PDF(Pubmed)
Abstract：
BACKGROUND: De-escalation is often advocated to reduce harm associated with violence and use of restrictive interventions, but there is insufficient understanding of factors that influence de-escalation behaviour in practice. For the first time, using behaviour change and implementation science methodology, this paper aims to identify the drivers that will enhance de-escalation in acute inpatient and psychiatric intensive care mental health settings.
METHODS: Secondary analysis of 46 qualitative interviews with ward staff (n = 20) and patients (n = 26) informed by the Theoretical Domains Framework.
RESULTS: Capabilities for de-escalation included knowledge (impact of trauma on memory and self-regulation and the aetiology and experience of voice hearing) and skills (emotional self-regulation, distress validation, reducing social distance, confirming autonomy, setting limits and problem-solving). Opportunities for de-escalation were limited by dysfunctional risk management cultures/ relationships between ward staff and clinical leadership, and a lack of patient involvement in safety maintenance. Motivation to engage in de-escalation was limited by negative emotion associated with moral formulations of patients and internal attributions for behaviour.
CONCLUSIONS: In addition to training that enhances knowledge and skills, interventions to enhance de-escalation should target ward and organisational cultures, as well as making fundamental changes to the social and physical structure of inpatient mental health wards. Psychological interventions targeting negative emotion in staff are needed to increase motivation. This paper provides a new evidence-based framework of indicative changes that will enhance de-escalation in adult acute mental health inpatient and PICU settings.
METHODS: Secondary analysis of 46 qualitative interviews with ward staff (n = 20) and patients (n = 26) informed by the Theoretical Domains Framework.
RESULTS: Capabilities for de-escalation included knowledge (impact of trauma on memory and self-regulation and the aetiology and experience of voice hearing) and skills (emotional self-regulation, distress validation, reducing social distance, confirming autonomy, setting limits and problem-solving). Opportunities for de-escalation were limited by dysfunctional risk management cultures/ relationships between ward staff and clinical leadership, and a lack of patient involvement in safety maintenance. Motivation to engage in de-escalation was limited by negative emotion associated with moral formulations of patients and internal attributions for behaviour.
CONCLUSIONS: In addition to training that enhances knowledge and skills, interventions to enhance de-escalation should target ward and organisational cultures, as well as making fundamental changes to the social and physical structure of inpatient mental health wards. Psychological interventions targeting negative emotion in staff are needed to increase motivation. This paper provides a new evidence-based framework of indicative changes that will enhance de-escalation in adult acute mental health inpatient and PICU settings.
摘要：
背景：通常主张降级以减少与暴力和使用限制性干预措施相关的伤害，但在实践中对影响降级行为的因素认识不足。第一次,使用行为改变和实施科学方法，本文旨在确定在急性住院和精神科重症监护精神健康环境中增强降级的驱动因素。
方法：根据理论领域框架对病房工作人员（n=20）和患者（n=26）进行的46次定性访谈的二次分析。
结果：降级能力包括知识（创伤对记忆和自我调节的影响以及声音听觉的病因和经验）和技能（情绪自我调节，遇险验证,减少社交距离，确认自主权，设置限制和解决问题)。降级的机会受到病区工作人员和临床领导之间功能失调的风险管理文化/关系的限制。和缺乏患者参与安全维护。参与降级的动机受到与患者道德表述和行为内部归因相关的负面情绪的限制。
结论：除了提高知识和技能的培训之外，加强降级的干预措施应针对病房和组织文化，以及从根本上改变住院精神健康病房的社会和身体结构。需要针对员工的负面情绪进行心理干预，以增加动机。本文提供了一个新的基于证据的指示性变化框架，该框架将增强成人急性心理健康住院患者和PICU设置的降级。
方法：根据理论领域框架对病房工作人员（n=20）和患者（n=26）进行的46次定性访谈的二次分析。
结果：降级能力包括知识（创伤对记忆和自我调节的影响以及声音听觉的病因和经验）和技能（情绪自我调节，遇险验证,减少社交距离，确认自主权，设置限制和解决问题)。降级的机会受到病区工作人员和临床领导之间功能失调的风险管理文化/关系的限制。和缺乏患者参与安全维护。参与降级的动机受到与患者道德表述和行为内部归因相关的负面情绪的限制。
结论：除了提高知识和技能的培训之外，加强降级的干预措施应针对病房和组织文化，以及从根本上改变住院精神健康病房的社会和身体结构。需要针对员工的负面情绪进行心理干预，以增加动机。本文提供了一个新的基于证据的指示性变化框架，该框架将增强成人急性心理健康住院患者和PICU设置的降级。
