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Psychiatr Prax 2013; 40(01): 14-20
DOI: 10.1055/s-0032-1327294
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Die intensive Überwachung von Patienten in der stationären psychiatrischen Akutversorgung

Eine systematische LiteraturübersichtSpecial Observation in Inpatient Treatment of People with Mental IllnessA Systematic Review of the Literature
André Nienaber
1   LWL-Klinik Lengerich
,
Michael Schulz
2   Fachhochschule der Diakonie Bielefeld
,
Bruno Hemkendreis
3   LWL-Klinikum Gütersloh
,
Michael Löhr
3   LWL-Klinikum Gütersloh
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
14. Januar 2013 (online)

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Zusammenfassung

Anliegen: Darstellung des Forschungsstandes zur Überwachung und Entwicklung von Implikationen für den deutschsprachigen Raum.

Methode: Systematische Literaturrecherche in elektronischen Datenbanken und zusätzliche Handsuche.

Ergebnisse: Einheitliche Konzepte zur Überwachung existieren nicht. Der Einsatz von Hilfskräften kann die Qualität beeinflussen und zur Häufung führen. Überwachung ist eine komplexe Tätigkeit und beinhaltet therapeutische und nicht therapeutische Anteile.

Schlussfolgerungen: Der Aufbau einer therapeutischen Beziehung und Förderung von Hoffnung sollten im Vordergrund von Überwachung stehen. Das Feld scheint wenig beforscht.

Abstract

Objective: To report the state of research about special observation and to develop implications for the German-speaking countries.

Methods: Systematic literature search.

Results: The literature consists mainly of descriptive studies. There are no standardized approaches. Use of assistants can have a negative impact on quality of the intervention and may result in an accumulation and change of measures. Nurses play a responsible role in special observation. There are different experiences and perceptions of patients and nurses. Special observation includes both therapeutic and non-therapeutic components.

Conclusions: The focus should be on therapeutic aspects of observation; particularly involvement and development of hope. Observation might restrict personal freedom and should be used as rarely as possible. Strengthening nurses in decision-making is associated with increased quality. More research is needed regarding the effectiveness, the frequency of utilization and opportunities for prevention. The importance of observation is in contrast to the lack of relevant data.

Schlüsselwörter

Überwachung - Literaturübersicht - Psychiatrie - stationär

Keywords

special observation - literature review - psychiatry - inpatient

Ergänzendes Material

 

  • Literatur

  • 1 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
    PubMedSuche in Google Scholar
  • 2 Harding AD. Observation assistants: sitter effectiveness and industry measures. Nurs Econ 2010; 28: 330-336
    PubMedSuche in Google Scholar
  • 3 Schmidt H. Anreize für Eigenverantwortung: Begriffsbestimmung und Evidenzlage. Z Evid Fortbild Qual Gesundhwes 2012; 106: 185-194
    CrossrefPubMedSuche in Google Scholar
  • 4 Vrijlandt AJ. Zwangsmaßnahmen im europäischen Vergleich. In: Kebbel J, Pörksen N, Hrsg. Gewalt und Zwang in der stationären Psychiatrie. Köln: Rheinland Verlag; 1997: 49-57
    Suche in Google Scholar
  • 5 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
    CrossrefPubMedSuche in Google Scholar
  • 6 Emerson RE, Pollner M. Dirty Work Designations: their features and Consequences in a Psychiatric Setting. Social Problems 1976; 23: 243-254
    CrossrefPubMedSuche in Google Scholar
  • 7 Steinert T. Ethische Einstellungen zu Zwangsunterbringung und -behandlung schizophrener Patienten. Psychiat Prax 2007; 34 (Suppl. 02) 186-190
    Thieme ConnectPubMedSuche in Google Scholar
  • 8 Gesetz über Hilfen und Schutzmaßnahmen bei psychischen Krankheiten (PsychKG). vom 17. Dez. 1999. In: GV. NRW. S.662, zuletzt geändert durch Gesetz vom 22. Nov. 2011. In: GV. NRW. S.587
    PubMed
  • 9 Kunz R, Khan KS, Kleijnen J et al. Systematische Übersichtsarbeiten und Meta-Analysen: Einführung in Instrumente der evidenzbasierten Medizin für Ärzte, klinische Forscher und Experten im Gesundheitswesen. 2.. vollst. überarb. Aufl. Bern: Huber; 2009
    Suche in Google Scholar
  • 10 National Institute for Health and Clinical Excellence (NICE). Violence – The short-term management of disturbed/violent behaviour in inpatient psychiatric settings and emergency departments. 2006 http://www.nice.org.uk/nicemedia/pdf/cg025fullguideline.pdf [Stand:15.06.2012]
    PubMedSuche in Google Scholar
  • 11 Behrens J, Langer G. Evidence-based nursing and caring: Methoden und Ethik der Pflegepraxis und Versorgungsforschung. 3.. überarb. Aufl. Bern: Huber; 2010
    Suche in Google Scholar
  • 12 Muralidharan S, Fenton M. Containment strategies for people with serious mental illness. Cochrane Database Syst Rev 2006; CD002084
    PubMedSuche in Google Scholar
  • 13 Shugar G, Rehaluk R. Continuous observation for psychiatric inpatients: a critical evaluation. Compr Psychiatry 1990; 31: 48-55
    CrossrefPubMedSuche in Google Scholar
  • 14 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN). Therapeutische Maßnahmen bei aggressivem Verhalten in der Psychiatrie und Psychotherapie. 2010 http://www.awmf.org/uploads/tx_szleitlinien/038-022_S2_Therapeutische_Massnahmen_bei_aggressivem_Verhalten_in_der_Psychiatrie_und_Psychotherapie_lang_08-2009_08-2014.pdf [Stand:15.06.2012]
    PubMedSuche in Google Scholar
  • 15 Gerber A, Plamper E, Lüngen M et al. Methodische Grundlagen von Gesundheitssystemvergleichen. In: Lauterbach K, Stock S, Brunner H, Hrsg. Gesundheitsökonomie. Bern: Verlag Hans Huber; 2006: 197-205
    Suche in Google Scholar
  • 16 Stewart D, Bowers L. Under the gaze of staff: special observation as surveillance. Perspect Psychiatr Care 2012; 48: 2-9
    CrossrefPubMedSuche in Google Scholar
  • 17 Bowers L, Crowder M. Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards-a cross sectional time series poisson regression study. Int J Nurs Stud 2012; 49: 15-20
    CrossrefPubMedSuche in Google Scholar
  • 18 Musisi SM, Wasylenki DA, Rapp MS. A psychiatric intensive care unit in a psychiatric hospital. Can J Psychiatry 1989; 34: 200-204
    PubMedSuche in Google Scholar
  • 19 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
    CrossrefPubMedSuche in Google Scholar
  • 20 Dodds P, Bowles N. Dismantling formal observation and refocusing nursing activity in acute inpatient psychiatry: a case study. J Psychiatr Ment Health Nurs 2001; 8: 183-188
    CrossrefPubMedSuche in Google Scholar
  • 21 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
    CrossrefPubMedSuche in Google Scholar
  • 22 Fletcher RF. The process of constant observation: perspectives of staff and suicidal patients. J Psychiatr Ment Health Nurs 1999; 6: 9-14
    CrossrefPubMedSuche in Google Scholar
  • 23 Becker T. Gemeindepsychiatrie: Entwicklungsstand in England und Implikationen für Deutschland. Stuttgart: Thieme; 1998
    Suche in Google Scholar
  • 24 Jones J, Ward M, Wellman N et al. Psychiatric inpatients' experience of nursing observation. A United Kingdom perspective. J Psychosoc Nurs Ment Health Serv 2000; 38: 10-20
    PubMedSuche in Google Scholar
  • 25 Bowers L, Gournay K, Duffy D. Suicide and self-harm in inpatient psychiatric units: a national survey of observation policies. J Adv Nurs 2000; 32: 437-444
    CrossrefPubMedSuche in Google Scholar
  • 26 Bowles N, Dodds P, Hackney D et al. Formal observations and engagement: a discussion paper. J Psychiatr Ment Health Nurs 2002; 9: 255-260
    CrossrefPubMedSuche in Google Scholar
  • 27 Green JS, Grindel CG. Supervision of suicidal patients in adult inpatient psychiatric units in general hospitals. Psychiatr Serv 1996; 47: 859-863
    PubMedSuche in Google Scholar
  • 28 Horsfall J, Cleary M. Discourse analysis of an 'observation levels' nursing policy. J Adv Nurs 2000; 32: 1291-1297
    CrossrefPubMedSuche in Google Scholar
  • 29 Phillips M, Peacocke J, Hermanstyne L et al. Continuous observation-Part 1. Who needs it?. Can Psychiatr Assoc J 1977; 22: 25-28
    PubMedSuche in Google Scholar
  • 30 Tardiff K. Emergency control measures for psychiatric inpatients. J Nerv Ment Dis 1981; 169: 614-618
    CrossrefPubMedSuche in Google Scholar
  • 31 Langenbach M, Junaid O, Hodgson-Nwaefulu CM et al. Observation levels in acute psychiatric admissions. Eur Arch Psychiatry Clin Neurosci 1999; 249: 28-33
    CrossrefPubMedSuche in Google Scholar
  • 32 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
    CrossrefPubMedSuche in Google Scholar
  • 33 Duffy D. Out of the shadows: a study of the special observation of suicidal psychiatric in-patients. J Adv Nurs 1995; 21: 944-950
    CrossrefPubMedSuche in Google Scholar
  • 34 Aidroos N. Nurses' response to doctors' orders for close observation. Can J Psychiatry 1986; 31: 831-833
    PubMedSuche in Google Scholar
  • 35 Neilson P, Brennan W. The use of special observations: an audit within a psychiatric unit. J Psychiatr Ment Health Nurs 2001; 8: 147-155
    CrossrefPubMedSuche in Google Scholar
  • 36 Cleary M, Jordan R, Horsfall J et al. Suicidal patients and special observation. J Psychiatr Ment Health Nurs 1999; 6: 461-467
    CrossrefPubMedSuche in Google Scholar
  • 37 Reid W, Long A. The role of the nurse providing therapeutic care for the suicidal patient. J Adv Nurs 1993; 18: 1369-1376
    CrossrefPubMedSuche in Google Scholar
  • 38 Hodgson CM, Kennedy J, Ruiz P et al. Who is watching them? A study of the interpretation of the observation policy in a mental health unit. Psychiatr Bull 1993; 17: 478-479
    CrossrefPubMedSuche in Google Scholar
  • 39 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
    CrossrefPubMedSuche in Google Scholar
  • 40 Salzmann-Erikson M, Eriksson H. Latent or manifest observers: two dichotomous approaches of surveillance in mental health nursing. Nurs Res Pract 2011; 2011 254041; Epub 2011 Jun 13
    PubMedSuche in Google Scholar
  • 41 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
    CrossrefPubMedSuche in Google Scholar
  • 42 Bjorkdahl A, Nyberg U, Runeson B et al. The development of the Suicidal Patient Observation Chart (SPOC): Delphi study. J Psychiatr Ment Health Nurs 2011; 18: 558-561
    CrossrefPubMedSuche in Google Scholar
  • 43 Kettles AM, Paterson K. Flexible observation: guidelines versus reality. J Psychiatr Ment Health Nurs 2007; 14: 373-381
    CrossrefPubMedSuche in Google Scholar
  • 44 Cardell R, Pitula CR. Suicidal inpatients’ perceptions of therapeutic and nontherapeutic aspects of constant observation. Psychiatr Serv 1999; 50: 1066-1070
    CrossrefPubMedSuche in Google Scholar
  • 45 Pitula CR, Cardell R. Suicidal inpatients’ experience of constant observation. Psychiatr Serv 1996; 47: 649-651
    CrossrefPubMedSuche in Google Scholar
  • 46 Moore P, Berman K, Knight M et al. Constant observation: implications for nursing practice. J Psychosoc Nurs Ment Health Serv 1995; 33: 46-50
    PubMedSuche in Google Scholar
  • 47 Ashaye A, Ikkos G, Rigby E. Study of effects of constant observation of psychiatric in-patients. Psychiatr Bull 1997; 21: 145-147
    CrossrefPubMedSuche in Google Scholar
  • 48 Goldberg RJ. Use of constant observation with potentially suicidal patients in general hospitals. Hosp Community Psychiatry 1987; 38: 303-305
    PubMedSuche in Google Scholar
  • 49 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
    CrossrefPubMedSuche in Google Scholar
  • 50 Buchanan-Barker P, Barker P. Observation: the original sin of mental health nursing?. J Psychiatr Ment Health Nurs 2005; 12: 541-549
    CrossrefPubMedSuche in Google Scholar
  • 51 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
    CrossrefPubMedSuche in Google Scholar
  • 52 Meerpohl JJ, Langer G, Perleth M et al. GRADE-Leitlinien: 4. Bewertung der Qualität der Evidenz – Studienlimitationen (Risiko für Bias). Z Evid Fortbild Qual Gesundhwes 2012; 106: 457-469
    CrossrefPubMedSuche in Google Scholar