关键词: 身体约束, 重症监护病房, 护士, 理论域框架, 质性研究

Abstract: Objective: To explore the obstacle factors for ICU nurses to perform physical restraint minimization action, and to provide reference for formulating standardized physical restraint management plan. Methods: The interview outline was developed based on the theoretical domains framework(TDF). Totally 12 ICU nurses from a tertiary hospital in Tianjin were selected for semi-structured interviews by purposive sampling, the transcribed texts were categorized according to the relevant domains of TDF, and the interview data were analyzed by content analysis. Results: In the current clinical work, ICU nurses had bias in understanding of physical restraint minimization action and unfamiliarity with the content of alternative restraint measures, which was one of the obstacles to their implementation of physical restraint minimization action. The decision process of evaluation tool of physical restraint minimization plan was not uniform and standardized, which has caused some obstacles to the development of restraint minimization action. The limitation of environmental factors and the concern about the outcome of reduction constraints made ICU nurses not confident enough to perform; The lack of organizational atmosphere supporting reduction constraints in the department made it difficult for nurses to pay attention to the implementation of reduction actions, and thus reduce the motivation of implementation. Combined with TDF, the above obstacles were classified into 5 domains: knowledge, beliefs about capabilities, environmental context and resources, social influences, behavioural regulation. Conclusion: On the basis of clarifying the obstacle factors, the department needs to strengthen the leadership’s attention and support to the implementation of physical restraint minimization, and develop the standardized decision-making process of restraint reduction assessment and training programs to advocate team cooperation, create an organizational atmosphere supporting physical restraint minimization action, encourage ICU nurses to firmly implement the confidence of restraint minimization, and promote the continuous implementation of physical restraint minimization action.

Key words: Physical restraint, ICU, Nurse, Theoretical domains framework, Qualitative study