Measures to keep staff and patients safe (containment) frequently involve coercion. A small proportion of patients is subject to a large proportion of containment use. To reduce the use of containment, we need a better understanding of the circumstances in which it is used and the understandings of patients and staff. Two sweeps were made of all the wards, spread over four hospital sites, in one large London mental health organization to identify patients who had been subject to high levels of containment in the previous two weeks. Data were then extracted from their case notes about their past history, current problem behaviours, and how they were understood by the patients involved and the staff. Nurses and consultant psychiatrists were interviewed to supplement the information from the case records. Twenty-six heterogeneous patients were identified, with many ages, genders, diagnoses, and psychiatric specialities represented. The main problem behaviours giving rise to containment use were violence and self-harm. The roots of the problem behaviours were to be found in severe psychiatric symptoms, cognitive difficulties, personality traits, and the implementation of the internal structure of the ward by staff. Staff's range and depth of understandings was limited and did not include functional analysis, defence mechanisms, specific cognitive assessment, and other potential frameworks. There is a need for more in-depth assessment and understanding of patients' problems, which may lead to additional ways to reduce containment use.

译文

确保工作人员和患者安全 (遏制) 的措施经常涉及胁迫。一小部分患者受到很大比例的安全壳使用。为了减少安全壳的使用,我们需要更好地了解使用安全壳的情况以及患者和工作人员的理解。在伦敦的一个大型精神卫生组织中,对所有病房进行了两次清扫,分布在四个医院地点,以识别在过去两周中受到高度遏制的患者。然后从他们的病例记录中提取有关其过去历史,当前问题行为以及相关患者和工作人员如何理解它们的数据。采访了护士和精神病顾问,以补充病例记录中的信息。确定了26名异质患者,代表了许多年龄,性别,诊断和精神病专科。导致使用遏制的主要问题行为是暴力和自我伤害。问题行为的根源在于严重的精神症状,认知困难,人格特质以及工作人员实施病房的内部结构。员工的理解范围和深度有限,不包括功能分析,防御机制,特定的认知评估和其他潜在框架。需要对患者的问题进行更深入的评估和了解,这可能会导致减少安全壳使用的其他方法。

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