Purpose

Inpatient violence is a substantial problem in psychiatric wards and de-escalation is difficult. When managing instances of violence through verbal techniques fail, mental health-care staff may use restrictive practices. The Six Core Strategies and debriefing exist for managing violence and restrictive practices in different mental health settings. Debriefing is used to get patients’ views on restrictive practices, ensure proper patient care and strengthen the role of patients as experts. This study aims to provide new information on debriefing implementation and how debriefing was used among different patient groups in a forensic hospital.

Design/methodology/approach

Quantitative seclusion time and debriefing reports (n = 524) were examined with Poisson regression analysis. Fisher’s exact test was used to determine the associations between debriefing and seclusion/restraint.

Findings

Debriefing (n = 524) was provided in 93% of violent episodes, which is an excellent result on an international level. There was significant variation in how often debriefing was used (p < 0.001) among different patient groups, i.e. dangerous, difficult-to-treat patients and criminal offenders whose sentences have been waived. Previous debriefing research has rarely specified what types of psychiatric patients have been subjected to seclusion or restraint.

Practical implications

The implementation of debriefing requires multiprofessional work within the organization and wards.

Originality/value

Debriefing seems to stimulate reflection at every level of a health-care organization, which fosters learning and can ultimately change clinical practices. The use of debriefing can strengthen the role of patients as well as professionals.

中文翻译：

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在法医精神病学护理中使用限制性做法后的汇报

目的

住院暴力是精神病房中的一个严重问题，并且很难降级。当通过口头技巧处理暴力事件失败时，精神卫生保健人员可能会使用限制性做法。存在六项核心策略和汇报，用于管理不同心理健康环境中的暴力和限制性做法。汇报用于了解患者对限制性做法的看法，确保适当的患者护理并加强患者作为专家的作用。本研究旨在提供有关汇报实施的新信息以及如何在法医医院的不同患者群体中使用汇报。

设计/方法/途径

使用泊松回归分析检查定量隔离时间和汇报报告（n = 524）。Fisher 精确检验用于确定汇报和隔离/约束之间的关联。

发现

在 93% 的暴力事件中提供了汇报（n = 524），这在国际水平上是一个很好的结果。不同患者群体（即危险的、难以治疗的患者和刑期已被免除的罪犯）使用情况汇报的频率存在显着差异 ( p < 0.001)。以前的汇报研究很少具体说明哪些类型的精神病患者受到隔离或约束。

实际影响

汇报的实施需要组织和病房内的多专业工作。

原创性/价值

汇报似乎可以激发医疗机构各个层面的反思，从而促进学习并最终改变临床实践。使用汇报可以加强患者和专业人员的作用。