Zwischen Kontrolle und Therapie: Eine evolutionäre Konzeptanalyse von Intensivbetreuung in der stationären Akutpsychiatrie

Ursina Zehnder; Franziska Rabenschlag; Eva-Maria Panfil

doi:10.1055/s-0034-1387244

Psychiatrische Praxis, Inhaltsverzeichnis

Psychiatr Prax 2015; 42(02): 68-75
DOI: 10.1055/s-0034-1387244

Übersicht

Zwischen Kontrolle und Therapie: Eine evolutionäre Konzeptanalyse von Intensivbetreuung in der stationären Akutpsychiatrie

Between Control and Therapy: An Evolutionary Concept Analysis of Special Observation in Acute Psychiatric Wards

Ursina Zehnder

¹Fachbereich Gesundheit, Fachhochschule Bern, Schweiz

²Direktion Pflege, Therapien und Soziale Arbeit, Forschung und Entwicklung, Psychiatrische Universitätsklinik Zürich, Schweiz

,

Franziska Rabenschlag

³Abteilung Entwicklung & Forschung Pflege, Universitäre Psychiatrische Kliniken Basel, Schweiz

,

Eva-Maria Panfil

¹Fachbereich Gesundheit, Fachhochschule Bern, Schweiz

› Institutsangaben

Abstract

Zusammenfassung

Einleitung: Aufgrund des schwerwiegenden Eingriffs in die Privatsphäre und einer hohen Ressourcen- und Kostenintensität ist eine wissenschaftliche Konzeptualisierung von Intensivbetreuung gefordert für Forschung und Praxis.

Methode: Evolutionäre Konzeptanalyse.

Ergebnisse: Die Vorbedingungen, Eigenschaften und Konsequenzen des Konzepts der Intensivbetreuung lassen sich in insgesamt 8 Kategorien einteilen. Sie bewegen sich in einem Spannungsfeld von Kontrolle und Therapie sowie Sicherheit der Betroffenen und Absicherung der Professionellen.

Schlussfolgerung: Die Ergebnisse erlauben Intensivbetreuung von anderen Überwachungsmaßnahmen zu unterscheiden, gezielt zu erforschen und weiterzuentwickeln.

Abstract

Objective: Special observation is a seriously invasive and resource intensive intervention. It is necessary to scientifically conceptualise this measure for further investigations and practice.

Methods: Evolutionary concept analysis.

Results: The identified antecedents, attributes and consequences of special observation range between control and therapy as well as the safety of patients and the coverage of the professionals. Antecedents comprise of legitimisation (indication, assessment, prescription), resources (internal guidelines, architectural structures, information) as well as context factors (security needs, personal attitudes). The identified attitudes are organisation (qualification, shifting carers, length, place), intervention (relationship, re-assessment, transparency) as well as the field of tension between control and therapy. The consequences consist of side effects (patients, nurses, resources) and conflicts (ethical dilemmas, role conflicts).

Conclusion: Society and discipline have influenced the concept over time and a distinction between the custodial and controlling pattern versus a therapeutic approach is recommended.

Schlüsselwörter

Intensivbetreuung - Akutpsychiatrie - stationär - Konzeptanalyse

Keywords

special observation - acute psychiatry - inpatient - concept analysis

Volltext

Referenzen

Literatur
1 Sturny I, Hell D. Psychiatrie, Psychotherapie, Psychologie. In: Kocher G, Oggier W, Hrsg. Gesundheitswesen Schweiz 2007–2009. Bern: Hans Huber; 2007
2 Steinert T, Gebhardt RP. Erfolgen Zwangsmaßnahmen willkürlich?. Psychiat Prax 2000; 27: 282-285
3 Schweizerisches Zivilgesetzbuch (ZGB). 3. Abteilung: Der Erwachsenenschutz. Artikel 426. 2014. Im Internet: http://www.admin.ch/opc/de/classified-compilation/19070042/index.html#a426 (Stand: 20.07.2014)
4 Needham I, Abderhalden C, Dassen T et al. Coercive procedures and facilities in Swiss psychiatry. Swiss Med Wkly 2002; 132: 253-258
5 Flood C, Bowers L, Parkin D. Estimating the costs of conflict and containment on adult acute inpatient psychiatric wards. Nurs Econ 2008; 26: 325-330
6 Nienaber A, Schulz M, Hemkendreis B et al. Die intensive Überwachung von Patienten in der stationären psychiatrischen Akutversorgung – Eine Literaturübersicht. Psychiat Prax 2013; 40: 14-20
7 Stewart D, Bilgin H, Bowers L. Special observation in psychiatric hospitals: a literature review. (Report from the Conflict and Containment Reduction Research Programm). Im Internet: http://www.kcl.ac.uk/iop/depts/hspr/research/ciemh/mhn/projects/litreview/LitRevSpecObs.pdf (Stand: 20.07.2014)
8 Deutsche Gesellschaft für Psychiatrie und Psychotherapie und Nervenheilkunde (DGPPN). Therapeutische Massnahmen bei aggressivem Verhalten in der Psychiatrie und Psychotherapie. 2009. Im Internet: http://www.dgppn.de/publikationen/leitlinien/leitlinien10.html (Stand: 20.07.2014)
9 Nienaber A, Löhr M, Hemkendreis B et al. Intensivbetreuung Empfehlenswert?. Psych Pflege Heute 2013; 19: 90-92
10 Janofsky JS. Reducing inpatient suicide risk: using human factors analysis to improve observation practices. J Am Acad Psychiatry Law 2009; 37: 15-24
11 Clinical Resource Audit Group (CRAG). Engaging People: Observation of People with acute mental health problems. 2002. Im Internet: http://www.scotland.gov.uk/Publications/2002/08/15296/10448 (Stand: 20.07.2014)
12 National Institute for Clinical Excellence (NICE). Violence – The short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments. 2005. Im Internet: http://www.nice.org.uk/CG25 (Stand: 20.07.2014)
13 Cutcliffe JR, McKenna HP. The essential concepts of nursing. Philadelphia: Elsevier; 2005
14 Meleis AI. Chapter 3: Theory: Metaphors, Symbols, Definitions. In: Meleis AI. Theoretical Nursing: Development & Progress. 3.. Aufl. Philadelphia: Lippincott Williams & Wilkins; 2005: 30-49
15 Rodgers BL. Concept Analysis: An Evolutionary View. In: Rodgers BL, Knafl KA, eds. Concept Development in Nursing: Foundations, Techniques, and Applications. 2.. Aufl. Philadelphia: Saunders; 2000: 77-102
16 Knafl KA, Deatrick JA. Knowledge Synthesis and Concept Development in Nursing. In: Rodgers BL, Knafl KA, eds. Concept Development in Nursing: Foundations, Techniques and Applications. 2.. Aufl. Philadelphia: Saunders; 2000: 39-54
17 Rodgers BL. Concepts, analysis and the development of nursing knowledge: the evolutionary cycle. J Adv Nurs 1989; 14: 330-335
18 Amering M, Schmolke M. Recovery – das Ende der Unheilbarkeit. 5.. Aufl. Bonn: Psychiatrie-Verlag; 2012
19 Steinke I. Gütekriterien qualitativer Forschung. In: Flick U, Kardoff E, Steinke I, Hrsg. Qualitative Forschung. Reinbek bei Hamburg: rororo; 2003: 319-331
20 Bowers L, Dack C, Gul N et al. Learning from prevented suicide in psychiatric inpatient care: an analysis of data from the National Patient Safety Agency. Int J Nurs Stud 2011; 48: 1459-1465
21 Kettles AM, Moir E, Woods P et al. Is there a relationship between risk assessment and observation level?. J Psychiatr Ment Health Nurs 2004; 11: 156-164
22 Bowers L, Whittington R, Nolan P et al. Relationship between service ecology, special observation and self-harm during acute in-patient care: City-128 study. Br J Psychiatry 2008; 193: 395-401
23 Kettles AM, Paterson K. Flexible observation: guidelines versus reality. J Psychiatr Ment Health Nurs 2007; 14: 373-381
24 Stewart D, Bowers L. Under the gaze of staff: special observation as surveillance. Perspect Psychiatr Care 2012; 48: 2-9
25 Stewart D, Bowers L, Ross J. Managing risk and conflict behaviours in acute psychiatry: the dual role of constant special observation. J Adv Nurs 2012; 68: 1340-1348
26 Stewart D, Bowers L, Warburton F. Constant special observation and self-harm on acute psychiatric wards: a longitudinal analysis. Gen Hosp Psychiatry 2009; 31: 523-530
27 Dewing J. Special observation and older persons with dementia/delirium: a disappointing literature review. Int J Older People Nurs 2013; 8: 19-28
28 Addo MA, McKie A, Kettles AM et al. Are nurses empowered to make decisions about levels of patient observation in mental health?. Nursing Times 2010; 106: 26-28
29 Cardell R, Pitula CR. Suicidal inpatients’ perceptions of therapeutic and nontherapeutic aspects of constant observation. Psychiatr Serv 1999; 50: 1066-1070
30 Cleary M, Jordan R, Horsfall J et al. Suicidal patients and special observation. J Psychiatr Ment Health Nurs 1999; 6: 461-467
31 Duffy D. Out of the shadows: a study of the special observation of suicidal psychiatric in-patients. Journal of advanced nursing 1995; 21: 944-950
32 Abderhalden C, Needham I, Dassen T et al. Predicting inpatient violence using an extended version of the Broset-Violence-Checklist: instrument development and clinical application. BMC Psychiatry 2006; 6: 17
33 Abderhalden C, Grieser M, Kozel B et al. Wie kann der pflegerische Beitrag zur Einschätzung der Suizidalität systematisiert werden?. Psych Pflege Heute 2005; 11: 160-164
34 Neu P, Erbe S. Akutpsychiatrie: das Notfall-Manual. Stuttgart: Schattauer; 2011
35 O’Brien L, Cole R. Close-observation areas in acute psychiatric units: a literature review. Int J Ment Health Nurs 2003; 12: 165-176
36 Neilson P, Brennan W. The use of special observations: an audit within a psychiatric unit. J Psychiatr Ment Health Nurs 2001; 8: 147-155
37 Langenbach M, Junaid O, Hodgson-Nwaefulu CM et al. Observation levels in acute psychiatric admissions. Eur Arch Psychiatry Clin Neurosci 1999; 249: 28-33
38 Page MJ. Methods of observation in mental health inpatient units. Nurs Times 2006; 102: 34-35
39 Fletcher RF. The process of constant observation: perspectives of staff and suicidal patients. J Psychiatr Ment Health Nurs 1999; 6: 9-14
40 Buchanan-Barker P, Barker P. Observation: the original sin of mental health nursing?. J Psychiatr Ment Health Nurs 2005; 12: 541-549
41 Pitula CR, Cardell R. Suicidal inpatients’ experience of constant observation. Psychiatr Serv 1996; 47: 649-651
42 Stevenson C, Cutcliffe J. Problematizing special observation in psychiatry: Foucault, archaeology, genealogy, discourse and power/knowledge. J Psychiatr Ment Health Nurs 2006; 13: 713-721
43 Jones J, Ward M, Wellman N et al. Psychiatric inpatients’ experience of nursing observation. J Psychosoc Nurs Ment Health Serv 2000; 38: 10-20
44 Salzmann-Erikson M, Eriksson H. Latent or manifest observers: two dichotomous approaches of surveillance in mental health nursing. Nurs Res Pract 2011; e-pub
45 Barre T, Evans R. Nursing observations in the acute inpatient setting: A contribution to the debate. Ment Health Pract 2002; 5: 10-14
46 Cutcliffe JR, Stevenson C. Never the twain? Reconciling national suicide prevention strategies with the practice, educational, and policy needs of mental health nurses (Part one). Int J Ment Health Nurs 2008; 17: 341-350
47 Vrale GB, Steen E. The dynamics between structure and flexibility in constant observation of psychiatric inpatients with suicidal ideation. J Psychiatr Ment Health Nurs 2005; 12: 513-518
48 Hamilton B, Manias E. The power of routine and special observations: producing civility in a public acute psychiatric unit. Nurs Inq 2008; 15: 178-188
49 Mackay I, Paterson B, Cassells C. Constant or special observations of inpatients presenting a risk of aggression or violence: nurses’ perceptions of the rules of engagement. J Psychiatr Ment Health Nurs 2005; 12: 464-471
50 Hamilton B, Manias E. Rethinking nurses’ observations: psychiatric nursing skills and invisibility in an acute inpatient setting. Soc Sci Med 2007; 65: 331-343
51 Ray R, Perkins E, Meijer B. The evolution of practice changes in the use of special observations. Arch Psychiatr Nurs 2011; 25: 90-100
52 Kiehne W. Suizidalität und Umgang mit suizidalen Patienten. Psych Pflege Heute 2005; 11: 17-22
53 Moore P, Berman K, Knight M et al. Constant observation: implications for nursing practice. J Psychosoc Nurs Ment Health Serv 1995; 33: 46-50
54 O’Brien L, Cole R. Mental health nursing practice in acute psychiatric close-observation areas. Int J Ment Health Nurs 2004; 13: 89-99
55 Cox RM, Hayter MR, Ruane J. Alternative approaches to “enhanced observations” in acute inpatient mental health care: a review of literature. J Psychiatr Ment Health Nurs 2010; 17: 162-171
56 Holyoake DD. I spy with my little eye something beginning with O: looking at what the myth of ‘doing the observations’ means in mental health nursing culture. J Psychiatr Ment Health Nurs e-first: DOI: 10.1111/jpm.12056
57 Foucault M. Überwachen und Strafen: die Geburt des Gefängnisses. 14.. Aufl. Frankfurt am Main: Suhrkamp; 1994
58 Becker T, Hoffman H, Puschner B et al. Versorgungsmodell in Psychiatrie und Psychoatherapie. Stuttgart: W. Kohlhammer GmbH; 2008
59 Amering M, Schmolke M. Hoffnung – Macht – Sinn Recovery Konzepte in der Psychiatrie. Manag Care 2006; 1: 20-22
60 Cutcliffe JR, Barker P. Considering the care of the suicidal client and the case for ‘engagement and inspiring hope’ or “observations”. J Psychiatr Ment Health Nurs 2002; 9: 611-621
61 Manna M. Effectiveness of formal observation in inpatient psychiatry in preventing adverse outcomes: the state of the science. J Psychiatr Ment Health Nurs 2010; 17: 268-273
62 Cutcliffe JR. How do nurses inspire and instil hope in terminally ill HIV patients?. J Adv Nurs 1995; 22: 888-895
63 Voigt-Radloff S, Stemmer R, Behrens J et al. Forschung zu komplexen Interventionen in der Pflege- und Hebammenwissenschaft und in den Wissenschaften der Physiotherapie, Ergotherapie und Logopädie. 2013. Im Internet: http://www.cochrane.de/sites/cochrane.de/files/uploads/GFB_Leitfaden.pdf (Stand: 20.07.2014)

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