Safewards: a new model of conflict and containment on psychiatric wards
Safewards: a new model of conflict and containment on psychiatric wards
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DOI：
10.1111/jpm.12129
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发表时间：
2014-08-01
影响因子：
2.7
通讯作者：
Bowers, L.
中科院分区：
文献类型：
--
作者：
Bowers, L.
暴力、自残、潜逃和其他威胁病人和工作人员安全的事件的发生率在医院病房之间有很大差异。有些病房的发病率很高，有些则很低。同样的情况也适用于工作人员的行动，以防止和遏制此类事件，如手动约束，胁迫用药等安全模型提供了一个简单而有力的解释，为什么这些差异的发生率。住院精神病系统的六个特点有能力引起爆发点，由此可能发生不良事件。Safewards模型使人们很容易产生改变的想法，这将使精神科病房更安全的病人和staff.AbstractConflict（侵略，自我伤害，自杀，潜逃，物质/酒精的使用和药物拒绝）和遏制（如所需的药物，胁迫肌肉注射药物，隔离，手动约束，特殊观察等）。使患者和工作人员面临严重伤害的风险。这些事件的发生频率因病房而异，但很少有解释为什么会这样，也缺乏一个连贯的模型。本文提出了一个全面的解释模型，这些差异，并勾勒出在住院病房减少风险和胁迫的方法的影响。这个安全模式描述了六个领域的起源因素：工作人员团队，物理环境，医院外，病人社区，病人的特点和监管框架。这些领域给爆发点带来风险，有可能引发冲突和/或遏制。工作人员的干预措施可以改变这些进程，减少引发冲突的因素，防止爆发点的出现，切断爆发点与冲突之间的联系，选择不使用遏制措施，并确保遏制措施的使用不会导致进一步的冲突。我们系统而详细地描述了这个模型，并展示了如何利用它来制定促进患者和工作人员安全的策略。
Rates of violence, self-harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc. The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur. Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow. The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff.AbstractConflict (aggression, self-harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict-originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff.