临床转化的促进和障碍因素，制订变革策略。方法基于循证方法，提取最佳证据并制订13条审查指标及方法，对某三级甲等儿童医院ICU护士及患儿进行审查，采用i-PARIHS框架的促进指引清单，根据基线审查结果，分析促进及障碍因素并制订变革策略。结果 552例ICU患儿证据应用前身体约束率为71.19%。13条审查指标中，3条指标执行率>60%，其余10条指标执行率均<60%，其中6条指标执行率为0。141名ICU护士身体约束知信行调查问卷总得分为（55.77±8.11）分；分析得出促进因素15条、障碍因素15条，制订11条变革策略。结论 ICU患儿最小化身体约束证据与临床实践尚存在较大差距，应制订科学的审查指标、全面分析促进和障碍因素并制订变革策略，为循证护理实践奠定基础。

关键词: ICU, 患儿, 身体约束, 最小化, 循证护理学, i-PARIHS框架

Abstract:

Objective To explore the potential facilitators and barriers to the clinical translation of evidence related to minimizing physical restraint in ICU children for formulating change strategies. Methods Based on the evidence-based method，the best evidence was extracted and 13 review indicators and methods were formulated. ICU nurses and children were reviewed in a tertiary class A Children’s Hospital. The promotion guideline list of the i-PARIHS framework was adopted. According to the review indicators and baseline review results，the promoting and barrier factors of evidence transformation were analyzed，and change strategies were formulated. Results The rate of physical restraint before best evidence application in ICU was 71.19%. Among the 13 review indicators，the implementation rate of 3 review indicators was >60%，the implementation rate of the remaining 10 review indicators was less than 60%，and the implementation rate of 6 review indicators was 0. The total score of ICU nurses’ knowledge and practice questionnaire on physical restraint was（55.77±8.11）. 15 facilitators and 15 barriers for minimizing physical constraint evidence transformation in ICU children were analyzed，and 11 change strategies were developed. Conclusion There is still a big gap between the best evidence of minimizing physical restraint among children in ICU and clinical practice. Scientific review indicators should be developed，facilitators and barriers factors should be comprehensively analyzed，and corresponding reform strategies should be implemented to lay the foundation for evidence-based nursing practice.

Key words: Intensive Care Units, Pediatric, Physical Restraint, Minimization, Evidence-Based Nursing, i-PARIHS Framework

宋楠, 迟巍, 臧娇娇, 张洁, 朱蕊, 金芸, 王文超. ICU患儿最小化身体约束证据转化的促进和障碍因素分析[J]. 中华急危重症护理杂志, 2025, 6(12): 1482-1488.

SONG Nan, CHI Wei, ZANG Jiaojiao, ZHANG Jie, ZHU Rui, JIN Yun, WANG Wenchao. Analysis of facilitators and barriers to evidence implementation of minimal physical restraint in ICU children[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(12): 1482-1488.

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