Effectiveness of Simulation-Based Multidisciplinary Teamwork Training of Physical Restraint in Psychiatric Wards

10.6145/jme.202303_27(1).0006

Liang-Wei Wang；Cheng-Heng Liu；Chun-Ti Yu；Yu-Chen Chiu；Ming-Hsien Hsieh；Wang-Huei Sheng；Chih-Wei Yang

multidisciplinary teamwork training ； physical restraint ； self-efficacy ； simulation-based training

Journal of Medical Education

27卷1期（2023 / 03 / 01）

57 - 64

英文

Purpose: In psychiatric inpatient units, staff often encounter threats and violence from agitated patients. De-escalation techniques are initially employed, but physical restraint may be necessary in extreme cases. Effective multidisciplinary teamwork is crucial to minimize complications. We explored the effectiveness of a simulation-based, multidisciplinary teamwork training program focusing on physical restraint. Methods and Materials: In August 2016, all medical staff in the National Taiwan University Hospital's psychiatric wards were recruited. Participants, including residents, nurses, and security guards, were divided into groups of five and engaged in high-fidelity simulations involving a standardized patient exhibiting threatening behavior. Self-efficacy was assessed using a 10-point questionnaire before (M1 Score) and after (M2 Score) training, while participants rated teamwork performance (Score T) post-simulation. Learning outcomes were analyzed using paired-T test and multivariate linear regression. Results: 35 medical staff , comprising 5 residents, 24 registered nurses, and 6 security guards. After the simulation-based training, score M showed a significant improvement, especially in patient management [6.71 to 8.71 (p < 0.001)] and fluency [6.6 to 8.6 (p < 0.001)]. The overall performance of teamwork (Score T) was rated as 7.84 (S.D. 1.167) out of 10. Medical personnel with no prior critical care experience, including security guards, improved their self-efficacy more than other participants. Conclusions: Simulation-based multidisciplinary teamwork training improves self-efficacy among medical staff in psychiatric wards, particularly benefiting those without prior critical care experience, which is effective and highly recommended.

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