Abstract:

Objective To apply the best evidence of stepwise physical restraint protocol for critically ill neurological patients in clinical practice，guided by a humanistic care model，and to evaluate its effectiveness. Methods The best evidence regarding stepwise physical restraint for critically ill neurological patients was systematically reviewed. Evidence-based nursing protocols were developed，baseline assessments were conducted to identify potential barriers，and a best implementation strategy was formulated. A stepwise physical restraint program incorporating the principles of humanistic care was designed. This program was implemented in the neurosurgical intensive care unit（ICU） of a Class Ⅲ Grade A hospital in Jiangsu Province. The compliance rates of various audit indicators，the duration of physical restraint，and the incidence of related complications were compared before and after the implementation of the evidence. Results There were statistically significant improvements in the implementation of 26 indicators following the application of the evidence. Statistically significant differences were observed in the physical restraint rate，total restraint time，first and second restraint durations，and negative patient experiences associated with restraint between the two groups（P<0.05）. The reduction in physical restraint did not lead to an increase in unplanned extubation. Conclusion The application of best evidence of stepwise physical restraint for critically ill neurological patients can effectively shorten restraint duration，reduce restraint rates，and ensure patient safety.

Key words: Humanistic Care, Severe Neurological Disease, Stepwise Physical Restraint, Application of Evidence, Evidence-based Nursing