Model dejavnikov, ki pojasnjujejo odnos zaposlenih v psihiatrični zdravstveni negi do uporabe posebnih varovalnih ukrepov

Bregar, Branko (author), Kores Plesničar, Blanka (mentor), Skela Savič, Brigita (comentor)

Izhodišča Raziskave kažejo, da sta v zdravstveni negi na področju psihiatrije odnos zaposlenih do posebnih varovalnih ukrepov (PVU) in pojavnost PVU medsebojno povezana. Zato je pomembno, da je odnos zaposlenih v psihiatriji do PVU v vsakem kliničnem okolju dobro raziskan. Namen Namen doktorskega dela je bil raziskati in pojasniti tako odnos zaposlenih do PVU kot tudi dejavnike, povezane s sprejemanjem/zavračanjem PVU, ter na podlagi tega izdelati priporočila za ukrepe v klinični praksi. Metode Uporabljen je bil mešan raziskovalni pristop. V presečni raziskavi je bil leta 2013 razdeljen vprašalnik celotni populaciji zaposlenih v zdravstveni negi (N = 599) v slovenskih psihiatričnih bolnišnicah. Odzvalo se je 367 (61,27 %) zaposlenih v zdravstveni negi. Za oceno odnosa zaposlenih do PVU je bil uporabljen Heymanov vprašalnik o odnosu zaposlenih do PVU (Survey of Nurses' Attitudes to Seclusion Survey – SNASS) v razmerju do nekaterih sociodemografskih dejavnikov, zadovoljstva z delom in strategij spoprijemanja s stresom. Za dodatno razumevanje pojava posebnega varovalnega ukrepa so bili v letu 2016 izvedeni polstrukturirani intervjuji na namenskem vzorcu 16 zaposlenih v zdravstveni negi. Za analizo kvantitativnih podatkov je bila uporabljena opisna statistika in bivariantna statistika, faktorska analiza (metoda glavnih komponent) ter regresija (metoda ENTER). Analiza intervjujev je bila narejena na osnovi analize besedila, odprtega kodiranja in združevanja vsebinsko podobnih kod v kategorije. Rezultati Pri ocenjevanju odnosa zaposlenih v psihiatrični zdravstveni negi do PVU se je izkazalo, da je prevladoval negativen odnos (M = 11,312 &#61617; 2,641) in ne pozitiven (M = 6,247 &#61617; 1,547). Dejavniki, ki so se v multivariatnem modelu izkazali povezani s pozitivnim odnosom, so bili: ženski spol (&#946; = –0,236; p < 0,001), manj let delovnih izkušenj (&#946; = –0,149; p = 0,023), strategije spoprijemanja s stresom, usmerjene v emocije (&#946; = 0,139; p = 0,020) in manj ogrožajoče vedenje (&#946; = 0,157; p = 0,012). Analiza kvalitativnega empiričnega gradiva je pokazala na pet kategorij. Odnos kot osrednjo kategorijo se deli na posamezne dimenzije odnosa, ki so opredeljene s podkategorijami: pozitiven, negativen in pragmatičen odnos. Analizirane dimenzije odnosa se lahko pojasni s štirimi kategorijami: dejavniki, odnos udeležencev do uporabe sile, oblike uporabe sile ter kategorijo, ki pojasnjuje stresnost posebnega varovalnega ukrepa za udeležence. Diskusija in zaključek Pomen nekaterih že znanih dejavnikov zaposlenih v zdravstveni negi v psihiatriji za odnos zaposlenih do PVU, kot so izobrazba, delo na zaprtem/odprtem oddelku, oblike ogrožajočega vedenja, zadovoljstvo z delom, se v izvedeni raziskavi niso izkazali kot pomembni. Prepoznani so bili novi dejavniki, kot so manj ogrožajoče vedenje in emocionalno usmerjene strategije spoprijemanja s stresom zaposlenih v zdravstveni negi, kar skupaj z ugotovitvami iz intervjujev kaže na to, da so zaposleni v zdravstveni negi v samem procesu odločanja za PVU postavljeni v položaj, kjer njihove odločitve niso strokovno podprte niti nimajo pomena na spremembo obstoječe klinične prakse. Zato se predpostavlja, da gre pri odnosu do PVU za izrazito nestabilen pojav, ki je potreben nadaljnjega raziskovanja. Pomembno je, da se na sam pojav vsakokratnega posebnega varovalnega ukrepa ne gleda kot na dokončno dejstvo, ki ga pogojujejo protokoli in smernice, ampak kot na proces vsakokratnega odločanja, za katerega morajo biti zaposleni v zdravstveni negi v psihiatriji izobraženi in pripravljeni.

• Language: Slovenian
• Keywords: medicinske sestre, nasilje, agresija, psihiatrija, stres, etika, morala.
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2019
• PID: 20.500.12556/RUL-108559
• COBISS.SI-ID: 300860928
• Publication date in RUL: 07.07.2019

Secondary language

• Language: English
• Title: A Model of Factors Affecting the Attitudes of the Mental Healthcare Personnel towards the Application of the Preventive and Security Measures in Patients Treatments

Abstract

Background Several studies show that there is a relationship between the attitude expressed by members of nursing staff and the application of special coercive measures (SCM). Therefore, the attitudes that nursing staff shows towards SCM must be well researched in all clinical environments. Aim The purpose of this doctoral thesis is to research and understand the attitude of nursing staff and factors that relate to SCM. Recommendations for clinical practise will be proposed in the thesis’s continuation. Methods A mixed research design was adopted. The cross-sectional study combined the whole population Slovenia’s psychiatric nursing staff (n = 367; 61.27%). The Survey of Nurses’ Attitudes to Seclusion (SNASS) was questioned in order to determine their attitude toward some sociodemographic factors, job satisfaction, and coping strategies. Sixty semi-structured interviews were conducted to additionally understand the phenomenon of SCM. Basic descriptive statistics, as well as bivariate statistic methods, factor analysis, and multivariate modelling using linear regression were used in quantitative analysis. The the semi-structured interviews were carried out with an open coded system and grouping of similar relevant codes into categories. Results The attitude of nursing staff is mainly negative (&#175;x = 11.312 &#61617; 2.641). Factors associated with a positive attitude are: female gender (&#946; = -0.236; p < 0.001), fewer years of working experience (&#946; = -0.149; p = 0.023), emotional coping strategies (&#946; = 0.139; p = 0.020), and less threatening behaviour (&#946; = 0.157; p = 0.012). Patients are exposed to some unprofessional and unethical overused force by the employees. In general the semi-structured interviews revealed that nursing staff has positive attitudes towards the SCM and the use of illegal force. Nursing staff faces many stressful situations, with no support in their working environment. Discussion and conclusion Some of the known factors affecting nursing in terms of SCM did not prove to be important. Research shows that SCM are an unstable phenomenon. On the other hand, they revealed some previously unknown factors as relevant, such as a patient’s slightly threatening behaviour and the emotional coping strategies that nursing staff employ. Based on the findings from interviews, I argued that nursing staff involved in decision-making processes leading to SCM are faced with unprofessional and unethical interventions, but have no influence on clinical practise. It is important that the application of SCM is viewed as the result of nursing staff’s decision-making process, which is contextually associated with their potential to actively participate.

• Keywords: nurses, violence, psychiatry, misuse of the power, ethics, morale.