School of Health Sciences, University of Southampton, Southampton, UK.
J Psychiatr Ment Health Nurs. 2024 Oct;31(5):716-728. doi: 10.1111/jpm.13027. Epub 2024 Jan 23.
WHAT IS KNOWN ON THE SUBJECT?: Mental health services report adverse incidents in different ways and the relationship between adverse incidents and the workforce is uncertain. In England, there are national datasets recording all incidents and workforce statistics though there is no peer-reviewed evidence examining recent trends. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Although there has been an overall increase in the number of mental health nurses, more are working in the community and the number of nurses relative to adverse incidents has decreased. There have been service-provision changes but the role of mental health nurses has not significantly changed in this period, and we can therefore assume that their current practice is saturated with risk or increased reporting. To help understand the relationship between nurses and incidents, we need to transform how incidents are recorded in England. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: English mental health services report greater levels of patient-related factors such as self-harm or aggression rather than missed or erroneous care. This makes it difficult to understand if a rise in incident frequency is linked to reporting behaviour, patient risk, unsafe/ineffective care or other reasons and therefore planning workforce deployment to improve care quality is problematic.
INTRODUCTION: There is a paucity of empirical data examining incidents and mental health nurses and the relationship between the two remains uncertain.
Comparison of English national data for incidents and nursing workforce to examine recent trends.
Descriptive analysis of two national datasets of incidents and workforce data for England between 2015 and 2022.
A 46% increase in incidents was found; the leading causes are self-harm and aggressive behaviour. Despite the rise in adverse incident reporting, a 6% increase in mental health nurses was found, with more nurses in community settings than hospitals.
Current services are incident reporting at greater concentrations than in previous years. Patient-related behaviour continues to be most prominently reported, rather than possible antecedent health services issues that may contribute to reporting. Whilst staffing has increased, this does not seem to have kept pace with the implied workload evident in the increase in incident reports.
Greater emphasis should be placed on health service behaviour in reporting mechanisms. Self-harm and aggression should continue to be considered adverse outcomes, but causal health service factors, such as missed care, should be present in pooled reporting to help reduce the occurrence of adverse outcomes.
精神卫生服务机构以不同的方式报告不良事件，不良事件与劳动力之间的关系尚不确定。在英国，有国家数据集记录所有事件和劳动力统计数据，但没有经过同行评审的证据来检验最近的趋势。
尽管精神科护士的数量总体上有所增加，但更多的护士在社区工作，护士人数相对于不良事件有所减少。服务提供方面发生了变化，但在这段时间内精神科护士的角色并没有发生重大变化，因此我们可以假设他们目前的实践充满了风险或报告增加。为了帮助理解护士与事件之间的关系，我们需要改变英国记录事件的方式。
英国精神卫生服务机构报告的与患者相关的因素（如自残或攻击）水平较高，而不是遗漏或错误的护理。这使得难以理解事件频率的上升是否与报告行为、患者风险、不安全/无效护理或其他原因有关，因此规划劳动力配置以提高护理质量存在问题。
背景：关于不良事件和精神科护士以及两者之间关系的实证数据很少。
比较 2015 年至 2022 年期间英国的不良事件和护理劳动力的两项国家数据，以检验最近的趋势。
对英格兰两个不良事件和劳动力数据的国家数据集进行描述性分析。
发现不良事件增加了 46%；主要原因是自残和攻击行为。尽管不良事件报告有所增加，但精神科护士人数增加了 6%，社区环境中的护士人数多于医院。
当前的服务以比以往更高的浓度报告不良事件。患者相关行为继续是最突出的报告内容，而不是可能导致报告的先前卫生服务问题。虽然人员配备有所增加，但这似乎并没有跟上不良事件报告增加所暗示的工作量。
报告机制应更加重视卫生服务行为。自残和攻击应继续被视为不良后果，但应在汇总报告中包含遗漏的护理等潜在卫生服务因素，以帮助减少不良后果的发生。
