"Catching your tail and firefighting": The impact of staffing levels on restraint minimization efforts
"Catching your tail and firefighting": The impact of staffing levels on restraint minimization efforts
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DOI：
10.1111/jpm.12532
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发表时间：
2019-06-01
影响因子：
2.7
通讯作者：
Duxbury, Joy
中科院分区：
文献类型：
--
作者：
McKeown, Mick;Thomson, Gill;Duxbury, Joy
简明扼要的摘要关于这个问题有什么已知的？英国和其他国家的心理健康护理面临着严重的劳动力危机。安全的人员配置水平是需要的，在一些管辖区已经立法。将人员配备水平与患者结局联系起来的证据基础有限。人员配备水平与精神卫生病房环境中服务使用者和工作人员的不良经历有关，它们可能会导致暴力和攻击程度以及限制性做法的应用，例如身体约束，但支持这一点的研究证据有限。“保障措施”、“不首先使用武力”、“接触模式”和“六项核心战略”等方案可以减少限制性做法的使用。这篇论文对现有的知识有什么补充？急性精神卫生病房的人员配备水平似乎是实施限制最小化项目的关键。工作人员和服务用户都暗示人员配备不足，在护理的关系要素，如缺乏护士和服务用户之间的面对面接触的缺陷。同样，工作人员的水平也与暴力和侵犯的起因及其应对措施方面的问题有关，尽管在尽量减少该项目中的限制性做法方面取得了成功，但在实施减少使用人身限制的替代做法方面，如降级方面，也存在困难。具有讽刺意味的是，一个与安全有关的项目本身就引起了对安全人员配备水平的关注。对实践有什么影响？如果没有足够的工作人员，减少限制性做法的努力将受到阻碍。限制性做法可被合理地界定为雇用关系问题。各组织和决策者应处理环境、背景和资源因素，而不是仅仅根据工作人员或服务使用者的异常行为来确定问题。引言安全的人员配备和强制性做法是心理健康服务的紧迫问题。这些是相互依赖的，其关系研究不足。目的探讨在试图尽量减少精神卫生病房的身体约束做法的背景下，对人员配备水平的看法。研究结果来自更广泛的数据集，其更广泛的目的是探索减少限制举措的经验。方法采用主题分析法对130名医务人员和32名服务使用者进行半结构式访谈。结果确定了五个主题，关于人员配备水平如何影响经验和复杂的努力，以尽量减少身体限制。我们将这些主题命名为“工作人员不足”;“对工作人员和服务用户的损害”;“文书工作：非临床任务的负担”;“虚假经济”;以及“你不能做这些干预。“从护理的关系方面减损的趋势并不是独立于人员配置的不合理性。能够减少使用限制手段的关系、沟通和组织发展需要大量劳动，而且容易因工作人员不足和技能低下而脱轨。除非病房配备足够的工作人员，否则限制性做法不可能降到最低。人员配备不足与限制性做法不无关系，并减少了为减轻个人痛苦而采取替代干预措施的机会。
Accessible summaryWhat is known on the subject?Mental health nursing in the UK and other countries faces an acute workforce crisis. Safe staffing levels are called for, and in some jurisdictions have been legislated for. The evidence base linking staffing levels and patient outcomes is limited. Staffing levels are implicated in adverse experiences of service users and staff within mental health ward settings, and they might contribute to levels of violence and aggression and the application of restrictive practices, such as physical restraint but there is limited research evidence to support this. Programmes such as Safewards, No Force First, the Engagement Model and the Six Core Strategies can reduce the use of restrictive practices. What does this paper add to existing knowledge?Staffing levels on acute mental health wards appeared crucial in the implementation of a restraint minimization project. Both staff and service users implicate insufficient staffing for deficiencies in the relational elements of care, such as lack of face-to-face contact between nurses and service users. Similarly, staffing levels are associated with perceived problems in the cause of violence and aggression and responses to it. Despite successes in minimizing restrictive practices in this project, difficulties implementing alternative forms of practice that would reduce use of physical restraint, such as de-escalation, were also attributed to staffing levels. There is an irony that a project concerned with safety itself provoked concern over safe staffing levels. What are the implications for practice?Efforts to reduce restrictive practices will be hampered without adequate staffing levels. Restrictive practices may justifyably be framed as an employment relations matter. Organisations and policy makers ought to address environmental, contextual and resourcing factors, rather than identify problems exclusively in terms of perceived aberrant behaviour of staff or service users. Introduction Safe staffing and coercive practices are of pressing concern for mental health services. These are inter-dependent, and the relationship is under-researched. Aim To explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative. Methods Thematic analysis of semi-structured interviews with staff (n = 130) and service users (n = 32). Results Five themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes-"insufficient staff to do the job"; "detriment to staff and service users"; "a paperwork exercise: the burden of non-clinical tasks"; "false economies"; and, "you can't do these interventions." Discussion Tendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developments that would enable reductions in use of restraint are labour intensive and vulnerable to derailment by insufficient and poorly skilled staff. Implications for practice Restrictive practices are unlikely to be minimized unless wards are adequately staffed. Inadequate staffing is not independent of restrictive practices and reduces access to alternative interventions for reducing individuals' distress.