Fletcher Justine, Hamilton Bridget, Kinner Stuart A, Brophy Lisa
Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
Centre for Psychiatric Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
Front Psychiatry. 2019 Jul 10;10:462. doi: 10.3389/fpsyt.2019.00462. eCollection 2019.
Mental health professionals working in acute inpatient mental health wards are involved in a complex interplay between an espoused commitment by government and organizational policy to be recovery-oriented and a persistent culture of risk management and tolerance of restrictive practices. This tension is overlain on their own professional drive to deliver person-centered care and the challenging environment of inpatient wards. Safewards is designed to reduce conflict and containment through the implementation of 10 interventions that serve to improve the relationship between staff and consumers. The aim of the current study was to understand the impact of Safewards from the perspectives of the staff. One hundred and three staff from 14 inpatient mental health wards completed a survey 12 months after the implementation of Safewards. Staff represented four service settings: adolescent, adult, and aged acute and secure extended care units. Quantitative results from the survey indicate that staff believed there to be a reduction in physical and verbal aggression since the introduction of Safewards. Staff were more positive about being part of the ward and felt safer and more connected with consumers. Qualitative data highlight four key themes regarding the model and interventions: This study found that from the perspective of staff, Safewards contributes to a reduction in conflict events and is an acceptable practice change intervention. Staff perspectives concur with those of consumers regarding an equalizing of staff consumer relationships and the promotion of more recovery-oriented care in acute inpatient mental health services.
在急性住院精神科病房工作的心理健康专业人员,卷入了政府和组织政策所倡导的以康复为导向的承诺与风险管理的持续文化以及对限制性措施的容忍之间的复杂相互作用之中。这种紧张关系叠加在他们自身提供以人为本护理的职业动力以及住院病房具有挑战性的环境之上。安全保障措施旨在通过实施10项干预措施来减少冲突和约束,这些措施有助于改善工作人员与患者之间的关系。本研究的目的是从工作人员的角度了解安全保障措施的影响。来自14个住院精神科病房的103名工作人员在安全保障措施实施12个月后完成了一项调查。工作人员代表了四个服务环境:青少年、成人、老年急性和安全的长期护理病房。调查的定量结果表明,工作人员认为自引入安全保障措施以来,身体和言语攻击行为有所减少。工作人员对成为病房的一员更为积极,并感到更安全,与患者的联系也更紧密。定性数据突出了关于该模式和干预措施的四个关键主题:本研究发现,从工作人员的角度来看,安全保障措施有助于减少冲突事件,是一种可接受的实践变革干预措施。在急性住院精神科服务中,工作人员的观点与患者在平衡工作人员与患者关系以及促进更以康复为导向的护理方面的观点一致。