Staff Perceptions and Organizational Factors as Predictors of Seclusion and Restraint on Psychiatric Wards
Staff Perceptions and Organizational Factors as Predictors of Seclusion and Restraint on Psychiatric Wards
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DOI：
10.1176/ps.62.5.pss6205_0484
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发表时间：
2011-05-01
影响因子：
3.8
通讯作者：
Lesage, Alain D.
中科院分区：
文献类型：
--
作者：
De Benedictis, Luigi;Dumais, Alexandre;Lesage, Alain D.
目的：有几个因素已被证明参与决定使用隔离和约束精神病住院设置。本研究探讨了工作人员的看法，有关因素的护理团队和暴力的病房预测使用隔离和约束精神科病房。研究方法：从魁北克省的8所大学精神病医院和综合医院精神病科共招募了309名工作人员（护士、康复指导员和护士助手），为严重精神障碍患者提供护理。评估的因素包括社会人口学特征，心理困扰，工作人员的侵略和精神病团队（团队气氛）的成员之间的相互作用的看法，和组织因素。结果如下：双变量分析表明，某些方面的团队气氛，工作人员的侵略性的看法，和组织因素与更多地使用隔离和约束。最后的多变量模型表明，以下因素独立预测更大的用途：类型的医院病房（急诊科和重症监护室），员工的看法，更高水平的表达愤怒和攻击的团队成员，感知的频率对自己的身体攻击的患者之间的事件，并在工作场所的安全措施不足的看法。结论：这些发现代表了一个旨在减少精神病患者使用隔离和限制的研究项目的第一阶段。他们强调，在审查使用这些有争议的干预措施的原因时，必须评估各种因素，包括对安全和暴力的看法。（精神病学服务62：484-491，2011）
Objective: Several factors have been shown to be involved in decisions to use seclusion and restraint in psychiatric inpatient settings. This study examined whether staff perceptions of factors related to the care team and violence on the ward predicted use of seclusion and restraint in psychiatric wards. Methods: A total of 309 staff members (nurses, rehabilitation instructors, and nurse's aides) providing care to patients with serious mental disorders were recruited from eight university psychiatric hospitals and general-hospital psychiatric units in the province of Quebec. Factors assessed included sociodemographic characteristics, psychological distress, staff perceptions of aggression and of interaction between members of the psychiatric team (team climate), and organizational factors. Results: Bivariate analyses showed that certain aspects of the team climate, staff perceptions of aggression, and organizational factors were associated with greater use of seclusion and restraint. The final multivariate model indicated that the following factors independently predicted greater use: type of hospital ward (emergency department and intensive care unit), staff perception of a higher level of expression of anger and aggression among team members, perception of the frequency of incidents of physical aggression against the self among patients, and perception of insufficient safety measures in the workplace. Conclusions: These findings represent the first stage of a research program aimed at reducing use of seclusion and restraint in psychiatric settings. They underscore the importance of evaluating a variety of factors, including perceptions of safety and violence, when examining reasons for use of these controversial interventions. (Psychiatric Services 62: 484-491, 2011)