Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.
Patient Safety Department, Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.
J Clin Nurs. 2022 Aug;31(15-16):2142-2153. doi: 10.1111/jocn.16027. Epub 2021 Aug 29.
To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints.
Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship.
A qualitative study design with a hermeneutical approach was developed.
A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research.
Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint.
Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints.
Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.
探讨精神科护士在管理伴有精神运动性激越的患者时的体验，以及影响使用机械约束决策的因素。
精神运动性激越是一种潜在的暴力性精神急症。对激越行为的管理包括机械约束作为最后的手段，尽管其使用对患者、专业人员和治疗关系都有后果。
采用定性研究设计和解释学方法。
从六家短中和中程精神科住院病房中，采用目的抽样法选择了 31 名护士。数据来自半结构化访谈。采用 Colaizzi 方法的七个步骤进行主题内容分析。三位研究人员在解释学范式的视角下独立进行了归纳分析。在进行这项研究时，遵循了 COREQ 清单。
分析产生了四个主题：1）护士对约束方法的看法，2）影响决策的因素，3）使用机械约束对专业人员的后果，4）机械约束的替代方法。
团队合作的重要性、认知失调问题、伦理冲突以及实施这些措施的障碍等方面影响着精神科护士的决策过程。了解这些方面对于进一步减少其发生率和负面后果以及实现机械约束的消除至关重要。
了解护士在患者伴有精神运动性激越发作时的感受以及影响是否使用强制性方法的因素，可以指导我们提供护理的质量。
