Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
Yoğun Bakımda Fiziksel Kısıtlama Karar Çarkının Uygulanması: Metodolojik Çalışma
Implementation of the Physical Restraint Decision Wheel in Intensive Care: A Methodological Study
Ramazan BOZKURTa , Nasibe Yağmur ZİYAİa , Özlem DOĞUa
aSakarya Üniversitesi, Sağlık Bilimleri Fakültesi, Hemşirelik Esasları AD, Sakarya, Türkiye
Turkiye Klinikleri J Nurs Sci. 2025;17(3):780-8
doi: 10.5336/nurses.2024-107100
Article Language: TR
Full Text
ÖZET
 Amaç: Hemşirelerin yoğun bakım ünitelerinde fiziksel kısıtlama kullanımının yaygın nedenlerini ve kısıtlamanın kullanımı yönünden riskli hastaları tanımlayabilecek, fiziksel tespit uygulamasının yararlarını ve zararlarını değerlendirebilecek bilgi birikimine ve yeterliliğe sahip olmaları gerekmektedir. Kısıtlama karar çarkının Türk diline ve kültürüne uyarlayarak geçerliliğini sağlamaktır. Gereç ve Yöntemler: Kısıtlama karar çarkı araştırmacılar tarafından önce Türkçeye çevrilmiştir ve Brislin metodu kullanılmıştır. Arkasından hemşirelik alanından 10 uzmana kapsam ve dil geçerliliği yönünden incelenmek üzere gönderilmiştir. Nihai kısıtlama karar çarkı belirlendikten sonra bir eğitim ve araştırma hastanesinin anestezi ve reanimasyon yoğun bakım ünitesinde yatan toplam 119 hasta ile çalışma tamamlanmıştır. Çalışmanın verileri Mayıs ile Temmuz 2024 tarihleri arasında Hasta Bilgi Formu, Glaskow Koma Skalası (GKS), Yoğun Bakım Ünitesinde Konfüzyon Değerlendirme Ölçeği, Richmond Ajitasyon Sedasyon Skalası (RASS) ve kısıtlama karar çarkı kullanılarak toplanmıştır. Her hasta 2 farklı gözlemci tarafından değerlendirilmiştir. Bulgular: Çalışmadaki hastaların yaş ortalaması 66,40±17,59, %67'si erkek, %23,5'i post kardiyopulmoner resüsitasyon sonrası takip ile izlenmekte ve %55,5'i kronik hastalığa sahiptir. Hastaların yoğun bakım yatış günü ortalaması 44,88±66,34 gün, GKS puan ortalaması 6,63±0,38, RASS puan ortalaması -0,78±0,2'i, %98,3'ü enteral yoldan beslenmekte, %26,1'i analjezik kullanmaktadır. Hastaların hiçbiri deliryumda değildir ve %75,6'sine fiziksel kısıtlama yapılmamıştır. Kısıtlama karar çarkının dil geçerlilik indeksi 0,73, kapsam geçerlilik indeksi 0,87 olarak tespit edilmiştir. Gözlemciler arası uyum olan Kappa değeri ise 0,94 olarak belirlenmiştir. Sonuç: Kısıtlama karar çarkı yoğun bakım ünitelerinde fiziksel tespit kararının verilmesinde uygulanabilir ve geçerli bir araçtır. Yoğun bakım hemşireleri ekip ile iş birliği içerisinde kısıtlama karar çarkını kullanarak fiziksel tespit kararının verilmesinde öncü rol oynayabilir.

Anahtar Kelimeler: Kısıtlama; fiziksel; hemşireler; yoğun bakım üniteleri
ABSTRACT
 Objective: Nurses should have the knowledge and competence to identify the common reasons for using physical restraint in intensive care units, identify patients at risk for the use of restraint, and evaluate the benefits and harms of physical restraint. To ensure the validity of the Restraint Decision Wheel by adapting it to the Turkish language and culture. Material and Methods: The researchers first translated the Restraint Decision Wheel into Turkish using the Brislin method. Then, it was sent to 10 experts in the field of nursing to be examined in terms of content and language validity. After determining the final Restraint Decision Wheel, the study was completed with 119 patients hospitalized in a training and research hospital's anesthesia and reanimation intensive care unit. Data were collected between May and July 2024 using the Patient Information Form, Glasgow Coma Scale (GCS), Confusion Assessment Method for the Intensive Care Unit, Richmond Agitation Sedation Scale (RASS), and Restraint Decision Wheel. Two different observers assessed each patient. Results: The mean age of the patients in the study was 66.40±17.59 years; 67% were male, 23.5% were followed up after post-cardiopulmonary resuscitation, and 55.5% had a chronic disease. The mean number of days of intensive care unit stay was 44.88±66.34 days, the mean GCS score was 6.63±0.38, the mean RASS score was -0.78±0.2, 98.3% were fed enteral nutrition, and 26.1% used analgesics. None of the patients were in delirium, and 75.6% had no physical restraint. The language validity index of the Restraint Decision Wheel was 0.73, and the content validity index was 0.87. The Kappa value, an inter-observer agreement, was determined as 0.94. Conclusion: The Restraint Decision Wheel is a valid and applicable tool for making physical restraint decisions in intensive care units. Intensive care nurses can lead in making physical restraint decisions by using the Restraint Decision Wheel in cooperation with the team.

Keywords: Restraint; physical; nurses; intensive care units
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