安全病房干预在精神科应用的范围综述

Application of safewards interventions in psychiatric wards:a scoping review

目的对安全病房干预在精神科的应用进行范围综述,为该干预今后在国内临床实施提供参考。方法以澳大利亚乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)发布的证据整合手册为该范围综述的方法学指导框架,检索PubMed、Embase、CINAHL、PsycINFO、Web of Science、Scopus、Cochrane Library、JBI循证实践、JBI证据整合、中国知网、万方数据库、维普数据库和中国生物医学文献数据库中有关安全病房干预的原始研究,检索时限为建库至2022年8月21日。由2名研究者独立筛选文献和提取数据,并对纳入文献进行汇总和分析。结果纳入的19篇文献从干预的有效性、干预的保真度和可行性等不同角度,对涉及到的14项安全病房实施性研究进行了全方位评价。结论如果有较高的实施保真度,安全病房干预可有效降低精神科病房冲突事件的发生和限制措施的使用,并改善病房氛围。安全病房干预可作为国内精神科病房开展创伤知情及以康复为导向的护理实践的重要方法,未来开展相关实施性研究时需加强对工作人员的培训、帮助工作人员树立积极的态度和信念,并获得医院管理层的支持。

Objective To describe the scope and breadth of primary research regarding the implementation of the Safewards Model and its interventions in psychiatric wards.Methods A comprehensive search of the electronic databases,such as PubMed,Embase,CINAHL,PsycINFO,Web of Science,Scopus,Cochrane Library,JBI Evidence-Based Practice,JBI Evidence Synthesis,CNKI,WANFANG,VIP,and SinoMed,from database inception to August 2022,has been conducted to retrieve all the potentially relevant articles.2 researchers independently screened and extracted information for the retrieved literature,and the evidence was then synthesized and summarized.Results The included 19 articles comprehensively evaluated 14 safewards implementation studies in terms of its effectiveness,intervention fidelity,and feasibility.Conclusion The safewards interventions,if implemented with high fidelity,can effectively reduce the incidence of conflict events in psychiatric wards and the use of restrictive practices,and improve the ward atmosphere.Safewards provide an opportunity and platform by which trauma-informed and recovery-oriented practices in psychiatric setting can be achieved.For the future implementation of safewards,it is necessary to strengthen the training of staff,to help staff develop positive attitudes and beliefs toward safewards,and to seek support from hospital management level.