Esario Iv Daguman, Alison Taylor, Matthew Flowers, Richard Lakeman, Marie Hutchinson
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Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices.</p><p><strong>Results: </strong>Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes.</p><p><strong>Conclusions: </strong>The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. 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引用次数: 0
摘要
目的：对澳大利亚新南威尔士州一个地区成人住院病房249天的心理健康护理降级日志进行分析，以确定对攻击同时发生的护理治疗反应组，并检查它们与限制性行为和情境攻击减少的关系。设计：采用单中心回顾性研究。方法：对护理干预进行分层聚类，建立共发生护理反应组。然后使用泊松混合效应模型来确定干预集群与限制性实践的关联。结果：出现了两个干预集群：集群1涉及言语降级、积极倾听和建立融洽关系，而集群2包括额外的限制设置和解决问题、分心、感觉调节、环境变化和员工个人时间。聚类1与隔离使用减少83%相关[IRR = 0.17, 95% CI (0.07, 0.41), p]。结论：干预聚类证明了辅助工具在显示护士治疗潜力方面的价值。干预集群之间限制性实践使用的差异表明，在帮助缓解升级和稳健评估缓解升级成分的可能性下，形成治疗关系的结构和进展。与临床实践的相关性：认可和支持护士的治疗工作有助于康复护理的发展和护士积极的职业认同。报告方法：本研究遵循适用的STROBE指南。患者或公众参与：由于研究是回顾性的，没有服务用户或公众参与。
Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit.
Aim: An analysis of mental health nursing de-escalation logs for 249 days from a regional adult inpatient unit in New South Wales, Australia, was completed to identify groups of cooccurring nursing therapeutic responses to aggression and examine their associations with reductions in restrictive practices and situational aggression.
Design: A single-centre retrospective study was undertaken.
Method: Hierarchical clustering of nursing interventions established groups of cooccurring nursing responses. Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices.
Results: Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes.
Conclusions: The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. The differences in restrictive practice use between intervention clusters signal the structure and progression of forming therapeutic relationships in aid of de-escalation and the possibility of assessing de-escalation components robustly.
Relevance to clinical practice: Acknowledging and supporting nurses' therapeutic work support the development of recovery-oriented care and a positive professional identity for nurses.
Reporting method: This study followed the applicable STROBE guidelines.
Patient or public involvement: Due to the study's retrospective nature, there was no service user or public involvement.
期刊介绍：
The Journal of Clinical Nursing (JCN) is an international, peer reviewed, scientific journal that seeks to promote the development and exchange of knowledge that is directly relevant to all spheres of nursing practice. The primary aim is to promote a high standard of clinically related scholarship which advances and supports the practice and discipline of nursing. The Journal also aims to promote the international exchange of ideas and experience that draws from the different cultures in which practice takes place. Further, JCN seeks to enrich insight into clinical need and the implications for nursing intervention and models of service delivery. Emphasis is placed on promoting critical debate on the art and science of nursing practice.
JCN is essential reading for anyone involved in nursing practice, whether clinicians, researchers, educators, managers, policy makers, or students. The development of clinical practice and the changing patterns of inter-professional working are also central to JCN''s scope of interest. Contributions are welcomed from other health professionals on issues that have a direct impact on nursing practice.
We publish high quality papers from across the methodological spectrum that make an important and novel contribution to the field of clinical nursing (regardless of where care is provided), and which demonstrate clinical application and international relevance.
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