'Monday's feel calmer when creative practitioners are here': a quality improvement project exploring whether creative-practitioner sessions on adult inpatient mental-health wards reduce levels of violence and aggression.

IF 1.3 Q4 HEALTH CARE SCIENCES & SERVICES
Luise V Marino, Sophie-Jo Peel, Lauren Iredale, Subha Thiyagesh, Wajid Khan, Vicki Whyte, Victoria Humble, David McQuillan
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Abstract

Background: Violence and aggression (V&A) are commonplace on mental-health wards and may lead to restrictive practice interventions (RPI), having a detrimental impact on patients and staff. In the 12 months preceding this quality improvement (QI) project, there was a mean V&A incidence of 52.7±113.0 and RPI of 37.6±84.1 per 1000 bed days.

Methods: Using QI methodology, a project involving creative practitioners was codeveloped to provide a range of activities delivered via a 7-day service, across 13 inpatient mental-health wards in five hospital settings, using levels of V&A and RPI as outcome measures. The creative practices used drew on successful projects arising from a linked charity, Creative Minds. Three plan-do-study-act cycles were completed. (1) Coproduction with ward staff, patients and creative practitioners of 4-week session plans, including an induction training package for creative practitioners. (2) Streamlined and centralised communication between creative practitioners and participating wards using a project coordinator. (3) Implementation of a creative-practitioner Rota to better support ward activity planning, staff and patient expectation setting.

Results: During the 12-month project wards with creative practitioners experienced statistically significant reduction in V&A levels (F (1, 168)=5.72, p=0.017) and RPI (F (1, 168)=8.40, p=0.0042). Wards not involved in the project, V&A levels (F (1, 142) =3.34, p<0.069) and RPI (F (132, 142)=0.99, p=0.52) remained unchanged. Ward length-of-stay was used as a balancing measure with no difference pre 45.0±4.9 days and post 46.9±5.0 days intervention (p=0.18). At the project peak, creative practitioners delivered around 300 hours per week of creative activity, which appears to be associated with reduced number of V&A/RPI incidents.

Conclusions: Recommendations for the project's next steps are to secure sustained funding for creative practitioners to further enhance patients/staff well-being, as well as the coproduction of a creative-practitioner implementation guide to be tested in other mental-health inpatient settings as a part of a research study to better understand the impact of the type/timing of activities (ie, day/evening/weekends) on important patient outcomes and staff well-being.

“有创意实践者在场,周一的人会感觉更平静”:这是一个质量改进项目,旨在探索在精神健康病房的成年住院病人中,创意实践者的课程是否会降低暴力和攻击水平。
背景:暴力和攻击(V&A)在精神卫生病房司空见惯,可能导致限制性实践干预(RPI),对患者和工作人员产生不利影响。在质量改善(QI)项目实施前的12个月,V&A平均发生率为52.7±113.0,RPI为37.6±84.1 / 1000床日。方法:采用QI方法,共同开发了一个涉及创意从业者的项目,通过7天的服务,在5家医院的13个住院精神卫生病房提供一系列活动,使用V&A和RPI水平作为结果测量。所使用的创造性实践借鉴了来自相关慈善机构creative Minds的成功项目。完成了三个计划-研究-行动周期。(1)与病房工作人员、患者和创意从业者共同制定为期4周的课程计划,包括创意从业者入职培训包。(2)透过项目协调人,简化和集中创意从业人员与参与病房之间的沟通。(3)实施创意医生Rota,以更好地支持病房活动规划、员工和患者期望设定。结果:在12个月的项目病房中,有创意从业者的V&A水平(F (1,168)=5.72, p=0.017)和RPI (F (1,168)=8.40, p=0.0042)有统计学意义的降低。未参与项目的病房,V&A水平(F (1,142) =3.34, p)对该项目的后续步骤的建议是,确保为创意从业者提供持续的资金,以进一步提高患者/工作人员的福祉,并共同编写一份创意从业者实施指南,作为一项研究的一部分,在其他精神卫生住院患者环境中进行测试,以更好地了解活动类型/时间(即白天/晚上/周末)对重要患者结果和工作人员福祉的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Quality
BMJ Open Quality Nursing-Leadership and Management
CiteScore
2.20
自引率
0.00%
发文量
226
审稿时长
20 weeks
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