Soininen Päivi, Putkonen Hanna, Joffe Grigori, Korkeila Jyrki, Välimäki Maritta
Department of Nursing Science, University of Turku, Turku, Finland.
BMC Psychiatry. 2014 Jun 4;14:162. doi: 10.1186/1471-244X-14-162.
Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients' perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay.
Systematic mixed studies review was the study method. Studies reporting patients' perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out.
Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient's refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22).
The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants' informed consent and respecting ethical procedures.
尽管精神科住院护理有所改善，但精神病医院仍在使用对患者的限制措施。研究在住院期间曾被隔离或身体约束的患者的看法具有挑战性。我们试图回顾定性和定量研究中的方法学和伦理挑战，这些研究旨在描述患者对强制手段的看法，尤其是住院期间的隔离和身体约束。
采用系统混合研究回顾法。纳入报告患者对强制手段看法的研究，尤其是住院期间的隔离和身体约束。系统地综合了研究设计、数据收集和招募过程、参与者、抽样、患者拒绝或不参与等方法学问题，以及知情同意过程和批准等伦理问题。对CINALH、MEDLINE、PsychINFO和Cochrane图书馆（1976 - 2012年）进行了电子检索。
在846条初始文献中，纳入了32项研究，其中14项定性研究和18项定量研究。使用了多种方法学途径，尽管大多数情况下采用的是描述性和探索性设计。定性研究中数据主要通过访谈收集（n = 13），定量研究中主要通过自我报告问卷收集（n = 12）。59%（n = 19）的研究解释了招募过程。大多数情况下采用便利抽样，但有5项研究使用了随机化。37%（n = 11）的研究报告了患者的拒绝或不参与情况。在所有研究中，56%（n = 18）报告在官方委员会或机构进行了伦理审查过程。69%（n = 22）的研究告知了受访者并征求了同意。
不同研究设计的使用使得方法学上的比较具有挑战性。数据收集的时间（考虑偏差和混杂因素）以及符合条件的参与者不参与的原因同样是方法学挑战，例如推荐的流程图有助于提供信息。其他确定的挑战包括招募大量且具有代表性的样本。伦理挑战包括征求参与者的知情同意和遵守伦理程序。
