Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial

被引:267
作者
Bowers, Len [1 ]
James, Karen [1 ]
Quirk, Alan [2 ]
Simpson, Alan [3 ]
Stewart, Duncan [1 ]
Hodsoll, John [1 ]
机构
[1] Kings Coll London, Inst Psychiat, London SE5 8AF, England
[2] Royal Coll Psychiatrists, London E1 8BB, England
[3] City Univ London, London EC1V 0HB, England
基金
美国国家卫生研究院;
关键词
Absconding; Inpatient; Psychiatry; Rapid tranquillisation; Restraint; Seclusion; Self harm; Special observation; Violence; SELF-HARM; SECLUSION; RESTRAINT; STAFF; AGGRESSION; ATTITUDES; VIOLENCE; SUICIDE; MODELS; CARE;
D O I
10.1016/j.ijnurstu.2015.05.001
中图分类号
R47 [护理学];
学科分类号
1011 ;
摘要
Background: Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both. Objective: To test the efficacy of these interventions. Design: A pragmatic cluster randomised controlled trial with psychiatric hospitals and wards as the units of randomisation. The main outcomes were rates of conflict and containment. Participants: Staff and patients in 31 randomly chosen wards at 15 randomly chosen hospitals. Results: For shifts with conflict or containment incidents, the experimental condition reduced the rate of conflict events by 15% (95% Cl 5.6-23.7%) relative to the control intervention. The rate of containment events for the experimental intervention was reduced by 26.4% (95% Cl 9.9-34.3%). Conclusions: Simple interventions aiming to improve staff relationships with patients can reduce the frequency of conflict and containment. Crown Copyright (C) 2015 Published by Elsevier Ltd.
引用
收藏
页码:1412 / 1422
页数:11
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