Ford R, Durcan G, Warner L, Hardy P, Muijen M
Sainsbury Centre for Mental Health, London SE1 1LB.
BMJ. 1998 Nov 7;317(7168):1279-83. doi: 10.1136/bmj.317.7168.1279.
To provide (via the Mental Health Act Commission's "national visit") empirical evidence on ward occupancy levels, use of the Mental Health Act 1983, nurse staffing, and care of female patients on acute adult psychiatric wards.
One day survey of a stratified random sample.
119/250 (47%) acute adult psychiatric inpatient units in England and Wales.
End sample of 263 acute psychiatric inpatient wards.
Ward occupancy rates; number of patients detained under the Mental Health Act and proportion "absent without leave"; nurse staffing levels, skill mix, and vacancies;proportion of women with self contained, women-only facilities.
Mean ward occupancy was 99% (95% confidence interval 97% to 102%). A ward mean of 30% (28% to 32%) of patients were detained under the Mental Health Act; of all detained patients, 1% (1% to 2%) were absent without leave. A ward mean of 0.3 (0.29 to 0.31) nurses were on duty per patient at the time of the visit. An estimated ward mean of 31% (30% to 32%) of nurse staffing may have been through casual contracts--higher in inner (48% (43% to 53%)) and outer London (45% (41% to 48%)). On 26% (21% to 32%) of wards, there were no nurses interacting with patients. A ward mean of 36% (30% to 41%) of female patients had self contained, women-only facilities.
Attention should focus on improving the quality of acute inpatient psychiatric care as well as of community care.
通过心理健康法案委员会的“全国巡查”，提供有关急性成人精神科病房的病房占用率、1983年《心理健康法案》的使用情况、护士配备以及女性患者护理方面的实证证据。
对分层随机样本进行为期一天的调查。
英格兰和威尔士250家急性成人精神科住院单元中的119家（47%）。
最终样本为263个急性精神科住院病房。
病房占用率；依据《心理健康法案》被拘留的患者数量及“擅自离岗”的比例；护士配备水平、技能组合及空缺情况；拥有独立的女性专用设施的女性患者比例。
病房平均占用率为99%（95%置信区间为97%至102%）。病房中平均30%（28%至32%）的患者依据《心理健康法案》被拘留；在所有被拘留患者中，1%（1%至2%）擅自离岗。巡查时病房平均每位患者有0.3（0.29至0.31）名护士值班。估计病房护士配备中平均31%（30%至32%）可能是临时合同工——在伦敦市中心（48%（43%至53%））和伦敦外围（45%（41%至48%））比例更高。在26%（21%至32%）的病房中，没有护士与患者互动。病房中平均36%（30%至41%）的女性患者拥有独立的女性专用设施。
应将注意力集中在提高急性住院精神科护理以及社区护理的质量上。
