Power Tamara, Baker Ashley, Jackson Debra
Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
Cumberland Hospital, Western Sydney Local Health District, Parramatta, New South Wales, Australia.
Int J Ment Health Nurs. 2020 Aug;29(4):674-684. doi: 10.1111/inm.12701. Epub 2020 Feb 11.
Nurses play a crucial role in the implementation of restrictive practices such as seclusion and restraint. Restrictive practices have been widely recognized as harmful practices and efforts to reduce their use have been in place for several years. While some reductions have been achieved, more information and insight into the perspectives and experiences of front-line mental health nursing staff is required if further changes are to be realized. Sixty-five respondents participated in an online survey to investigate Australian mental health nurses' personal experiences and opinions regarding restrictive practices. Analysis revealed restrictive practices as a complex, contested and challenging area of practice. Analysis of data revealed five main ways that restrictive practices were framed by respondents. These were as follows: as a response to fear; to maintain safety for all; a legacy of time and place; the last resort; and, a powerful source of occupational distress. In addition, findings revealed the need to support staff involved in restrictive practices. This need could be satisfied through the implementation of procedures to address post-restrictive distress at all levels of the organization. Ensuring an optimal work environment that includes appropriate staffing, availability of supportive education and structured routine debriefing of all episodes of restrictive practice is critical in achieving further reductions in seclusion and restraint.
护士在实施诸如隔离和约束等限制性措施中发挥着关键作用。限制性措施已被广泛认为是有害的做法，并且减少其使用的努力已经开展了数年。虽然已经取得了一些减少，但如果要实现进一步的改变，就需要更多关于一线精神科护理人员观点和经历的信息与见解。65名受访者参与了一项在线调查，以探究澳大利亚精神科护士关于限制性措施的个人经历和看法。分析表明，限制性措施是一个复杂、有争议且具有挑战性的实践领域。对数据的分析揭示了受访者构建限制性措施的五种主要方式。具体如下：作为对恐惧的反应；为所有人维护安全；时间和地点的遗留产物；最后手段；以及职业困扰的强大来源。此外，研究结果表明需要支持参与限制性措施的工作人员。通过在组织各级实施应对限制性措施后困扰的程序，可以满足这一需求。确保一个包括适当人员配备、提供支持性教育以及对所有限制性措施事件进行结构化定期汇报的最佳工作环境，对于进一步减少隔离和约束至关重要。
