Daguman Esario Iv, Taylor Alison, Flowers Matthew, Owen Dane, Wilson Allyson, Lakeman Richard, Hutchinson Marie
Faculty of Health, Southern Cross University, Coffs Harbour, New South Wales, Australia.
Integrated Mental Health, Alcohol and Other Drugs, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia.
PLoS One. 2025 Jun 3;20(6):e0325558. doi: 10.1371/journal.pone.0325558. eCollection 2025.
There is a shared goal of organising reform efforts in mental health services to eliminate restrictive practices and improve therapeutic relationships. However, evidence on high-quality, culturally safe, co-produced, and strengths-based interventions and evaluations is limited, especially for complex interventions centred on therapeutic responding. In response, a multi-centre, mixed concurrent control study is underway to evaluate the Safe Steps for De-escalation, a multi-component intervention focused on a structured framework for mental health nurses' therapeutic responses to emotional distress and interpersonal conflict in acute adult mental health inpatient units. The aims of this evaluation were: 1) What is the effectiveness of Safe Steps in reducing restrictive practice events and duration and physical injuries? 2) Does Safe Steps improve people's service experience, perceived staff action towards violence prevention, and nurses' professional quality of life and emotionally intelligent workplace behaviours? 3) What factors influence the successful implementation of Safe Steps? It is hypothesised that: a) intervention sites will demonstrate more significant decreases in restrictive practice events and duration and physical injuries, compared to within-group baseline and control group, and b) measures of people's experiences and perceptions and nurses' outcomes and behaviours will improve, compared to within-group baseline. Safe Steps has three components: i) a structured de-escalation framework, ii) an in-person and online training programme, and iii) a regular conduct of strengths-based, data-informed restrictive practice review meetings. The control group will be usual care. Other outcomes include nursing intervention clusters, their associations with various outcomes, and factors influencing intervention implementation and restrictive practice use. There is no randomisation, but inverse probability weighting will be applied. The sample sizes were determined through power analyses and supporting evidence on saturation in qualitative research. Various quantitative and qualitative data treatments and measures will be undertaken to minimise research biases.
在精神卫生服务领域组织改革工作，以消除限制性措施并改善治疗关系，这是一个共同目标。然而，关于高质量、文化安全、共同制定且基于优势的干预措施和评估的证据有限，特别是对于以治疗性回应为核心的复杂干预措施而言。作为回应，一项多中心、混合同期对照研究正在进行，以评估“安全降级步骤”，这是一项多成分干预措施，专注于为成人急性精神科住院病房的精神科护士对情绪困扰和人际冲突的治疗性回应构建结构化框架。该评估的目的是：1）“安全步骤”在减少限制性措施事件、持续时间和身体伤害方面的效果如何？2）“安全步骤”是否能改善人们的服务体验、对工作人员预防暴力行动的认知，以及护士的职业生活质量和情商型职场行为？3）哪些因素影响“安全步骤”的成功实施？假设如下：a）与组内基线和对照组相比，干预地点的限制性措施事件、持续时间和身体伤害将有更显著的减少；b）与组内基线相比，人们的体验和认知以及护士的结果和行为指标将得到改善。“安全步骤”有三个组成部分：i）一个结构化的降级框架；ii）一个面对面和在线培训项目；iii）定期召开基于优势、数据驱动的限制性措施审查会议。对照组将接受常规护理。其他结果包括护理干预集群、它们与各种结果的关联，以及影响干预实施和限制性措施使用的因素。不进行随机分组，但将应用逆概率加权法。样本量通过功效分析和定性研究中饱和度的支持性证据来确定。将采取各种定量和定性的数据处理及测量方法，以尽量减少研究偏差。
