Yoğun Bakım Hastalarında Kısıtlama Uygulamalarının ve Nörovasküler Etkilerinin İncelenmesi

Abstract

Introduction: The purpose of this study is to examine the characteristics of restraints applied in intensive care units and the neurovascular effects on patients to whom physical restraints are applied. Material and Methods: The cross-sectional observational study was conducted between April 2018 and September 2018 in the internal and surgical intensive care units of a state hospital. The study included 120 patients to whom physical restraints were applied. The data were collected using a data collection form developed in accordance with the literature through a review of patient records in addition to observation and interview methods. The patients under restraint were observed and the nurses responsible for patient care were interviewed. Approval for the study was granted by the Local Ethics Committee, permission was obtained from the institution and informed consent from the relatives of the intensive care units patients in the study. Data obtained in the study were analysed statistically using SPSS vn 22.0 software and descriptive statistics, the Cochran Q test, Chi-square test, Friedman test and the Kruskal Wallis test. Results: A statistically significant increase was observed in oedema and colour change in the region below the physical restraint in a 5-day observation period and pulse strength was determined to have decreased (p<0.05). No significant change was determined in the temperature and capillary filling time of the restrained area in the 5-day observation period (p>0.05). No significant difference was determined between the restraining materials used in respect of oedema and pulse strength. A statistically significant difference was determined between the restraining materials used in respect of colour change, capillary filling time and temperature parameters on the second and third days of the restricted area (p<0.05). Conclusion: The results of the study showed that in physical restraint, which is mostly preferred in intensive care units, an increase in the period of physical restraint increases the possibility of neurovascular complications and the use of special restraint equipment could reduce the potential development of neurovascular complications.

Yoğun Bakımda Çalışan Hemşirelerin Fiziksel ve Kimyasal Tespit Uygulamalarındaki Bilgi, Tutum ve Becerileri

“…Çalışmamızda hemşirelerin "Fiziksel Tespit Uygulama" puan ortalaması da, daha önceki çalışmalarla benzerdir 28,29 Günümüzde yoğun bakım hastalarında daha hafif ve aralıklı sedasyon uygulamasının, uyanık hastalarda fiziksel tespit uygulamasına olan gerekliliği arttırdığı belirtilmektedir 30 . Literatür incelendiğinde; kimyasal tespitin, fiziksel tespite alternatif veya ek bir yöntem olarak düşünüldüğü için; fiziksel ve kimyasal tespitin bir arada kullanıldığı uygulamalar da görülmüştür 8,31 . Bu çalışmayı destekler nitelikte yapılmış başka bir çalışmada da; mekanik ventilatöre bağlı hastaların kendi kendilerine entübasyon tüpünü çekmemeleri adına, fiziksel tespitin kimyasal tespitle kombine kullanıldığı belirtilmiştir 32 .…”

“…Özellikle demans, ajitasyon, deliryum gibi hasta güvenliğinin tehlikeye girdiği durumlarda alternatif yöntemler yetersiz kalabilmekte; tespit uygulaması kaçınılmaz olabilmektedir [5][6][7] . Tespit, fiziksel ve kimyasal tespit (sedasyon) olarak ikiye ayrılmaktadır 8 . Fiziksel tespit, hastayı bir ip veya sınırlama bandı kullanarak bir sandalyeye, yatağa bağlamak ve bir eldiven veya yatak çiti kullanarak hastanın hareket serbestliğini sınırlamak olarak tanımlanırken; kimyasal tespit (sedasyon) hastasının çevreyle olan ilişkisinin ve bilinç durumunun ilaçlar yardımıyla santral sinir sistemini baskılayarak azaltılmasıdır 9 .…”

Physical Restraint Practices at the Emergency Department of a Mental Health Hospital

“…Legal regulations regarding physical restraint practices vary in each country. 1 , 5 , 12 In Turkey, legal regulations regarding compulsory treatment and restraint practices are included in various laws, such as the Turkish Penal Code, the Code of Criminal Procedure, the Turkish Civil Code, and the Law on the Execution of Criminal and Security Measures. The presence of different legal frameworks on the same issue can sometimes lead to difficulties in practice.…”