RESUMEN
In secure psychiatric services where the potential for 'burnout' by nurses is high, clinical supervision is viewed as a key to reflective practice to support staff in stressful working environments. Barriers to the uptake of clinical supervision in such service settings are personal and organizational. The study was prompted by the need to evaluate the effectiveness of supervision for registered nurses and health-care assistants (HCAs) and a desire to use survey findings to improve the quality and uptake of supervision. The study examined the perceived benefits, the best practice elements and the practical aspects of clinical supervision including how to improve practice. An approximate uptake of clinical supervision by 50% of staff confirmed previous findings; that HCAs were significantly less likely to engage in supervision and less likely to perceive benefit from it. Initiatives to address the training and managerial obstacles to the provision of formal supervision are described.
Asunto(s)
Enfermeras y Enfermeros/psicología , Supervisión de Enfermería/organización & administración , Auxiliares de Psiquiatría/psicología , Servicio de Psiquiatría en Hospital/organización & administración , Adulto , Femenino , Humanos , Enfermeras y Enfermeros/organización & administración , Supervisión de Enfermería/normas , Auxiliares de Psiquiatría/organización & administraciónAsunto(s)
Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Australia , Identidad de Género , Historia del Siglo XIX , Historia del Siglo XX , Hospitales Psiquiátricos/organización & administración , Humanos , Trastornos Mentales/terapia , Auxiliares de Psiquiatría/organización & administraciónAsunto(s)
Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Australia , Códigos de Ética/historia , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Humanos , Perfil Laboral , Trastornos Mentales/terapia , Selección de Personal/organización & administración , Auxiliares de Psiquiatría/organización & administraciónAsunto(s)
Personal Administrativo/historia , Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Personal Administrativo/organización & administración , Australia , Códigos de Ética/historia , Femenino , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Humanos , Masculino , Trastornos Mentales/terapia , Auxiliares de Psiquiatría/organización & administraciónAsunto(s)
Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Australia , Femenino , Identidad de Género , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Humanos , Masculino , Trastornos Mentales/terapia , Principios Morales , Selección de Personal , Auxiliares de Psiquiatría/organización & administración , Restricción FísicaAsunto(s)
Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Desarrollo de Personal/historia , Australia , Femenino , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Humanos , Masculino , Trastornos Mentales/terapia , Principios Morales , Selección de Personal , Auxiliares de Psiquiatría/organización & administración , Restricción Física , Salarios y Beneficios/historia , Desarrollo de Personal/organización & administraciónAsunto(s)
Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Australia , Femenino , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Humanos , Masculino , Trastornos Mentales/terapia , Principios Morales , Auxiliares de Psiquiatría/organización & administración , Restricción Física , Salarios y Beneficios , ViolenciaAsunto(s)
Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Australia , Femenino , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Humanos , Masculino , Trastornos Mentales/terapia , Principios Morales , Auxiliares de Psiquiatría/organización & administración , Restricción Física , Salarios y BeneficiosAsunto(s)
Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Auxiliares de Psiquiatría/historia , Salarios y Beneficios/historia , Australia , Familia , Identidad de Género , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Vivienda/historia , Humanos , Masculino , Estado Civil , Trastornos Mentales/terapia , Auxiliares de Psiquiatría/organización & administraciónAsunto(s)
Administración Hospitalaria/historia , Hospitales Psiquiátricos/historia , Trastornos Mentales/historia , Médicos/historia , Auxiliares de Psiquiatría/historia , Australia , Femenino , Historia del Siglo XIX , Hospitales Psiquiátricos/organización & administración , Humanos , Relaciones Interprofesionales , Masculino , Trastornos Mentales/terapia , Auxiliares de Psiquiatría/organización & administración , ViolenciaRESUMEN
OBJECTIVE: Inpatient aggression is poorly documented in official records. Video technology can improve detection, but is labor-intensive and costly. We examined the effectiveness of interventions to improve reporting on a secure inpatient research unit equipped with audio/video surveillance. METHOD: Systematic review of all video recorded during a six-week period in 2000 revealed that official documentation omitted 16/71 aggressive incidents (23%). Subsequent interventions to improve reporting involved therapy aides, whose jobs entail continuous direct contact with patients. We reviewed the corresponding period in 2005 to investigate changes in aggression and reporting. RESULTS: Although the number of aggressive incidents did not change significantly, reporting improved: 59/62 (95%) events detected in 2005 had been reported. Physical aggression decreased and verbal aggression increased. CONCLUSIONS: Improved reporting may have the unanticipated benefit of reducing physical aggression, perhaps by fostering recognition of and intervention in events that might otherwise escalate into more serious aggression.
Asunto(s)
Agresión/psicología , Hospitalización , Trastornos Psicóticos/psicología , Gestión de Riesgos/estadística & datos numéricos , Esquizofrenia/terapia , Psicología del Esquizofrénico , Violencia/prevención & control , Adulto , Preescolar , Conducta Peligrosa , Femenino , Unidades Hospitalarias/normas , Unidades Hospitalarias/estadística & datos numéricos , Humanos , Masculino , Auxiliares de Psiquiatría/organización & administración , Gestión de Riesgos/normas , Conducta Verbal/clasificación , Grabación en Video/métodos , Violencia/estadística & datos numéricosRESUMEN
Despite the development of community care and associated processes of de-institutionalisation, the hospital remains the hub of mental health services in the UK. However, previous quantitative and survey research indicates that quality of care in acute psychiatric (admission) wards has been compromised or is under threat, and points to a bleak experience for people who are admitted. Indicators of this include that there have been increases in admission rates, the proportion of compulsory admissions, and bed occupancy rates. There is also evidence of violence, sexual harassment and substance misuse in this setting, accompanied by rapid staff turnover, low staff morale, and an increasing proportion of 'difficult' patients (especially young men with schizophrenia). This paper reviews the evidence about life on psychiatric wards, focusing on how it is experienced by patients in acute settings. Research conducted in the UK in the 1990s, supports the impression that organisational pressures are having a negative impact on the quality of care. It shows that: nurse-patient (N-P) relationships are perceived to be an important aspect of care, but that N-P contact has declined; and patients are critical of conditions on the ward and view life there as both boring and unsafe. However, very little in-depth ethnographic research has been conducted on acute wards in the UK (and none since the 1970s) leaving us with a 'black box' view of in-patient care in this setting. Studies conducted during earlier 'care paradigms', notably those in the USA by Goffman and Strauss et al., provide useful insights into the patient's experience, but the extent to which these can be conceptually generalised to the present situation is unknown. The paper concludes by outlining questions and priorities for future investigation, focusing on the role of qualitative research.