Institute for Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia.
School of Nursing, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Int J Ment Health Nurs. 2023 Dec;32(6):1544-1560. doi: 10.1111/inm.13189. Epub 2023 Jul 6.
The principles of least restrictive care and recovery-focused practice are promoted as contemporary practice in the care of individuals with mental ill health, underpinning legislation concerning mental health and illness in many jurisdictions worldwide. Inpatient mental health units with locked doors are incompatible with this style of care and throwback to a time where care for mental illness was primarily custodial. The aim of this scoping review is to determine whether evidence exists for locking mental health unit doors, whether this practice is compatible with recovery-focused care and to determine whether door locking has changed since a review conducted by Van Der Merwe et al. (Journal of Psychiatric and Mental Health Nursing, 16, 2009, 293) found that door locking was not the preferred practice in the management of acute mental health units. We used Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8, 2005, 19) framework for scoping reviews, with our initial search locating 1377 studies, with screening narrowing final papers for inclusion to 20. Methodologies for papers included 12 using quantitative methodology, 5 qualitative and 3 that used mixed methods designs. Poor evidence was found for door locking to mitigate risks such as absconding, aggression or illicit substance importation. Furthermore, locked doors had a detrimental impact on the therapeutic relationship, nurse job satisfaction and intention to leave the profession. This scoping review indicates that research is urgently needed to address a mental healthcare culture where door locking is an entrenched practice. Studies of alternative approaches to risk management are required to ensure inpatient mental health units are truly least-restrictive, therapeutic environments.
最不限制护理和以康复为重点的实践原则被提倡为精神健康护理的当代实践，为世界上许多司法管辖区的精神健康和疾病立法提供了依据。带锁门的住院精神科病房与这种护理方式不兼容，这是对精神疾病护理主要是监护的一种倒退。本范围综述的目的是确定是否有证据支持锁定精神科病房的门，这种做法是否与以康复为重点的护理兼容，以及自 Van Der Merwe 等人进行的审查以来（精神病学和心理健康护理杂志，16，2009，293）发现锁定门不是急性精神科病房管理的首选做法后，锁定门的做法是否发生了变化。我们使用了 Arksey 和 O'Malley 的（国际社会研究方法杂志：理论与实践，8，2005，19）范围综述框架，我们最初的搜索定位了 1377 项研究，筛选缩小了最终包括的论文，以缩小范围。论文的方法包括 12 项使用定量方法、5 项定性方法和 3 项使用混合方法设计。几乎没有证据表明锁定门可以降低逃跑、攻击或非法药物进口等风险。此外，锁定门对治疗关系、护士工作满意度和离开该行业的意愿产生了不利影响。本范围综述表明，迫切需要进行研究，以解决精神保健文化中锁定门是一种根深蒂固的做法的问题。需要对风险管理的替代方法进行研究，以确保住院精神科病房真正是限制最少、具有治疗效果的环境。
