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首页> 美国卫生研究院文献>Wiley-Blackwell Online Open >Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice
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Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice

机译：精神科住院医疗的安全性：风险管理文化对心理健康护理实践的影响

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摘要

The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.
机译：安全的论述通过制度化和现代精神病护理实践，为精神疾病患者的护理提供了信息。安全起因于局限性：出于社会污名和对公共安全的恐惧，以及出于仁慈的家长式保护个人免受自我伤害的目的。在本文中，我们认为在当前的精神病患者住院环境中，安全性是主要价值所在，而风险管理是护理的基石。尽管有证据反驳了这种功效，并且患者的观点表明了危害，但通过安全性话语，使符合这一价值的做法合法化并永久存在。为了说明这种在精神卫生护理中日益增长的关注，我们提供了四个在精神科住院患者中使用的风险管理策略示例：仔细观察，隔离，门锁和防御性护理实践。这些策略的使用证明了改变护理安全性和风险性观点的必要性。我们建议，为了重新为患者提供有意义的支持和治疗，护士应提供结合安全措施的个性化，灵活的护理，同时从根本上重新评估引起有害行为并使其合法化的风险管理文化。

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