Bowers L
Section of Mental Health Nursing, Institute of Psychiatry, London, UK.
J Psychiatr Ment Health Nurs. 2014 Aug;21(6):499-508. doi: 10.1111/jpm.12129. Epub 2014 Feb 19.
Conflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff.
冲突（攻击、自我伤害、自杀、逃跑、药物/酒精滥用及拒绝服药）和管控措施（按需用药、强制肌内注射、隔离、人工约束、特别观察等）会使患者和工作人员面临受到严重伤害的风险。这些事件的发生频率在不同病房之间有所差异，但对于造成这种差异的原因却鲜有解释，而且缺乏一个连贯的模型。本文提出了一个关于这些差异的全面解释模型，并概述了其对降低住院病房风险和强制措施的方法的影响。这个安全保障模型描述了六个引发因素领域：工作人员团队、物理环境、医院外部、患者群体、患者特征和监管框架。这些领域会引发闪点，而闪点有可能引发冲突和/或管控措施。工作人员的干预措施可以通过减少冲突引发因素、防止闪点出现、切断闪点与冲突之间的联系、选择不采用管控措施以及确保管控措施的使用不会导致进一步冲突来改变这些过程。我们系统且详细地描述了这个模型，并展示了如何利用它来制定促进患者和工作人员安全的策略。
