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Psychiatr Prax 2015; 42(02): 68-75
DOI: 10.1055/s-0034-1387244
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

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
1   Fachbereich Gesundheit, Fachhochschule Bern, Schweiz
2   Direktion Pflege, Therapien und Soziale Arbeit, Forschung und Entwicklung, Psychiatrische Universitätsklinik Zürich, Schweiz
,
Franziska Rabenschlag
3   Abteilung Entwicklung & Forschung Pflege, Universitäre Psychiatrische Kliniken Basel, Schweiz
,
Eva-Maria Panfil
1   Fachbereich Gesundheit, Fachhochschule Bern, Schweiz
› Author Affiliations
Further Information

Publication History

Publication Date:
27 October 2014 (online)

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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

Ergänzendes Material

 

  • Literatur

  • 1 Sturny I, Hell D. Psychiatrie, Psychotherapie, Psychologie. In: Kocher G, Oggier W, Hrsg. Gesundheitswesen Schweiz 2007–2009. Bern: Hans Huber; 2007
    Search in Google Scholar
  • 2 Steinert T, Gebhardt RP. Erfolgen Zwangsmaßnahmen willkürlich?. Psychiat Prax 2000; 27: 282-285
    PubMedSearch in Google Scholar
  • 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)
    Search in Google Scholar
  • 4 Needham I, Abderhalden C, Dassen T et al. Coercive procedures and facilities in Swiss psychiatry. Swiss Med Wkly 2002; 132: 253-258
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 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)
    Search in Google Scholar
  • 9 Nienaber A, Löhr M, Hemkendreis B et al. Intensivbetreuung Empfehlenswert?. Psych Pflege Heute 2013; 19: 90-92
    Thieme ConnectPubMedSearch in Google Scholar
  • 10 Janofsky JS. Reducing inpatient suicide risk: using human factors analysis to improve observation practices. J Am Acad Psychiatry Law 2009; 37: 15-24
    PubMedSearch in Google Scholar
  • 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)
    Search in Google Scholar
  • 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)
    Search in Google Scholar
  • 13 Cutcliffe JR, McKenna HP. The essential concepts of nursing. Philadelphia: Elsevier; 2005
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 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
    Search in Google Scholar
  • 17 Rodgers BL. Concepts, analysis and the development of nursing knowledge: the evolutionary cycle. J Adv Nurs 1989; 14: 330-335
    CrossrefPubMedSearch in Google Scholar
  • 18 Amering M, Schmolke M. Recovery – das Ende der Unheilbarkeit. 5.. Aufl. Bonn: Psychiatrie-Verlag; 2012
    Search in Google Scholar
  • 19 Steinke I. Gütekriterien qualitativer Forschung. In: Flick U, Kardoff E, Steinke I, Hrsg. Qualitative Forschung. Reinbek bei Hamburg: rororo; 2003: 319-331
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 23 Kettles AM, Paterson K. Flexible observation: guidelines versus reality. J Psychiatr Ment Health Nurs 2007; 14: 373-381
    CrossrefPubMedSearch in Google Scholar
  • 24 Stewart D, Bowers L. Under the gaze of staff: special observation as surveillance. Perspect Psychiatr Care 2012; 48: 2-9
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 27 Dewing J. Special observation and older persons with dementia/delirium: a disappointing literature review. Int J Older People Nurs 2013; 8: 19-28
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 29 Cardell R, Pitula CR. Suicidal inpatients’ perceptions of therapeutic and nontherapeutic aspects of constant observation. Psychiatr Serv 1999; 50: 1066-1070
    CrossrefPubMedSearch in Google Scholar
  • 30 Cleary M, Jordan R, Horsfall J et al. Suicidal patients and special observation. J Psychiatr Ment Health Nurs 1999; 6: 461-467
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 34 Neu P, Erbe S. Akutpsychiatrie: das Notfall-Manual. Stuttgart: Schattauer; 2011
    Search in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 38 Page MJ. Methods of observation in mental health inpatient units. Nurs Times 2006; 102: 34-35
    PubMedSearch in Google Scholar
  • 39 Fletcher RF. The process of constant observation: perspectives of staff and suicidal patients. J Psychiatr Ment Health Nurs 1999; 6: 9-14
    CrossrefPubMedSearch in Google Scholar
  • 40 Buchanan-Barker P, Barker P. Observation: the original sin of mental health nursing?. J Psychiatr Ment Health Nurs 2005; 12: 541-549
    CrossrefPubMedSearch in Google Scholar
  • 41 Pitula CR, Cardell R. Suicidal inpatients’ experience of constant observation. Psychiatr Serv 1996; 47: 649-651
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 45 Barre T, Evans R. Nursing observations in the acute inpatient setting: A contribution to the debate. Ment Health Pract 2002; 5: 10-14
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 52 Kiehne W. Suizidalität und Umgang mit suizidalen Patienten. Psych Pflege Heute 2005; 11: 17-22
    Thieme ConnectPubMedSearch in Google Scholar
  • 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
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    PubMed
  • 57 Foucault M. Überwachen und Strafen: die Geburt des Gefängnisses. 14.. Aufl. Frankfurt am Main: Suhrkamp; 1994
    Search in Google Scholar
  • 58 Becker T, Hoffman H, Puschner B et al. Versorgungsmodell in Psychiatrie und Psychoatherapie. Stuttgart: W. Kohlhammer GmbH; 2008
    Search in Google Scholar
  • 59 Amering M, Schmolke M. Hoffnung – Macht – Sinn Recovery Konzepte in der Psychiatrie. Manag Care 2006; 1: 20-22
    PubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 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
    CrossrefPubMedSearch in Google Scholar
  • 62 Cutcliffe JR. How do nurses inspire and instil hope in terminally ill HIV patients?. J Adv Nurs 1995; 22: 888-895
    PubMedSearch in Google Scholar
  • 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)
    Search in Google Scholar