Journal of Psychiatric and Mental Health Nursing最新文献_第9页

Experiences of restrictive interventions in psychiatric health care from the perspectives of patients and health care professionals: Meta-synthesis of qualitative evidence 从患者和医护人员的角度看精神科医疗保健中限制性干预的经验：定性证据的元综合。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-26 DOI: 10.1111/jpm.13076

Jiu Kim, Soo-Hyun Nam

<div> <section> <h3> What Is Known on the Subject</h3> <div> <ul> <li>Following their experience, patients with physical restraints often experienced traumatic sensations.</li> <li>The experiences of healthcare professionals' (HCPs') are primarily concerned with moral distress or conflicts between loyalty to the treatment and oppression of the patient's freedom when implementing RIs.</li> </ul> </div> </section> <section> <h3> What the Paper Adds to Existing Knowledge</h3> <div> <ul> <li>Improving the competency of HCPs can help establish therapeutic relationships rooted in compassionate care and facilitate appropriate assessments to determine whether and how often RIs are necessary. Furthermore, fostering an environment that guarantees patient safety and dignity, assuring a sufficient staffing ratio, and providing opportunities to share RI experiences can help improve the quality of care and build safe environments for RIs.</li> </ul> </div> </section> <section> <h3> What Are the Implications for Practice</h3> <div> <ul> <li>Effective interaction between HCPs and patients, thorough patient assessment, and compassionate patient care may improve competency of HCPs intervene RIs procedures. Creating a safe therapeutic environment, including improvements to structural environments, increasing the staff-to-patient ratio, establishing organizational policies that guarantee staff debriefing, provide emotional support, provide appropriate training programs to HCPs to their coping skills during RIs also reduce the use of RIs and improve the quality of mental health care.</li> </ul> </div> </section> <section> </section> <section> <h3> Introduction</h3> <p>Restrictive interventions (RIs) are used in psychiatric inpatient units for ensuring safety. However, few studies have comprehensively reviewed physical restraint and seclusion experiences from the perspectives of both patients and healthcare professionals' (HCPs'). This study aims to gain an in-depth understanding of the RI experiences of mental health inpatients and HCPs.</p> </section> <section> <h3> Methods</h3> <p>A meta-synthesis was undertaken of qua

这方面的已知情况：在经历过身体束缚后，患者往往会产生创伤感。医疗保健专业人员（HCPs）的经历主要涉及道德上的痛苦，或在实施限制性约束时忠诚于治疗与压迫病人自由之间的冲突：提高医护人员的能力有助于建立植根于仁爱之心的治疗关系，并有助于进行适当的评估，以确定是否有必要以及多长时间进行一次 RI。此外，营造一个保证患者安全和尊严的环境、确保足够的人员配备比例以及提供分享 RI 经验的机会，都有助于提高护理质量并为 RI 营造安全的环境：医护人员与患者之间的有效互动、对患者的全面评估以及对患者的人文关怀可以提高医护人员干预 RI 程序的能力。创造一个安全的治疗环境，包括改善结构环境、提高医护人员与患者的比例、制定保证医护人员汇报工作的组织政策、提供情感支持、为医护人员提供适当的培训计划以提高他们在限制性干预过程中的应对技巧，也能减少限制性干预的使用并提高心理健康护理的质量。然而，很少有研究从患者和医护人员（HCPs）的角度全面回顾了身体约束和隔离的经验。本研究旨在深入了解精神疾病住院患者和医护人员的相关体验：方法：对探讨 RI 体验的定性研究进行了元综合。我们检索了五个电子数据库，并对过去十年内发表的研究进行了额外的人工检索。共收录了 12 篇文章，并进行了专题分析。采用批判性评估技能计划（CASP）清单评估数据质量：确定了两个主要次主题：结果：确定了两个主要的次主题："医护人员的能力"（三个次主题：患者与医护人员之间的互动、评估方法和护理）和 "系统"（三个次主题：环境、培训协议和汇报），包括正面和负面的经验：讨论：医护人员的能力和病房环境是导致患者需求得不到满足的关键因素。医护人员与患者之间的有效互动、对患者的全面评估以及对患者的关爱是实施 RI 的重要因素：保证安全和有尊严的护理的环境、充足的人员配备比例以及分享康复治疗经验的机会可以提高护理质量，并为康复治疗创造安全的环境。

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引用次数: 0

The mental health nurse as cyborg: Technology, a blessing or a curse? 作为电子人的心理健康护士：技术，是福还是祸？

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-26 DOI: 10.1111/jpm.13080

Mick McKeown, Konstantina Poursanidou, Charley Baker

<p>The Luddites famously resisted the industrialisation of hand-loom weaving by wrecking the machinery that threatened to bring their livelihoods under the oppressive control of factory owners. The industrial revolution was relocating their workplaces from hearth to hades: a shift from homeworking into the dark satanic mills of William Blake. Far from being valorised as heroes, the Luddites have suffered abjectly under the ‘enormous condescension of posterity’ (Thompson, <span>1963</span>: 12). They are remembered, if at all, as hopeless vandals, with the term Luddism now reserved for unthinking or irrational opposition to technological advancement. To some extent this is surprising, as there cannot be many human beings who have not experienced a detrimental psychological impact from lacking control over their jobs. Indeed, the history of work under capitalism is arguably a history of the alienation of workers. The application of technologies to the work process is undisputedly a major aspect of this alienation, regardless of perceived benefits associated with new technologies.</p><p>The sociologist Harry Braverman (<span>1974</span>) notably pointed out the ways mechanisation of the labour process degrades the experience of work. This analysis has been applied to nursing work, where routinisation and task focused care can mimic the deleterious impact of production line technologies (McKeown, <span>1995</span>). In this sense, mental health nursing is an occupation that is as much subject to the vagaries and vicissitudes of how work is owned, controlled and organised as any other job. Despite professional rhetoric and exhortations, nurses are workers who neither completely control their work, the products of their work, nor the context in which they work. The substantial gap between an aspiration for a respected, professionally agentic role and the reality of prevailing, alienated impediments to fully-fledged autonomy is apparent wherever we care to look for it. That said, the alienation of nurses is relatively minor compared with the often-crushing alienation of patients within increasingly restrictive and coercive contemporary services. To rehash Erich Fromm's (<span>1968</span>) observation, psychiatric care might be best thought of as alienated people, being cared for by alienated practitioners, using alienated and alienating technologies. One optimistic insight that can be gleaned from such a negative situation, is that staff and patients may have a common interest in defeating alienation and taking a critical or resistive stance towards potentially oppressive technologies.</p><p>Right now, and increasingly for the future, the introduction of novel technologies into mental health care systems raise some pressing concerns for nurses and patients. Adapting the work of David Graeber, mental health nursing faces accelerating existential threats associated with (assumed) technological advances enmeshed in the organisation of healthcare work under

卢德分子通过破坏机器来抵制手工纺织业的工业化，因为机器可能会将他们的生计置于工厂主的压迫控制之下。工业革命将他们的工作场所从炉膛搬到了地狱：从在家工作变成了威廉-布莱克笔下黑暗的撒旦工厂。卢德分子非但没有被尊为英雄，反而在 "后人的巨大屈尊"（汤普森，1963 年：12）之下受尽折磨。在人们的记忆中，他们是毫无希望的破坏者，"卢德主义 "一词现在仅指不假思索或非理性地反对技术进步。这在某种程度上是令人惊讶的，因为不可能有多少人没有经历过因无法控制自己的工作而产生的有害心理影响。事实上，资本主义下的工作史可以说就是一部工人被异化的历史。社会学家哈里-布拉夫曼（Harry Braverman，1974 年）特别指出了劳动过程机械化降低工作体验的方式。这一分析也被应用到护理工作中，在护理工作中，常规化和以任务为中心的护理会模仿生产线技术的有害影响（McKeown，1995 年）。从这个意义上说，心理健康护理是一种职业，它与其他任何工作一样，受制于工作的拥有、控制和组织方式的变幻莫测和瞬息万变。尽管有专业的言论和劝诫，但护士是既不能完全控制自己的工作、工作成果，也不能完全控制工作环境的工作者。无论我们在哪里寻找答案，都会发现在对受尊重的专业代理角色的渴望与现实中普遍存在的对完全自主的疏远阻碍之间存在着巨大差距。尽管如此，与病人在日益严格和强制的现代服务中经常受到的异化相比，护士的异化相对较小。重提埃里希-弗洛姆（Erich Fromm，1968）的观点，精神病护理最好被视为被异化的人，由被异化的从业者使用被异化和异化的技术进行护理。从这种负面情况中，我们可以得到一个乐观的启示，那就是员工和患者在战胜异化、对潜在的压迫性技术采取批判或抵制的态度方面可能有着共同的兴趣。根据戴维-格雷伯（David Graeber）的研究，心理健康护理面临着与新自由主义下医疗工作组织中（假定的）技术进步相关的生存威胁（McKeown，2023 年）。对指标的贪得无厌和防御性风险管理实践相结合，导致用于记录的时间激增，而不是更多的关系护理。其他技术，如随身携带的摄像机、闭路电视和远程监控系统，可以说进一步削弱了专业人员对亲情实践和护理伦理的承诺。此外，从患者的角度来看，这些技术本身也与精神压迫的加剧有关，并且一直处于近期护理争议的前沿（例如，Stop Oxevision, 2023）。关系型护理与技术驱动型实践管理的近距离和情感距离之间的紧张关系为护士和患者带来了一系列独特的疏离环境，并预示着护理工作在一个被格雷伯命名为 "公牛化 "的过程中正在受到侵蚀。我们认为，这种趋势的作用是将护士从理想化的专业身份--真正的护理提供者--中疏离出来，并在一定程度上加深了她们对自身人性的疏离，以及随之而来的成为他人生活中积极力量的需要。后者就是卡尔-马克思（Karl Marx）在具体的人文主义分析中所说的 "与物种存在的疏离"。另外，以唐娜-哈拉维（Donna Haraway）的著作为代表的后人文主义理论将人类视为一个独特的兴趣点，并确定了思考技术发展的有趣方式。哈拉维（Haraway，2000 年）以这种方式探讨了半机械人（cyborg）的概念，以揭示人类与技术之间的互动关系，但她敦促说，技术好坏的二元对立是无益的。这样的视角为我们提供了关于护士与机器的实践和本体融合的有趣观察。例如，在精神科病房，计算机的（过度）使用表明了人类与技术的混合：作为电子人的护士可以说提供了一系列天意或危险的有害后果（McKeown，2023 年）。正如在远距离杀害他人的无人机操作员面临着有害的心理后果（Wilcox，2017）一样，操作远程、非个人化观察技术的心理健康护士可能会经历疏离的痛苦和长期、累积的不安，因为他们开始意识到自己与直接的患者护理在情感上被疏远了。事实上，这里存在着潜在的双重打击，因为这种疏远或技术的侵入，增加了与病人发生冲突的风险，而病人对隐私被侵犯和自主权被践踏的不满是可以理解的。我们认为，只要精神科服务与在新自由主义政体下运作的社会治理体系相联系，那么护士和病人都不能被视为决策的主导者。我们可以采用其他方式来组织社会、心理健康护理和护士工作。这些方式可能包括分布式民主或共同生产概念中提出的更为平等、合作和互助的形式，但迄今为止在精神健康护理或更广泛的社会中尚未充分实现。激进的护士们越来越强烈地呼吁进行这样的改革、转型或废除（见 Dillard-Wright 等人，2023 年），当然，对于日益壮大的服务使用者、幸存者或服务拒绝者运动来说，这样的要求并不陌生（见 Crossley，2004 年）。在更公平、更民主的护理系统中，因缺乏控制权而产生的疏离感会被立即化解，可以说更有可能充分实现双方同意提供护理和支持的专业理想；最大限度地减少对物种存在的疏离感。在这种情况下，我们可能更有能力在精神医疗空间中为技术找到一个可以接受的位置，更好地利用现有技术来达到积极的目的，或者，事实上，拒绝那些被合理地视为压迫性和争议性的技术。最后，我们强调在精神医疗技术问题上采取批判性的矛盾方法的价值和必要性。注意避免对技术的好坏进行二元对立的思考，应能让我们充分认识到这一尖锐争议领域的复杂性、困难性和混乱性。从矛盾的视角出发，我们可以避免过度沉迷于技术的某些观点，摆脱 "令人担忧的确定性政治"（Breslow, 2022）。即使是卢德分子也可能同意，如果纺织品生产的工业化是在社会化经济体系、福利（甚至全民基本收入）、工作组织完全民主化的合作社的背景下进行的，那么从家庭工作到工厂工作的转变就不会促使新技术遭到破坏。我们很自豪地宣布，我们有逐渐成为 "卢德主义者 "的倾向，并敦促心理健康护士和盟友们批判性地思考与技术 "进步 "的共谋关系，努力创造民主、亲情关怀的形式，为积极对话提供空间，讨论哪些技术更可取，以及如何应用这些技术。环境是关键，如果我们想有机会对心理健康技术进行人性化的控制，我们就必须大力改善心理健康技术的运行环境。

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引用次数: 0

Individual factors as predictors of secondary traumatic stress and burnout in forensic inpatient staff 个人因素是法医住院人员二次创伤压力和职业倦怠的预测因素。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-25 DOI: 10.1111/jpm.13079

Katrina Jade Chapman, Helen Scott, Michelle Rydon-Grange

<div> <section> <h3> What is known on the subject</h3> <div> <ul> <li>Secondary traumatic stress (STS) is the indirect traumatisation of a person through the stress of helping or knowing about other's trauma. Burnout is gradual exhaustion in response to long-term work-related stress. Both have negative psychological, physiological and/or organisational consequences; however, the existing research in forensic health care professionals (FHCPs) is limited.</li> <li>One study explored STS in FCHPs and found that lower psychological flexibility (ability to adapt) was a predictor of greater STS. Existing research on burnout in FHCPs suggests that individual differences, such as the ways in which we cope (talking to people vs. using substances), may predict burnout levels.</li> </ul> </div> </section> <section> <h3> What the paper adds to existing knowledge</h3> <div> <ul> <li>Prevalence findings add to the recent evidence base, which also found moderate levels of burnout. However, this study is the first to find high levels of secondary traumatic stress in FHCPs.</li> <li>Similar to existing literature, the study's findings suggest that FHCP's with lower levels of psychological flexibility and more maladaptive coping strategies may experience greater STS and burnout symptoms, while staff who use more adaptive coping strategies may experience less burn-out.</li> <li>Unexpectedly, staff who reported a more anxious attachment style were burnt-out; however, there are limitations to this finding.</li> </ul> </div> </section> <section> <h3> What are the implications for practice</h3> <div> <ul> <li>Policies and practices in forensic settings should reflect the risk of STS and burnout.</li> <li>Practices or interventions should enhance adaptive coping strategies and psychological flexibility, such as Resilience Enhancement Programmes or Acceptance and Commitment Therapy (ACT).</li> </ul> </div> </section> <section> </sect

相关知识：继发性创伤压力（STS）是指一个人由于帮助或了解他人的创伤而受到的间接创伤。职业倦怠（Burnout）是对长期工作压力的逐渐衰竭。两者都会对心理、生理和/或组织造成负面影响；然而，现有关于法医保健专业人员（FHCPs）的研究十分有限。一项研究探讨了法医保健专业人员的 STS，发现较低的心理灵活性（适应能力）是较大 STS 的预测因素。现有的关于家庭健康护理专业人员职业倦怠的研究表明，个体差异，如我们的应对方式（与人交谈与使用药物），可能会预测职业倦怠水平：本文对现有知识的补充：流行率研究结果补充了最近的证据基础，该基础也发现了中等程度的职业倦怠。然而，本研究是首次在家庭健康护理人员中发现高水平的继发性创伤压力。与现有文献类似，本研究的结果表明，心理灵活性较低、适应不良的应对策略较多的家庭健康护理人员可能会出现更严重的继发性创伤应激反应和职业倦怠症状，而采用适应性较强的应对策略的员工可能会出现较少的职业倦怠。出乎意料的是，报告焦虑依恋风格较多的工作人员出现了职业倦怠；然而，这一发现存在局限性：法医环境中的政策和实践应反映出 STS 和职业倦怠的风险。实践或干预措施应增强适应性应对策略和心理灵活性，如复原力增强计划或接纳与承诺疗法（ACT）。摘要：引言：住院法医医护人员（FHCPs）的二次创伤压力（STS）和职业倦怠文献有限，尽管会产生心理、生理和组织后果。研究方法：98 名在英国两家法医住院机构工作的医护人员完成了以下评估项目：职业倦怠、STS、心理灵活性、应对方式、依恋方式，以及一份记录服务年限和员工性别的人口统计学问卷：结果表明，STS和职业倦怠程度分别较高和适中。预测 STS 和职业倦怠的主要因素是较差的心理灵活性和较强的不适应应对方式，而较强的适应应对方式和焦虑的依恋方式则可预测较低的职业倦怠：本研究为有限的证据基础做出了贡献，表明较差的心理灵活性和较强的适应不良应对方式可能是导致家庭健康护理人员 STS 和职业倦怠的风险因素，而较强的适应不良应对方式可能是保护因素：研究结果表明，接受与承诺疗法（ACT）和应对技能干预等干预措施可为住院法医专业人员提供保护性益处。

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引用次数: 0

Evaluation of a novel co-designed and co-delivered training package to de-escalate violence and aggression in UK acute inpatient, PICU and forensic mental health settings 在英国急诊住院病人、重症监护病房和法医精神卫生机构，对共同设计和共同实施的新型培训教材进行评估，以缓和暴力和攻击行为。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-22 DOI: 10.1111/jpm.13074

Andrew C. Grundy, Cat Papastravrou Brooks, Isobel Johnston, Lindsey Cree, Patrick Callaghan, Owen Price

<div> <section> <h3> What is known on the subject?</h3> <div> <ul> <li>Clinical guidelines and staff training recommend using de-escalation over restrictive practices, such as restraint and seclusion</li> <li>Evidence suggests that restrictive practices continue to be used frequently despite training</li> <li>This suggests a lack of impact of existing staff de-escalation training.</li> </ul> </div> </section> <section> <h3> What does this paper add to existing knowledge?</h3> <div> <ul> <li>The features of de-escalation training that are acceptable to staff and perceived to be impactful</li> <li>A co-designed and co-delivered training session on a trauma-informed approach to de-escalation on mental health wards was acceptable and perceived to be impactful</li> <li>Those attending training particularly valued how lived experience was incorporated into the training content and co-delivery</li> <li>The organizational and team context may need more consideration in adapting the training.</li> </ul> </div> </section> <section> <h3> What are the implications for practice?</h3> <div> <ul> <li>De-escalation training that adopts a trauma-informed approach and considers the context of ward environments is acceptable to staff</li> <li>Co-delivery models of training to tackle restrictive practice can be acceptable and impactful</li> <li>Further research will show how clinically effective this training is in improving outcomes for service users in ward contexts.</li> </ul> </div> </section> <section> </section> <section> <h3> Background</h3> <p>Evidence suggests a discrepancy between recommended and routine practice in de-escalation in mental he

临床指南和员工培训建议使用降级方法，而不是限制性方法，如束缚和隔离有证据表明，尽管进行了培训，限制性方法仍被频繁使用。本文对现有知识有何补充？参加培训的人员尤其看重将生活经验融入培训内容和共同授课的方式。在调整培训内容时，可能需要更多地考虑组织和团队的具体情况。对实践有何意义？采用创伤知情方法并考虑到病房环境背景的降级培训是可以被员工接受的，共同提供培训以解决限制性做法的模式是可以接受的，也是有影响力的。摘要：背景：有证据表明，在精神卫生机构中，建议的降级做法与常规做法之间存在差异，这表明现有培训缺乏影响力。目的：调查共同设计/交付的培训干预措施的可接受性和感知影响，该干预措施是在精神卫生病房中采用创伤知情的降级方法：方法：邀请受训人员在培训后填写培训可接受性评分量表（TARS）。对定量项目的回答采用描述性统计进行总结，对开放文本的回答采用内容分析法进行编码：在 214 名学员中，有 211 人完成了 TARS。受训人员对培训的评价是好的（总体 TARS 中位数 = 55/63）、可接受的（中位数 33/36）和有影响的（中位数 23/27）。共有五个定性主题：感兴趣的模块；多角度；授课方式；根据具体情况进行调整；修改其他内容：讨论：EDITION 培训被认为是可接受和有影响力的，学员们尤其重视共同授课模式。受训人员提出了几种可以改进培训的方法，特别是需要根据具体的病房环境/团队情况进一步调整干预措施：我们建议共同设计、共同实施针对精神卫生专业人员的员工培训，以解决限制性做法的问题：这项研究与那些希望参与对精神卫生专业人员进行限制性实践培训的生活体验实践者相关，表明了他们的声音的价值和重要性。本研究对目前提供降级培训的机构和接受培训的员工都有意义，它概述了一种新颖但可接受且有影响力的心理健康实践关键领域的培训形式。它对任何有兴趣通过共同提供培训来减少限制性做法的人都有意义。

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引用次数: 0

Assessing the impact of long-acting injectable compared to oral antipsychotic medications on readmission to a state psychiatric hospital 评估长效注射抗精神病药物与口服抗精神病药物相比，对再次入住州立精神病院的影响。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-22 DOI: 10.1111/jpm.13075

Chizimuzo T. C. Okoli, Bassema Abufarsakh, Tianyi Wang, Andrew Makowski, Andrew Cooley

<div> <section> <h3> What is known on the subject</h3> <div> <ul> <li>People living with schizophrenia spectrum disorder (SSD) have a higher death rate which is caused, in part, by poorer adherence to treatment as compared to those with other mental illnesses.</li> <li>Using long-acting injectable antipsychotic (LAI) medications can improve medication adherence and reduce hospitalizations for people living with SSD but are often underutilized.</li> </ul> </div> </section> <section> <h3> What the paper adds to existing knowledge</h3> <div> <ul> <li>As compared to oral antipsychotic medications provided to patients with SSD at discharge from a psychiatric hospitalization, being provided with an LAI antipsychotic medication may reduce subsequent rehospitalization.</li> <li>Specifically, patients discharged on an atypical or second-generation LAI medication are less likely to be readmitted to the hospital when compared to those discharged on a typical first-generation oral medication.</li> </ul> </div> </section> <section> <h3> What are the implications for practice</h3> <div> <ul> <li>Because LAI antipsychotic medications are often underutilized as treatment options, the study findings suggest that this modality may be considered for patients with SSD when being discharged from a psychiatric hospitalization.</li> <li>Ideally, psychiatric-mental health nurses can educate patients about indications, benefits, and risks of using atypical or second-generation LAI antipsychotic medications during hospitalization and at discharge prevent the risk for future rehospitalizations.</li> </ul> </div> </section> <section> </section> <section> <h3> Introduction</h3> <p>People living with schizophrenia spectrum disorder (SSD) have poorer medication adherence compared to those with other mental illnesses. Long-acting injectable antipsychotic (LAI) medication use is associated with greater adherence, reduced re-hospitalizations, and improved recovery outcomes when compared to oral formulations.</p> </section> <section> <h3> Aim</h3>

相关知识精神分裂症谱系障碍（SSD）患者的死亡率较高，部分原因是与其他精神疾病患者相比，他们的治疗依从性较差。使用长效注射抗精神病药物（LAI）可以提高精神分裂症谱系障碍患者的服药依从性并减少住院次数，但这种药物往往未得到充分利用：与精神科住院患者出院时接受口服抗精神病药物治疗相比，接受LAI抗精神病药物治疗可减少随后的再次住院。具体来说，与使用典型的第一代口服药物出院的患者相比，使用非典型或第二代LAI药物出院的患者再次入院的可能性更低：由于LAI抗精神病药物作为治疗选择往往未得到充分利用，研究结果表明，患有SSD的患者在从精神病院出院时可以考虑使用这种治疗方式。理想情况下，精神科-心理健康护士可以在住院期间和出院时向患者讲解使用非典型或第二代LAI抗精神病药物的适应症、益处和风险，以防止未来再次住院的风险。摘要：引言：与其他精神疾病患者相比，精神分裂症谱系障碍（SSD）患者的服药依从性较差。与口服制剂相比，长效注射型抗精神病药物（LAI）的使用与更高的依从性、减少再入院次数和改善康复效果有关。目的：比较LAI抗精神病药物与口服制剂在住院患者再入院时的使用情况：方法：对美国南部地区一家州立精神病院的医疗记录（N = 707）进行了审查。在控制人口统计学变量的前提下，采用逻辑回归分析法研究了LAI与口服制剂在再入院时的对比情况：结果：与使用口服抗精神病药物出院的患者相比，使用 LAI 的患者在 6 个月和 1 年内的再入院率较低，但在 30 天或 2 年内的再入院率较低。在控制人口统计学变量后，与服用典型口服抗精神病药物的患者相比，服用非典型LAI的患者在24年内再次入院的几率明显较低：讨论：与口服药物相比，非典型抗精神病药物不会增加并可能减轻精神病院的再入院率：实践启示：精神心理健康护士和其他专业人员可根据 SSD 患者的病情推荐 LAIs。

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引用次数: 0

Stakeholder perspectives on continuous observation in inpatient psychiatric wards 利益相关者对精神病住院病房持续观察的看法。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-22 DOI: 10.1111/jpm.13072

Lottie Anstee, Denford Chifamba, Wasim Loothfaully, Suleiman Suleiman, Chetan Shah, Brian Littlechild, Asif Zia

<div> <section> <h3> What is known on the subject?</h3> <div> <ul> <li>Continuous observation is often used in mental health wards to support the safety of service users, where they will be constantly watched by a member of staff.</li> <li>Evidence suggests that continuous observations may be unhelpful and restrictive, but not enough is known about the practice or the best ways to improve it.</li> </ul> </div> </section> <section> <h3> What this paper adds to existing knowledge?</h3> <div> <ul> <li>This evaluation integrates the perspectives of service users, informal carers and staff to explore current continuous observation experiences and inform future improvements.</li> <li>While previous research highlights the importance of therapeutic engagement, this study additionally emphasizes how the observation procedure could be adapted to individual needs.</li> </ul> </div> </section> <section> <h3> What are the implications for practice?</h3> <div> <ul> <li>Continuous observations could be more beneficial if they are therapeutic, proportional to the level of risk and co-developed with the service user, informal carer and staff.</li> <li>Further training about communication could support staff engagement and the observation process could be formalized to ensure regular collaborative reviews.</li> </ul> </div> </section> <section> </section> <section> <h3> Introduction</h3> <p>Continuous observation is a frequently used tool to manage high levels of risk on psychiatric wards. However, there is little previous research on its use in practice.</p> </section> <section> <h3> Aim</h3> <p>This qualitative service evaluation aims to explore the continuous observation experiences of service users, informal carers and staff in a local NHS Mental Health Trust, informing suggested future improvements to current practice.</p> </section> <section> <h3> Method</h3> <p>Five service users, three informal carers and seven healthca

相关知识：持续观察通常用于精神健康病房，以保障服务使用者的安全，在这里，他们将一直受到一名工作人员的监视。有证据表明，持续观察可能是无益和限制性的，但人们对这种做法或改进这种做法的最佳方法了解得还不够。本文对现有知识有何补充？本评估综合了服务使用者、非正式照护者和工作人员的观点，以探讨当前的持续观察经验，并为未来的改进提供信息。以往的研究强调了治疗参与的重要性，而本研究则进一步强调了如何根据个人需求调整观察程序。对实践有何意义？如果持续观察是治疗性的，与风险程度成正比，并且是与服务使用者、非正式照护者和工作人员共同制定的，那么持续观察会更有益。有关沟通的进一步培训可以支持员工的参与，观察过程也可以正规化，以确保定期合作审查。摘要：简介：持续观察是精神病病房管理高风险的常用工具。目的：这项定性服务评估旨在探索当地一家 NHS 精神健康信托机构的服务使用者、非正式照护者和工作人员的持续观察经验，为今后改进当前实践提供参考：五名服务使用者、三名非正式照护者和七名医护人员完成了半结构化访谈，并对访谈内容进行了主题分析，最终确定了四个主题：积极的互动和参与活动对于采用治疗方法进行观察、支持服务使用者和医护人员尽量减少可能出现的非生产性行为至关重要。在安全与隐私之间取得平衡的困难表明，针对每位服务使用者制定适度的、量身定制的观察程序非常重要。确保服务使用者和非正式照护者的声音始终是护理决策的核心，可以进一步改善观察体验：本研究强调，治疗性、适度和共同制作的观察是改进实践的关键特征。对观察过程的进一步培训和正规化可以促进文化变革，使风险管理更加长期化。

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引用次数: 0

Effective provider communication for personal agency in mental health recovery: A cross-sectional study on Japanese users' perspectives 在心理健康康复过程中，有效的医疗服务提供者沟通对个人的影响：关于日本用户观点的横断面研究。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-22 DOI: 10.1111/jpm.13078

Satoshi Okumura, Fujika Katsuki

<div> <section> <h3> What is known on the subject?</h3> <div> <ul> <li>Recovery-oriented practices in community-based mental health services are of increasing importance. The recovery journey of individuals with mental illness starts with a sense of agency, and a therapeutic relationship with the providers who support them is a prerequisite.</li> <li>In Japan, the construction of community-based integrated care systems for individuals with mental illness is positioned as a priority health issue, with communication with familiar individuals being particularly important for recovery in Japanese and Asian cultures.</li> </ul> </div> </section> <section> <h3> What the paper adds to existing knowledge?</h3> <div> <ul> <li>This study is the first to examine effective communication factors for personal agency in the recovery of individuals with mental illness, focusing on addressing uncertainty about treatment choices and dissatisfaction with decision-making, and considering the user's personal recovery journey.</li> <li>In recovery-oriented practice, it is important to prioritize addressing the emotional aspects of decision-making alongside the mental illness condition, supporting users' self-determination in their unique recovery journeys.</li> </ul> </div> </section> <section> <h3> What are the implications for practice?</h3> <div> <ul> <li>The findings emphasized the need to actively engage with users' perspectives and emotions, emphasize shared life planning, and foster a therapeutic relationship based on partnership. Providers should approach dialogue as carefully as medication prescriptions, prioritizing the establishment of an effective therapeutic relationship with the user.</li> <li>These characteristics are essential for developing a strong therapeutic relationship and effectively facilitating users' recovery. The findings are applicable not only to nurses but to all mental health service providers, contributing to the advancement of recovery-oriented practice.</li> </ul> </div> </section> <section>

对这一主题的了解有多少？社区心理健康服务中以康复为导向的实践越来越重要。精神疾病患者的康复之路始于自主意识，而与支持他们的服务提供者建立治疗关系则是先决条件。在日本，为精神疾病患者构建以社区为基础的综合护理系统被定位为一个优先的健康问题，而在日本和亚洲文化中，与熟悉的人沟通对于康复尤为重要。本文对现有知识有何补充？本研究首次探讨了精神疾病患者康复过程中个人代理的有效沟通因素，重点是解决治疗选择的不确定性和对决策的不满，并考虑使用者的个人康复历程。在以康复为导向的实践中，重要的是要优先解决决策过程中与精神疾病状况相关的情感问题，支持使用者在其独特的康复历程中的自我决定。对实践有什么影响？研究结果强调，需要积极地从使用者的角度和情感出发，强调共同的生活规划，并在伙伴关系的基础上培养治疗关系。医疗服务提供者应像对待药物处方一样谨慎对待对话，优先考虑与使用者建立有效的治疗关系。这些特点对于建立稳固的治疗关系和有效促进使用者康复至关重要。研究结果不仅适用于护士，也适用于所有精神健康服务提供者，有助于推进以康复为导向的实践。摘要：引言：社区精神健康服务中以康复为导向的实践对精神疾病患者至关重要，而在日本和亚洲文化中，与熟悉的人沟通对康复非常重要。目的：本研究旨在通过调查精神疾病患者感知到的通过沟通提供的支持与个人能动性之间的关联，研究促进康复的有效沟通因素：方法：对居住在社区的日本精神健康服务使用者进行了一项横断面研究，评估了他们的主观能动性、决策冲突、工作人员对个人康复的支持、精神健康自我管理的积极性、人口统计学变量和生活困难。多元线性回归分析确定了预测主观能动性的因素，揭示了提供者为促进康复而进行有效沟通的特点：对 222 名用户的数据进行了分析，发现治疗选择的不确定性和无效决策与较高的主观能动性呈负相关，而工作人员对个人康复的支持与较高的主观能动性呈正相关：讨论：在以康复为导向的实践中，在决策过程中优先考虑使用者的情感体验并支持他们在独特的康复历程中自主决定至关重要：对实践的启示：医疗服务提供者应该像对待药物处方一样谨慎对待对话，优先考虑与使用者建立治疗性伙伴关系。研究结果不仅适用于护理人员，也适用于所有心理健康服务提供者，推动了以康复为导向的实践理论的发展。

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引用次数: 0

Caregivers' experiences in helping individuals with severe and enduring mental health challenges integrate into the community: A qualitative descriptive study in Singapore 照顾者在帮助有严重和持久精神健康问题的人融入社区方面的经验：新加坡的一项定性描述性研究。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-20 DOI: 10.1111/jpm.13071

Yong-Shian Goh, Jenna Qing Yun Ow Yong, Chee Keong Vincent Ng, Ziqiang Li, Yanan Hu, Wai-San Wilson Tam, Su Hui Cyrus Ho

<div> <section> <h3> What is known about the subject</h3> <div> <ul> <li>Individuals with severe and enduring mental health challenges continued to consume mental health services for an average of 13 years as they needed multiple acute psychiatric admissions due to the challenges they experienced in their everyday activities.</li> <li>As caregivers of individuals with severe and enduring mental health challenges, they often bear the brunt of caregiving through their assistance with activities of daily living (ADL), providing emotional support and ensuring medication compliance for their loved ones.</li> <li>When caring for their loved ones, caregivers often reported psychological stress, social isolation and emotional exhaustion due to stressors such as uncertainty of the future, the lack of support from professional services and the isolation from their own social network and support mechanism.</li> </ul> </div> </section> <section> <h3> What the paper adds to existing knowledge</h3> <div> <ul> <li>Insights from this study revealed that caregivers for individuals with severe and enduring mental health challenges went through a lonely and exhausting journey fraught with psychological, physical, social and financial challenges, echoing the caregiving needs and the prevalence of the caregiver burden.</li> </ul> </div> </section> <section> <h3> What are the implications for practice</h3> <div> <ul> <li>Insights shared by the caregivers demonstrated the need for a centralised point of contact to navigate Singapore's fragmented mental healthcare sector.</li> <li>Peer-support groups should be further promoted because they offer the benefits of information exchange, mutual support and a sense of empowerment and hopefulness, which may help ease the caregiver burden.</li> <li>Life skills training, such as teaching how to communicate empathetically with family members, resolve conflicts using open communication, maintain a structured daily routine and solve pragmatic problems in daily life, is more critical for individuals with severe and enduring mental health challenges. This will help them learn how to manage their well-being, live independently, and stabilise their conditions

对该主题的了解：有严重和持久精神健康问题的人平均 13 年都要继续接受精神健康服务，因为他们在日常活动中所经历的挑战使他们需要多次急性精神病入院治疗。作为严重持久性精神障碍患者的照护者，他们往往首当其冲地承担起照护的责任，包括协助患者进行日常生活活动（ADL）、提供情感支持以及确保患者遵医嘱服药。在照顾亲人的过程中，由于未来的不确定性、缺乏专业服务的支持以及与自身社会网络和支持机制的隔离等压力因素，照顾者往往会感到心理压力、社会隔离和情感疲惫：这项研究揭示了严重和持久心理健康挑战者的照顾者经历了一段孤独和疲惫的旅程，其中充满了心理、生理、社会和经济方面的挑战，这与照顾者的需要和照顾者负担的普遍性相呼应：护理者们分享的观点表明，在新加坡分散的精神医疗保健领域，需要一个集中的联络点。应进一步推广同伴互助小组，因为它们可以提供信息交流、相互支持、赋权和充满希望的感觉，这可能有助于减轻照顾者的负担。生活技能培训，例如教导如何以同理心与家人沟通，用开放的交流方式解决冲突，维持有条理的日常作息，解决日常生活中的实际问题，对于有严重和持久精神健康挑战的人来说更为重要。这将帮助他们学会如何管理自己的幸福、独立生活和稳定病情。最后，公众宣传活动应通过强调照顾者的力量、韧性和奉献精神来表达对他们的敬意。国家可以通过减免他们的年收入税或提供照顾者津贴的形式，为他们提供经济援助，以减轻照顾者所面临的经济压力。摘要：导言：随着精神医疗保健逐步非机构化，照顾严重精神疾病患者的责任越来越多地从医护人员转移到家庭照顾者身上。照护者必须在帮助亲人融入社区的同时，兼顾许多义务，而这些义务往往会损害他们的整体健康和幸福。目的确定并了解照顾者在帮助患有严重和持久性精神疾病的人融入社区时所面临的需求和挑战。方法本研究采用描述性定性方法来探讨严重持久性精神障碍患者的照顾者在重返社区时所面临的经验和挑战。在 2021 年 12 月至 2022 年 11 月期间进行的视频会议访谈中使用了半结构化指南。本研究根据 32 项定性研究报告综合标准（COREQ）清单进行报告。研究结果主要作者对 14 名护理人员进行了单独访谈。大多数照顾者为女性，平均有 15 年照顾亲人的经验。利用布劳恩和克拉克的六阶段主题框架，我们从数据中归纳出了主题和次主题。这两个主题分别是：(i) 挑战（其次主题包括照顾过程中的个人挑战、缺乏意识、污名化和就业）；(ii) 支持（其次主题包括社会化对精神疾病患者的重要性、现有的支持途径和潜在的支持领域）。讨论我们的调查结果显示，护理人员在照顾有严重和持久精神健康问题的人融入社区时，需要满足他们的当代需求。与全球精神疾病患者所面临的挑战一样，社会心理支持和其他辅助支持仍然是精神健康环境中的共同主题。研究结果进一步特别强调了作为资源的无障碍联络点以及就业扶持和维持举措的重要性，以帮助管理照顾者的情绪和系统挑战，从而解决研究结果中发现的差距。照顾者的同伴支持小组、生活技能培训和公众心理健康意识也是照顾者的呼声所需要的。对实践的启示优先领域包括在社区内为照顾者建立一个集中的联络点。

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引用次数: 0

Correction to ‘Why patients diagnosed with bipolar disorder start, continue or discontinue health-related apps supporting their self-management’ 更正 "被诊断为双相情感障碍的患者为何开始、继续或停止使用支持其自我管理的健康相关应用程序"。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-14 DOI: 10.1111/jpm.13070

B. Geerling, S. M. Kelders, A. W. M. M. Stevens, R. W. Kupka, and E. T. Bohlmeijer, “Why Patients Diagnosed with Bipolar Disorder Start, Continue or Discontinue Health-Related Apps Supporting Their Self-Management,” Journal of Psychiatric and Mental Health Nursing 30, no. 3 (2023): 537–546, https://doi.org/10.1111/jpm.12894.

A new co-author, Eline Lolkema, was added as second author of the paper, who has made substantial contributions to the submitted work. The correct author list reads:

‘Bart Geerling, Eline C. Lolkema*, Saskia M. Kelders, Anja W. M. M. Stevens, Ralph W. Kupka, Ernst T. Bohlmeijer’

*Saxion University of Applied Sciences, Deventer, The Netherlands.

The authors also asked to include an author contribution statement, as follows:

B. Geerling: Conception and design of the study and analysis, analysis and/or interpretation of data and writing the manuscript. E. C. Lolkema: Conception and design of the study and analysis, analysis and/or interpretation of data, data collection and writing the manuscript. S. Kelders, A. Stevens, R. Kupka and E. Bohlmeijer: Writing the manuscript. This study was based on the Bachelor thesis of E. C. Lolkema, performed at the Saxion University of Applied Sciences (Lolkema, 2018).

The authors wished to make another correction, concerning the data saturation mentioned in their paper. The statement in the article that data saturation was achieved is incorrect. Due to limited interviewee participation, no group selection could be made, and data saturation was not achieved. The authors apologise for this oversight.

B.Geerling、S. M. Kelders、A. W. M. M. Stevens、R.W. Kupka, and E. T. Bohlmeijer, "Why Patients Diagnosed with Bipolar Disorder Start, Continue or Discontinue Health-Related Apps Supporting Their Self-Management," Journal of Psychiatric and Mental Health Nursing 30, no.3 (2023):537-546，https://doi.org/10.1111/jpm.12894.A，新的合著者 Eline Lolkema 被添加为论文的第二作者，她对提交的工作做出了重大贡献。正确的作者名单为：'Bart Geerling, Eline C. Lolkema*, Saskia M. Kelders, Anja W. M. M. Stevens, Ralph W. Kupka, Ernst T. Bohlmeijer'*Saxion University of Applied Sciences, Deventer, The Netherlands.作者还要求加入作者贡献声明，内容如下：B.Geerling：研究的构思和设计、数据分析和/或解释以及撰写手稿。E. C. Lolkema：研究的构思和设计以及数据分析、分析和/或解释、数据收集和撰写手稿。S. Kelders、A. Stevens、R. Kupka 和 E. Bohlmeijer：撰写手稿。本研究基于 E. C. Lolkema 在萨克森应用科学大学完成的学士学位论文（Lolkema, 2018）。作者希望就其论文中提到的数据饱和度再做一次更正。文章中关于已达到数据饱和度的说法是不正确的。由于受访者参与人数有限，无法进行分组选择，因此没有达到数据饱和。作者对此疏忽表示歉意。

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引用次数: 0

Attitudes of nurses and nurse managers towards violence risk assessment and management: A cross-sectional study in psychiatric inpatient settings 护士和护士管理人员对暴力风险评估和管理的态度：精神病住院患者的横断面研究。

IF 2.6 4区医学 Q1 NURSING

Journal of Psychiatric and Mental Health Nursing

Pub Date : 2024-06-07 DOI: 10.1111/jpm.13069

Jaakko Varpula, Maria Ameel, Tella Lantta

<div> <section> <h3> What is known on the subject</h3> <div> <ul> <li>Workplace violence is a significant challenge in psychiatric hospital care.</li> <li>Some existing practices of violence risk assessment and management are based on nurses' intuition and clinical experience instead of structured tools.</li> </ul> </div> </section> <section> <h3> What the paper adds to existing knowledge</h3> <div> <ul> <li>Nurses and nurse managers consider violence risk assessment and management their responsibility. Still, nurses and nurse managers have mixed attitudes towards the use of validated risk assessment tools.</li> <li>The attitudes towards service users' positive risk-taking in nurses and nurse managers vary, with some nurses and nurse managers supporting its importance.</li> </ul> </div> </section> <section> <h3> What are the implications for practice</h3> <div> <ul> <li>Change in nurses' and nurse managers' attitudes towards risk assessment tools is required before their implementation into practice.</li> <li>More profound change in practices towards recovery-oriented care is required also in risk assessment.</li> </ul> </div> </section> <section> </section> <section> <h3> Introduction</h3> <p>Workplace violence is a prevalent issue in psychiatric inpatient care. Prevention efforts require the identification of at-risk service users using validated violence risk assessment tools. The shift in violence prevention emphasises preventive measures and collaborative risk assessment together with service users. Nurses have a central role in this process. Therefore, their attitudes are crucial when implementing evidence-based methods.</p> </section> <section> <h3> Aim</h3> <p>To assess the attitudes of nurses and nurse managers towards violence risk assessment and management.</p>

对这一问题的了解：工作场所暴力是精神病院护理工作面临的一项重大挑战。现有的一些暴力风险评估和管理实践是基于护士的直觉和临床经验，而不是结构化的工具：护士和护士管理者认为暴力风险评估和管理是他们的责任。然而，护士和护士管理者对使用有效的风险评估工具的态度不一。护士和护士管理人员对服务对象积极承担风险的态度各不相同，有些护士和护士管理人员支持其重要性：对实践的启示：在将风险评估工具应用于实践之前，需要改变护士和护士管理者对其的态度。在风险评估中，还需要对以康复为导向的护理实践进行更深刻的变革。摘要：简介：工作场所暴力是精神病住院护理中的一个普遍问题。预防工作需要使用有效的暴力风险评估工具来识别有风险的服务使用者。暴力预防的转变强调预防措施以及与服务使用者共同进行风险评估。护士在这一过程中发挥着核心作用。目的：评估护士和护士管理人员对暴力风险评估和管理的态度：方法：在芬兰精神病住院护理中进行横断面在线调查。采用统计方法进行数据分析。报告采用 STROBE 指南：护士（n = 142）重视风险评估，并认为这是他们的责任。对于服务对象在康复过程中冒险的态度各不相同。对于风险评估工具的有效性，护士们的态度不一。年龄较大的参与者和护士长对风险评估工具的态度更为积极：讨论：研究结果凸显了护士对暴力风险评估的责任感，同时他们也更倾向于自己的临床判断：对实践的启示：在培训和实施过程中，了解护士的态度对于消除顾虑、提供支持和增强积极态度至关重要。

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引用次数: 0