Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
Hastalarda Fiziksel Tespit Kullanımı, Sonuçları ve Hemşirelik Girişimleri: Geleneksel Derleme
Use of Physical Restraint in Patients, its Results and Nursing Interventions: Traditional Review
Gülendam HAKVERDİOĞLU YÖNTa , Sezer KISAb
aİzmir Tınaztepe Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, İzmir, Türkiye
bOslo Metropolitan Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik ve Sağlığın Teşviki ve Geliştirilmesi Bölümü, Oslo, Norveç
Turkiye Klinikleri J Nurs Sci. 2023;15(2):536-41
doi: 10.5336/nurses.2022-94259
Article Language: TR
Full Text
ÖZET
 Fiziksel tespit ''kişinin vücuduna bağlı veya bitişik herhangi bir yöntemi kullanarak, kişinin hareketini ve/veya vücuduna normal erişimini engelleyen, kontrol edemediği veya kolayca çıkaramadığı herhangi bir eylem veya prosedür'' olarak tanımlanmaktadır. Tespit, bir kişinin insan haklarını ve hareket özgürlüğünü ihlal edebilecek fiziksel, kimyasal, izolasyon/tecrit ve çevresel müdahaleler olarak da tanımlanmaktadır. Fiziksel tespit girişimi, özellikle yoğun bakım ünitelerinde, nöroloji kliniklerinde, psikiyatri ve acil servis ünitelerinde ve bakımevlerinde hastanın tıbbi araç bağlantılarını çıkarmasını, kendine zarar vermesini ve yataktan düşmesini önlemek, güvenliğini sağlamak ve ajitasyonunu azaltmak ve vücut postürünü korumak amacıyla kullanılmaktadır. Yapılan çalışmalarda, fiziksel tespitin en çok kullanılan tespit yöntemlerinden biri olduğu bildirilmektedir. Tıbbi uygulamalarda fiziksel tespit kullanımının sağlık hizmetlerinin başlangıcından beri mevcut olduğu, en az 3 yüzyıl öncesine dayanan psikiyatrik hasta popülasyonunda kısıtlamaların kullanıldığına dair kanıtlar bulunmaktadır. Fiziksel tespitin faydasına bilimsel bir kanıt bulunmamakla birlikte nörolojik veya kardiyovasküler yaralanmalar, deliryum ve travma sonrası stres bozukluğu gibi birçok kısa ve uzun vadeli fiziksel ve psikolojik olumsuz etkilerinin olduğu rapor edilmiştir. Tespit uygulamasının ne zaman, kimlere ve ne kadar süre ile uygulanacağı konusunda tartışmalı literatür, sağlık çalışanlarının tespit kullanımı ve yanlış kullanımı sonucunda neler olabileceği konusunda farkındalık yaratılmasının önemi üzerinde durmaktadır. Hastaya verilecek kaliteli bakımın temel amacı, kişiye özgü hemşirelik bakımının kanıta dayalı uygulamalar ile sağlanmasından geçmektedir. Bu nedenle bu makalede yaşlı hastalarda uygulanan fiziksel tespit uygulamalarının prevalansı, sık kullanılan fiziksel tespit yöntemleri, fiziksel tespit kullanımını azaltmaya yönelik uygulamalar ulusal ve uluslararası literatür doğrultusunda tartışılacaktır.

Anahtar Kelimeler: Bakım; fiziksel tespit; hasta; hemşire; yoğun bakım
ABSTRACT
 Physical restraint is defined as ''any act or procedure which, by using any method attached to or adjacent to the person's body, impedes the person's movement and/or normal access to the body, which she cannot control or easily'' remove. Restraint is defined as physical chemical, isolation/isolation and environmental interventions that may violate a person's human rights and freedom of movement. Physical restraint intervention is used especially in intensive care units, neurology clinics, psychiatry and emergency units, and nursing homes to prevent the patient from disconnecting from the medical device, self-harming and falling out of bed, ensuring safety, reducing agitation, and maintaining body posture. It is reported in the studies that physical restraint is one of the most used restraint methods. There is evidence of the use of restraints in the psychiatric patient population dating back at least three centuries, with the use of physical restraints in medical practice since the beginning of healthcare. Although there is no scientific evidence for the benefit of physical restraint, it has been reported to have many short- and long-term physical and psychological adverse effects, such as neurological or cardiovascular injuries, delirium, and post-traumatic stress disorder. Controversial literature on when, to whom and for how long the fixation application will be applied emphasizes the importance of raising awareness about what can happen as a result of the use and misuse of restraint by healthcare professionals. The main purpose of the quality care to be given to the patient is to provide personalized nursing care with evidence-based practices. Therefore, in this article, the prevalence of physical restraint applications in elderly patients, frequently used physical restraint methods, and applications to reduce the use of physical restraints will be discussed in line with the national and international literature.

Keywords: Care; physical restraint; patient; nurse; critical care
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