24 research outputs found

    Nursing Perspectives: Reflecting History and Informal Coercion in De-escalation Strategies

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    Health professionals like nurses respond to aggression and violence with de-escalation techniques, and still often with coercive measures. Such measures applied by institutions are often rooted in historically grown traditions rather than evidence, reflection, or formation. In this article, we present de-escalation strategies integrating a high and critical awareness toward traditions and the practice of formal and informal coercion

    A Recovery-Oriented Approach for an Acute Psychiatric Ward: Is It Feasible and How Does It Affect Staff Satisfaction?

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    To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implementation of the recovery concept, attitudes towards recovery, coercion, perceptions of the ward and working satisfaction were assessed with questionnaires and computed using Chi square and ANOVA variance analyses. The members of the intervention ward (n=17) did not differ from the control group (n=21), except that control group members were younger. The recovery-orientation of the study ward (ROSE questionnaire) increased significantly (alpha level=0.05) from study begin to study end (p=0.003), and compared to the control group (p=0.002). The attitudes towards coercion did not change significantly in the intervention group, but did so compared to the control group. The contentedness (GMI) and the satisfaction with working conditions (ABB) of the intervention group members compared to control group was significantly higher (GMI: p=0.004, ABB subscale working conditions: p=0.043, satisfaction: p=0.023). The study indicates that recovery-oriented principles can be implemented even in an acute admission ward, increasing team satisfaction with work, while attitudes towards coercion did not change significantly within this single-unit project

    Die schweizerische Agenda fĂĽr klinische Pflegeforschung von 2007 bis 2017 : der Stand der Umsetzung

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    Eine Forschungsagenda fasst relevante Fragestellungen der Forschung zu einem bestimmten Thema zusammen und zeigt wichtige Handlungsfelder auf. Der Schweizerische Verein für Pflegewissenschaft (VFP) setzte sich zum Ziel, die Entwicklung der Pflegewissenschaft und damit verbunden die Forschung in der Schweiz zu fördern und zu unterstützen. Daniela Händler-Schuster und ihr Autorenteam stellen im Folgenden die Entwicklung und die derzeitige Umsetzung der Swiss Research Agenda in Nursing vor

    Psychiatrische Intensivbetreuung

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    Was ist zu diesem Thema bereits bekannt? Um mit Menschen in Krisensituationen in Beziehung zu treten und um sie selber oder andere vor Gefährdung zu schützen, werden im stationären Setting Einzelbetreuungen angeboten und empfohlen: die psychiatrische Intensivbetreuung. Wie wird eine neue Perspektive eingebracht? Unmittelbare Begegnung ohne Zweck, Mitgefühl, Zuhören und Da-Sein sind wirkungsvolle Mittel und sollen bewusst eingesetzt werden. Was sind die Auswirkungen für die Praxis? Interaktionen, Beziehungsaufbau und „Da-Sein“ kann eine Herausforderung sein und neben spezifischen Methoden als weniger zielgerichtet scheinen. Deshalb sind im Rahmen psychiatrischer Intensivbetreuung Weiterbildung und Supervision wichtig

    Measuring recovery: validity of the "Recovery Process Inventory" and the "Recovery Attitudes Questionnaire"

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    Considerable lack of publications and inconsistent results on construct validity make it difficult to choose an appropriate instrument to measure recovery. The aim of the present study was to evaluate additional psychometric aspects of two established measures of personal recovery with differing focuses. Bivariate associations of the recovery measures with personal, clinical and subjective factors were conducted as indicators of concurrent (convergent and divergent) validity. The scales were also tested concerning internal consistency. The sample comprised of 81 inpatients on an acute psychiatric ward (main diagnoses: 27% substance-related disorders, 27% schizophrenic disorders, 25% affective disorders, 10% neurotic or stress-related disorders, and 11% personality disorders). The "Recovery Attitudes Questionnaire (RAQ)" has to be reevaluated before further administration due to serious psychometric shortcomings concerning internal consistency and concurrent validity. The "Recovery Process Inventory (RPI)" total scale showed acceptable concurrent and within-scale validity and can be recommended in order to measure the personal recovery process for clinical and scientific purposes

    Zwischen Kontrolle und Therapie: Eine evolutionäre Konzeptanalyse von Intensivbetreuung in der stationären Akutpsychiatrie.

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    Einleitung: Aufgrund des schwerwiegenden Eingriffs in die Privatsphäre und einer hohen Ressourcen- und Kostenintensität ist eine wissenschaftliche Konzeptualisierung von Intensivbetreuung gefordert für Forschung und Praxis. Methode: Evolutionäre Konzeptanalyse. Ergebnisse: Die Vorbedingungen, Eigenschaften und Konsequenzen des Konzepts der Intensivbetreuung lassen sich in insgesamt 8 Kategorien einteilen. Sie bewegen sich in einem Spannungsfeld von Kontrolle und Therapie sowie Sicherheit der Betroffenen und Absicherung der Professionellen. Schlussfolgerung: Die Ergebnisse erlauben Intensivbetreuung von anderen Überwachungsmaßnahmen zu unterscheiden, gezielt zu erforschen und weiterzuentwickeln

    Informal coercion in acute inpatient setting—knowledge and attitudes held by mental health professionals

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    This pilot study aimed at investigating how mental health professionals on acute psychiatric wards recognize different levels of formal and informal coercion and treatment pressures as well as their attitude towards these interventions. An explorative cross-sectional survey among mental health professionals (N=39) was conducted using a questionnaire that consisted of 15 vignettes describing typical clinical situations on five different stages of the continuum of coercion. Low levels of coercion are recognized adequately while higher levels are grossly underestimated. The degree of coercion inherent to interventions comprising persuasion and leverage was underestimated by professionals with a positive attitude and overestimated by those with a negative attitude towards the respective interventions. No associations with ward or staff related variables were found. Higher knowledge on ambiguous variations of coercive interventions seems to foster more balanced reflections about their ethical implications. Advanced understanding of influencing factors of professionals’ attitudes towards coercion could lead to improved training of professionals in utilizing interventions to enhance treatment adherence in an informed and ethical way

    Patients’ subjective perspective on recovery orientation on an acute psychiatric unit

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    Background : Evaluations of the recovery orientation of mental health services have focused on outpatient and rehabilitative rather than acute inpatient facilities. Aim : This naturalistic observational study seeks to evaluate the subjective perspective and functional outcome of inpatients before and after structural alterations. The changes made were the introduction of treatment conferences and conjoint treatment planning, reduction of the total time spent on reports about patients (in their absence), and recovery-oriented staff training on an acute psychiatric unit of the University Hospital of Psychiatry, Zurich, Switzerland. Methods : During 1 year (2011/2012) eligible patients on the study unit were interviewed on a voluntary basis using established instruments to assess several recovery-relevant aspects. Two different samples (before and after the project; n 34 and n 29) were compared with regard to subjective parameters (e.g. patients ’ attitudes toward recovery, quality of life, perceived coercion, treatment satisfaction, and hope), clinical and socio-demographic basic data, as well as the functional outcome according to the Health of the Nation Outcome Scales (HoNOS). Results: Some patient attitudes towards recovery and their self-assessment of the recovery process improved during the study. Other subjective parameters remained stable between samples. Functional outcome was better in subjects who were treated after the implementation of the new concept. The length of stay remained unchanged. Conclusions: The implementation of recovery-oriented structures and providing the necessary theoretical underpinning on an acute psychiatric unit is feasible and can have an impact on attitudes and knowledge of personal recovery

    Who benefits from peer support in psychiatric institutions?

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    This study examines the influence of recovery-oriented peer events on participants' recovery attitudes and explores who benefits most from such events. Changes in participants' recovery attitudes were evaluated (pre, post, follow-up), and compared with changes of control groups. Distributions of recovery-related values in subgroups were analyzed descriptively. The results of non-parametric tests (Friedman) showed participants with significantly higher values in the dimension Recovery is possible directly after the interventions (P = 0.006), but not 6 months later, and not in comparison with members of control groups. On a descriptive level, women, participants with schizophrenia and with two or more episodes of the disorder showed higher recovery-related values compared to men, participants with an affective disorder and only one episode. Within their feedback, organizations and peers express a positive view of peer support, but evidence for a positive impact of the evaluated peer events on recovery attitude is limited
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