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Mitarbeiterschulungen und Deeskalation

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S3-Leitlinie Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen

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Zusammenfassung

Die Thematik des aggressiven Verhaltens psychiatrischer Patientinnen und Patienten spielte lange Zeit in der Fachweiterbildung für Ärztinnen und Ärzte sowie in der Ausbildung für Pflegende eine lediglich marginale Rolle. Es existierten keine standardisierten Ausbildungsmodule, die Mitarbeitende psychiatrischer Einrichtungen adäquat auf diese Problematik vorbereiteten. Allerdings haben sich im Weiterbildungsbereich Trainingsprogramme zur Schulung von Mitarbeitenden zur Prävention und Bewältigung aggressiven Patientenverhaltens seit Mitte der 1990er-Jahre etabliert. In den 2000er-Jahren wurden diese zudem den spezifischen Bedürfnissen von Pflegeschülerinnen und -schülern und Studierenden angepasst (Nau et al. 2009, 2010).

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Literatur

Kapitel 9

  • Antai-Otong D (2001) Critical incident stress debriefing: a health promotion model for workplace violence. Perspectives Psychiatr Care 37(4):125–132, 139

    Article  CAS  Google Scholar 

  • Ashcraft L, Anthony W (2008) Eliminating seclusion and restraint in recovery-oriented crisis services. Psychiatr Serv (Washington DC) 59(10):1198–1202. https://doi.org/10.1176/ps.2008.59.10.1198

    Article  PubMed  Google Scholar 

  • Beech B, Leather P (2003) Evaluating a management of aggression unit for student nurses. J Adv Nurs 44(6):603–612

    Article  PubMed  Google Scholar 

  • Bloor R, McHugh A, Pearson D, Wain I (2004) A training course for psychiatric nurses in Russia. Nurs Stand (through 2013) 18(39):39

    Article  PubMed  Google Scholar 

  • Bowers L, Nijman H, Allan T, Simpson A, Warren J, Turner L (2006) Prevention and management of aggression training and violent incidents on U.K. Acute psychiatric wards. Psychiatr Serv (Washington DC) 57(7):1022–1026. https://doi.org/10.1176/ps.2006.57.7.1022

    Article  PubMed  Google Scholar 

  • Breakwell GM (1998) Aggression bewältigen. Umgang mit Gewalttätigkeit in Klinik, Schule und Sozialarbeit. Huber, Bern

    Google Scholar 

  • Calabro K, Mackey TA, Williams S (2002) Evaluation of training designed to prevent and manage patient violence. Issues Ment Health Nurs 23(1):3–15

    Article  PubMed  Google Scholar 

  • Carmel H, Hunter M (1990) Compliance with training in managing assaultive behavior and injuries from inpatient violence. Hosp Community Psychiatry 41(5):558–560

    CAS  PubMed  Google Scholar 

  • Cavanaugh C, Campbell J, Messing JT (2014) A longitudinal study of the impact of cumulative violence victimization on comorbid posttraumatic stress and depression among female nurses and nursing personnel. Workplace Health Safety 62(6):224–232. https://doi.org/10.1177/216507991406200602

    Article  PubMed  Google Scholar 

  • Chapman R, Styles I, Perry L, Combs S (2010) Nurses’ experience of adjusting to workplace violence: a theory of adaptation. Int J Ment Health Nurs 19(3):186–194. https://doi.org/10.1111/j.1447-0349.2009.00663.x

    Article  PubMed  Google Scholar 

  • Colenda CC, Hamer RM (1991) Antecedents and interventions for aggressive behavior of patients at a geropsychiatric state hospital. Hosp Community Psychiatry 42(3):287–292

    CAS  PubMed  Google Scholar 

  • Cowin L, Davies R, Estall G, Berlin T, Fitzgerald M, Hoot S (2003) De-escalating aggression and violence in the mental health setting. Int J Ment Health Nurs 12(1):64–73

    Article  PubMed  Google Scholar 

  • Dickens G, Rogers G, Rooney C, Mc Guinness A, Doyle D (2009) An audit of the use of breakaway techniques in a large psychiatric hospital: a replication study. J Psychiatr Ment Health Nurs 16(9):777–783. https://doi.org/10.1111/j.1365-2850.2009.01449.x

    Article  CAS  PubMed  Google Scholar 

  • Ekman P (1993) Facial expression and emotion. Am Psychol 48(4):384–392

    Article  CAS  PubMed  Google Scholar 

  • Everly GS Jr, Boyle SH (1999) Critical incident stress debriefing (CISD): a meta-analysis. Int J Emerg Ment Health 1(3):165–168

    PubMed  Google Scholar 

  • Fisher WA (2003) Elements of successful restraint and seclusion reduction programs and their application in a large, urban, state psychiatric hospital. J Psychiatr Pract 9(1):7–15

    Article  PubMed  Google Scholar 

  • Forster PL, Cavness C, Phelps MA (1999) Staff training decreases use of seclusion and restraint in an acute psychiatric setting. Arch Psychiatr Nurs 13:269–271

    Google Scholar 

  • Fuchs JM (1998) 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. Huber, Göttingen, S 59–72

    Google Scholar 

  • Gertz B (1980) Training for prevention of assaultive behavior in a psychiatric setting. Hosp Community Psychiatry 31(9):628–630

    CAS  PubMed  Google Scholar 

  • Grenyer BFS, Ilkiw-Lavalle O, Biro P, Middleby-Clements J, Comninos A, Coleman M (2004) Safer at work: development and evaluation of an aggression and violence minimization program. Aust N Z J Psychiatr 38(10):804–810. https://doi.org/10.1080/j.1440-1614.2004.01465.x

    Article  Google Scholar 

  • Hahn S, Needham I, Abderhalden C, Duxbury JAD, Halfens RJG (2006) The effect of a training course on mental health nurses’ attitudes on the reasons of patient aggression and its management. J Psychiatr Ment Health Nurs 13(2):197–204. https://doi.org/10.1111/j.1365-2850.2006.00941.x

    Article  CAS  PubMed  Google Scholar 

  • Hoeffer B, Rader J, McKenzie D, Lavelle M, Stewart B (1997) Reducing aggressive behavior during bathing cognitively impaired nursing home residents. J Gerontol Nurs 23(5):16–23

    Article  CAS  PubMed  Google Scholar 

  • Hücker F (1997) Rhetorische Deeskalation, 1. Aufl. Boorberg, Stuttgart

    Google Scholar 

  • Huizing AR, Hamers JPH, Gulpers MJM, Berger MPF (2006) Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial. BMC Geriatr 6(1):17

    Article  PubMed  PubMed Central  Google Scholar 

  • Hurlebaus AE, Link S (1997) The effects of an aggressive behavior management program on nurses’ levels of knowledge, confidence, and safety. J Nurs Staff Dev JNSD 13(5):260–265

    CAS  PubMed  Google Scholar 

  • Ilkiw-Lavalle O, Grenyer BFS, Graham L (2002) Does prior training and staff occupation influence knowledge acquisition from an aggression management training program? Int J Ment Health Nurs 11(4):233–239

    Article  PubMed  Google Scholar 

  • Infantino JA Jr, Musingo SY (1985) Assaults and injuries among staff with and without training in aggression control techniques. Hosp Community Psychiatry 36(12):1312–1314

    PubMed  Google Scholar 

  • Jones DW (1997) Pennsylvania hospital continues to reduce seclusion and restraints. Jt Comm Perspect Jt Comm Accredit Healthc Organ 17(2):17

    Google Scholar 

  • Jonikas JA, Cook JA, Rosen C, Laris A, Kim J-B (2004) A program to reduce use of physical restraint in psychiatric inpatient facilities. Psychiatr Serv (Washington DC) 55(7):818–820. https://doi.org/10.1176/appi.ps.55.7.818

    Article  Google Scholar 

  • Kelly EL, Subica AM, Fulginiti A, Brekke JS, Novaco RW (2015) A cross-sectional survey of factors related to inpatient assault of staff in a forensic psychiatric hospital. J Adv Nurs 71(5):1110–1122. https://doi.org/10.1111/jan.12609

    Article  PubMed  Google Scholar 

  • Laker C, Gray R, Flach C (2010) Case study evaluating the impact of de-escalation and physical intervention training. J Psychiatr Ment Health Nurs 17(3):222–228. https://doi.org/10.1111/j.1365-2850.2009.01496.x

    Article  CAS  PubMed  Google Scholar 

  • Lehmann LS, Padilla M, Clark S, Loucks S (1983) Training personnel in the prevention and management of violent behavior. Hosp Community Psychiatry 34(1):40–43

    CAS  PubMed  Google Scholar 

  • Lepping P, Steinert T, Needham I, Abderhalden C, Flammer E, Schmid P (2009) Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence. J Psychiatr Ment Health Nurs 16(7):629–635. https://doi.org/10.1111/j.1365-2850.2009.01425.x

    Article  CAS  PubMed  Google Scholar 

  • Livingston JD, Verdun-Jones S, Brink J, Lussier P, Nicholls T (2010) A narrative review of the effectiveness of aggression management training programs for psychiatric hospital staff. J Forensic Nursing 6(1):15–28. https://doi.org/10.1111/j.1939-3938.2009.01061.x

    Article  Google Scholar 

  • lkiw-Lavalle O, Grenyer BFS, Graham L (2002) Does prior training and staff occupation influence knowledge acquisition from an aggression management training program? Int J Ment Health Nurs 11:233–239

    Article  Google Scholar 

  • Martin KH (1995) Improving staff safety through an aggression management program. Arch Psychiatr Nurs 9(4):211–215

    Article  CAS  PubMed  Google Scholar 

  • Mason T, Chandley M (1999) Managing violence and aggression. Manual Nurs Health Care Workers 11:233–239

    Google Scholar 

  • Mavandadi V, Bieling PJ, Madsen V (2016) Effective ingredients of verbal de-escalation: validating an English modified version of the ‚De-Escalating Aggressive Behaviour Scale‘. J Psychiatr Ment Health Nurs 23(6–7):357–368. https://doi.org/10.1111/jpm.12310

    Article  CAS  PubMed  Google Scholar 

  • Maxfield MC, Lewis RE, Cannon S (1996) Training staff to prevent aggressive behavior of cognitively impaired elderly patients during bathing and grooming. J Gerontol Nurs 22(1):37–43

    Article  CAS  PubMed  Google Scholar 

  • McCue RE, Urcuyo L, Lilu Y, Tobias T, Chambers MJ (2004) Reducing restraint use in a public psychiatric inpatient service. J Behav Health Serv Res 31(2):217–224

    Article  PubMed  Google Scholar 

  • McGowan S, Wynaden D, Harding N, Yassine A, Parker J (1999) Staff confidence in dealing with aggressive patients: a benchmarking exercise. Aust N Z J Ment Health Nurs 8(3):104–108

    Article  CAS  PubMed  Google Scholar 

  • Meehan T, Fjeldsoe K, Stedman T, Duraiappah V (2006) Reducing aggressive behaviour and staff injuries: a multi-strategy approach. Aust Health Rev Publ Aust Hospital Assoc 30(2):203–210

    Article  Google Scholar 

  • Mortimer A (1995) Reducing violence on a secure ward. Psychiatr Bull 19:605–608

    Article  Google Scholar 

  • National Institute for Health and Care Excellence (NICE) (Hrsg) (2015) Violence and aggression: short-term management in mental health, health and community settings: updated edition. British Psychological Society, London

    Google Scholar 

  • Nau J, Dassen T, Needham I, Halfens R (2009) The development and testing of a training course in aggression for nursing students: a pre- and post-test study. Nurse Educ Today 29(2):196–207. https://doi.org/10.1016/j.nedt.2008.08.011

    Article  PubMed  Google Scholar 

  • Nau J, Halfens R, Needham I, Dassen T (2010) Student nurses’ de-escalation of patient aggression: a pretest-posttest intervention study. Int J Nurs Stud 47(6):699–708. https://doi.org/10.1016/j.ijnurstu.2009.11.011

    Article  PubMed  Google Scholar 

  • Nay WR (2004) Taking charge of anger how to resolve conflict, sustain relationships, and express yourself withoug losing control. Guilford Press, New York

    Google Scholar 

  • Needham I, Abderhalden C, Meer R, Dassen T, Haug HJ, Halfens RJG, Fischer JE (2004) The effectiveness of two interventions in the management of patient violence in acute mental inpatient settings: report on a pilot study. J Psychiatr Ment Health Nurs 11(5):595–601. https://doi.org/10.1111/j.1365-2850.2004.00767.x

    Article  CAS  PubMed  Google Scholar 

  • Needham I, Abderhalden C, Halfens RJG, Dassen T, Haug HJ, Fischer JE (2005a) 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 42(6):649–655. https://doi.org/10.1016/j.ijnurstu.2004.10.003

    Article  CAS  PubMed  Google Scholar 

  • Needham I, Abderhalden C, Halfens RJG, Fischer JE, Dassen T (2005b) Non-somatic effects of patient aggression on nurses: a systematic review. J Adv Nurs 49(3):283–296. https://doi.org/10.1111/j.1365-2648.2004.03286.x

    Article  PubMed  Google Scholar 

  • Nienhaus A, Drechsel-Schlund C, Schambortski H, Schablon A (2016) Violence and discrimination in the workplace. The effects on health and setting-related approaches to prevention and rehabilitation. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 59(1):88–97. https://doi.org/10.1007/s00103-015-2263-x

    Article  Google Scholar 

  • Nijman HL, Merckelbach HL, Allertz WF, a Campo JM (1997) Prevention of aggressive incidents on a closed psychiatric ward. Psychiatr Serv (Washington DC) 48(5):694–698. https://doi.org/10.1176/ps.48.5.694

    Article  CAS  Google Scholar 

  • Parkes J (1996) Control and restraint training: a study of its effectiveness in a medium secure psychiatric unit. Am J Forensic Psychiatr 7:525–534

    Article  Google Scholar 

  • Paterson B, Turnbull J, Aitken I (1992) An evaluation of a training course in the short-term management of violence. Nurse Educ Today 12(5):368–375

    Article  CAS  PubMed  Google Scholar 

  • Paterson B, Leadbetter D, Bowie V (1999) Supporting nursing staff exposed to violence at work. Int J Nurs Stud 36(6):479–486

    Article  CAS  PubMed  Google Scholar 

  • Perkins J, Leadbetter D (2002) An evaluation of aggression management training in a special educational setting. Emot Behav Diffic 7:19–34

    Article  Google Scholar 

  • Phillips D, Rudestam KE (1995) Effect of nonviolent self-defense training on male psychiatric staff members’ aggression and fear. Psychiatr Serv (Washington DC) 46(2):164–168. https://doi.org/10.1176/ps.46.2.164

  • Price O, Baker J, Bee P, Lovell K (2015) Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression. Br J Psychiatry J Ment Sci 206(6):447–455. https://doi.org/10.1192/bjp.bp.114.144576

    Article  Google Scholar 

  • Putkonen A, Kuivalainen S, Louheranta O, Repo-Tiihonen E, Ryynanen O-P, Kautiainen H, Tiihonen J (2013) Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia. Psychiatr Serv (Washington DC) 64(9):850–855. https://doi.org/10.1176/appi.ps.201200393

    Article  PubMed  Google Scholar 

  • Rice ME, Helzel MF, Varney GW, Quinsey VL (1985) Crisis prevention and intervention training for psychiatric hospital staff. Am J Community Psychol 13(3):289–304

    Article  CAS  PubMed  Google Scholar 

  • Richmond I, Trujillo D, Schmelzer J, Phillips S, Davis D (1996) Least restrictive alternatives: do they really work? J Nurs Care Qual 11(1):29–37

    Article  CAS  PubMed  Google Scholar 

  • Richter D (2006) Non-physical conflict management and de-escalation. In: Whittington R, Richter D (Hrsg) Violence in mental health settings. Causes, consequences, management. Springer, New York, S 125–144

    Chapter  Google Scholar 

  • Richter D, Berger K (2001) Patientenübergriffe auf Mitarbeiter Eine prospektive Untersuchung der Häufigkeit, Situationen und Folgen. Nervenarzt 72(9):693–699

    Article  CAS  PubMed  Google Scholar 

  • Richter D, Needham I (2007) Effekte von mitarbeiterbezogenen Trainingsprogrammen zum Aggressionsmanagement in Einrichtungen der Psychiatrie und Behindertenhilfe – Systematische Literaturübersicht. Psychiatr Prax 34

    Google Scholar 

  • Richter D, Fuchs JM, Bergers KH (2001) Konfliktmanagement in psychiatrischen Einrichtungen, 1. Aufl. Gemeindeunfallversicherungsverband Westfalen-Lippe, Rheinischer Gemeindeunfallversicherungsverband und Landesunfallkasse Nordrhein-Westfalen, Münster/Düsseldorf. SElm. https://www.gesundheitsdienstportal.de/files/PIN1_Konfliktmanagement_in_psychiatrischen_Einrichtungen.pdf

    Google Scholar 

  • van Rixtel A, Nijman H, Jansen A (1997) Aggressie en psychiatrie: Heeft training effect? Verpleegkunde 12:111–119

    PubMed  Google Scholar 

  • Sauter D, Richter D (Hrsg) (1998) Gewalt in der psychiatrischen Pflege. Huber, Göttingen

    Google Scholar 

  • Sclafani MJ, Humphrey FJ 2nd, Repko S, Ko HS, Wallen MC, Digiacomo A (2008) Reducing patient restraints: a pilot approach using clinical case review. Perspectives Psychiatr Care 44(1):32–39. https://doi.org/10.1111/j.1744-6163.2008.00145.x

    Article  Google Scholar 

  • Shah A, De T (1998) The effect of an educational intervention package about aggressive behaviour directed at the nursing staff on a continuing care psychogeriatric ward. Int J Geriatr Psychiatr 13(1):35–40

    Article  CAS  Google Scholar 

  • Sjostrom N, Eder DN, Malm U, Beskow J (2001) Violence and its prediction at a psychiatric hospital. Eur Psychiatry J Assoc Eur Psychiatr 16(8):459–465

    Article  PubMed  Google Scholar 

  • Smoot SL, Gonzales JL (1995) Cost-effective communication skills training for state hospital employees. Psychiatr Serv (Washington DC) 46(8):819–822. https://doi.org/10.1176/ps.46.8.819

    Article  CAS  Google Scholar 

  • St. Thomas Psychiatric Hospital (1976) A program for the prevention and management of disturbed behavior. Hosp Community Psychiatry 27(10):724–727

    Google Scholar 

  • Steinert T, Schmid P, von Gewalt, Arbeitskreis zur Prävention (2014) Zwangsmaßnahmen in psychiatrischen Kliniken in Deutschland. Nervenarzt 85(5):621–629

    Article  CAS  PubMed  Google Scholar 

  • Sullivan AM, Bezmen J, Barron CT, Rivera J, Curley-Casey L, Marino D (2005) Reducing restraints: alternatives to restraints on an inpatient psychiatric service – utilizing safe and effective methods to evaluate and treat the violent patient. Psychiatr Q 76(1):51–65

    Article  PubMed  Google Scholar 

  • Tarquinio C, Rotonda C, Houlle WA, Montel S, Rydberg JA, Minary L et al (2016) Early psychological preventive intervention for workplace violence: a randomized controlled explorative and comparative study between EMDR-recent event and critical incident stress debriefing. Issues Ment Health Nurs 37(11):787–799. https://doi.org/10.1080/01612840.2016.1224282

    Article  PubMed  Google Scholar 

  • Testad I, Aasland AM, Aarsland D (2005) The effect of staff training on the use of restraint in dementia: a single-blind randomised controlled trial. Int J Geriatr Psychiatr 20(6):587–590

    Article  CAS  Google Scholar 

  • Thackrey M (1987) Clinician confidence in coping with patient aggression. Assess Enhanc Prof Psychol Res Prac 18:57–60

    Article  Google Scholar 

  • Visalli H, McNasser G (2000) Reducing seclusion and restraint: meeting the organizational challenge. J Nurs Care Qual 14(4):35–44

    Article  CAS  PubMed  Google Scholar 

  • Walters H, Kay R (2004) Developing a compassionate control strategy. Aust Nurs J ANJ 12(4):21

    Google Scholar 

  • Wesuls R, Heinzmann T, Brinker L (2003) Professionelles Deeskalationsmanagement (ProDeMa) Praxisleitfaden zum Umgang mit Gewalt und Aggression in Gesundheitsberufen. Unfallkasse Baden-Württemberg, Stuttgart

    Google Scholar 

  • Whittington R, Richter D (2005) Interactional aspects of violent behaviour on acute psychiatric wards. Psychol Crime Law 11(4):377–388

    Article  Google Scholar 

  • Whittington R, Wykes T (1996) An evaluation of staff training in psychological techniques for the management of patient aggression. J Clin Nurs 5(4):257–261

    Article  CAS  PubMed  Google Scholar 

  • Whittington R, Baskind E, Paterson B (2006) Coercive measures in the management of imminent violence restraint, seclusion and enhanced observation. In: Whittington R, Richter D (Hrsg) Violence in mental health settings. Causes, consequences, management. Springer, New York, S 145–172

    Google Scholar 

  • Wilkinson CL (1999) An evaluation of an educational program on the management of assaultive behaviors. J Gerontol Nurs 25(4):6–11

    Article  CAS  PubMed  Google Scholar 

  • Wright S (2003) Control and restraint techniques in the management of violence in inpatient psychiatry: a critical review. Med Sci Law 43(1):31–38. https://doi.org/10.1258/rsmmsl.43.1.31

    Article  PubMed  Google Scholar 

  • Yang C-PP, Hargreaves WA, Bostrom A (2014) Association of empathy of nursing staff with reduction of seclusion and restraint in psychiatric inpatient care. Psychiatr Serv (Washington DC) 65(2):251–254. https://doi.org/10.1176/appi.ps.201200531

    Article  PubMed  Google Scholar 

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  1. Weissenau, Klinik fur Psychiatrie und Psychotherapy, Ravensburg, Germany

    Prof. Dr. med. Tilman Steinert

  2. ZfP Weissenau, Ravensburg, Germany

    Dr. med. Sophie Hirsch

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  1. Prof. Dr. med. Tilman Steinert
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  1. ZfP Weissenau, Abteilung Psychiatrie I der Universität Ulm, Ravensburg/Ulm, Germany

    Tilman Steinert

  2. ZfP Weissenau, Abteilung Psychiatrie I der Universität Ulm, Ravensburg/Ulm, Germany

    Sophie Hirsch

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Steinert, T., Hirsch, S. (2019). Mitarbeiterschulungen und Deeskalation. In: Steinert, T., Hirsch, S. (eds) S3-Leitlinie Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58684-6_11

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