51
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Kodal JS, Kjær JN, Larsen ER. Mechanical restraint and characteristics of patient, staff and shifts in a psychiatric ward. Nord J Psychiatry 2018; 72:103-108. [PMID: 29073823 DOI: 10.1080/08039488.2017.1393560] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The use of coercion is a balance between depriving the patients' autonomy and dignity and preventing endangerment of the body or health of self or others. It is of importance to obtain more knowledge about mechanisms leading to mechanical restraint in the attempt of reducing it. OBJECTIVE To analyse for associations between incidence of mechanical restraint (MR) and staffing level, staff demographics, patient characteristics, type of shift (day/evening/night) and change of shifts. METHOD A naturalistic descriptive method was used to study cases of MR in a psychiatric ward. Data for each case of MR was obtained from an electronic reporting system. Care workers from each shift were identified using duty rosters. Analyses included binary logistic regression analyses. RESULTS In 82% of the 114 cases of MR, the patient was diagnosed with personality disorders. In the multiple regression analysis, a significant association was found between the use of MR and the presence of male care workers on the ward (OR:1.44, 95% CI: 1.01-2.05; p = .04). Moreover, MR was associated with evening shifts, compared with day and night shifts (OR =1,29, 95% CI: 1.14-2.57, p = .01). Besides, months from January to December was associated with a decrease in MRs (OR: 0.88, 95% CI: 0.83-0.94; p = 7.3 E-6). No significant associations were found between MR and staffing level or experience. CONCLUSIONS MR was associated with evening shifts, higher number of male care workers on duty and a decrease from January to December.
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Affiliation(s)
- Johanne Sofie Kodal
- a Department of Affective Disorders Q, Mood Disorders Research Unit , Aarhus University Hospital , Aarhus , Denmark.,b Psychiatric Research Academy, Department of Affective Disorders Q , Aarhus University Hospital , Aarhus , Denmark
| | - Jesper Nørgaard Kjær
- b Psychiatric Research Academy, Department of Affective Disorders Q , Aarhus University Hospital , Aarhus , Denmark
| | - Erik Roj Larsen
- a Department of Affective Disorders Q, Mood Disorders Research Unit , Aarhus University Hospital , Aarhus , Denmark
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52
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Yakov S, Birur B, Bearden MF, Aguilar B, Ghelani KJ, Fargason RE. Sensory Reduction on the General Milieu of a High-Acuity Inpatient Psychiatric Unit to Prevent Use of Physical Restraints: A Successful Open Quality Improvement Trial. J Am Psychiatr Nurses Assoc 2018; 24:133-144. [PMID: 29039238 DOI: 10.1177/1078390317736136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impaired sensory gating in patients with acute mental illness predisposes to overstimulation and behavioral dyscontrol. OBJECTIVE Explore use of sensory reduction interventions on a high-acuity inpatient milieu to reduce high assault/restraint rates. DESIGN A multidisciplinary team using failure mode and effect analysis to explore high restraint use between 4:00 p.m. and 7:00 p.m. observed patient/staff overstimulation contributed to behavioral escalations. The team implemented sensory reduction/integration improvements over a 5-month period to prevent excessive restraint use. RESULTS Restraint rates dropped immediately following light and sound reduction interventions and by 72% at 11 months postimplementation. Mann-Whitney statistics for unpaired 6-month comparisons, 1-year pre- and postintervention showed significant reductions: Assault rates (median pre = 1.37, post = 0.18, U = 4, p = .02); Restraint rates (median pre = 0.50, post = 0.06, U = 0, p = .002). CONCLUSION Sensory reduction during a high-stress time period on a high-acuity psychiatric unit was associated with a reduction in assaults and restraints.
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Affiliation(s)
- Svetlana Yakov
- 1 Svetlana Yakov, MD, University of Alabama at Birmingham, AL, USA
| | - Badari Birur
- 2 Badari Birur, MD, University of Alabama at Birmingham, AL, USA
| | - Melissa F Bearden
- 3 Melissa F. Bearden, MACN, OT/L, University of Alabama at Birmingham, AL, USA
| | - Barbara Aguilar
- 4 Barbara Aguilar, BSN-BC, RN, University of Alabama at Birmingham, AL, USA
| | - Kinjal J Ghelani
- 5 Kinjal J. Ghelani, MD, University of Alabama at Birmingham, AL, USA
| | - Rachel E Fargason
- 6 Rachel E. Fargason, MD, University of Alabama at Birmingham, AL, USA
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53
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McKenna B, McEvedy S, Maguire T, Ryan J, Furness T. Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study. Int J Ment Health Nurs 2017; 26:491-499. [PMID: 28960741 DOI: 10.1111/inm.12383] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 01/09/2023]
Abstract
Seclusion and mechanical restraint are restrictive interventions that should be used only as a last resort and for the shortest possible time, yet little is known about duration of use in the broader context. Adult area mental health services throughout Victoria, Australia, were asked to complete a report form for prolonged episodes of seclusion (>8 hours) and mechanical restraint (>1 hour). The present, retrospective cohort study aimed to understand the individual (age, sex, type of service, duration of intervention) and contextual factors associated with prolonged use of restrictive interventions. Contextual factors describing the reasons for prolonged use of the restrictive interventions were captured qualitatively, and then coded using content analysis. Median duration was compared across individual factors using Mann-Whitney U-tests. During 2014, 690 episodes of prolonged restrictive intervention involving 311 consumers were reported. Close to half (n = 320, 46%) involved mechanical restraint. Seclusion episodes (n = 370) were longer in forensic mental health services compared to adult area mental health services (median: 24 hours and 18 min vs 16 hours and 42 min, P < 0.001). Mechanical restraint episodes (n = 320) were shorter in forensic mental health services compared to adult area mental health services (median: 3 hours and 25 min vs 4 hours and 15 min, P = 0.008). Some consumers were subject to multiple episodes of prolonged seclusion (55/206, 27%) and/or prolonged mechanical restraint (31/131, 24%). The most commonly occurring contextual factor for prolonged restrictive interventions was 'risk of harm to others'. Means for reducing the use of prolonged restrictive interventions are discussed in light of the findings.
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Affiliation(s)
- Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, and Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia
| | - Samantha McEvedy
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia.,Nursing Practice Development Unit, Forensicare, Melbourne, Victoria, Australia
| | - Jo Ryan
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia.,Nursing Practice Development Unit, Forensicare, Melbourne, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Para medicine, Australian Catholic University and North Western Mental Health, Melbourne Health, Melbourne, Victoria, Australia
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Abstract
Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals' descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.
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55
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Lora A, Lesage A, Pathare S, Levav I. Information for mental health systems: an instrument for policy-making and system service quality. Epidemiol Psychiatr Sci 2017; 26:383-394. [PMID: 27780495 PMCID: PMC6998623 DOI: 10.1017/s2045796016000743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 09/10/2016] [Indexed: 10/20/2022] Open
Abstract
AIMS Information is crucial in mental healthcare, yet it remains undervalued by stakeholders. Its absence undermines rationality in planning, makes it difficult to monitor service quality improvement, impedes accountability and human rights monitoring. For international organizations (e.g., WHO, OECD), information is indispensable for achieving better outcomes in mental health policies, services and programs. This article reviews the importance of developing system level information with reference to inputs, processes and outputs, analyzes available tools for collecting and summarizing information, highlights the various goals of information gathering, discusses implementation issues and charts the way forward. METHODS Relevant publications and research were consulted, including WHO studies that purport to promote the use of information systems to upgrade mental health care in high- and low-middle income countries. RESULTS Studies have shown that once information has been collected by relevant systems and analyzed through indicator schemes, it can be put to many uses. Monitoring mental health services, represents a first step in using information. In addition, studies have noted that information is a prime resource in many other areas such as evaluation of quality of care against evidence based standards of care. Services data may support health services research where it is possible to link mental health data with other health and non-health databases. Information systems are required to carefully monitor involuntary admissions, restrain and seclusion, to reduce human rights violations in care facilities. Information has been also found useful for policy makers, to monitor the implementation of policies, to evaluate their impact, to rationally allocate funding and to create new financing models. CONCLUSIONS Despite its manifold applications, Information systems currently face many problems such as incomplete recording, poor data quality, lack of timely reporting and feedback, and limited application of information. Corrective action is needed to upgrade data collection in outpatient facilities, to improve data quality, to establish clear rules and norms, to access adequate information technology equipment and to train health care personnel in data collection. Moreover, it is necessary to shift from mere administrative data collection to analysis, dissemination and use by relevant stakeholders and to develop a "culture of information" to dismantle the culture of intuition and mere tradition. Clinical directors, mental health managers, patient and family representatives, as well as politicians should be educated to operate with information and not just intuition.
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Affiliation(s)
- A. Lora
- Department of Mental Health - Manzoni Hospital, Lecco, Italy
| | - A. Lesage
- Centre de recherche de l'Institut Universitaire en Santé Mentale, Université de Montréal, Montreal, Canada
| | - S. Pathare
- Centre for MH Law & Policy, Indian Law Society, Pune, India
| | - I. Levav
- Department of Community Mental Health, Faculty of Welfare and Health Sciences, University of Haifa, Israel
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56
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Deichmann Nielsen L, Bech P, Hounsgaard L, Alkier Gildberg F. 'Mechanical restraint-confounders, risk, alliance score': testing the clinical validity of a new risk assessment instrument. Nord J Psychiatry 2017; 71:441-447. [PMID: 28471329 DOI: 10.1080/08039488.2017.1318949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Unstructured risk assessment, as well as confounders (underlying reasons for the patient's risk behaviour and alliance), risk behaviour, and parameters of alliance, have been identified as factors that prolong the duration of mechanical restraint among forensic mental health inpatients. AIM To clinically validate a new, structured short-term risk assessment instrument called the Mechanical Restraint-Confounders, Risk, Alliance Score (MR-CRAS), with the intended purpose of supporting the clinicians' observation and assessment of the patient's readiness to be released from mechanical restraint. METHODS The content and layout of MR-CRAS and its user manual were evaluated using face validation by forensic mental health clinicians, content validation by an expert panel, and pilot testing within two, closed forensic mental health inpatient units. RESULTS The three sub-scales (Confounders, Risk, and a parameter of Alliance) showed excellent content validity. The clinical validations also showed that MR-CRAS was perceived and experienced as a comprehensible, relevant, comprehensive, and useable risk assessment instrument. CONCLUSIONS MR-CRAS contains 18 clinically valid items, and the instrument can be used to support the clinical decision-making regarding the possibility of releasing the patient from mechanical restraint. IMPLICATIONS The present three studies have clinically validated a short MR-CRAS scale that is currently being psychometrically tested in a larger study.
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Affiliation(s)
- Lea Deichmann Nielsen
- a Department of Psychiatry , Middelfart , Denmark.,b University College South Denmark , Esbjerg Ø , Denmark.,c OPEN, Odense Patient data Explorative Network , Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science , University of Southern Denmark , Odense , Denmark
| | - Per Bech
- e Psychiatric Research Unit , Mental Health Centre North Zealand, University of Copenhagen , Hilleroed , Denmark
| | - Lise Hounsgaard
- c OPEN, Odense Patient data Explorative Network , Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science , University of Southern Denmark , Odense , Denmark.,f Institute of Nursing and Health Science , University of Greenland , Nuuk , Greenland.,g University College Lillebaelt , Vejle , Denmark
| | - Frederik Alkier Gildberg
- a Department of Psychiatry , Middelfart , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science , University of Southern Denmark , Odense , Denmark
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57
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Pollastri AR, Lieberman RE, Boldt SL, Ablon JS. Minimizing Seclusion and Restraint in Youth Residential and Day Treatment Through Site-Wide Implementation of Collaborative Problem Solving. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/0886571x.2016.1188340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alisha R. Pollastri
- Think:Kids at Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Kairos, Grants Pass, Oregon, USA
| | - Robert E. Lieberman
- Research and Evaluation, Think:Kids at Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan L. Boldt
- Research and Evaluation, Think:Kids at Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - J. Stuart Ablon
- Think:Kids at Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Kairos, Grants Pass, Oregon, USA
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58
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Larue C, Goulet MH, Prevost MJ, Dumais A, Bellavance J. Identification and Analysis of Factors Contributing to the Reduction in Seclusion and Restraint for a Population with Intellectual Disability. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 31:e212-e222. [PMID: 27910254 DOI: 10.1111/jar.12309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND A cohort of 11 patients with an intellectual disability and a psychiatric diagnosis present severe behavioural disorders in psychiatric hospital of Quebec in 2009. Control-measure use for this clientele has now been reduced. How do management personnel, families and care teams explain the changes? What clinical interventions did management and care providers implement that contributed to the reduction? METHOD A retrospective case study was conducted. Five focus groups were held with people involved in their care, and the patient files were examined. RESULTS The factors contributing to this change were the cohesion of the care providers, the involvement of the families and the efforts to determine the function of the behaviour. IMPLICATIONS This study may inspire other care teams to try new approaches in dealing with patients with severe behavioural disorders. Also, the model of factors and interventions supporting a reduction in seclusion and restraint measures may inspire future studies.
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Affiliation(s)
- Caroline Larue
- Faculty of Nursing, Université de Montréal, Montreal, Canada.,Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Canada.,Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Montreal, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, Université de Montréal, Montreal, Canada.,Quebec Nursing Intervention Research Network (RRISIQ), Montreal, Canada.,Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Montreal, Canada
| | | | - Alexandre Dumais
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Montreal, Canada.,Institut Philippe-Pinel de Montréal, Montreal, Canada
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59
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Repique RJR, Vernig PM, Lowe J, Thompson JA, Yap TL. Implementation of a Recovery-Oriented Training Program for Psychiatric Nurses in the Inpatient Setting: A Mixed-Methods Hospital Quality Improvement Study. Arch Psychiatr Nurs 2016; 30:722-728. [PMID: 27888966 DOI: 10.1016/j.apnu.2016.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/19/2016] [Indexed: 11/27/2022]
Abstract
This mixed-methods hospital quality improvement (QI) study primarily aimed to reduce the use of mechanical restraints in a short-stay inpatient psychiatric setting by facilitating change in care delivery through recovery-oriented nursing practice. The implementation of an evidence-based education for psychiatric-mental health registered nurses (PMH-RNs) intended to improve their knowledge of, and attitudes toward, recovery-focused mental health treatment principles. Findings suggest that recovery-oriented training programs for PMH-RNs can be a potentially useful hospital strategy for restraint reduction. In this article, the authors report their findings using the SQUIRE 2.0 framework for publication of QI studies (Ogrinc et al., 2015).
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Affiliation(s)
| | | | - John Lowe
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL
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60
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Abstract
BACKGROUND Mechanical restraints and forced procedures in psychiatric wards are of major concern in Denmark and there is a desire to reduce these procedures to a minimum. So far, focus has primarily been on identifying and changing internal (intramural) factors when seeking to reduce coercion. AIM To identify possible external (extramural) factors that may increase the risk of coercion during admission to a closed psychiatric ward. METHOD Using a retrospective case-controlled design, 235 patients admitted to a closed ward during 2011-2013 were randomly selected. Coercion comprised belt restraint, physical restraint, and forced medication. The data source was the electronic patient records, which include statutory information on all forced measures. Multiple logistic regression analyses were applied to calculate the risk (odds ratio, OR (95% confidence interval)) of forced measures being used. RESULTS Out of the 235 patients, 66 (28%) were subject to coercion. The time of forced procedures was predominately during the first hours after admission. The risk of forced measures being applied was significantly higher if patients were involuntarily admitted (OR = 6.4 (3.4-11.9)), or were acutely intoxicated by substances at the time of admission (OR = 3.7 (1.7-8.2)). CONCLUSION Extramural factors should be included when mental health authorities plan efforts to reduce coercion during admission to psychiatric wards. A reduced threshold for admission and improved integrated effort between mental health services and treatment for substance abuse could improve the course of disease for this group of patients and reduce the need for involuntary admissions and subsequently coercion.
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Affiliation(s)
- Kjeld Andersen
- a Psychiatry in Southern Denmark, Department of Psychiatry Odense , University Function , Denmark
| | - Bent Nielsen
- b Institute of Clinical Research , University of Southern Denmark , Odense , Denmark
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61
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Timbo W, Sriram A, Reynolds EK, DeBoard-Lucas R, Specht M, Howell C, McSweeney C, Grados MA. Risk Factors for Seclusion and Restraint in a Pediatric Psychiatry Day Hospital. Child Psychiatry Hum Dev 2016; 47:771-9. [PMID: 26643416 DOI: 10.1007/s10578-015-0608-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The use of seclusion and restraints (SR) in acute hospital settings remains a controversial practice. Despite the focus on SR in the psychiatric services literature, data on SR use in pediatric day hospital settings is lacking. A case-control retrospective analysis for children admitted into a pediatric psychiatry day hospital in a 2-year span examined predictors of SR use. Demographic and clinical descriptors were examined in relation to SR events using univariate and multivariate regression models. Significant univariate risk factors for SR use were psychiatric morbidity, history of physical abuse, post-traumatic stress disorder, having any anxiety disorder, and younger age. Knowledge of risk factors for SR use in pediatric psychiatric day hospitals can avert use of SR and lead to improved safety in a trauma-informed care model.
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Affiliation(s)
- Wuroh Timbo
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | | | - Elizabeth K Reynolds
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | | | - Matthew Specht
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | - Carolyn Howell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA
| | | | - Marco A Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans St., 12th Floor, Baltimore, MD, 21287, USA.
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62
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Oster C, Gerace A, Thomson D, Muir-Cochrane E. Seclusion and restraint use in adult inpatient mental health care: An Australian perspective. Collegian 2016. [DOI: 10.1016/j.colegn.2015.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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63
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The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals. PSYCHIATRY JOURNAL 2015; 2015:347246. [PMID: 26682211 PMCID: PMC4670873 DOI: 10.1155/2015/347246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 11/03/2015] [Indexed: 11/17/2022]
Abstract
Background. The use of coercion within the psychiatric services is problematic and raises a range of ethical, legal, and clinical questions. “Physical restraint” is an emergency procedure used in psychiatric hospitals to control patients that pose an imminent physical danger. We wished to review the literature published in scientific peer-reviewed journals describing studies on the use of physical restraint in Norway, in order to identify the current state of knowledge and directions for future research. Design. The databases PubMed, PsycINFO, CINAHL, Web of Science, and Embase were searched for studies relating to physical restraint (including holding) in Norwegian psychiatric hospitals, supplemented with hand searches. Results. 28 studies were included. Most of the studies were on rates of restraint, but there were also some studies on perceptions of patients and staff, case studies, and ethnographic studies. There was only one intervention study. There are differences in use between wards and institutions, which in part may be explained by differences in patient populations. Staff appear to be less negative to the use of restraint than patients. Conclusions. The studies that were identified were primarily concerned with rates of use and with patients' and staff's perspectives. More interventional studies are needed to move the field forward.
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64
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Scanlan JN, Novak T. Sensory approaches in mental health: A scoping review. Aust Occup Ther J 2015; 62:277-85. [DOI: 10.1111/1440-1630.12224] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Justin Newton Scanlan
- Faculty of Health Sciences; University of Sydney; Sydney Australia
- Mental Health Services; Sydney Local Health District; Concord Centre for Mental Health; Concord Australia
| | - Theresa Novak
- Mental Health Services; Sydney Local Health District; Professor Marie Bashir Centre; Royal Prince Alfred Hospital; Camperdown New South Wales Australia
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65
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Mann-Poll PS, Smit A, Koekkoek B, Hutschemaekers G. Seclusion as a necessary vs. an appropriate intervention: a vignette study among mental health nurses. J Psychiatr Ment Health Nurs 2015; 22:226-33. [PMID: 25912268 DOI: 10.1111/jpm.12176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2014] [Indexed: 11/30/2022]
Abstract
In a vignette study, mental health nurses were asked to score vignettes on necessity and appropriateness using a Likert scale. Sixty-nine clinical nurses from four mental health institutes scored 64 vignettes on necessity (there is no alternative) and appropriateness (seclusion supports patients' treatment) of seclusion simultaneously. Data analysis focused on the differences between both scores, and included general linear model analysis, t-test statistics and Kendall's tau. The t-test resulted in a significantly higher score on necessity than on appropriateness. Differences between both scores could be explained for 32% by a combination of nurse characteristics and vignette variables. Necessity and appropriateness were found to be strongly associated with each other, showing that underpinning patterns were largely the same. This research enhances the understanding of underlying factors that influence the decision of nurses to use seclusion. This is essential for the development of interventions aimed at the reduction of seclusion use in mental health practice.
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Affiliation(s)
- P S Mann-Poll
- ProCES (Pro Persona Centre for Education and Science), Pro Persona Mental Health Care, Nijmegen, The Netherlands
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66
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Rubio-Valera M, Luciano JV, Ortiz JM, Salvador-Carulla L, Gracia A, Serrano-Blanco A. Health service use and costs associated with aggressiveness or agitation and containment in adult psychiatric care: a systematic review of the evidence. BMC Psychiatry 2015; 15:35. [PMID: 25881240 PMCID: PMC4356166 DOI: 10.1186/s12888-015-0417-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. METHODS Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. RESULTS Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. CONCLUSIONS Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.
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Affiliation(s)
- Maria Rubio-Valera
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,School of Pharmacy, Universitat de Barcelona, Barcelona, Spain. .,Research & Development Unit, Parc Sanitari Sant Joan de, 22 Déu. C/ Dr. Antoni Pujadas 42, 08830, Sant Boi de Llobregat, Barcelona, Spain.
| | - Juan V Luciano
- Fundació Sant Joan de Déu, Esplugues de Llobregat, Spain. .,Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Open University of Catalonia (UOC), Barcelona, Spain.
| | | | - Luis Salvador-Carulla
- Centre for Disability Research and Policy, Faculty of Health Sciences, and Mental Health Policy Unit, Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
| | | | - Antoni Serrano-Blanco
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Barcelona, Spain. .,Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
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67
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Boumans CE, Walvoort SJW, Egger JIM, Hutschemaekers GJM. The methodical work approach and the reduction in the use of seclusion: how did it work? Psychiatr Q 2015; 86:1-17. [PMID: 25270895 DOI: 10.1007/s11126-014-9321-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The prevention of seclusion and other coercive measures has become a priority for mental health facilities, and numerous comprehensive programs to reduce the use of these containment procedures, have been developed. It is, however, poorly understood which interventions or elements of programs are effective and by which mechanisms or processes change is mediated. The present study explores the effects of an intervention by which a reduction in the use of seclusion was achieved. The intervention concerned a transformation of the treatment process, based on the principles of the methodical work approach, at a ward for the intensive treatment of patients with psychosis and substance use disorders. Changes in the working practice and team process were analyzed on the basis of case examples and team evaluation. The methodical work approach appears to have provided a guidance for the multidisciplinary team, the patient and the family to work together in a systematic and goal-directed way with cyclic evaluation and readjustment of the treatment and nurse care plan. Also implicit, positive changes were found in the team process: increased interdisciplinary collaboration, team cohesion, and professionalization. It is argued that the implicit or non-specific effects of an intervention to prevent seclusion may constitute a major contribution to the results and therefore merit further research.
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68
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Gildberg FA, Fristed P, Makransky G, Moeller EH, Nielsen LD, Bradley SK. As time goes by: reasons and characteristics of prolonged episodes of mechanical restraint in forensic psychiatry. JOURNAL OF FORENSIC NURSING 2015; 11:41-50. [PMID: 25622065 DOI: 10.1097/jfn.0000000000000055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Evidence suggests the prevalence and duration of mechanical restraint are particularly high among forensic psychiatric inpatients. However, only sparse knowledge exists regarding the reasons for, and characteristics of, prolonged use of mechanical restraint in forensic psychiatry. This study therefore aimed to investigate prolonged episodes of mechanical restraint on forensic psychiatric inpatients. Documentary data from medical records were thematically analyzed. Results show that the reasons for prolonged episodes of mechanical restraint on forensic psychiatric inpatients can be characterized by multiple factors: "confounding" (behaviors associated with psychiatric conditions, substance abuse, medical noncompliance, etc.), "risk" (behaviors posing a risk for violence), and "alliance parameters" (qualities of the staff-patient alliance and the patients' openness to alliance with staff), altogether woven into a mechanical restraint spiral that in itself becomes a reason for prolonged mechanical restraint. The study also shows lack of consistent clinical assessment during periods of restraint. Further investigation is indicated to develop an assessment tool with the capability to reduce time spent in mechanical restraint.
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Affiliation(s)
- Frederik A Gildberg
- Author Affiliations: 1Research & Development Unit, Department of Psychiatry, Middelfart, Region of Southern Denmark; 2Faculty of Health Sciences, Institute of Regional Health Research, University of Southern Denmark; 3Department of Psychiatry, Middelfart, Region of Southern Denmark; 4Faculty of Health Science, Institute of Psychology, University of Southern Denmark; and 5Catherine McAuley School of Nursing and Midwifery Brookfield Health Sciences Complex, University College, Cork
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69
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Jaeger M, Ketteler D, Rabenschlag F, Theodoridou A. Informal coercion in acute inpatient setting--knowledge and attitudes held by mental health professionals. Psychiatry Res 2014; 220:1007-11. [PMID: 25249438 DOI: 10.1016/j.psychres.2014.08.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 07/16/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
Abstract
This pilot study aimed at investigating how mental health professionals on acute psychiatric wards recognize different levels of formal and informal coercions and treatment pressures as well as their attitude towards these interventions. An explorative cross-sectional survey among mental health professionals (N=39) was conducted using a questionnaire that consisted of 15 vignettes describing typical clinical situations on five different stages of the continuum of coercion. Low levels of coercion are recognized adequately while higher levels are grossly underestimated. The degree of coercion inherent to interventions comprising persuasion and leverage was underestimated by professionals with a positive attitude and overestimated by those with a negative attitude towards the respective interventions. No associations of the ability to recognize different levels of coercion with ward or staff related variables were found. Higher knowledge on ambiguous variations of coercive interventions seems to foster more balanced reflections about their ethical implications. Advanced understanding of influencing factors of professionals׳ attitudes towards coercion could lead to improved training of professionals in utilizing interventions to enhance treatment adherence in an informed and ethical way.
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Affiliation(s)
- Matthias Jaeger
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland.
| | - Daniel Ketteler
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
| | - Franziska Rabenschlag
- Nursing, Quality and Services, Development and Research, Psychiatric University Clinics, Wilhelm Klein-Strasse 27, CH-4012 Basel, Switzerland
| | - Anastasia Theodoridou
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Lenggstrasse 31, 8032 Zurich, Switzerland
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70
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Kalisova L, Raboch J, Nawka A, Sampogna G, Cihal L, Kallert TW, Onchev G, Karastergiou A, Del Vecchio V, Kiejna A, Adamowski T, Torres-Gonzales F, Cervilla JA, Priebe S, Giacco D, Kjellin L, Dembinskas A, Fiorillo A. Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1619-29. [PMID: 24737189 DOI: 10.1007/s00127-014-0872-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/18/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries. METHODS Involuntarily admitted patients (N = 2,027) were divided into two groups. The first group (N = 770) included patients that had been subject to at least one of these coercive measures during hospitalization: restraint, and/or seclusion, and/or forced medication; the other group (N = 1,257) included patients who had not received any coercive measure during hospitalization. To identify predictors of use of coercive measures, both patients' sociodemographic and clinical characteristics and centre-related characteristics were tested in a multivariate logistic regression model, controlled for countries' effect. RESULTS The frequency of the use of coercive measures varied significantly across countries, being higher in Poland, Italy and Greece. Patients who received coercive measures were more frequently male and with a diagnosis of psychotic disorder (F20-F29). According to the regression model, patients with higher levels of psychotic and hostility symptoms, and of perceived coercion had a higher risk to be coerced at admission. Controlling for countries' effect, the risk of being coerced was higher in Poland. Patients' sociodemographic characteristics and ward-related factors were not identifying as possible predictors because they did not enter the model. CONCLUSIONS The use of coercive measures varied significantly in the participating countries. Clinical factors, such as high levels of psychotic symptoms and high levels of perceived coercion at admission were associated with the use of coercive measures, when controlling for countries' effect. These factors should be taken into consideration by programs aimed at reducing the use of coercive measures in psychiatric wards.
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Affiliation(s)
- Lucie Kalisova
- Department of Psychiatry, 1st Medical School, Charles University, Prague, Czech Republic,
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71
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Valenkamp M, Delaney K, Verheij F. Reducing seclusion and restraint during child and adolescent inpatient treatment: still an underdeveloped area of research. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2014; 27:169-74. [PMID: 25100241 DOI: 10.1111/jcap.12084] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PROBLEM Half of all youth hospitalized in inpatient psychiatric facilities manifest aggressive behavior. When aggression escalates to the point of danger, measures must be employed to guarantee safety of both patients and staff. In this paper, the current empirical evidence for intervention models to reduce restriction and restraint utilization in children and adolescents is reviewed. METHOD PubMed and PsycINFO were searched for English-language articles published between 2006 and 2013. Included were empirical studies of child or adolescent inpatient populations using a pretest and posttest design. FINDING Included in this review are three empirical papers describing two different intervention models that met the inclusion criteria. CONCLUSIONS The review indicates there are two empirical supported intervention models that are helpful in reducing seclusion and restraint utilization in children and adolescents. The promising empirical findings support evidence and application to the child/adolescent population for at least three of the six National Association of State Mental Health Program Directors core strategies for restraint reduction. The modest number of empirical papers reflects that reducing restrictive measures in child/adolescent inpatient treatment remains an underdeveloped area of research.
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Affiliation(s)
- Marije Valenkamp
- Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; VanMontfoort Consultancy, Woerden, The Netherlands
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72
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McCann TV, Baird J, Muir-Cochrane E. Factors influencing clinicians' attitudes about aggression in Australian acute old age psychiatry inpatient units: a cross sectional survey design. Issues Ment Health Nurs 2014; 35:542-50. [PMID: 24963855 DOI: 10.3109/01612840.2014.883559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient aggression occurs in old age psychiatry and is problematic. The aim of this study is to identify the factors that influence clinicians' attitudes toward aggression in old age psychiatry. Eighty-five individuals, comprising nurses (n = 75) and medical and allied health staff (n = 10), completed the questionnaire. The results show that gender, profession, and work experience do not affect attitudes toward aggression. A low score indicated agreement with an attitudinal statement. However, younger age, better higher level of completed education, and place of work increased the likelihood of participants endorsing the questionnaire's attitudinal statements about aggression. The findings suggest clinicians' attitudes may affect the way they attempt to prevent and manage aggression.
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Affiliation(s)
- Terence V McCann
- Victoria University, Discipline of Mental Health Nursing, College of Health and Biomedicine, Centre for Chronic Disease Prevention and Management, Melbourne, Australia
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73
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Bak J, Zoffmann V, Sestoft DM, Almvik R, Brandt-Christensen M. Mechanical restraint in psychiatry: preventive factors in theory and practice. A Danish-Norwegian association study. Perspect Psychiatr Care 2014; 50:155-66. [PMID: 25040212 DOI: 10.1111/ppc.12036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 06/10/2013] [Accepted: 06/27/2013] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. DESIGN AND METHODS This study employed a retrospective association design, and linear regression was used to assess the associations. FINDINGS Three mechanical restraint preventive factors were significantly associated with low rates of mechanical restraint use: mandatory review (exp[B] = .36, p < .01), patient involvement (exp[B] = .42, p < .01), and no crowding (exp[B] = .54, p < .01). PRACTICE IMPLICATIONS None of the three mechanical restraint preventive factors presented any adverse effects; therefore, units should seriously consider implementing these measures.
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Affiliation(s)
- Jesper Bak
- Mental Health Centre Sct. Hans, Roskilde, Denmark
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74
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Rabenschlag F, Konrad A, Rueegg S, Jaeger M. A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does it affect staff satisfaction? Psychiatr Q 2014; 85:225-39. [PMID: 24307177 DOI: 10.1007/s11126-013-9285-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implementation of the recovery concept, attitudes towards recovery, coercion, perceptions of the ward and working satisfaction were assessed with questionnaires and computed using Chi square and ANOVA variance analyses. The members of the intervention ward (n = 17) did not differ from the control group (n = 21), except that control group members were younger. The recovery-orientation of the study ward (ROSE questionnaire) increased significantly (alpha level = 0.05) from study begin to study end (p = 0.003), and compared to the control group (p = 0.002). The attitudes towards coercion did not change significantly in the intervention group, but did so compared to the control group. The contentedness (GMI) and the satisfaction with working conditions (ABB) of the intervention group members compared to control group was significantly higher (GMI: p = 0.004, ABB subscale working conditions: p = 0.043, satisfaction: p = 0.023). The study indicates that recovery-oriented principles can be implemented even in an acute admission ward, increasing team satisfaction with work, while attitudes towards coercion did not change significantly within this single-unit project.
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75
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Boumans CE, Egger JIM, Souren PM, Hutschemaekers GJM. Reduction in the use of seclusion by the methodical work approach. Int J Ment Health Nurs 2014; 23:161-70. [PMID: 23890418 DOI: 10.1111/inm.12037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patient care in a psychiatric setting can benefit from a more systematic, transparent, and goal-driven way of working. The methodical work approach, with its cyclic five phases, provides such an approach: (i) translation of problems into goals; (ii) search for means to realize the goals; (iii) formulation of an individualized plan; (iv) implementation of the plan; and (v) evaluation and readjustment. We examined the effect of the methodical work approach on the use of seclusion at a ward for the intensive treatment of inpatients with psychoses and substance-use disorders. The team of this ward implemented the methodical work approach. Special attention was paid to the involvement of the patient and his/her family in the treatment process and to the role of the coordinating nurse. Compared to control wards within the same hospital, at the ward where the methodical work approach was implemented, a more pronounced reduction was achieved in the number of incidents and in the total hours of seclusion. Implementation of the methodical work approach can contribute to a reduction in the use of seclusion.
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Affiliation(s)
- Christien E Boumans
- Centre for Psychosis and Substance Use Disorders, Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands; Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
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76
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Luciano M, Sampogna G, Del Vecchio V, Pingani L, Palumbo C, De Rosa C, Catapano F, Fiorillo A. Use of coercive measures in mental health practice and its impact on outcome: a critical review. Expert Rev Neurother 2014; 14:131-41. [PMID: 24382132 DOI: 10.1586/14737175.2014.874286] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Although coercive measures have always been part of the psychiatric armamentarium, the ethical dilemma between the use of a "therapeutic" coercion and the loss of patients' dignity is one of the major controversial issues in mental health research and practice. The aims of the present review are to explore the existing literature on predictors of use of coercive measures and to explore the relationship between coercive measures and patient outcome. A literature search was conducted using MEDLINE, PsychyINFO, Scopus, Web of Knowledge and the Cochrane Database. In all selected papers, references were cross-checked to identify other possible eligible papers. The use of coercive measures was predicted by patients' clinical and socio-demographic features, staff characteristics and ward-related factors. Coercive measures have only a limited impact on patients' clinical and social outcome. At the current level of knowledge, coercion is still a controversial issue in mental health practice. Only few studies with a solid methodology have been carried out. Large multicenter and rigorous studies, with long-term follow-ups, are highly needed.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Naples SUN, Naples, Italy
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77
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Soares MH, de Vargas D. [The translation and cultural adaptation of the Management of Aggression and Violence Attitude Scale - MAVAS - for nurses in Brazil]. Rev Esc Enferm USP 2013; 47:899-906. [PMID: 24310688 DOI: 10.1590/s0080-623420130000400018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 02/13/2013] [Indexed: 11/22/2022] Open
Abstract
This study translated and culturally adapted the Management of Aggression and Violence Attitude Scale - MAVAS - for use in Brazil (BR). The methodology followed the international guidelines for the cultural adaptation of psychometric scales: conceptual equivalence, semantic equivalence, items equivalence, and operational equivalence. A group of judges performed a content validity analysis that resulted in a 23-item scale divided into four factors with satisfactory content validity coefficients (CVCs) for the following parameters: clarity of language (CL; 0.88), practical relevance (PR; 0.91), and theoretical relevance (TR; 0.92). The data were collected in Londrina, state of Paraná, BR in 2011. The MAVAS was translated and culturally adapted for use in BR, and the MAVAS-BR exhibited satisfactory content validity. Future studies concerning the MAVAS-BR are suggested, including the evaluation of psychometric qualities, such as its construct validity and reliability.
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Affiliation(s)
- Marcos Hirata Soares
- Department of Nursing, Centro de Ciências da Saúde, Universidade Estadual de Londrina, LondrinaPR, Brasil,
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78
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Cutcliffe JR, Riahi S. Systemic perspective of violence and aggression in mental health care: towards a more comprehensive understanding and conceptualization: part 2. Int J Ment Health Nurs 2013; 22:568-78. [PMID: 23750853 DOI: 10.1111/inm.12028] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This is the second of a two part paper which seeks to explore a wide range of phenomena that have been found to have an association with aggression and violence (A/V) in inpatient mental health care, synthesize these propositions according to fit or congruence into a systemic model of A/V, explore the empirical evidence pertaining to these propositions, and begin to consider application of this model to better inform our individual and/or organizational responses to A/V in mental health care. The systemic model is comprised of four thematic categories with part two of the paper focusing on the final two categories: mental health-care system-related phenomena and clinician-related phenomena. The paper then discusses a number of implications arising out of embracing a more systemic model of A/V in mental health care. In broadening our understanding to include all the phenomena that contribute increased risk of A/V incidents, we are able to move away from inaccurate views that disproportionately assign 'responsibility' to clients for causing A/V when the evidence indicates that the client-related phenomena may only account for a small portion of these incidents.
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Affiliation(s)
- John R Cutcliffe
- University of Ottawa, Ottawa, Ontario, Canada; School of Nursing, University of Coimbra, Coimbra, Portugal; University of Malta, Msida, Malta
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79
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Gaskin CJ, McVilly KR, McGillivray JA. Initiatives to reduce the use of seclusion and restraints on people with developmental disabilities: a systematic review and quantitative synthesis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:3946-3961. [PMID: 24025440 DOI: 10.1016/j.ridd.2013.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 08/05/2013] [Indexed: 06/02/2023]
Abstract
Contrary to the expectations articulated in public policy, restrictive interventions are commonly used in support services for people with developmental disabilities. This systematic review and quantitative synthesis was undertaken to investigate whether the use of seclusion and restraints on people with developmental disabilities can be reduced. Searches of the Academic Search Complete, CINAHL, MEDLINE, and PsycINFO electronic databases returned 7226 records, of which 11 met the inclusion criteria for this review. A further 3 papers were obtained through scanning the reference lists of those articles included from the initial literature search. All 14 studies were single-subject designs focusing on initiatives to reduce physical or mechanical restraint. Between the baseline and intervention phases, there were mean reductions in the frequency and duration of restraint use of 79% (SD=21%, n=13 subjects from 7 studies) and 45% (SD=58%, n=10 subjects from 6 studies), respectively. For studies in which restraint use to manage agitation and aggression was targeted, there was a 79% (SD=21%, n=13 subjects from 7 studies) decrease in the frequency and a 28% (SD=67%, n=6 subjects from 3 studies) reduction in the duration of restraint. With respect to studies in which restraint use to prevent self-harm was targeted, there was a 71% (SD=34%, n=4 subjects from 3 studies) reduction in restraint use. Effect sizes were calculable, using non-overlap approaches, for 9 of the 14 studies. The magnitudes of the effect sizes suggest that, on average, the interventions were effective in reducing the use of restraints. The effects generated in studies where restraint use for self-harm was targeted were typically more pronounced than those in which restraint use for agitation and aggression was addressed. There were broad variations, however, in the percentage reductions in restraint use and in the magnitudes of the effect sizes. Although the findings of this review are encouraging, more research is needed, in which greater attention must be paid to rigorous research design, application, and analysis.
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Affiliation(s)
- Cadeyrn J Gaskin
- Centre for Mental Health and Wellbeing Research, School of Psychology, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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80
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Rickard ED, Chan J, Merriman B. Issues Emanating From the Implementation of Policies on Restraint Use With People With Intellectual Disabilities. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2013. [DOI: 10.1111/jppi.12047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Jeffrey Chan
- University of Queensland; Brisbane QLD Australia
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81
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Paterson B, McIntosh I, Wilkinson D, McComish S, Smith I. Corrupted cultures in mental health inpatient settings. Is restraint reduction the answer? J Psychiatr Ment Health Nurs 2013; 20:228-35. [PMID: 22632655 DOI: 10.1111/j.1365-2850.2012.01918.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The early years of the 21st century have seen successful efforts in a number of countries to reduce the use of restraint in services for people with mental health problems. An underlying emphasis on 'cultural change' is characteristic of such initiatives reflecting, it appears, the re-emergence of interest in the therapeutic milieu. Such efforts have though lacked a comprehensive explanation of how organizational culture plays a role in the development of the excessive use of restraint, which seems to respond to such initiatives. This paper seeks to address that deficit and draws in particular on the concepts of corrupted culture, institutional violence, trauma, parallel processing and contemporary research on restraint and seclusion reduction. In doing so it examines whether restraint reduction initiatives represent part of the solution to the problem of corruption, which is intrinsically associated with the legitimatization of coercion.
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Affiliation(s)
- B Paterson
- School of Nursing Midwifery, University of Stirling, Stirling, UK.
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82
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Vruwink FJ, Mulder CL, Noorthoorn EO, Uitenbroek D, Nijman HLI. The effects of a nationwide program to reduce seclusion in the Netherlands. BMC Psychiatry 2012; 12:231. [PMID: 23249413 PMCID: PMC3538066 DOI: 10.1186/1471-244x-12-231] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 12/15/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND From 2006 to 2009, the Dutch government provided €5 m annually for a nationwide program to reduce seclusion in psychiatric hospitals by 10% a year. We aimed to establish whether the numbers of both seclusion and involuntary medication changed significantly after the start of this national program. METHODS Using Poisson regression to estimate difference in logit slopes, we analyzed data for 1998-2009 from the Dutch Health Care Inspectorate, retrospectively examining the national numbers of seclusion and involuntary medication before and after the start of the program. RESULTS The difference in slopes of the numbers of seclusion before and after the start of the program was statistically significant (difference 5.2%: p < 0.001). After the start of the program seclusions dropped 2.0% per year. Corrected for the increasing number of involuntary hospitalizations this figure was 4.7% per year. The difference in slopes of the numbers of involuntary medication did not change statistically significant (difference 0.5%, n.s.). After correction for the increasing number of involuntary hospitalizations the difference turned significant (difference 3.3%, p = 0.002). CONCLUSIONS After the start of the nationwide program the number of seclusions fell, and although significantly changing, the reduction was modest and failed to meet the objective of a 10% annual decrease. The number of involuntary medications did not change; instead, after correction for the number of involuntary hospitalizations, it increased.
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Affiliation(s)
| | - Cornelis L Mulder
- Public Mental Health, Research Center O3, Erasmus MC, Rotterdam, the Netherlands,Bavo Europoort, Mental Health Center Rotterdam, Prins Constantijnweg 48-54, 3066 TA, Rotterdam, the Netherlands
| | - Eric O Noorthoorn
- GGNet, Bestuursbureau, PO Box 2003, 7230 GC, Warnsveld, the Netherlands
| | - Daan Uitenbroek
- Quantitative Skills, Consultancy for Research and Statistics, Lieven de Keylaan 7, 1222 LC, Hilversum, The Netherlands
| | - Henk LI Nijman
- Forensic psychology, Behavioural Science Institute (BSI), Radboud University, Nijmegen, the Netherlands,Altrecht Aventurijn, Dolderseweg 164, 3734 BN, Den Dolder, the Netherlands
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83
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Novak T, Scanlan J, McCaul D, MacDonald N, Clarke T. Pilot study of a sensory room in an acute inpatient psychiatric unit. Australas Psychiatry 2012; 20:401-6. [PMID: 23014117 DOI: 10.1177/1039856212459585] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The use of sensory rooms (also known as comfort rooms) to reduce seclusion rates has generated a great deal of interest. This study examined the outcomes associated with the introduction of a sensory room in an acute inpatient psychiatric unit. METHOD Consumers rated distress and staff rated a variety of disturbed behaviours before and after each use of the room. Items used during each episode were recorded. RESULTS Use of the room was associated with significant reductions in distress and improvements in a range of disturbed behaviours. Those individuals who used the weighted blanket reported significantly greater reductions in distress and clinician-rated anxiety than those who did not. No changes were noted in rates of seclusion or aggression. CONCLUSIONS The sensory room was an effective intervention to ameliorate distress and disturbed behaviour, although this did not translate into reductions in overall rates of seclusion or aggression. Weighted blankets appear to be particularly useful.
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Affiliation(s)
- Theresa Novak
- Missenden Psychiatric Unit, Sydney and South Western Sydney Local Health Districts, Sydney, NSW, Australia.
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Paccione-Dyszlewski MR, Conelea CA, Heisler WC, Vilardi JC, Sachs HT. A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome. J Psychiatr Pract 2012; 18:304-11. [PMID: 22805906 DOI: 10.1097/01.pra.0000416022.76085.9e] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.
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85
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Goetz SB, Taylor-Trujillo A. A change in culture: violence prevention in an acute behavioral health setting. J Am Psychiatr Nurses Assoc 2012; 18:96-103. [PMID: 22442017 DOI: 10.1177/1078390312439469] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A multilayered implementation of safety measures in an inpatient psychiatric facility created a sustained change in culture related to patient and staff safety. The model was developed over a 5-year period in a freestanding 80-bed behavioral health facility that is part of a Level II trauma center in the Midwest. The model has nine components that the nursing leadership team saw as integral to maintaining a safe environment. The nine elements include trauma-informed care principles, aggression management, code event review, leadership involvement, quality feedback, recovery orientation, patient assessment, education, and collaboration. The metrics collected to determine the effectiveness of the model included patient violence events and staff injuries. This article describes the development of this model and its impact on the reduction of patient violence events and staff injuries at this facility. The recommendations include considerations for the replication of this model at other facilities.
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Affiliation(s)
- Suzanne Barnum Goetz
- Richard H. Young Hospital, Good Samaritan Health Systems, Kearney, NE 68845, USA.
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86
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Abstract
This study examined patients' preferences for coercive methods and the extent to which patients' choices were determined by previous experience, demographic, clinical and intervention-setting variables. Before discharge from closed psychiatric units, 161 adult patients completed a questionnaire. The association between patients' preferences and the underlying variables was analyzed using logistic regression. We found that patients' preferences were mainly defined by earlier experiences: patients without coercive experiences or who had had experienced seclusion and forced medication, favoured forced medication. Those who had been secluded preferred seclusion in future emergencies, but only if they approved its duration. This suggests that seclusion, if it does not last too long, does not have to be abandoned from psychiatric practices. In an emergency, however, most patients prefer to be medicated. Our findings show that patients' preferences cannot guide the establishment of international uniform methods for managing violent behaviour. Therefore patients' individual choices should be considered.
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87
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Exploring patterns of seclusion use in Australian mental health services. Arch Psychiatr Nurs 2011; 25:e1-8. [PMID: 21978809 DOI: 10.1016/j.apnu.2011.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/19/2011] [Accepted: 04/02/2011] [Indexed: 01/01/2023]
Abstract
Seclusion has remained a common practice in mental health services. In Australia, recent mental health policy has reflected a desire to reduce (and, if possible, eliminate) the use of seclusion. The collection and analysis of data on the use of seclusion have been identified as an important component of the success of reduction initiatives. A cross-sectional design was used in the collection of inpatient unit data on seclusions that occurred in 11 mental health services in Australia over a 6-month period. During this time, there were 4,337 episodes of care. One or more seclusions occurred in 6.8% of episodes of care, with consumers being secluded, on average, 2.32 times and with 44% of them having been secluded more than once. The average length of the seclusions was 2 hours 52 minutes, with 51.4% of seclusions being less than 2 hours. These rates were lower than those reported in previous research studies. The practice of seclusion occurred more commonly on the first 2 days following admission, on weekdays than weekends, and between the hours of 9:00 a.m. and midnight. An understanding of seclusion data can provide fundamental information from which strategies to reduce seclusion can be developed.
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