Badouin Julia, Bechdolf Andreas, Bermpohl Felix, Baumgardt Johanna, Weinmann Stefan
Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.
Department of Psychiatry and Neuroscience, Charité Campus Mitte Charité-University Medicine Berlin, Berlin, Germany.
Front Psychiatry. 2023 Feb 7;14:1089484. doi: 10.3389/fpsyt.2023.1089484. eCollection 2023.
The use of restraint as a means of managing patients is considered a critical factor that interferes with recovery. Strategies to create a less restrictive environment within psychiatric facilities are therefore eagerly sought. Peer support workers (PSWs) are increasingly employed in mental health settings. The prevailing theory is that PSWs have the potential to contribute to conflict and restraint prevention efforts in acute psychiatric wards. However, to date, research in support of this claim remains limited.
The present study aimed at assessing the effectiveness of employing peer support workers with regard to reducing the use of restraint.
This prospective controlled pre-post study sought to evaluate the implementation of peer support in one locked ward compared to treatment as usual (TAU) with no implementation of peer support in a second locked ward of a psychiatry department in Berlin, Germany. The pre-post comparison was planned to consist of two assessment periods of 3 months each, taking place directly before and after peer support implementation or TAU. Both assessments were extended to a period of 6 months, before and after the initially planned 12-month implementation process, in order to balance the effects of disruptions and of the COVID-19 pandemic. Using routine data, the proportion, frequency, and duration of mechanical restraint, forced medication as well as mechanical restraint in combination with forced medication, were evaluated.
In the control group, an increase in the proportion of patients subjected to measures of restraint was found between pre- and post-assessment, which was accompanied by a further increase in the mean number of events of restraint per patient within this group. In the intervention group, no significant change in the application of restraint was observed during the study period.
There is some indication that peer support may be protective with regard to restraint in acute wards. However, our study faced major challenges during the implementation process and the post-assessment period, such as COVID-19 and staff reorganization. This may have led to peer support not reaching its full potential. The relationship between the implementation of peer support and the use of restraint therefore merits further investigation.
使用约束措施来管理患者被认为是妨碍康复的一个关键因素。因此，人们急切地寻求在精神科机构内营造限制较少环境的策略。同伴支持工作者（PSW）在心理健康环境中的使用越来越多。普遍的理论是，同伴支持工作者有潜力为急性精神科病房的冲突预防和约束预防工作做出贡献。然而，迄今为止，支持这一说法的研究仍然有限。
本研究旨在评估雇佣同伴支持工作者在减少约束措施使用方面的有效性。
这项前瞻性对照前后研究试图评估在德国柏林一家精神病科的一个封闭病房实施同伴支持的效果，并与另一个未实施同伴支持的封闭病房的常规治疗（TAU）进行比较。前后比较计划包括两个为期3个月的评估期，分别在同伴支持实施或常规治疗之前和之后进行。为了平衡干扰因素和新冠疫情的影响，两次评估都延长至最初计划的12个月实施过程之前和之后的6个月。利用常规数据，评估了机械约束、强制用药以及机械约束与强制用药相结合的比例、频率和持续时间。
在对照组中，评估前后接受约束措施的患者比例有所增加，且该组内每位患者的平均约束事件数进一步增加。在干预组中，研究期间约束措施的应用没有显著变化。
有迹象表明同伴支持可能对急性病房的约束措施有保护作用。然而，我们的研究在实施过程和评估后期面临重大挑战，如新冠疫情和人员重组。这可能导致同伴支持未能充分发挥其潜力。因此，同伴支持的实施与约束措施的使用之间的关系值得进一步研究。
