Einfluss der Personalbesetzung auf Konflikte auf psychiatrischen Stationen

Abstract

Acute psychiatric wards are an important element in the mental healthcare of people at risk for acute harm to others or self-harm. Unfortunately, aggression, violence (conflict) and the use of coercion (containment) are still part of psychiatric care. The decisive factor for the correct handling of these situations is the quantity as well as the quality of the employees. Therefore, the present study dealt with the care situation on acute psychiatric wards. The hypothesis is that both the number of beds on the acute psychiatric ward and the number of caregivers have an impact on the occurrence of conflict and containment. For this purpose, data were collected in 6 clinics on a total of 12 acute psychiatric wards. The Patient Staff Conflict Checklist - Shift Report (PCC-SR) was used as the data entry tool. A total of 2026 shifts (early, late and night shifts) were recorded and evaluated. The staffing of the wards with nursing personnel varied considerably. The results show that both the size of the ward and also the number of caregivers on acute psychiatric wards have a significant impact on the occurrence of conflicts. The results also show that the incidence of conflicting behavior of patients differs both in terms of the wards of the hospitals involved and in the type of service considered. In addition, it can be seen that the extent of closure of an acute ward (i. e. the closed ward or entrance door) and the size of a ward (i. e. the number of beds) have a negative impact on the incidence of inpatient acute psychiatric contexts. The occurrence of conflict behavior can lead to alien or self-endangerment and to a variety of de-escalating and containment measures. This requires appropriate human resources.

Wählen wir die richtigen Mittel zur Zwangsvermeidung?

“…Die Antworten der Teilnehmenden decken sich damit mit den Befunden anderer Befragungen, dass Behandelnde in Krisensituationen vermehrt auf Medikamente [12,21,22] oder ZM zurückgreifen als auf andere potenziell hilfreiche MM [16,17]. Zudem stellen die Nennung von Verhaltensregeln, die Ankündigung einer drohenden ZM sowie der Überzeugungsversuch bereits informelle ZM dar [23] und sind damit nur eingeschränkt als MM zu zählen.…”

“…Mittlerweile ist es unstrittig, dass das Risiko für eine ZM nicht ausschließlich von Merkmalen der betroffenen PatientInnen [8,11] abhängt, sondern von einer Vielzahl relevanter Einflussfaktoren wie der strukturellen Ausstattung und den Behandlungstraditionen der Kliniken selbst [12,13]. Ein ebenso relevanter Faktor ist ferner die Interaktion zwischen PatientInnen und pflegerisch-therapeutischen MitarbeiterInnen (= Behandelnde), welche die Eskalation im Vorfeld von ZM häufig maßgeblich beeinflusst [14].…”

Individual and Needs-Based: The Platform-Model for Personnel Allocation in Child and Adolescent Psychiatry and Psychotherapy

“…Additionally, changes in the patient structure (e. g., more patients with needs for multimodal support by health care system and youth welfare system) and changes in society (e. g., more patients with divorced parents or patchwork families) were not recognized (APK, 2017;Beck, 2015;Koch-Stoecker & Kölch, 2020). Moreover, deescalative measures to avoid force and coercion toward patients became more important, including more talking-based interventions and 1:1 intensive care (Nienaber et al, 2018). Psych-PV was stopped by law on January 1, 2019.…”

“…The absence of normative personnel requirements might lead to market-based decisions which counteract sensible, adequate, patient-and quality-oriented treatment (Godemann et al, 2015). Several studies showed that there is a connection between staffi ng levels and confl icts or other negative health outcomes (Blume et al, 2019;Nienaber et al, 2018).…”

Influência do rácio enfermeiro–utente na contenção física em psiquiatria: revisão sistemática

“…Importa ainda que todos os profissionais recebam formação, tanto na sua admissão como, no máximo, a cada 3 anos, sobre técnicas de prevenção da (Nienaber et al, 2018), 1 por publicação duplicada (Morrison, 1995) e dois por não analisarem influência do rácio (Allen, Fetzer & Cummings, 2020;Magnowski & Cleveland, 2019). Assim, incluíram-se 4 artigos na revisão qualitativa.…”