دانلود رایگان مقاله انگلیسی کاهش آموزش کارکنان در نگهداری فیزیکی در خدمات سلامت روان در چین - الزویر 2018

ABSTRACT

OBJECT: The purpose of this article was to synthesize the evidence regarding the reduction of physical restraint, and to seek some practical recommendations based on the current situation in China. METHOD: Nine databases were retrieved; these were PubMed, CINAHL, MEDLINE, Trip Database, PsysINFO, Cochrane Library, CNKI (Chinese database), Wanfang (Chinese database) and CBM (Chinese database) respectively. The selected articles were screened manually, and the identified researches were appraised through Review manager 5.3. RESULT: Eight studies (four randomized controlled trials and four quasi-experimental studies) published between June 2013 and May 2017 were selected. Risk ratios (RRs) with 95% confidence intervals (CIs) were used as the effect index for dichotomous variables. The standardized mean differences (SMDs) with 95% CIs were calculated as the pooled continuous effect. The outcome of meta-analysis suggested staff training reduced the duration (IV = −0.88; 95% CIs = −1.65 to −0.10; Z = 2.22; p = 0.03) and adverse effect (RR, 0.16; 95% CIs = 0.09 to 0.30; Z = 5.96; p < 0.00001) of physical restraint, but there were no statistical change in the frequency of physical restraint (RR, 0.74; 95% CIs = 0.43 to 1.28; Z = 1.07; p = 0.28). Noticeably, the result of pooled estimates from 3 RCTs suggested staff training had no effects on the incidence of physical restraint. (RR, 1.01; 95% CIs = 0.45 to 2.24; Z = 0.02; p = 0.99) CONCLUSION: Staff training was an effective measure to minimize the duration and adverse effects of physical restraint. More studies are needed to examine the effectiveness of staff training in relation to reduce the prevalence of physical restraint. Furthermore, considering the nurse's education background in China, it is recommended to conduct a compulsory training program to reduce the unnecessary restraint.

DISCUSSION

Demonstrated with the identified studies, staff training was an essential part of a program for reducing physical restraint. Noticeably, for the purpose of enhancing the effectiveness in restraint reducing, Stewart et al. (2010) suggested staff training should be implemented together with other strategies, including changing local policy, review procedure, crisis management, the PRN medication, patient education, violence awareness, and risk assessment. In terms of staff training, lecture learning and seminar were two of the most widely employed approaches. However, staff training emphasized cultivating nurses' capability of providing health education in specific topic which required professional knowledge in mental health nursing, such as emotion management, aggressive behavior management, and stress coping strategy (Pellfolk, Gustafson, Bucht, & Karlsson, 2010). In addition to nurses' capability, strengthening the awareness of risk and reflections of clinical dynamic scenario were other indispensable elements in training programme; and seminar and group discussion were main approaches to achieve these goals (Putkonen et al., 2013). This review has following limitations. Firstly, the identified studies were randomized controlled trials and quasi-experimental studies. However, the evidence of quasi-experimental studies provided practical but not convincing argument in relation to the proposed PICO question. To summarize the identified evidence above, in relation to the randomized controlled trials, despite the rigor in randomization, the design of every trial were reasonable and acceptable. The measurements of patient and staff at baseline and follow-up were absent. However it was preferable but unrealistic to collect the characteristic of participants as it consumes great resources. On the other hand, the trials concerning sta ff training should be conducted at organizational level, meaning all the members within an organization would take part in its implementation.