Uncovering Complexities in Reducing Aggression, Conflict and Restrictive Practices in Acute Mental Healthcare Settings: An Overview of Reviews.

Esario Iv Daguman, Marie Hutchinson, Richard Lakeman
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Abstract

Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high-level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re-extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy-based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand-alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff-related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity-informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups.

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揭示在急诊精神医疗机构中减少攻击、冲突和限制性做法的复杂性:综述。
在急症心理健康服务中,攻击、冲突和限制性行为以及为减少这些行为而实施的服务变革都是非常复杂的。现有发表的文献需要就这些服务变革的有效性及其相关的实施因素提供更高层次的指导。因此,我们对系统综述进行了综述,以确定 (i) 在急症心理健康环境中减少冲突、攻击和限制性行为的非药物干预措施,以及 (ii) 它们对不同临床结果的影响。然后从主要研究中进行平行再提取(iii),以确定影响干预措施成功实施的因素。在从九个数据库和登记处获取的 124 篇文章中,有四篇综述被保留下来进行最终分析,分析中使用了效果方向、表格和叙述性摘要。这些综述包括针对住院青少年、成人和老年人群的计划或干预措施。它们报告了替代遏制策略、风险评估、安全保障、感官室和设备、基于六项核心战略的干预措施和员工培训。综述发现,将旨在改善关系和减少人际冲突的干预措施结合起来,可能有助于减少攻击、冲突和限制性做法。同时,单独的人员培训和感官室及设备可能会产生不同的效果。将这些干预措施与减少攻击、冲突和限制性行为联系起来的证据质量有限。成功实施取决于多种因素:干预措施的特点、准备和规划、评估和监测、结果解释、利益相关者的参与/投资、与工作人员有关的因素和环境因素。任何实施举措都可能得益于使用务实和以复杂性为依据的研究方法,包括与服务使用者、同伴工作者和不同文化群体的有意义参与相结合。
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