City University, Philpot Street, London, E1 2EA, UK.
Soc Psychiatry Psychiatr Epidemiol. 2011 Feb;46(2):143-8. doi: 10.1007/s00127-010-0180-8. Epub 2010 Jan 16.
Conflict (aggression, substance use, absconding, etc.) and containment (coerced medication, manual restraint, etc.) threaten the safety of patients and staff on psychiatric wards. Previous work has suggested that staff variables may be significant in explaining differences between wards in their rates of these behaviours, and that structure (ward organisation, rules and daily routines) might be the most critical of these. This paper describes the exploration of a large dataset to assess the relationship between structure and other staff variables.
A multivariate cross-sectional design was utilised. Data were collected from staff on 136 acute psychiatric wards in 26 NHS Trusts in England, measuring leadership, teamwork, structure, burnout and attitudes towards difficult patients. Relationships between these variables were explored through principal components analysis (PCA), structural equation modelling and cluster analysis.
Principal components analysis resulted in the identification of each questionnaire as a separate factor, indicating that the selected instruments assessed a number of non-overlapping items relevant for ward functioning. Structural equation modelling suggested a linear model in which leadership influenced teamwork, teamwork structure; structure burnout; and burnout feelings about difficult patients. Finally, cluster analysis identified two significantly distinct groups of wards: the larger of which had particularly good leadership, teamwork, structure, attitudes towards patients and low burnout; and the second smaller proportion which was poor on all variables and high on burnout. The better functioning cluster of wards had significantly lower rates of containment events.
The overall performance of staff teams is associated with differing rates of containment on wards. Interventions to reduce rates of containment on wards may need to address staff issues at every level, from leadership through to staff attitudes.
冲突（攻击、药物滥用、逃跑等）和遏制（强制用药、手动约束等）威胁到精神病病房患者和工作人员的安全。先前的工作表明，员工变量可能在解释病房之间这些行为发生率的差异方面具有重要意义，而结构（病房组织、规则和日常程序）可能是这些变量中最关键的。本文描述了对大型数据集的探索，以评估结构与其他员工变量之间的关系。
采用多变量横断面设计。从英格兰 26 个 NHS 信托基金的 136 个急性精神病病房的工作人员那里收集数据，测量领导力、团队合作、结构、倦怠和对困难患者的态度。通过主成分分析（PCA）、结构方程建模和聚类分析探索这些变量之间的关系。
主成分分析确定了每个问卷作为一个单独的因素，表明所选工具评估了与病房功能相关的许多非重叠项目。结构方程建模表明，领导力影响团队合作、团队合作结构；结构倦怠；以及对困难患者的倦怠感。最后，聚类分析确定了两个明显不同的病房群：较大的病房具有特别好的领导力、团队合作、结构、对患者的态度和较低的倦怠；第二小比例的病房在所有变量上都较差，倦怠度较高。运作较好的病房群的遏制事件发生率明显较低。
员工团队的整体表现与病房遏制率的不同有关。减少病房遏制率的干预措施可能需要从领导力到员工态度，在各个层面上解决员工问题。
