Zusammenfassung
Hintergrund Über die Effektivität von mitarbeiterbezogenen Trainingsprogrammen zum Aggressionsmanagement in der Psychiatrie ist bisher wenig bekannt. Methode Systematische Literaturübersicht. Ergebnisse Es ergab sich kein eindeutiger Trend für die Minderung von aggressiven Vorfällen durch die Trainingsprogramme, jedoch positive Effekte auf das Wissen sowie auf die Zuversicht, schwierige Situationen besser bewältigen zu können. Schlussfolgerungen Trotz der nicht eindeutigen Ergebnisse hinsichtlich der Gewaltvorfälle wird die Durchführung von umfassenden Trainingsprogrammen empfohlen.
Abstract
Background Aggression management trainings for staff have been implemented in many organizations of mental health care and disability care. The efficacy of such programmes has rarely been analysed. Methods A systematic review was conducted which contains all published evaluation studies on aggression management trainings. Inclusion criteria were before-and-after-comparisons or control group designs. Results 39 published studies were included. Study quality has to be regarded as low. Concerning the results of the studies, no clear trend emerged in direction of minimising violent incidents. However, studies revealed clear positive effects on knowledge about violence and on staff's confidence to cope with difficult situations. Conclusions Sensitisation effects in staff after getting trained probably lead to reporting bias. Although the results on the number of violent incidents remain unclear, it is recommended to conduct comprehensive aggression management trainings in mental health and disability care institutions.
Schlüsselwörter
Gewalt - Training - systematische Literaturübersicht
Key words
violence - trainings - systematic review
Literatur
1
Steinert T, Vogel W D, Beck M, Kehlmann S.
Aggressionen psychiatrischer Patienten in der Klinik.
Psychiat Prax.
1991;
25
221-226
2
Richter D, Berger K.
Patientenübergriffe auf Mitarbeiter - Eine prospektive Untersuchung der Häufigkeit, Situationen und Folgen.
Nervenarzt.
2001;
72
693-699
3 Steinert T. Indikation von Zwangsmaßnahmen in psychiatrischen Kliniken. In: Ketelsen R, Schulz M, Zechert C (Hrsg) Seelische Krise und Aggressivität. Bonn; Psychiatrie-Verlag 2004: 44-52
4 Fähndrich E, Ketelsen R. Die medikamentöse Behandlung des psychiatrischen Notfalls. In: Ketelsen R, Schulz M, Zechert C (Hrsg) Seelische Krise und Aggressivität: Der Umgang mit Deeskalation und Zwang. Bonn; Psychiatrie-Verlag 2004: 80-88
5 Fuchs J M. Kontrollierter Umgang mit physischer Gewalt und Aggression in der Psychiatrie? Bericht über ein Praxisseminar. In: Sauter D, Richter D (Hrsg) Gewalt in der psychiatrischen Pflege. Bern; Huber 1998: 59-72
6 Mason T, Chandley M. Managing violence and aggression: A manual for nurses and health care workers. Edinburgh; Churchill Livingstone 1999
7 Richter D. Non-physical conflict management and de-escalation. In: Richter D, Whittington R (eds) Violence in Mental Health Settings: Causes, Consequences, Management. New York; Springer/Kluwer 2006: 125-144
8 Anke M, Bojack B, Krämer G, Seißelberg K. Deeskalationsstrategien in der psychiatrischen Arbeit. Bonn; Psychiatrie-Verlag 2003
9 Richter D, Fuchs J M, Bergers K-H. Konfliktmanagement in psychiatrischen Einrichtungen. Prävention in NRW. Münster/Düsseldorf; Gemeindeunfallversicherungsverband Westfalen-Lippe, Rheinischer Gemeindeunfallversicherungsverband, Landesunfallkasse Nordrhein-Westfalen 2001
10
Farrell G, Cubit K.
Nurses under threat: A comparison of content of 28 aggression management programs.
Int J Ment Health Nurs.
2005;
14
44-53
11
Grube M.
Aggressivität bei psychiatrischen Patienten: Einflussmöglichkeiten durch ein Selbstschutztraining.
Nervenarzt.
2001;
72
867-871
12
Weisman R L, Lamberti J S.
Violence prevention and safety training for case management services.
Community Ment Health J.
2002;
38
339-348
13
Jambunathan J, Bellaire K.
Evaluating staff use of Crisis Prevention Intervention techniques: A pilot study.
Issues Ment Health Nurs.
1996;
17
541-558
14
Lee S-S, Gerberich S G, Waller L A, Anderson A, McGovern P.
Work-related assault injuries among nurses.
Epidemiology.
1999;
10
685-691
15 Allen D. Training carers in physical intervention: Research towards evidence-based practice. Kidderminster; British Institute for Learning Disabilities 2001
16
Ogilvie D, Hamilton V, Egan M, Petticrew M.
Systematic reviews of health effects of social interventions: 1. Finding the evidence: how far should you go?.
J Epidemiol Community Health.
2005;
59
804-808
17 UKCC .The Recognition, Prevention and therapeutic management of violence in mental health care. o. O.: United Kingdom Central Council for Nursing, Midwifery and Health Visiting 2001
18 NICE. Clinical Practice Guidelines for Violence .The Short-Term Management of Disturbed/Violent Behaviour in Psychiatric In-patient and Emergency Departments Guideline. o. O.: National Institute for Clinical Excellence 2005
19 Robson L S, Shannon H S, Goldenhar L M, Hale A R. Guide to Evaluating the Effectiveness of Strategies for Preventing Work Injuries: How to Show Whether a Safety Intervention Really Works. Cincinnati; National Institute for Occupational Safety and Health 2001
20
Philips D, Rudestam K E.
Effect of nonviolent self-defense training on male psychiatric staff members' aggression and fear.
Psychiatr Serv.
1995;
46
164-168
21
Poster E C.
A multinational study of psychiatric nursing staff's beliefs and concerns about work safety and patient assaults.
Arch Psychiatr Nurs.
1996;
10
365-373
22
Fitzwater E L, Gates D M.
Testing an intervention to reduce assaults on nursing assistants in nursing homes: a pilot study.
Geriatr Nurs.
2002;
23
18-23
23
Feldt K S, Ryden M B.
Aggressive behavior: Educating nursing assistants.
J Gerontol Nurs.
1992;
18
3-12
24
Hagan B F, Sayers D.
When caring leaves bruises: The effects of staff education on resident aggression.
J Gerontol Nurs.
1995;
21
7-16
25
Perkins J, Leadbetter D.
An evaluation of aggression management training in a special educational setting.
Emot Behav Difficult.
2002;
7
19-34
26
Needham I, Abderhalden C, Halfens R J, Dassen T, Haug H J, Fischer J E.
The effect of a training course in aggression management on mental health nurses' perceptions of aggression: a cluster randomised controlled trial.
Int J Nurs Stud.
2005;
42
649-655
27
Whittington R, Wykes T.
An evaluation of staff training in psychological techniques for the management of patient aggression.
J Clin Nurs.
1996;
5
257-261
28
Nijman H LI, Merckelbach H LGJ, Allertz W FF, à Campo J MLG.
Prevention of aggressive incidents on a closed ward.
Psychiatr Serv.
1997;
48
694-698
29
Smooth S L, Gonzales J L.
Cost-effective communication skills training for state hospital employees.
Psychiatr Serv.
1995;
46
819-822
30
Infantino J A, Musingo S-Y.
Assaults and injuries among staff with and withoug training in aggression control techniques.
Hosp Community Psychiatry.
1985;
36
1312-1314
31
Ore T.
Workplace assault management training: An outcome evaluation.
J Healthc Prot Manage.
2002;
18
61-93
32
Rice M F, Helzel M F, Varney G W, Quinsey V I.
Crisis prevention and intervention training for psychiatric hospital staff.
Am J Community Psychol.
1985;
13
289-304
33
Carmel H, Hunter M.
Compliance with training in managing assaultive behavior and injuries from inpatient violence.
Hosp Community Psychiatry.
1990;
41
558-560
34
Rixtel A MJ van, Nijman H LI, Jansen A.
Aggressie en psychiatrie: Heeft training effect?.
Verpleegkunde.
1997;
12
111-119
35
McGowan S, Wynaden D, Harding N, Yassine A, Parker J.
Staff confidence in dealing with aggressive patients: A benchmark exercise.
Aust N Z J Ment Health Nurs.
1999;
8
104-108
36
Hurlebaus A E, Link S.
The effects of an aggressive behavior management program on nurses' levels of knowledge, confidence and safety.
J Nurs Staff Develop.
1997;
13
260-265
37
Allen D, Tynan H.
Responding to aggressive behavior: Impact of training on staff members' knowledge and confidence.
Ment Retard.
2000;
38
97-104
38
Thackrey M.
Clinician confidence in coping with patient aggression: Assessment and enhancement.
Prof Psychol Res Pr.
1987;
18
57-60
39
St. Thomas Psychiatric Hospital .
A program for the prevention and management of disturbed behavior.
Hosp Community Psychiatry.
1976;
27
724-727
40
Mortimer A.
Reducing violence on a secure ward.
Psychiatr Bull.
1995;
19
605-608
41
Colenda C C, Hamer R M.
Antecedents and interventions for aggressive behavior of patients at a geropsychiatric state hospital.
Hosp Community Psychiatry.
1991;
42
287-292
42
Hoeffer B, Rader J, McKenzie D, Lavelle M, Stewart B.
Reducing aggressive behavior during bathing cognitively impaired nursing home residents.
J Gerontol Nurs.
1997;
25
16-23
43
Maxfield M C, Lewis R E, Cannon S.
Training staff to prevent aggressive behavior of cognitively impaired elderly patients during bathing and grooming.
J Gerontol Nurs.
1996;
22
37-43
44
Shah A, De T.
The effect of an educational intervention package about aggressive behaviour directed at the nursing staff on a continuing care psychogeriatric ward.
Int J Geriatr Psychiatry.
1998;
13
35-40
45
Parkes J.
Control and restraint training: A study of its effectiveness in a medium secure psychiatric unit.
J Forensic Psychiatry.
1996;
7
525-534
46
Forster P L, Cavness C, Phelps M A.
Staff training decreases use of seclusion and restraint in an acute psychiatric setting.
Arch Psychiatr Nurs.
1999;
13
269-271
47
Wilkinson C L.
An evaluation of an educational program on the management of assaultive behaviours.
J Gerontol Nurs.
1999;
25
6-11
48
Gertz B.
Training for prevention of assaultive behavior in a psychiatric setting.
Hosp Community Psychiatry.
1980;
31
628-630
49
Allen D, McDonald L, Dunn C, Doyle T.
Changing care staff approaches to the prevention and management of aggressive behaviour in a residential treatment unit for persons with mental retardation and challenging behaviour.
Res Dev Disabil.
1997;
18
101-112
50
Calabro K, Mackey T A, Williams S.
Evaluation of training designed to prevent and manage patient violence.
Issues Ment Health Nurs.
2002;
23
3-15
51
Martin K H.
Improving staff safety through and aggression management program.
Arch Psychiatr Nurs.
1995;
11
211-215
52
Lehmann L S, Padilla M, Clark S, Loucks S.
Training personnel on the prevention and management of violent behavior.
Hosp Community Psychiatry.
1983;
34
40-43
53
Sjöström N, Eder D N, Malm U, Beskow J.
Violence and its prediction at a psychiatric hospital.
Eur Psychiatry.
2001;
16
459-465
54
Baker P A, Bissmire D.
A pilot study of the use of physical intervention in the crisis management of people with intellectual disabilities who present challenging behaviour.
J Appl Res Intellect Disabil.
2000;
13
38-45
55
Needham I, Abderhalden C, Meer R, Dassen T, Haug H J, Halfens R JG, Fischer J E.
The effectiveness of two interventions in the management of patient violence in acute mental inpatient settings.
J Psychiatr Ment Health Nurs.
2004;
11
595-601
56
Paterson B, Turnbull J, Aitken I.
An evaluation of a training course in the short-term management of violence.
Nurse Educ Today.
1992;
12
368-375
57
McDonnell A.
Training care staff to manage challenging behaviour: An evaluation of a three day training course.
Br J Dev Disabil.
1997;
43
156-162
58
Ilkiw-Lavalle O, Grenyer B FS, Graham L.
Does prior training and staff occupation influence knowledge acquisition from an aggression management training program?.
Int J Ment Health Nurs.
2002;
11
233-239
59
Ogilvie D, Egan M, Hamilton V, Petticrew M.
Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go?.
J Epidemiol Community Health.
2005;
59
886-892
60
Arnetz J E, Arnetz B B.
Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers.
J Adv Nurs.
2000;
31
668-680
61
Petticrew M.
Why certain systematic reviews reach uncertain conclusions.
BMJ.
2003;
326
756-758
62
Grades of Recommendation Assessment Development and Evaluation (GRADE) Working Group .
Grading quality of evidence and strength of recommendations.
BMJ.
2004;
328
1490-1494
63
Alderson P.
Absence of evidence is not evidence of absence.
BMJ.
2004;
328
476-477
64
Alderson P, Roberts I.
Should journals publish systematic reviews that find no evidence to guide practice? Examples from injury research.
BMJ.
2000;
320
376-377
1 Der ausführliche Bericht mit zusätzlicher, nicht veröffentlichter Literatur und weiteren methodischen Details ist erhältlich unter http://miami.uni-muenster.de/servlets/DerivateServlet/Derivate-2473/richter.pdf oder vom Erstautor.
PD Dr. Dirk Richter
Westfälische Klinik Münster
Postfach 202 252
48103 Münster
Phone: 0251/591-5175
Fax: 0251/591-5194
Email: dirk.richter@uni-muenster.de