需要管路照護的居家個案使用身體約束的相關因子分析：南台灣一橫斷性研究

Factors Associated with Use of Physical Restraints on The Invasive Catheterized Adults with Home Care: A Cross-Sectional Study in South Taiwan

約束在醫療機構被視為用來保護個案的方法之一，而約束在保護個案的同時也降低了他們的自主性，甚至造成不同程度的傷害。雖然約束的議題在醫療機構中被廣泛討論，但在居家護理卻較少被提及。本研究目的是為探索：(1)居家護理個案受到約束的比例，(2)約束的原因，以及(3)約束相關因素。使用橫斷面研究設計，以某區域醫院申請居家護理個案之主要照顧者為研究樣本。以問卷作為資料收集工具。收集個案之基本人口學變項、被約束的原因、工具與時間、管路使用、意識、認知與日常生活功能以及四肢肌力等資料。以卡方與Mann-Whitney U比較約束及無約束個案之間的差異，再以多變量邏輯斯迴歸分析長期居家照護個案接受約束之顯著相關因素。本研究調查了114位個案，有83名被約束，約束率約72.8%。多元邏輯斯迴歸分析中，約束者使用鼻胃管(Adj. OR = 5.34, 95% CI = 1.10-25.93)以及照護人力缺乏的情況下(Adj.OR = 4.07, 95% CI = 1.32-12.50)，個案被約束的勝算較高。嘉義地區居家照護約束比例超過七成。有鼻胃管及沒有輪替人力與被約束有顯著關聯性。

Physical Restraint is usually used for the subjects for keeping them safe and preventing them from falling accident in healthcare institutes. However, restraints would reduce their autonomy and increase the injury caused by restraints. Although there were a few studies regarding restraints in healthcare institutes, the data is limited in the home-care subjects. The purposes of this study were to investigate the prevalence of physical restraints in subjects requiring homecare and its associated factors with restraints. A crosssectional study was conducted, including subjects who received regular home care by registered nursing staff. Demographic data and the use of physical restraints for subjects were collected using questionnaires and interviews. Cognitive function, physical function and muscle power were also measured and recorded. The Chi-Squared and Mann-Whitney U test were used to compare the difference between the subjects with or without physical restraint. The multivariate logistic regression model was used to identify factors significantly associated with physical restraint use. Among 114 home-care subjects, 83 were under physical restraint, the rate of physical restraint was 72.8%. Multivariate logistic analysis showed that the use of nasogastric tube (Adj. OR = 5.34, 95% CI = 1.10-25.93) and higher loading (Adj. OR = 4.07, 95% CI = 1.32-12.50) were significantly associated with odds of physical restraint. The prevalence of physical restraint in home-care subjects was high. We observed the subjects with physical restraints had relatively higher ratio of nasogastric tube, and they had fewer support from their caregivers.