Suchergebnisse

BACKGROUND: De-escalation is the recommended first-line response to potential violence and aggression in healthcare settings. Related scholarly activity has increased exponentially since the 1980s, but there is scant research about its efficacy and no guidance on what constitutes the gold standard for practice. OBJECTIVES: To clarify the concept of de-escalation of violence and aggression as described within the healthcare literature. DESIGN: Concept analysis guided by Rodgers' evolutionary approach. DATA SOURCES: Multiple nursing and healthcare databases were searched using relevant terms. REVIEW METHODS: High quality and/or highly cited, or otherwise relevant published empirical or theoretical English language literature was included. Information about surrogate terms, antecedents, attributes, consequences, and the temporal, environmental, disciplinary, and theoretical contexts of use were extracted and synthesised. Information about the specific attributes of de-escalation were subject to thematic analysis. Proposed theories or models of de-escalation were assessed against quality criteria. RESULTS: N =79 studies were included. Mental health settings were the most commonly reported environment in which de-escalation occurs, and nursing the disciplinary group most commonly discussed. Five theories of de-escalation were proposed; while each was adequate in some respects, all lacked empirical support. Based on our analysis the resulting theoretical definition of de-escalation in healthcare is "a collective term for a range of interwoven staff-delivered components comprising communication, self-regulation, assessment, actions, and safety maintenance which aims to extinguish or reduce patient aggression/agitation irrespective of its cause, and improve staff-patient relationships while eliminating or minimising coercion or restriction". CONCLUSIONS: While a number of theoretical models have been proposed, the lack of advances made in developing a robust evidence-base for the efficacy of de-escalation is striking and must, at least in part, be credited to the lack of a clear conceptualisation of the term. This concept analysis provides a framework for researchers to identify the theoretical model that they purport to use, the antecedents that their de-escalation intervention is targeting, its key attributes, and the key negative and positive consequences that are to be avoided or encouraged.

4.1 Introduction Conducted electrical weapons, or "Tasers," are currently used by over 15,000 law enforcement and military agencies worldwide. There are concerns regarding the effectiveness, potential for harm and overuse with people experiencing mental distress. 4.2 Aim To explore the literature about police use of Tasers with people experiencing mental distress. 4.3 Method An integrative review was undertaken, and qualitative and quantitative analytical approaches were used. 4.4 Results Thirty‐one studies were included. Of all recorded usage, overall prevalence of Taser use on people experiencing mental distress was 28%. This population may require a greater number of shocks to subdue them than other people. 4.5 Discussion There are substantial gaps in the research literature particularly with respect to the decision‐making processes involved in deploying Tasers on this population and the physical and psychological consequences of Taser use in this context. 4.6 Implications for practice Police use of Tasers in mental health crises is relatively common and occurs in a variety of environments including mental health settings. Mental health professionals need to work with police towards greater understanding of the needs of people with mental illness and to promote the use of non‐coercive interventions in mental health crisis events.

Health and social care professionals are well placed to identify and respond to those affected by gender-based violence; yet students across a range of health disciplines describe a lack of knowledge, preparation and confidence in dealing with the issue. Our study aimed to explore health and social care students' perceptions of their own knowledge and confidence on the subject of gender-based violence, recollections of gender-based violence learning opportunities through university and clinical placements, and opinions about the content of future e-learning curricula on the subject. We designed and implemented a multinational, cross-sectional survey across six universities from five countries: Australia, Canada, England, New Zealand and Scotland. Responses were obtained from 377 students across seven health and social care disciplines. Principally, the study found that students were underprepared in their professional programmes in terms of dealing with gender-based violence. Many students had witnessed or heard about cases of gender-based violence on clinical placement, but reported feeling generally unconfident in dealing with the issue. Regarding future e-learning, students indicated that content should be inclusive and relate directly to clinical practice. We argue that there is a universal need for health care education programmes to include the issue of gender-based violence in curricula.