Boumans Christien E, Egger Jos I M, Bouts Richard A, Hutschemaekers Giel J M
Mental Health Institute Oost Brabant, Boekel, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Pompe Institute for Forensic Psychiatry, Pro Persona, Nijmegen, The Netherlands.
Int J Law Psychiatry. 2015 Jul-Aug;41:1-11. doi: 10.1016/j.ijlp.2015.03.001. Epub 2015 Apr 4.
Variation in seclusion rates between psychiatric facilities cannot be adequately explained by patient characteristics alone and there is a growing awareness of the influence of 'cultural' and staff factors on the use of seclusion. In this study, staff variables as well as seclusion parameters were investigated during the implementation of an innovation project, against the background of an institutional program to reduce the use of coercive measures. The results demonstrate the impact of confidence within the team, staffing level and communication with the patient on nurses' decisions on seclusion. The importance of the organizational context is further illustrated by the negative effects of organizational instability on nurses' attitudes and decision making with respect to seclusion, and on seclusion rates. A reduction in the use of seclusion was achieved after the implementation of the innovation project; however, during a period of organizational turmoil, the work engagement scores of staff decreased and the use of seclusion increased. The results of this study show the vulnerability of innovations within the continuously changing organizational context of mental health care.
精神科机构之间隔离率的差异不能仅由患者特征充分解释，人们越来越意识到“文化”和工作人员因素对隔离使用的影响。在本研究中，在一项旨在减少强制手段使用的机构项目背景下，在创新项目实施期间对工作人员变量以及隔离参数进行了调查。结果表明团队内部的信心、人员配备水平以及与患者的沟通对护士关于隔离的决策有影响。组织不稳定对护士关于隔离的态度和决策以及隔离率产生负面影响，进一步说明了组织背景的重要性。创新项目实施后，隔离的使用有所减少；然而，在组织动荡期间，工作人员的工作投入得分下降，隔离的使用增加。本研究结果表明，在不断变化的精神卫生保健组织背景下，创新具有脆弱性。
