综合医院住院患者自杀预防的最佳证据总结
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摘要
目的总结综合医院住院患者自杀预防的相关证据,为预防住院患者自杀提供参考。方法根据问题开发工具PIPOST确立综合医院住院患者自杀预防的循证问题,检索Cochrane图书馆、JBI循证卫生保健国际合作中心图书馆、BMJ Best Practice、美国国立指南库(NGC)、加拿大安大略注册护士协会(RNAO)循证护理指南、Wiley Online Library、JAMA、Pub Med以及中国生物医学文献库(CBM),进行文献质量评价,并对证据进行总结。结果纳入8篇文献,总结出15项证据,包括自杀风险评估、自杀安全管理、自杀治疗护理、自杀随访及自杀守门人培训5个主题。结论综合医院住院患者自杀预防的证据实证性强,可用于临床。护理人员在应用证据时应评估具体临床情形及障碍因素,结合专业判断形成有效、可行的自杀预防策略,动态评价证据应用效果,切实防范自杀行为。
Objective To summarize the available evidence on prevention of inpatient suicide at general hospitals,and to provide reference for clinical practice.Methods Following the Population-Intervention-Professional-Outcome-Setting-Type model,we proposed " prevention of inpatient suicide at general hospitals" as a research question,then we searched evidence in the databases and resources of evidence-based medicine,e.g.Cochrane Library,JBI Library,BMJ Best Practice,National Guideline Clearinghouse(NGC),Registered Nurses' Association of Ontario(RNAO),Wiley Online Library,JAMA,Pub Med and Chinese Biomedical Database(CBM).After evaluation of quality of the literatures,we summarized the evidence.Results Fifteen items of evidence were extracted from 8 publications,including suicide risk assessment,safety management,treatment and caring,follow-up and suicide gatekeeper training.Conclusion The evidence on suicide prevention among inpatients is of practicability.Nurses should assess clinical situation and barriers,use professional judgment and consider patient preference to formulate effective and practical strategies for prevention of suicide and dynamically evaluate the effect,thus to prevent patient suicide.
Objective To summarize the available evidence on prevention of inpatient suicide at general hospitals,and to provide reference for clinical practice.Methods Following the Population-Intervention-Professional-Outcome-Setting-Type model,we proposed " prevention of inpatient suicide at general hospitals" as a research question,then we searched evidence in the databases and resources of evidence-based medicine,e.g.Cochrane Library,JBI Library,BMJ Best Practice,National Guideline Clearinghouse(NGC),Registered Nurses' Association of Ontario(RNAO),Wiley Online Library,JAMA,Pub Med and Chinese Biomedical Database(CBM).After evaluation of quality of the literatures,we summarized the evidence.Results Fifteen items of evidence were extracted from 8 publications,including suicide risk assessment,safety management,treatment and caring,follow-up and suicide gatekeeper training.Conclusion The evidence on suicide prevention among inpatients is of practicability.Nurses should assess clinical situation and barriers,use professional judgment and consider patient preference to formulate effective and practical strategies for prevention of suicide and dynamically evaluate the effect,thus to prevent patient suicide.
引文
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[2]Martelli C,Awad H,Hardy P.Inpatients suicide:epidemiology and prevention[J].Encephale,2010,36(2):83-91.
[3]Tseng M C,Cheng I C,Hu F C.Standardized mortality ratio of inpatient suicide in a general hospital[J].J Formos Med Assoc,2011,110(4):267-269.
[4]胡德英,曾莉,刘义兰.护士在预防患者自杀中的守门人角色探析[J].护理学杂志,2015,30(3):89-92.
[5]熊宇,胡德英,颜巧元,等.对消化内科护士开展住院患者自杀认知与防范行为培训[J].护理学杂志,2014,29(11):39-42.
[6]毕波.沈阳市综合医院急诊室自杀未遂患者干预的一年随访研究[D].沈阳:中国医科大学,2010.
[7]黄海燕,米元元,喻姣花,等.危重症住院患者失禁相关性皮炎预防及护理的最佳证据总结[J].护理学杂志,2017,32(21):50-53.
[8]胡雁,李晓玲,郝玉芳,等.循证护理学[M].北京:人民卫生出版社,2012:109-110.
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[11]Department of Veterans Affairs,Assessment and Management of Risk for Suicide Wor-king Group.VA/Do D clinical practice guideline for assessment and management of patients at risk for suicide[EB/OL].(2013-06-01)[2018-01-13].https://www.guideline.gov/summaries/summary/47023/vadod-clinical-practice-guideline-for-assessment-and-management-of-patients-at-risk-for-suicide.
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[13]Emergency Nursing Association.Clinical practice guideline:suicide risk assessment[EB/OL].(2012-12-01)[2018-01-13].https://www.guidelinecentral.com/summaries/clinical-practice-guideline-suicide-risk-assessment.
[14]U.S.Preventive Services Task Force.Screening for suicide risk in adolescents,adults,and older adults in primary care:U.S.Preventive Services Task Force recommendation statement[EB/OL].(2014-05-20)[2018-01-13].http://annals.org/aim/fullarticle/1872851/screening-suicide-riskadolescents-adults-older-adults-primary-care-u.
[15]RNAO Development Panel.Assessment and care of adults at risk for suicidal ideation and behaviour[EB/OL].(2009-01-09)[2018-01-13].http://rnao.ca/bpg/guidelines/assessment-and-care-adults-risk-suicidal-ideation-and-behaviour
[16]BMJ Best Practice Development Panel.Suicide risk management[EB/OL].(2017-12-13)[2018-01-13].http://bestpractice.bmj.com/topics/en-gb/1016.
[17]Mann J J,Apter A,Bertolote J,et al.Suicide prevention strategies:a systematic review[J].JAMA,2005,294(16):2064-2074.
[18]Chesin M,Stanley B.Risk assessment and psychosocial intervention for suicidal patients[J].Bipolar Disord,2013,15(5):584-593.
[19]Chehil S,Kutcher S P.Suicide risk management:a manual for health professionals[M].Chichester:Wiley-Blackwell,2012:2-4.
[20]Zonda T.One-hundred cases of suicide in Budapest:a casecontrolled psychological autopsy study[J].Crisis,2006,27(3):125-129.
[21]Scottish Development Centre for Mental Health.Risk and protective factors for suicide and suicide behaviour:a li-terature review.Scottish Government Social Research[EB/OL].(2008-10-23)[2018-01-13].http://www.scotland.gov.uk/socialresearch.
[22]Hockberger R S,Rothstein R J.Assessment of suicide potential by nonpsychiatrists using the Sad Persons Score[J].JEmerg Med,2003,6(2):99-107.
[23]McCann T,Clark E,McConnachie S,et al.Accident and emergency nurses'attitudes towards patients who self-harm[J].Accid Emerg Nurs,2006,14(1):4-10.
[24]Jones J,Ward M,Wellman N,et al.Psychiatric inpatients'experience of nursing observation:a United Kingdom perspective[J].J Psychosoc Nurs Ment Health Serv,2000,38(12):10-20.
[25]胡德英,熊宇,丁小萍,等.自杀风险管理方案在综合医院住院患者中的应用[J].中华护理杂志,2018,53(8):941-947.
[26]Eskin M,Ertekin K,Demir H.Efficacy of a problem-solving therapy for depression and suicide potential in adolescents and young adults[J].Cogn Ther Res,2008,32(2):227-245.
[27]Tarrier N,Taylor K,Gooding P.Cognitive-behavioral interventions to reduce suicide behavior:a systematic review and meta-analysis[J].Behav Modif,2008,32(1):77-108.
[28]Linehan M M,Comtois K A,Murray A M,et al.Two-year randomized controlled trial and fallow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder[J].Arch Gen Psychiatry,2006,63(7):757-766.
[29]The UK ECT Review Group.Efficacy and safety of electroconvulsive therapy in depressive disorders:a systema-tic review and meta-analysis[J].Lancet,2003,361(9360):799-808.(本文编辑韩燕红)
[2]Martelli C,Awad H,Hardy P.Inpatients suicide:epidemiology and prevention[J].Encephale,2010,36(2):83-91.
[3]Tseng M C,Cheng I C,Hu F C.Standardized mortality ratio of inpatient suicide in a general hospital[J].J Formos Med Assoc,2011,110(4):267-269.
[4]胡德英,曾莉,刘义兰.护士在预防患者自杀中的守门人角色探析[J].护理学杂志,2015,30(3):89-92.
[5]熊宇,胡德英,颜巧元,等.对消化内科护士开展住院患者自杀认知与防范行为培训[J].护理学杂志,2014,29(11):39-42.
[6]毕波.沈阳市综合医院急诊室自杀未遂患者干预的一年随访研究[D].沈阳:中国医科大学,2010.
[7]黄海燕,米元元,喻姣花,等.危重症住院患者失禁相关性皮炎预防及护理的最佳证据总结[J].护理学杂志,2017,32(21):50-53.
[8]胡雁,李晓玲,郝玉芳,等.循证护理学[M].北京:人民卫生出版社,2012:109-110.
[9]谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.
[10]The Joanna Briggs Institute.Critical Appraisal Tool[S/OL].(2018-01-08)[2018-01-13].http://joannabriggs.org/research/critical-appraisal-tools.html.
[11]Department of Veterans Affairs,Assessment and Management of Risk for Suicide Wor-king Group.VA/Do D clinical practice guideline for assessment and management of patients at risk for suicide[EB/OL].(2013-06-01)[2018-01-13].https://www.guideline.gov/summaries/summary/47023/vadod-clinical-practice-guideline-for-assessment-and-management-of-patients-at-risk-for-suicide.
[12]Ministry of Health(Spain),Working Group of the Clinical Practice Guideline for the Prevention and Treatment.Clinical practice guideline for the prevention and treatment of suicidal behaviour[EB/OL].(2012-08-21)[2018-01-13].https://www.guidelinecentral.com/summaries/clinical-practice-guideline-for-the-prevention-and-treatment-of-suicidalbehaviour.
[13]Emergency Nursing Association.Clinical practice guideline:suicide risk assessment[EB/OL].(2012-12-01)[2018-01-13].https://www.guidelinecentral.com/summaries/clinical-practice-guideline-suicide-risk-assessment.
[14]U.S.Preventive Services Task Force.Screening for suicide risk in adolescents,adults,and older adults in primary care:U.S.Preventive Services Task Force recommendation statement[EB/OL].(2014-05-20)[2018-01-13].http://annals.org/aim/fullarticle/1872851/screening-suicide-riskadolescents-adults-older-adults-primary-care-u.
[15]RNAO Development Panel.Assessment and care of adults at risk for suicidal ideation and behaviour[EB/OL].(2009-01-09)[2018-01-13].http://rnao.ca/bpg/guidelines/assessment-and-care-adults-risk-suicidal-ideation-and-behaviour
[16]BMJ Best Practice Development Panel.Suicide risk management[EB/OL].(2017-12-13)[2018-01-13].http://bestpractice.bmj.com/topics/en-gb/1016.
[17]Mann J J,Apter A,Bertolote J,et al.Suicide prevention strategies:a systematic review[J].JAMA,2005,294(16):2064-2074.
[18]Chesin M,Stanley B.Risk assessment and psychosocial intervention for suicidal patients[J].Bipolar Disord,2013,15(5):584-593.
[19]Chehil S,Kutcher S P.Suicide risk management:a manual for health professionals[M].Chichester:Wiley-Blackwell,2012:2-4.
[20]Zonda T.One-hundred cases of suicide in Budapest:a casecontrolled psychological autopsy study[J].Crisis,2006,27(3):125-129.
[21]Scottish Development Centre for Mental Health.Risk and protective factors for suicide and suicide behaviour:a li-terature review.Scottish Government Social Research[EB/OL].(2008-10-23)[2018-01-13].http://www.scotland.gov.uk/socialresearch.
[22]Hockberger R S,Rothstein R J.Assessment of suicide potential by nonpsychiatrists using the Sad Persons Score[J].JEmerg Med,2003,6(2):99-107.
[23]McCann T,Clark E,McConnachie S,et al.Accident and emergency nurses'attitudes towards patients who self-harm[J].Accid Emerg Nurs,2006,14(1):4-10.
[24]Jones J,Ward M,Wellman N,et al.Psychiatric inpatients'experience of nursing observation:a United Kingdom perspective[J].J Psychosoc Nurs Ment Health Serv,2000,38(12):10-20.
[25]胡德英,熊宇,丁小萍,等.自杀风险管理方案在综合医院住院患者中的应用[J].中华护理杂志,2018,53(8):941-947.
[26]Eskin M,Ertekin K,Demir H.Efficacy of a problem-solving therapy for depression and suicide potential in adolescents and young adults[J].Cogn Ther Res,2008,32(2):227-245.
[27]Tarrier N,Taylor K,Gooding P.Cognitive-behavioral interventions to reduce suicide behavior:a systematic review and meta-analysis[J].Behav Modif,2008,32(1):77-108.
[28]Linehan M M,Comtois K A,Murray A M,et al.Two-year randomized controlled trial and fallow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder[J].Arch Gen Psychiatry,2006,63(7):757-766.
[29]The UK ECT Review Group.Efficacy and safety of electroconvulsive therapy in depressive disorders:a systema-tic review and meta-analysis[J].Lancet,2003,361(9360):799-808.(本文编辑韩燕红)