Lavelle Mary, Attoe Chris, Tritschler Christina, Cross Sean
Florence Nightingale Faculty of Nursing & Midwifery, King's College London, WC2R 2LS, UK.
Maudsley Simulation, South London & Maudsley NHS Foundation Trust, Lambeth Hospital, SW9 9NT, UK.
Nurse Educ Today. 2017 Dec;59:103-109. doi: 10.1016/j.nedt.2017.09.009. Epub 2017 Sep 21.
In the UK, people with severe mental illness die up to 20years earlier than the general population, prompting increased focus on physical health in mental illness. However, training for mental health inpatient staff to meet patients' physical health needs has not received the same attention, with physical health training often being reactive and lacking evidence of effectiveness.
To evaluate an interprofessional, in situ, simulation training intervention for managing medical deterioration in mental health settings. Investigating the impact of training on: 1. Participants' knowledge, confidence, and attitudes towards managing medical deterioration; and 2. Incident reporting, as an objective index of incident management. Participants' perceptions of the impact on their practice were qualitatively explored.
This evaluation employed a mixed-methods pre-post intervention design.
PARTICIPANTS & SETTINGS: Fifty-three healthcare professionals participated including: mental health nurses, psychiatrists, healthcare assistants, and activity co-ordinators from two busy psychiatric triage wards in South London, UK.
The intervention comprised eight half-day sessions delivered weekly across two wards. Structured surveys assessed participants' knowledge, confidence, and attitudes towards medical deterioration pre and post training. Participants' experience of training was qualitatively captured through post-course surveys and focus groups three months post training. Incident reporting rates for seven-month periods pre and post training were compared.
Following training, participants showed significant improvement in knowledge (p<0.001), confidence (p<0.001), and attitudes towards (p<0.02) managing medical deterioration. Incident reporting increased by 33% following training. Participants' reported improved confidence in managing medical deterioration, better understanding of effective communication, improved self-reflection and team working, and an increased sense of responsibility for patients' physical health.
Interprofessional, in situ simulation training for medical deterioration yielded promising outcomes for individuals and teams. Simulation is an under-used training modality in mental health, offering a holistic training approach with the potential to provide educational and clinical benefits while supporting workforce resilience.
在英国，患有严重精神疾病的人比普通人群早逝多达20年，这促使人们更加关注精神疾病患者的身体健康。然而，针对精神科住院医护人员满足患者身体健康需求的培训却未受到同等关注，身体健康培训往往是被动的，且缺乏有效性证据。
评估一项跨专业的现场模拟培训干预措施，以应对精神卫生环境中的医疗恶化情况。调查培训对以下方面的影响：1. 参与者对处理医疗恶化的知识、信心和态度；2. 事件报告，作为事件管理的客观指标。定性探索参与者对其实践影响的看法。
本评估采用干预前-后混合方法设计。
53名医疗保健专业人员参与其中，包括：来自英国伦敦南部两个繁忙精神科分诊病房的精神科护士、精神科医生、医疗助理和活动协调员。
干预包括在两个病房每周进行的8次为期半天的课程。通过结构化调查评估培训前后参与者对医疗恶化的知识、信心和态度。通过培训后调查和培训后三个月的焦点小组定性了解参与者的培训体验。比较培训前后七个月期间的事件报告率。
培训后，参与者在处理医疗恶化的知识（p<0.001）、信心（p<0.001）和态度（p<0.02）方面有显著改善。培训后事件报告增加了33%。参与者报告称，他们在处理医疗恶化方面的信心增强，对有效沟通有了更好的理解，可以更好地进行自我反思和团队协作，并且对患者的身体健康责任感增强。
针对医疗恶化的跨专业现场模拟培训对个人和团队产生了良好效果。模拟是精神卫生领域中未充分利用的培训方式，提供了一种全面的培训方法，有可能在支持劳动力适应能力的同时提供教育和临床益处。
