ICU护士低价值身体约束决策影响因素的质性研究 [中文引用][英文引用]

目的  探讨重症监护室（intensive care unit，ICU）护士低价值身体约束决策的影响因素，为制定有效干预策略提供依据。方法  采用描述性质性研究方法，采用目的抽样法，2024 年 12 月至 2025 年 3 月对 21 名 ICU 护士进行半结构化访谈，运用主题分析法进行资料分析。结果  共提炼出 3 个主题及 10 个亚主题：护士专业能力不足（低价值身体约束知识缺乏、约束实践经验欠缺）；护士决策呈现有限理性（护理风险规避、依赖经验或直觉快速判断、偏向维持现状、高估自身决策准确性）；ICU护理工作环境和工作性质（护理人力不足、工作节奏紧张、约束标准不统一明确、防御性医疗氛围）。结论  ICU 护士低价值身体约束决策受到个人专业能力、心理和工作环境多种因素的影响，建议通过加强低价值身体约束知识教育与临床实践培训、减少有限理性影响以及构建支持性工作环境等综合措施，减少低价值身体约束的发生，进而提升临床护理质量。

Objective To explore the factors influencing low-value physical restraint decision-making among ICU nurses， and to provide a basis for developing effective intervention strategies. Methods A descriptive qualitative research method was adopted. Between December 2024 and March 2025，21 ICU nurses were selected through purposive sampling and underwent semistructured interviews. Thematic analysis was employed to analyse the acquired data. Results Three main themes and ten sub-themes were extracted：insufficient professional competence of nurses（lack of knowledge about low-value physical restraint，lack of practical experience in restraint）；bounded rationality in decision-making of nurses（avoidance of nursing risks，reliance on experience or intuition for rapid judgment，status quo bias，overestimation of the accuracy of their own decisions）；and the ICU nursing work environment and its nature（shortage of nursing staff，intensive work pace，inconsistent or unclear restraint standards，defensive medical atmosphere）. Conclusion Low-value physical restraint decision-making among ICU nurses is influenced by multiple factors，including personal professional competence，psychological factors，and the work environment. It is recommended to take comprehensive measures such as to strengthen education on low-value physical restraint and clinical practice training，mitigate the impact of bounded rationality，and build a supportive work environment，thereby reducing the occurrence of low-value physical restraint and improving clinical nursing quality.