关键词: 米勒金字塔模型, 身体约束, 培训, 神经外科监护室, 护士

Abstract:

Objective To explore the application effects of a physical restraint training program for nurses in neurosurgical intensive care unit（NICU） based on Miller's Pyramid design. Methods A physical restraint training program for NICU nurses was designed based on Miller's Pyramid，which incorporating findings from on-site observations，questioning，and semi-structured interviews. Nurses working in the NICU of a tertiary hospital were divided into an experimental or a control group（19 nurses each） based on their actual patient assignments. The control group received routine physical restraint training，while the experimental group underwent physical restraint training designed based on Miller's Pyramid. A total of 139 patients managed by each group from January to March 2024 were selected as observation participants through convenience sampling. The correct application rate of physical restraints，along with the incidence rates of physical restraint use，unplanned extubation，and skin injuries among patients cared for by both groups，were collected and compared. Results The experimental group demonstrated a higher correct application rate of physical restraints and lower physical restraint application rates compared to the control group（P<0.05）. Besides，no statistically significant differences were observed in the incidence rates of unplanned extubation and skin injuries between the two groups（P>0.05）. Conclusion Physical restraint training based on Miller's Pyramid can improve the correct application rate of restraints by NICU nurses and reduce physical restraint usage in patients without increasing adverse event rates，making it suitable for further implementation.

Key words: Miller's Pyramid, Physical restraint, Training, Neurosurgical intensive care units, Nurses