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Bosch Alcaraz A, Corrionero Alegre J, Gil Domínguez S, Luna Castaño P, Piqueras Rodríguez P, Belda Hofheinz S, Ángeles Saz Roy M, Zuriguel Pérez E, Fernández Lorenzo R, Mata Ferro M, Martín Gómez A, Serradell Orea M, Martínez Oliva M, González Rivas S, Añaños Montoto N, José Espildora González M, Martín-Peñasco Osorio E, Carracedo Muñoz E, López Fernández E, Lozano Almendral G, Victoria Ureste Parra M, Gomez Merino A, García Martínez A, Morales Cervera D, Frade Pardo L, García Piñero JM. Intention to use physical restraint in paediatric intensive care units and correlated variables: A multicentre and cross-sectional study. Intensive Crit Care Nurs 2024; 83:103690. [PMID: 38598942 DOI: 10.1016/j.iccn.2024.103690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/31/2024] [Accepted: 03/17/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVES To determine the intention to use physical restraint (PR) and the relationship with sociodemographic and professional variables of the Paediatric Intensive Care Unit (PICU) nurses. RESEARCH METHODOLOGY/DESIGN AND SETTING A multicentre and correlational study was carried out from October 2021 to December 2023 in five paediatric intensive care units from five maternal and child hospitals in Spain. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire was provided. Moreover, sociodemographic and employment variables were registered. RESULTS A total of 230 paediatric nurses participated in the study. A total of 87.7 % were females with an average age of 35.5 ± 9.7 years and working experience of 10.5 ± 8.4 years. The mean scores obtained were 21.1 ± 3.8 for attitude, 13.1 ± 5.0 for subjective norms, 14.4 ± 4.3 for perceived behavioural control and 28.0 ± 6.0 for intention. The nurses apply more physical restraint to anxious patients, with scarce analgesics and sedation, those affected with pharmacological withdrawal symptoms and those with a high risk of accidental removal of vital support devices or fall from bed. The sex (p = 0.007) and type of employment contract (p = 0.01) are the variables that are significantly correlated with the intention to use of PR. CONCLUSION The paediatric nurses analysed had a moderate attitude, social pressure and perceived behavioural control towards the use of PR. IMPLICATIONS FOR CLINICAL PRACTICE It is important to know the factors that influence the intention to use physical restraint in order to standardise safe practice for critically ill paediatric and to ensure that patients' rights are respected by obtaining informed consent and assessing the prescription, continuation and removal of physical restraint.
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Affiliation(s)
- Alejandro Bosch Alcaraz
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona (UB), Barcelona, Spain; Mental Health, Psychosocial and Complex Nursing Care Research Group-NURSEARCH, University of Barcelona, Barcelona, Spain.
| | | | | | | | - Pedro Piqueras Rodríguez
- Pediatric Intensive Care Unit Nursing Supervisor, La Paz Hospital, Madrid, Spain; Research Member in Health Care, Health Research Institute, La Paz Hospital - IdiPAZ, Madrid, Spain
| | | | - M Ángeles Saz Roy
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona (UB), Barcelona, Spain; Mental Health, Psychosocial and Complex Nursing Care Research Group-NURSEARCH, University of Barcelona, Barcelona, Spain.
| | - Esperanza Zuriguel Pérez
- Nurse, Department of Knowledge Management and Evaluation, Vall d'Hebron Hospital, Barcelona, Spain; Multidisciplinary Nursing Research Group. Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | | | - María Mata Ferro
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, Barcelona, Spain
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Luccarelli J, Kalluri AS, Kalluri NS, McCoy TH. Pediatric Physical Restraint Coding in US Hospitals: A 2019 Kids Inpatient Database Study. Hosp Pediatr 2024; 14:337-347. [PMID: 38567417 PMCID: PMC11163444 DOI: 10.1542/hpeds.2023-007562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Reduction of physical restraint utilization is a goal of high-quality hospital care, but there is little nationally-representative data about physical restraint utilization in hospitalized children in the United States. This study reports the rate of physical restraint coding among hospitalizations for patients aged 1 to 18 years old in the United States and explores associated demographic and diagnostic factors. METHODS The Kids' Inpatient Database, an all-payors database of community hospital discharges in the United States, was queried for hospitalizations with a diagnosis of physical restraint status in 2019. Logistic regression using patient sociodemographic characteristics was used to characterize factors associated with physical restraint coding. RESULTS A coded diagnosis of physical restraint status was present for 8893 (95% confidence interval [CI]: 8227-9560) hospitalizations among individuals aged 1 to 18 years old, or 0.63% of hospitalizations. Diagnoses associated with physical restraint varied by age, with mental health diagnoses overall the most frequent in an adjusted model, male sex (adjusted odds ratio [aOR] 1.56; 95% CI: 1.47-1.65), Black race (aOR 1.43; 95% CI: 1.33-1.55), a primary mental health or substance diagnosis (aOR 7.13; 95% CI: 6.42-7.90), Medicare or Medicaid insurance (aOR 1.33; 95% CI: 1.24-1.43), and more severe illness (aOR 2.83; 95% CI: 2.73-2.94) were associated with higher odds of a hospitalization involving a physical restraint code. CONCLUSIONS Physical restraint coding varied by age, sex, race, region, and disease severity. These results highlight potential disparities in physical restraint utilization, which may have consequences for equity.
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Affiliation(s)
- James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Aditya S. Kalluri
- Harvard Medical School, Boston, MA, USA
- Boston Combined Residency Program in Pediatrics, Boston, MA 02115
| | - Nikita S. Kalluri
- Harvard Medical School, Boston, MA, USA
- Department of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115
| | - Thomas H. McCoy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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Versitano S, Shvetcov A, Paton J, Perkes I. Art therapy is associated with a reduction in restrictive practices on an inpatient child and adolescent mental health unit. J Ment Health 2024:1-9. [PMID: 38584367 DOI: 10.1080/09638237.2024.2332813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/26/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND The elimination of restrictive practices, such as seclusion and restraint, is a major aim of mental health services globally. The role of art therapy, a predominantly non-verbal mode of creative expression, is under-explored in this context. This research aimed to determine whether art therapy service provision was associated with a reduction in restrictive practices on an acute inpatient child and adolescent mental health services (CAMHS) unit. METHODS The rate (events per 1,000 occupied bed days), frequency (percent of admitted care episodes with incident), duration, and number of incidents of restrictive practices occurring between July 2015 and December 2021 were analysed relative to art therapy service provision. The rate, frequency and number of incidents of intramuscular injected (IM) sedation, oral PRN (as-needed medication) use, and absconding incidents occurring in conjunction with an episode of seclusion or restraint were also analysed. RESULTS The rate, frequency, duration, and total number of incidents of seclusion, the frequency and total number of incidents of physical restraint, and the rate, frequency and total number of incidents of IM sedation showed a statistically significant reduction during phases of art therapy service provision. CONCLUSIONS Art therapy service provision is associated with a reduction in restrictive practices in inpatient CAMHS.
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Affiliation(s)
- Sarah Versitano
- School of Social Sciences, Western Sydney University, Sydney, Australia
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, Australia
| | - Artur Shvetcov
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Psychiatry and Mental Health and Discipline of Paediatrics and Children's Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joy Paton
- School of Social Sciences, Western Sydney University, Sydney, Australia
| | - Iain Perkes
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Sydney, Australia
- Discipline of Psychiatry and Mental Health and Discipline of Paediatrics and Children's Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
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Moell A, Rozental A, Buchmayer S, Kaltiala R, Långström N. Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff. BMC Psychiatry 2024; 24:102. [PMID: 38317134 PMCID: PMC10845720 DOI: 10.1186/s12888-024-05553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care. METHODS During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context. RESULTS The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy. CONCLUSIONS The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.
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Affiliation(s)
- Astrid Moell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Susanne Buchmayer
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, and Tampere University Hospital, Department of Adolescent Psychiatry, Tampere University, Tampere, Finland
| | - Niklas Långström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Haran M, Killeen D, Healy M, Brophy P, Donohue A, Whyte I, Doody B. Prevalence and correlates of restrictive interventions in an Irish child and adolescent psychiatric unit: a 4-year retrospective study. Ir J Med Sci 2023; 192:2929-2936. [PMID: 36813877 PMCID: PMC10692034 DOI: 10.1007/s11845-023-03316-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND There has been a global effort to reduce the use of restrictive interventions (RIs) in healthcare settings. In order to reduce unnecessary RIs, it is essential to understand their use in mental health settings. To date, there have been few studies examining the use of RIs in child and adolescent mental health settings, with no such studies in Ireland. AIMS The purpose of this study is to examine the prevalence and frequency of physical restraints and seclusion and to identify any associated demographic and clinical characteristics. METHODS This is a 4-year retrospective study of the use of seclusion and physical restraint in an Irish child and adolescent psychiatric inpatient unit from 2018 to 2021. Computer-based data collection sheets and patient records were retrospectively reviewed. Eating disorder and non-eating disorder samples were analysed. RESULTS Of 499 hospital admissions from 2018 to 2021, 6% (n = 29) had at least one episode of seclusion and 18% (n = 88) had at least one episode of physical restraint. Age, gender and ethnicity were not significantly associated with rates of RI. Unemployment, prior hospitalization, involuntary legal status and longer length of stay were significantly associated with higher rates of RIs in the non-eating disorder group. Involuntary legal status was associated with higher rates of physical restraint in the eating disorder group. Patients with a diagnosis of eating disorder and psychosis had the highest prevalence of physical restraints and seclusions respectively. CONCLUSIONS Identifying youth who are at greater risk of requiring RIs may allow early and targeted intervention and prevention.
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Affiliation(s)
- Maeve Haran
- Department of Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland.
- Children's Health Ireland at Crumlin, Dublin, D12N512, Ireland.
| | - David Killeen
- Dublin North City and County CAMHS - Ballymun CAMHS, Ballymun Civic Centre, Dublin, Ireland
| | - Mike Healy
- Linn Dara Inpatient Unit, Cherry Orchard Hospital, Ballyfermot Rd, Cherry Orchard, Dublin, Ireland
| | - Peadar Brophy
- Linn Dara Inpatient Unit, Cherry Orchard Hospital, Ballyfermot Rd, Cherry Orchard, Dublin, Ireland
| | - Aoife Donohue
- Linn Dara Inpatient Unit, Cherry Orchard Hospital, Ballyfermot Rd, Cherry Orchard, Dublin, Ireland
| | - Imelda Whyte
- Linn Dara Inpatient Unit, Cherry Orchard Hospital, Ballyfermot Rd, Cherry Orchard, Dublin, Ireland
| | - Brendan Doody
- Linn Dara Inpatient Unit, Cherry Orchard Hospital, Ballyfermot Rd, Cherry Orchard, Dublin, Ireland
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
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DePorre AG, Larson I, Staggs VS, Nadler C. Characteristics of Patients Associated With Restraint Use at a Midwest Children's Hospital. Hosp Pediatr 2023; 13:877-885. [PMID: 37691599 DOI: 10.1542/hpeds.2023-007210] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Restraint use is associated with negative mental health outcomes, injury risk, and known disparities in use. Improved understanding of restraint use among hospitalized children is critical given the increased frequency of hospitalized children with complex and/or acute mental health needs. Our objective is to describe the demographic and clinical features of children associated with mechanical restraint. METHODS In a single-center retrospective cohort study of patients hospitalized from 2017 to 2021, restraint encounters were identified from electronic health records. Odds of restraint was modeled as a function of patient demographic and clinical characteristics, as well as hospitalization characteristics using logistic regression modeling adjusted for clustering of hospitalizations within patients and for varying lengths of stay. RESULTS Among 29 808 children (46 302 encounters), 225 patients (275 encounters) had associated restraint use. In regression modeling, odds of restraint were higher with restraint at the preceding hospitalization (adjusted odds ratio [aOR] 8.6, 95% confidence interval [CI] 4.8-15.5), diagnosis of MH conditions such as psychotic disorders (aOR 5.4, 95% CI 2.7-10.4) and disruptive disorders (aOR 4.7, 95% CI 2.8-7.8), male sex (aOR 1.9, 95% CI 1.5-2.5), and Black race (aOR relative to White patients 1.9, 95% CI 1.4-2.6). CONCLUSIONS Our results suggest racial inequities in restraint use for hospitalized children. This finding mirrors inequities in restraint use in the emergency department and adult settings. Understanding the behavioral needs of such patients may help in reducing restraint use and improving health equity.
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Affiliation(s)
- Adrienne G DePorre
- Division of Hospital Medicine, Department of Pediatrics
- University of Missouri - Kansas City
- University of Kansas Medical Center, Kansas City, Kansas
| | | | - Vincent S Staggs
- Biostatistics & Epidemiology Core
- University of Missouri - Kansas City
| | - Cy Nadler
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
- University of Missouri - Kansas City
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Kelly P, Saab MM, Hurley EJ, Heffernan S, Goodwin J, Mulud ZA, O Malley M, O Mahony J, Curtin M, Groen G, Ivanova S, Jörns-Presentati A, Korhonen J, Kostadinov K, Lahti M, Lalova V, Petrova G, O Donovan A. Trauma Informed Interventions to Reduce Seclusion, Restraint and Restrictive Practices Amongst Staff Caring for Children and Adolescents with Challenging Behaviours: A Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:629-647. [PMID: 37593061 PMCID: PMC10427579 DOI: 10.1007/s40653-023-00524-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 08/19/2023]
Abstract
Engaging with children and adolescents in mental health settings who are exhibiting behaviours that challenge can often result in the use of seclusion, restraint and coercive practices. It is recognised that more therapeutic ways to engage this population are needed, adopting trauma informed interventions may provide a solution. The aim of this systematic review is to synthesize the evidence in relation to the effect of trauma-informed interventions on coercive practices in child and adolescent residential settings. The review is guided by elements of the Cochrane Handbook for Systematic Reviews of Interventions and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. Results were synthesized and reported narratively. Nine studies met the eligibility criteria for this review. There was a lack of homogeneity amongst the studies. The trauma-informed interventions used were typically multi-faceted, underpinned by a variety of approaches and sought to bring about changes to clinical practice. Most studies (n = 8) reported significant reductions in the use of restrictive practices following the implementation of a trauma informed approach. The use of a trauma-informed approach, underpinned by an organisational change or implementation strategy, have the potential to reduce coercive practices with children and adolescents. However, the included interventions were insufficiently described to draw strong conclusions.
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Affiliation(s)
- Peter Kelly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mohamad M. Saab
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Emma J. Hurley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sinéad Heffernan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Zamzaliza A. Mulud
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
- Centre for Nursing Studies, Universiti Teknologi MARA Selangor, Puncak Alam, Selangor, Malaysia
| | - Maria O Malley
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - James O Mahony
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Margaret Curtin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Gunter Groen
- Sciences Hamburg Department of Social Work, University of Applied, Hamburg, Germany
| | - Svetla Ivanova
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Joonas Korhonen
- Faculty of Health and Well-Being, Turku University of Applied Science, Turku, Finland
| | - Kostadin Kostadinov
- Department of Social Medicine and Public Health, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Mari Lahti
- Faculty of Health and Well-Being, Turku University of Applied Science, Turku, Finland
| | - Valentina Lalova
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Gergana Petrova
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Aine O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Jones N, Decker VB, Houston A. De-Escalation Training for Managing Patient Aggression in High-Incidence Care Areas. J Psychosoc Nurs Ment Health Serv 2023; 61:17-24. [PMID: 36853038 DOI: 10.3928/02793695-20230221-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Health care personnel who have close, face-to-face patient contact experience more workplace violence (WPV) than employees in other fields. Certain health care departments (i.e., high-incidence care areas) have elevated rates of WPV that can have adverse emotional, physical, and financial consequences for patients, employees, and institutions. Health care workers need de-escalation training to efficiently manage patient aggression while also safeguarding patients' dignity and patient-provider trust. The current Plan, Do, Study, Act quality improvement project used insights from an in-depth literature review to create a 1-hour, evidence-based, in-service de-escalation training for personnel from high-incidence care areas. A pre/post design was used to evaluate participants' responses to the Confidence Coping with Patient Aggression Instrument. Post-training, participants reported significantly increased feelings of safety regarding potential patient aggression (p = 0.001) and more efficacy regarding their aggression management techniques (p = 0.039). Based on the training's results, recommendations were made for future institutional de-escalation initiatives. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 17-24.].
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Pértega E, Holmberg C. A systematic mapping review identifying key features of restraint research in inpatient pediatric psychiatry: A human rights perspective. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 88:101894. [PMID: 37244128 DOI: 10.1016/j.ijlp.2023.101894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Restraints, a highly regulated and contentious measure in pediatric psychiatry, have significant negative impacts on children. The application of international human rights standards, such as the Convention of the Rights of the Child (CRC) and the Convention of the Rights of Persons with Disabilities (CRPD), has spurred global efforts to reduce or eliminate the use of restraints. However, a lack of consensus on definitions and terminology, as well as quality indicators in this field, hinders the ability to compare studies and evaluate interventions consistently. AIM To systematically map existing literature on restraints imposed upon children in inpatient pediatric psychiatry against a human rights perspective. Specifically, to identify and clarify gaps in literature in terms of publication trends, research approaches, study contexts, study participants, definitions and concepts being used, and legal aspects. These aspects are central to assess whether published research is contributing to achieve the CRPD and the CRC in terms of interpersonal, contextual, operational, and legal requirements of restraints. METHODS A systematic mapping review based on PRISMA guidelines was conducted, adopting a descriptive-configurative approach to map the distribution of available research and gaps in the literature about restraints in inpatient pediatric psychiatry. Six databases were searched for literature reviews and empirical studies of all study designs published between each database's inception and March 24, 2021, manually updated on November 25, 2022. RESULTS The search yielded 114 English-language publications, with a majority (76%) comprising quantitative studies that relied primarily on institutional records. Contextual information about the research setting was provided in less than half of the studies, and there was an unequal representation of the three main stakeholder groups: patients, family, and professionals. The studies also exhibited inconsistencies in the terms, definitions, and measurements used to examine restraints, with a general lack of attention given to human rights considerations. Additionally, all studies were conducted in high-income countries and mainly focused on intrinsic factors such as age and psychiatric diagnosis of the children, while contextual factors and the impact of restraints were not adequately explored. Legal and ethical aspects were largely absent, with only one study (0.9%) explicitly referencing human rights values. CONCLUSIONS Research on restraints of children in psychiatric units is increasing; however, inconsistent reporting practices hinder the understanding of the meaning and frequency of restraints. The exclusion of crucial features, such as the physical and social environment, facility type, and family involvement, indicates inadequate incorporation of the CRPD. Additionally, the lack of references to parents suggests insufficient consideration of the CRC. The shortage of quantitative studies focusing on factors beyond patient-related aspects, and the general absence of qualitative studies exploring the perspectives of children and adolescents regarding restraints, suggest that the social model of disability proposed by the CRPD has not yet fully penetrated the scientific research on this topic.
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Affiliation(s)
- Elvira Pértega
- Faculty of Law, University of Technology Sydney, Sydney, Australia; Child and Adolescens Mental Health Department, Hospital Lucus augusti, Lugo, Spain.
| | - Christopher Holmberg
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
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Gallen K, Sonnenberg J, Loughran C, Smith MJ, Sheppard M, Schuster K, Kaufman E, Song JS, Hall EC. Health Effects of Policing in Hospitals: a Narrative Review. J Racial Ethn Health Disparities 2023; 10:870-882. [PMID: 35267188 DOI: 10.1007/s40615-022-01275-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Law enforcement activity, in the form of outside agencies or hospital security forces, is increasingly common in American healthcare. Little is known about the potential effects of this prevalent, modifiable exposure on hospital staff and patient health. This narrative review characterizes existing evidence on the direct and indirect health effects of law enforcement activity in hospitals. OBSERVATIONS Law enforcement activity in hospitals can affect health outcomes through four mechanisms: (1) physical health effects related to workplace violence, restraint use, excessive force, and weapon use; (2) mental health effects involving perceptions of safety and psychological distress; (3) social effects related to the patient-provider relationship, mistrust, and bias and discrimination; and (4) legal and ethical considerations affecting overall well-being. CONCLUSIONS AND RELEVANCE Unchecked law enforcement activity in hospitals may risk patient physical and mental health, reduce patient trust, result in bias and discrimination, and contribute to legal and ethical rights violations. Importantly, law enforcement activity in hospitals may also contribute to staff perceptions of safety. To fill knowledge gaps on the measurable impact of law enforcement activity in the hospital on staff and patients, hospitals should collect and publicly share robust data on law enforcement activity in their facilities, create and adopt patient-centered policies to ensure safety and protect patient health and privacy, and implement evidence-based interventions that safely reduce law enforcement involvement with patients.
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Affiliation(s)
- Kate Gallen
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | | | - Mildred Sheppard
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Kirsten Schuster
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ji Seon Song
- School of Law, University of California, Irvine, CA, USA
| | - Erin C Hall
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA.
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11
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Baker J, Kendal S, Berzins K, Canvin K, Branthonne‐Foster S, McDougall T, Goldson B, Kellar I, Wright J, Duxbury J. Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study. CHILDREN & SOCIETY 2022; 36:1351-1401. [PMID: 36588794 PMCID: PMC9790399 DOI: 10.1111/chso.12581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 06/17/2023]
Abstract
Restrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad-scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings.
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Affiliation(s)
| | | | | | | | | | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | | | | | | | - Joy Duxbury
- Manchester Metropolitan UniversityManchesterUK
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12
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Magnowski SR, Kick D, Cook J, Kay B. Algorithmic Prediction of Restraint and Seclusion in an Inpatient Child and Adolescent Psychiatric Population. J Am Psychiatr Nurses Assoc 2022; 28:464-473. [PMID: 33251913 DOI: 10.1177/1078390320971014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restraint and seclusion in an inpatient child and adolescent psychiatric population adversely affects the overall value and safety of care. Due to adverse events, negative outcomes, and associated costs, inpatient psychiatric hospitals must strive to reduce and ultimately eliminate restraint and seclusion with innovative, data-driven approaches. AIM To identify patterns of client characteristics that are associated with restraint and seclusion in an inpatient child and adolescent psychiatric population. METHOD A machine learning application of fast-and-frugal tree modeling was used to analyze the sample. RESULTS The need for restraint and seclusion were correctly predicted for 73% of clients at risk (sensitivity), and 76% of clients were correctly predicted as negative or low risk (specificity), for needing restraint and seclusion based on the following characteristics: having a disruptive mood dysregulation disorder and/or attention-deficit hyperactivity disorder diagnosis, being 12 years old or younger, and not having a depressive and/or bipolar disorder diagnosis. CONCLUSIONS The client characteristics identified in the predictive algorithm should be reviewed on admission to recognize clients at risk for restraint and seclusion. For those at risk, interventions should be developed into an individualized client treatment plan to facilitate a proactive approach in preventing behavioral emergencies requiring restraint and seclusion.
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Affiliation(s)
- Stefani R Magnowski
- Stefani R. Magnowski, DNP, RN, NE-BC, CPHQ, Rogers Behavioral Health, Oconomowoc, WI, USA
| | - Dalton Kick
- Dalton Kick, MS, Rogers Behavioral Health, Oconomowoc, WI, USA
| | - Jessica Cook
- Jessica Cook, MS, Rogers Behavioral Health, Oconomowoc, WI, USA
| | - Brian Kay
- Brian Kay, MS, Rogers Behavioral Health, Oconomowoc, WI, USA
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13
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Dror C, Hertz-Palmor N, Barzilai Y, Gila S, Tali BZ, Alex G, Tal L, Maya KL, Talia S, Doron G, Bloch Y. Youth Psychiatric Hospitalization in Israel during COVID-19: A Multi-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9870. [PMID: 36011509 PMCID: PMC9407708 DOI: 10.3390/ijerph19169870] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
During the COVID-19 pandemic there have been numerous reports of increases in psychiatric morbidity and a deterioration of status among existing patients. There is little information about how this increase has affected youth and rates of adolescent psychiatric hospitalization. Our study was aimed at examining trends in youth psychiatric hospitalization during the first year of the COVID-19 pandemic. Method: We used medical records to compare trends in hospitalization rates from 2019 to 2020, among psychiatric youth wards from five different centers in Israel. Results: The number of patients that were hospitalized in youth psychiatric wards decreased significantly from 2019 (Mean ± SD=52.2 ± 28.6 per month) to 2020 (M ± SD = 40.8 ± 22.0; unstandardized B = −11.4, 95% CI = −14.4 to −8.3, p < 0.0001). There was a significant decrease in the number of patients that were hospitalized due to internalizing disorders from 2019 (M ± SD = 22.3 ± 9.3 per month) to 2020 (M ± SD = 16.8 ± 7.7; B = −5.5, 95% CI = −8.0 to −3.0, p = 0.0002) and a marginally significant increase in the number of restraints per month (2019: M ± SD = 2.8 ± 6.8, 2020: M ± SD = 9.0 ± 14.5; Z = −1.96, Rosenthal’s r = 0.36, p = 0.07). Conclusions: There was a significant decline in psychiatric hospitalizations during the pandemic, specifically among patients suffering from internalizing disorders. The reasons for this decline, and the future impact these changes had on hospitalizations during the pandemic demand further research. Study limitations: This is a retrospective multicenter study from five medical centers in Israel, therefore generalizability of our findings is limited.
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Affiliation(s)
- Chen Dror
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Nimrod Hertz-Palmor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yael Barzilai
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
| | - Schoen Gila
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Bretler-Zager Tali
- Ziv Medical Center (Safed), Safed 13100, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Poriya 15208, Israel
| | - Gizunterman Alex
- Eitanim Mental Health Center, Harav Rafael Katzalbogen, Jerusalem 9097200, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Lahav Tal
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Nes-ziona Mental Health Center, Beer Yaakov 70350, Israel
| | - Kritchmann-Lupo Maya
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Saker Talia
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Gothelf Doron
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yuval Bloch
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
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14
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Boulton KA, Raghupathy V, Guastella AJ, Bowden MR. Reducing seclusion use in an Australian child and adolescent psychiatric inpatient unit. J Affect Disord 2022; 305:1-7. [PMID: 35227762 DOI: 10.1016/j.jad.2022.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions. METHOD Multi-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions. RESULTS There was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July-September 2015, to 4.7 episodes in January-March 2016, reaching 0.0 episodes by April-June 2016. This reduction was maintained until April-June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant. LIMITATIONS Due to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change. CONCLUSIONS Multidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions.
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Affiliation(s)
- Kelsie A Boulton
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Veena Raghupathy
- Psychological Medicine, Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, Australia
| | - Adam J Guastella
- Autism Clinic for Translational Research, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Child Neurodevelopment and Mental Health Team, Brain and Mind Centre, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Michael R Bowden
- Psychological Medicine, Children's Hospital at Westmead, Sydney Children's Hospital Network, Sydney, Australia; Mental Health - Children and Young People, Mental Health Branch, NSW Health, Sydney, Australia; Faculty of Medicine and Health, Sydney Medical School, University of Sydney, Sydney, Australia
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15
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Perers C, Bäckström B, Johansson BA, Rask O. Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care. Psychiatr Q 2022; 93:107-136. [PMID: 33629229 PMCID: PMC8993718 DOI: 10.1007/s11126-021-09887-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Abstract
Restraints and seclusions are restrictive interventions used in psychiatric inpatient units when there is an imminent risk of harm to the patient or others. Coercive measures are controversial and can lead to negative consequences, including negative emotions, re-traumatization, injuries, or death. The article summarizes the last 10 years of literature regarding methods and strategies used for reducing seclusions and restraints in child and adolescent psychiatric inpatient units, and reports on their outcomes. The literature was reviewed by searching PubMed and PsycInfo for English-language articles published between May 2010 and May 2020. Eighteen articles were found that described methods or strategies aimed at reducing restraint or seclusion utilization in child and adolescent psychiatric inpatient units. The following interventions were evaluated: Trauma-Informed Care (TIC), Six Core Strategies, Child and Family Centered Care (CFCC), Collaborative & Proactive Solutions (CPS), Strength-Based Care, Modified Positive Behavioral Interventions and Supports (M-PBIS), Behavioral Modification Program (BMP), Autism Spectrum Disorder Care Pathway (ASD-CP), Dialectical Behavior Therapy (DBT), sensory rooms, Mindfulness-Based Stress Reduction Training (MBSR) of staff, and Milieu Nurse-Client Shift Assignments. Most of the interventions reduced the use of seclusions and/or restraints. Two child-centered and trauma-informed initiatives eliminated the use of mechanical restraints. This review shows that the use of coercive measures can be reduced and should be prioritized. Successful implementation requires ongoing commitment on all levels of an organization and a willingness to learn. To facilitate comparisons, future models should evaluate different standardized parameters.
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Affiliation(s)
| | - Beata Bäckström
- Skåne Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden
| | - Björn Axel Johansson
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden
- Skåne Child & Adolescent Psychiatry, Regional Inpatient Care, Emergency Unit, Malmö, Sweden
| | - Olof Rask
- Skåne Child & Adolescent Psychiatry, Unit for Pediatric Bipolar & Psychotic Disorders, Lund, Sweden
- Department of Clinical Sciences Lund, Division of Child & Adolescent Psychiatry, Lund University, Lund, Sweden
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16
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Boel-Studt SM. Treatment Mediators and Outcomes of Latent Classes of Youth in Psychiatric Residential Treatment. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:15-26. [PMID: 35222772 PMCID: PMC8837761 DOI: 10.1007/s40653-021-00344-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 06/14/2023]
Abstract
The purpose of this study was to examine differences in discharge outcomes between latent classes of youth in psychiatric residential treatment. The mediating effect of family therapy, behavioral management incidents, and length of stay on class membership and treatment outcomes were examined. The sample included 447 youth assigned to one of four classes. Guided by Thornberry and Krohn's (2005) interactional theory of continuity and change, change in functional impairment was predicted based on the composition of risk versus protective factors that comprised the latent classes. A manual 3-step approach was used to fit a latent class mixture model and estimate conditional effects on impairment at discharge. A mediation model was used to examine indirect effects of treatment factors on outcomes between latent classes. The results showed that classes with lower-level risk factors and more protective factors experienced significantly greater reductions in impairment on average. Treatment outcomes were mediated by behavioral management incidents but not length of stay or the number family therapy sessions. The results demonstrate the usefulness of person-centered approaches for conducting subgroup analyses in residential care outcomes studies; highlighting differences in outcomes between groups and treatment factors that may mediate these differences.
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Affiliation(s)
- Shamra M. Boel-Studt
- College of Social Work, Florida State University, 296 Champions Way, University Center-C, Tallahassee, FL USA
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17
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Griffiths R, Dawber A, McDougall T, Midgley S, Baker J. Non-restrictive interventions to reduce self-harm amongst children in mental health inpatient settings: Systematic review and narrative synthesis. Int J Ment Health Nurs 2022; 31:35-50. [PMID: 34626155 PMCID: PMC9293022 DOI: 10.1111/inm.12940] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/03/2021] [Accepted: 09/27/2021] [Indexed: 11/30/2022]
Abstract
Rates of self-harm amongst children appear to be increasing. This presents challenges for practitioners responsible for maintaining the safety of children admitted to mental health inpatient settings. Policy guidelines recommend that practitioners should aim to avoid the use of restrictive practices for children. It is currently unclear, however, what evidence-based alternatives to restrictive practices are available. We aimed to identify what non-restrictive interventions have been proposed to reduce self-harm amongst children in mental health inpatient settings and to evaluate the evidence supporting their use in clinical practice. A systematic search of five databases (CINAHL, Embase, Ovid MEDLINE, APA Psycinfo, and Cochrane) was conducted to identify articles reporting on non-restrictive interventions aimed at reducing self-harm amongst children in mental health inpatient settings. Articles were quality assessed and relevant data were extracted and synthesized using narrative synthesis. Searches identified relatively few relevant articles (n = 7) and these were generally of low methodological quality. The underlying theoretical assumptions and putative mechanisms of change for the interventions described were often unclear. Despite concerns about the rates of self-harm amongst children in mental health inpatient settings, there is a lack of high-quality research to inform clinical practice. There is an urgent need to develop effective non-restrictive interventions aimed at reducing self-harm for children using inpatient mental health services. Intervention development should be theoretically informed and be conducted in collaboration with people who have lived experience of this issue.
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Affiliation(s)
- Robert Griffiths
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Alison Dawber
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Tim McDougall
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Salli Midgley
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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18
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Yates NJ, Lathlean J. Exploring factors that influence success when introducing "The Safewards Model" to an acute adolescent ward: A qualitative study of staff perceptions. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2022; 35:218-229. [PMID: 35080065 PMCID: PMC9544454 DOI: 10.1111/jcap.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 11/23/2021] [Accepted: 01/03/2022] [Indexed: 11/28/2022]
Abstract
Problem The Safewards’ model identifies factors that can lead to conflict and addresses these factors, using ten interventions, within inpatient mental health wards aiming to reduce “conflict and containment.” The Department of Health (2014) and Care Quality Commission (2017) supported the use of Safewards to reduce restrictive practice across all mental health settings in the UK, but its application to adolescent mental health remains relatively unexplored. This study therefore aims to address the research question: “What are the factors influencing the success of ten Safewards’ interventions when implemented onto an acute adolescent ward?” Methods Eight healthcare assistants and two nurses who had attended Safewards’ training participated in semi‐structured interviews four months after Safewards was introduced to an acute adolescent ward. The interviews were transcribed verbatim and analyzed using thematic analysis. Data analysis was conducted inductively by developing data‐driven themes. Findings Many of the factors influencing Safewards’ success in adolescent mental health (e.g., acuity; dependence on nonregular staffing; lack of leadership and operating procedures) paralleled the evidence found in adult services. Conclusions This study contributes new information by implementing “mutual help” and “calm down” principles with adolescents, as well as discussing barriers of operational procedures and benefits of patient involvement.
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Affiliation(s)
- Nicholas J Yates
- Department of Health Sciences, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Judith Lathlean
- Department of Health Sciences, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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19
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Agraharkar S, Horwitz S, Lewis K, Goldstein G, Havens J, Gerson R. Agitation and Restraint in a Pediatric Psychiatric Emergency Program: Clinical Characteristics and Diagnostic Correlates. Pediatr Emerg Care 2021; 37:e836-e840. [PMID: 34908377 DOI: 10.1097/pec.0000000000002385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Agitation and restraint among pediatric psychiatric patients are a frequent, yet little studied, source of morbidity and, rarely, mortality in the emergency department (ED). This study examined agitation and restraint among youth patients in a specialized pediatric psychiatric ED, considering clinical and sociodemographic characteristics of those who required restraint to determine the clinical correlates of agitation and restraint in this population. METHODS This descriptive study was a 6-year retrospective chart review of all patients restrained for acute agitation. Demographics, clinical characteristics, diagnoses, and reasons for restraint were collected. Relationships between sociodemographic and clinical variables to types of restraints used were examined, along with change over the study period in rate of and mean time in restraint. RESULTS The average restraint rate was 1.94%, which remained fairly consistent throughout study period, although average time in restraint decreased significantly. Restraints were more common in males. Adolescents were overrepresented in the ED population, and after controlling for this, restraint rates were similar in adolescents and younger children. Physical aggression was the most frequent precipitant, although among adolescents verbal aggression was also a precipitant (more so than in younger children). Disruptive behavior disorder diagnoses were most frequently associated with restraint. CONCLUSIONS A lower rate of restraint is reported here than has been seen in programs where youths are treated in medical or adult psychiatric EDs. Hospitals without specialized pediatric psychiatric emergency programs should invest in staff training in deescalation techniques and in access to pediatric psychiatric treatment. The finding that, of youth restrained, a significant proportion were under 12 years old and/or carried diagnoses not typically associated with aggressive behavior, indicates that crisis prevention, management, and treatment should include younger populations and diverse diagnostic groups, rather than focusing narrowly on older patients with psychotic or substance use disorders.
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Affiliation(s)
- Shilpa Agraharkar
- From the New York University Langone Health Child Study Center, Bellevue Hospital, New York, NY
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20
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Bourke EM, Say DF, Carison A, Hill A, Craig S, Hiscock H, Babl FE, O'Donnell SM. Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder. J Paediatr Child Health 2021; 57:1572-1579. [PMID: 33963626 DOI: 10.1111/jpc.15535] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/13/2021] [Accepted: 04/21/2021] [Indexed: 11/29/2022]
Abstract
AIM To characterise the key features and management of young people presenting to the emergency department (ED) with a mental health (MH) complaint and a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). METHODS Retrospective review of all ED MH presentations in children aged 7-17 years, presenting over a 12-month period from the 1st of January 2018 to the 31st of December 2018, to the Royal Children's Hospital in Melbourne, Australia. Univariate analyses were carried out to examine the relationship between an underlying diagnosis of ASD and/or ADHD and a number of key presentation variables. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for ED management outcomes. RESULTS There were 374 presentations in this cohort, representing 28% of the total MH presentations in 2018. The most common reason for presentation was acute severe behavioural disturbance. Young people with ASD and ADHD were at increased risk of having an acute crisis team response activated (ASD RR 2.3, CI 1.6-3.3, ADHD RR 2.2, CI 1.2-4.1). Compared to those without either diagnosis, young people with ASD were more likely to be physically restrained (RR 2.8, CI 1.7-4.6), managed in seclusion (RR 3.3, CI 1.7-6.4) and to receive medication to assist with behavioural de-escalation (RR 2.8, CI 1.6-4.9). CONCLUSIONS Children with ASD and/or ADHD represent one-quarter of all children presenting to the ED with MH complaints. They experience high rates of acute severe behavioural disturbance. Future research is needed to co-design, implement and evaluate better approaches for their management.
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Affiliation(s)
- Elyssia M Bourke
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Daniela F Say
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anna Carison
- Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ashley Hill
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Simon Craig
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Emergency Department, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Unit, Royal Children's Hospital, Melbourne, Victoria, Australia.,Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Franz E Babl
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Sinead M O'Donnell
- Emergency Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia
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21
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Rassenhofer M, Korger S, Fegert JM, Hoffmann U. Häufigkeiten von Übergriffen auf Kinder und Jugendliche durch Angehörige der Heil- und Pflegeberufe. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Kindesmisshandlung, -missbrauch und Vernachlässigung stellen ein gesamtgesellschaftliches Entwicklungsrisiko für Kinder in Deutschland dar. Zweithäufigster Kontext des Geschehens nach dem familiären Umfeld sind Institutionen. Fragestellung: Der vorliegende Artikel gibt eine Übersicht zu Häufigkeiten von Übergriffen durch Angehörige der Heil- und Pflegeberufe mit Schwerpunkt auf dem kinder- und jugendpsychiatrischen/-psychotherapeutischen Bereich. Methode: Mittels Literaturrecherche wird der Forschungsstand zum Thema dargestellt. Ergebnisse: Neben Auswertungen zu Zwangsmaßnahmen, welche von Betroffenen häufig als viktimisierend erlebt werden, existieren für Deutschland zwei repräsentative retrospektive Befragungen zum medizinischen Bereich. Hier ergaben sich Prävalenzen zwischen einem Fünftel und einem Drittel der Befragten, die mindestens eine Form von Gewalt oder Vernachlässigung bejahten. Diskussion und Schlussfolgerung: Neben alarmierenden Zahlen zeigt sich der große Bedarf an weiterer Forschung zum Thema.
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Affiliation(s)
- Miriam Rassenhofer
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Simone Korger
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Ulrike Hoffmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
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22
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Nielson S, Bray L, Carter B, Kiernan J. Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. J Child Health Care 2021; 25:342-367. [PMID: 32633554 PMCID: PMC8422777 DOI: 10.1177/1367493520937152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Physical restraint is regularly used in children and adolescent mental health care, often as a reactive behaviour management strategy. Physical restraint has been associated with physical injury, but psychological consequences are poorly understood. The aim of this systematic review was to examine physical restraint of children and adolescents in inpatient mental healthcare services. Healthcare databases were searched to identify English language publications discussing anyone aged ≤18 years who had experienced physical restraint as a mental health inpatient. No date restrictions were applied. Sixteen quantitative studies are included within this review. Most studies are retrospective in nature. Publications were appraised using the Critical Appraisal Skills Programme quality assessment tool. Common characteristics associated with children and adolescents who experience physical restraint include age, gender, diagnosis, and history. Most studies associate physical restraint with the management of aggression. Findings suggest that it may be a combination of patient (intrinsic) and environmental (extrinsic) factors which ultimately lead to children and adolescents experiencing restraint. This review confirms that little is known about children and adolescents' first-hand experiences of physical restraint. Future research should address children and adolescents' perceptions and first-hand experiences of physical restraint.
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Affiliation(s)
- Simon Nielson
- Faculty of Health and Social Care, Edge Hill University, UK
| | - Lucy Bray
- Faculty of Health and Social Care, Edge Hill University, UK
| | - Bernie Carter
- Faculty of Health and Social Care, Edge Hill University, UK
| | - Joann Kiernan
- Faculty of Health and Social Care, Edge Hill University, UK
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Roy C, Castonguay A, Fortin M, Drolet C, Franche-Choquette G, Dumais A, Lafortune D, Bernard P, Geoffrion S. The Use of Restraint and Seclusion in Residential Treatment Care for Youth: A Systematic Review of Related Factors and Interventions. TRAUMA, VIOLENCE & ABUSE 2021; 22:318-338. [PMID: 31122160 DOI: 10.1177/1524838019843196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Children placed in residential treatment centers (RTCs) typically present challenging behavior including aggression. In this context, restraint and seclusion (R&S) are seen as "last resort" strategies for educators to manage youth aggression. The use of R&S is controversial, as they can lead to psychological and physical consequences for both the client and the care provider and have yet to be empirically validated as therapeutic. The objectives of this systematic review are to identify the factors related to R&S use in RTCs for youth and to review the interventions aiming to reduce the use of R&S. The identification of these factors is the first step to gaining a better understanding of the decision-making process leading to the use of R&S and ultimately to reducing the use of these strategies to a minimum. Thus, the present systematic review was conducted by searching PubMed, CINAHL, ERIC, and PsycNET for articles published between 2002 and 2017. Key words used were synonyms of R&S, youth, and RTCs. Thirty-one studies met the inclusion criteria: must report on factors affecting the use of R&S in RTCs, must be conducted in RTCs for youth under the age of 21, and must report on original and empirical data. Factors related to the characteristics of the client, the care provider, and the environment, as well as to the implementation of programs for the reduction of R&S, were found to influence the use of R&S in RTCs. A conceptual model is presented. The implementation of programs to reduce R&S use is discussed.
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Affiliation(s)
- Camille Roy
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Ariane Castonguay
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Maxime Fortin
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Christine Drolet
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Geneviève Franche-Choquette
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
| | - Alexandre Dumais
- Research Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, 5622University of Montreal, Montreal, Quebec, Canada
- Philippe Pinel Institute of Montreal, Montreal, Quebec, Canada
| | - Denis Lafortune
- University Institute for Troubled Youth, Montreal, Quebec, Canada
- School of Criminology, 5622University of Montreal, Montreal, Quebec, Canada
| | - Paquito Bernard
- Research Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- Department of Physical Activity Sciences, University of Quebec in Montreal, Montreal, Quebec, Canada
| | - Steve Geoffrion
- School of Psychoeducation, 5622University of Montreal, Montreal, Quebec, Canada
- Trauma Studies Center, 26612Montreal Mental Health University Institute, Montreal, Quebec, Canada
- University Institute for Troubled Youth, Montreal, Quebec, Canada
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24
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Reen GK, Bailey J, McGuigan L, Bloodworth N, Nawaz RF, Vincent C. Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis. Eur Child Adolesc Psychiatry 2021; 30:1173-1186. [PMID: 32719945 PMCID: PMC8310847 DOI: 10.1007/s00787-020-01607-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022]
Abstract
Existing interventions to reduce self-harm in adolescents admitted to psychiatric wards are usually focused on individual psychological treatments. However, the immediate ward environment in which treatment takes place is an important factor in the success of the treatment and can also influence the likelihood of self-harming behaviours. The aim of the current study was to evaluate changes made to a psychiatric ward environment on incidence of self-harm in adolescents. A quasi-experimental interrupted time series study was conducted on one child and adolescent psychiatric ward. An intervention was developed alongside staff and patients to address the high incidence of self-harm on weekday evenings on the ward. The intervention components involved adding a regular twilight shift (3-11 pm) for nursing staff and introducing a structured evening activity programme on the ward. A segmented regression analysis of an interrupted time series found that the rate of self-harm per 100 bed days was already declining at baseline and continued to decline post-intervention, but the rate of decline was not significant (p = 0.415). However, the proportion of patients self-harming was increasing at baseline and significantly reduced post-intervention (p = 0.001), and this reduction was significantly larger in the evenings (p = 0.004) compared to other times of day (p = 0.09). A tailored intervention targeting the psychiatric ward environment helped to reduce the proportion of adolescents self-harming on the ward. An interrupted time series analysis should be considered for future interventions making changes to health systems over time.
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Affiliation(s)
- Gurpreet K Reen
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG, UK. .,Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX, UK.
| | - Jill Bailey
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX UK
| | - Lorna McGuigan
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX UK
| | - Natasha Bloodworth
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG UK ,Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX UK
| | - Rasanat Fatima Nawaz
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG UK ,Patient Safety Collaborative, Oxford Academic Health Science Network, Oxford, OX4 4GA UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, OX2 6GG UK ,Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, Oxford, OX3 7JX UK
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Geissler JM, Werner E, Dworschak W, Romanos M, Ratz C. German Law Reform Does Not Reduce the Prevalence of Coercive Measures in Residential Institutions for Children, Adolescents, and Young Adults With Intellectual and Developmental Disabilities. Front Psychiatry 2021; 12:765830. [PMID: 34777067 PMCID: PMC8581219 DOI: 10.3389/fpsyt.2021.765830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Approximately 10% of children, adolescents and young adults with an intellectual and developmental disability (IDD) in Bavaria live in residential institutions. 2015 saw media reports raising suspicions about excessive use of coercive measures (cM) in those institutions. Until a law reform at the end of 2017 made permission from family courts mandatory for cM, their use was governed by parental consent. The REDUGIA project conducted a representative survey comparing cM and their relation to challenging behaviour (cB) and employee stress in Bavaria pre and post reform. Methods: We sent questionnaires to 65 residential institutions for children, adolescents and young adults with IDD in 2017 (pre reform, T1) and 2019 (post reform, T2). To assess changes, we analysed data from all available questionnaire pairs (T1 and T2, N = 43). We calculated paired t-test and correlative analyses concerning the relationship between cB, cM, and employee stress. Results: The number of residents overall (T1: N = 1,661; T2: N = 1,673) and per institution (T1: m = 38.6 ± 32.0; T2: m = 38.9 ± 34.5, p = 0.920) remained stable. We did not see any changes in the Index cB (p = 0.508) or the proportion of residents per institution displaying various types of challenging behaviour (all ps>0.220). There was no change in the Index cM (p = 0.089) or any indicator of employee stress, all ps > 0.323. At follow-up, the Index cB correlated positively with the Index cM (r = 0.519 p < 0.001). Regarding employee stress, the Index cB correlated positively with the frequency of sick leave (r = 0.322, p = 0.037) and physical attacks on employees (r = 0.552, p < 0.001). The Index cM also correlated positively with the frequency of sick leave (r = 0.340, p = 0.028) and physical attacks on employees (r = 0.492, p = 0.001). Discussion: Coercive measures are not a general phenomenon, but are focused on specialised institutions. The law reform did not lead to changes in the number of children, adolescents and young adults with IDD affected by coercive measures in residential institutions in Bavaria. There were still large discrepancies between institutions in the prevalence of challenging behaviour and coercive measures. Coercive measures were associated with challenging behaviour and employee stress. Taken together, findings from REDUGIA emphasise the need to prevent challenging behaviour and thus coercive measures.
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Affiliation(s)
- Julia M Geissler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Elisabeth Werner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Wuerzburg, Germany.,Chair of Special Education IV-Education for People With Intellectual and Developmental Disabilities, University of Wuerzburg, Wuerzburg, Germany
| | - Wolfgang Dworschak
- Chair of Special Education-Education for People With Developmental and Intellectual Disabilities University of Regensburg, Regensburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Wuerzburg, Wuerzburg, Germany.,German Centre of Prevention Research in Mental Health, University Wuerzburg, Wuerzburg, Germany
| | - Christoph Ratz
- Chair of Special Education IV-Education for People With Intellectual and Developmental Disabilities, University of Wuerzburg, Wuerzburg, Germany.,German Centre of Prevention Research in Mental Health, University Wuerzburg, Wuerzburg, Germany
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26
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Hidayat MT, Lawn S, Muir-Cochrane E, Oster C. The use of pasung for people with mental illness: a systematic review and narrative synthesis. Int J Ment Health Syst 2020; 14:90. [PMID: 33372617 PMCID: PMC7720453 DOI: 10.1186/s13033-020-00424-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022] Open
Abstract
Background Pasung is the term used in Indonesia and a number of other countries for seclusion and restraint of people with mental illness in the community, usually at home by their family. While pasung has been banned because it is contrary to human rights, its practice continues to exist within the community, particularly where community mental health services are limited, and in the absence of adequate social support, and pervasive negatives beliefs about mental illness. It is essential to understand the reasons for the ongoing use of pasung and to examine potential solutions. Methods A systematic review and narrative synthesis of peer-reviewed international literature was conducted to identify the socio-cultural contexts for pasung use, and interventions to address it. The analysis draws on the socio-ecological framework, which focused on relationships between the individual and their environment. Result Fifty published articles were included in the review; all studies were conducted in Asia and Africa, with 32 undertaken in Indonesia. Most studies were qualitative (n = 21). Others included one case–control study, one cross-sectional study, and seven surveys; only four studies examined the application of an intervention, and each used a pre and post methodology. Of these, two studies tested psychoeducational interventions which aimed to overcome family burden due to pasung, and each suggested a community mental health approach. The remaining two studies evaluated the intervention of ‘unlocking’; one study used a community-based culturally sensitive approach, and the other used a community-based rehabilitation program. Reasons for pasung given by family appear to be as a last resort and in the absence of other supports to help them care for the person with severe mental illness. Conclusion The findings highlight that a mixture of individual, interpersonal, community and policy interventions are needed to reduce the use of pasung. While consumer and carer involvement as part of a socio-ecological approach is understood to be effective in reducing pasung, an understanding of how to elaborate this in the management of pasung remains elusive. Review Registration CRD42020157543: CRD
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Affiliation(s)
- Muhamad Taufik Hidayat
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia.,West Java Psychiatric Hospital, Bandung, Indonesia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia. .,South Australian Mental Health Commissioner, Adelaide, South Australia, Australia.
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Candice Oster
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia, 5001, Australia
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27
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Black V, Bobier C, Thomas B, Prest F, Ansley C, Loomes B, Eggleston G, Mountford H. Reducing seclusion and restraint in a child and adolescent inpatient area: implementation of a collaborative problem-solving approach. Australas Psychiatry 2020; 28:578-584. [PMID: 32378414 DOI: 10.1177/1039856220917081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether implementation of a collaborative problem-solving approach would be associated with a decrease in seclusion and restraint in a child and adolescent inpatient unit. METHOD A collaborative problem-solving (CPS) approach was implemented. Seclusion and restraint, length of treatment, clinician- and patient/parent-rated outcomes and staff utility and acceptability were surveyed pre and post implementation. RESULTS The number of restrictive events significantly decreased, including full restraint, partial restraint and seclusion. Length of treatment and routine clinician-rated outcome measures remained consistent. Patient or parent-rated outcomes showed greater reduction post implementation. Despite some initial scepticism, the staff found this approach useful. CONCLUSIONS A CPS approach was successfully implemented, and in this naturalistic study was associated with a significant decrease in seclusions and restraints.
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Affiliation(s)
- Valerie Black
- The Princess Margaret Hospital, New Zealand.,Otago Medical School, New Zealand
| | | | - Baiju Thomas
- The Princess Margaret Hospital, New Zealand.,Otago Medical School, New Zealand
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28
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Muir-Cochrane E, Grimmer K, Gerace A, Bastiampillai T, Oster C. Prevalence of the use of chemical restraint in the management of challenging behaviours associated with adult mental health conditions: A meta-synthesis. J Psychiatr Ment Health Nurs 2020; 27:425-445. [PMID: 31867795 DOI: 10.1111/jpm.12585] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 12/15/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The use of chemical restraint in emergency situations is to control aggression or violence to protect consumers and staff and is to be used as a last resort when all other behavioural control alternatives have been exhausted. Chemical restraint involves the use of medication. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first paper to systematically review the prevalence of the use of chemical restraint. The use of chemical restraint is common across emergency departments and acute psychiatric inpatient units worldwide. Consumers who are restrained are also likely to receive chemical restraint. The studies reviewed demonstrate that there is a need for more standardized data collection so that clearer comparisons can be made between healthcare settings and countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Implications of practice include the need to report adverse events post-chemical restraint as these can deleteriously affect a person's physical health. Identification of and staff education about first-line management techniques before chemical restraint is administered are significant to reduce its use. ABSTRACT: Introduction Chemical restraint is used to manage uncontrolled aggression, agitation or violent behaviours of consumers with mental health disorders admitted to acute psychiatric or emergency settings. Aim This systematic review aimed to synthesize the international prevalence of chemical restraint for non-consenting adults. Method PsycINFO, CINAHL, MEDLINE/PubMed and Google Scholar databases were searched for peer-reviewed literature published between January 1996 and July 2018. This paper reports on data extracted from retrospective audits of chemical restraint practice. Results Forty-eight papers were included. The median prevalence of use of any restraint was 21.2% (25th% 8.0 to 75th% 36.3). Median prevalence of people who were chemically restrained, of all people restrained in any manner, was 43.1% (25th% 22.9% to 75th% 70.7%). Of all people admitted to facility(ies), the median prevalence of chemical restraint was 7.4% (25th% 2.7 to 75th% 17.6). There was no statistically significant difference in any prevalence measure considering healthcare setting or country. There was a significant decrease over the review period in the use of any restraint, including chemical restraint. Discussion and implications for practice This is the first known comprehensive meta-view of chemical restraint use worldwide, highlighting the need for standardized data collection to enable comparisons between healthcare settings and countries. Relevance statement There is an international imperative to reduce or eliminate the use of coercive practices, such as physical and chemical restraint, in mental health care. This study provides important information for mental health nursing by synthesizing the international prevalence of chemical restraint for non-consenting adults. This meta-view of the worldwide use of chemical restraint can inform ongoing efforts to reduce its use.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Karen Grimmer
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Adam Gerace
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Wayville, SA, Australia
| | - Tarun Bastiampillai
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Candice Oster
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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29
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Vidal C, Reynolds EK, Praglowski N, Grados M. Risk Factors for Seclusion in Children and Adolescents Inpatient Psychiatry: The Role of Demographic Characteristics, Clinical Severity, Life Experiences and Diagnoses. Child Psychiatry Hum Dev 2020; 51:648-655. [PMID: 32026261 DOI: 10.1007/s10578-020-00963-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand the risk factors for seclusion in a sample of children and adolescents admitted to an inpatient psychiatry unit looking at demographic, clinical severity, life experience, and diagnostic characteristics. METHODS An unmatched case-control retrospective analysis of psychiatric records in a pediatric inpatient unit from December 2011 to December 2015 (N = 1986) RESULTS: Individual characteristics, including demographics, clinical severity, and clinical presentation as per the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) jointly predicted seclusion in adolescents, with younger age, male sex, black race, having a prior admission, and having a disruptive behavior or bipolar and related disorder diagnoses being predictive of seclusion. While demographic and clinical severity factors were predictive of seclusion in multivariate models, clinical diagnoses only added modestly to the variance explained. CONCLUSIONS High-risk demographic and clinical characteristics for seclusion events in children and adolescents can provide valuable information to guide interventions to prevent seclusion events during their hospitalization.
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Affiliation(s)
- Carol Vidal
- School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287-3335, USA.
| | - Elizabeth K Reynolds
- School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287-3335, USA
| | | | - Marco Grados
- School of Medicine, Johns Hopkins University, 1800 Orleans St, Baltimore, MD, 21287-3335, USA
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30
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Montreuil M, Thibeault C, McHarg L, Carnevale FA. Moral Experiences of Crisis Management in a Child Mental Health Setting: A Participatory Hermeneutic Ethnographic Study. Cult Med Psychiatry 2020; 44:80-109. [PMID: 31218498 DOI: 10.1007/s11013-019-09639-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Restraints and seclusion are routinely used in child mental health settings for conflict and crisis management, but raise significant ethical concerns. Using a participatory hermeneutic ethnographic framework, we studied conflict and crisis management in a child mental health setting offering care to children aged 6-12 years old in Quebec, Canada. The use of this framework allowed for an in-depth examination of the local imaginaries, of what is morally meaningful to the people in the setting, in addition to institutional norms, structures and practices. Data collection involved participant observation, interviews, and documentation review, with an interpretive framework for data analysis. We argue that the prevalent view of children shared by staff members as "incomplete human becomings" led to the adoption and legitimization of authoritative norms, structures and practices guided largely by a behavioral approach, which sometimes led to an increased use of control measures for reasons other than imminent harm. Children experienced these controlling practices as abusive and hindering the development of trusting relationships, which impeded the implementation of more collaborative approaches staff members sought to put in place to prevent the use of control measures. Study results are discussed in light of conceptions of children as moral agents.
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Affiliation(s)
- Marjorie Montreuil
- Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC, H3A 2M7, Canada.
| | | | - Linda McHarg
- Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC, H3A 2M7, Canada
| | - Franco A Carnevale
- Ingram School of Nursing, McGill University, 680 Sherbrooke Street West, Montreal, QC, H3A 2M7, Canada
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31
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Leibold A, Melter M, Doerfler C, Alikadic S, Zimmermann M, Hanses F, Zant R. Massive Pulmonary Embolism after a Short Episode of Physical Restraint in an Adolescent Psychiatric Patient. J Pediatr Intensive Care 2019; 8:247-250. [PMID: 31673462 DOI: 10.1055/s-0039-1694018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022] Open
Abstract
Medical restraints, when used for short periods of time, can pose additional risk for deep vein thrombosis in adolescent psychiatric patients. The problem is often unrecognized, and there is a lack of awareness of this potential risk. However, as associated major adverse events may result in fatal outcomes, an individual patient's risk for deep vein thrombosis should be assessed and prophylactic anticoagulation may be indicated.
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Affiliation(s)
| | - Michael Melter
- KUNO University Children's Hospital, Regensburg, Germany
| | | | - Samra Alikadic
- KUNO University Children's Hospital, Regensburg, Germany
| | - Markus Zimmermann
- Emergency Unit, University Medical Center Regensburg, Regensburg, Germany
| | - Frank Hanses
- Emergency Unit, University Medical Center Regensburg, Regensburg, Germany
| | - Robert Zant
- KUNO University Children's Hospital, Regensburg, Germany.,Department of Pediatric Cardiology, University Hospital Erlangen-Nuernberg, Erlangen, Germany
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32
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Preisz A, Preisz P. Restraint in paediatrics: A delicate balance. J Paediatr Child Health 2019; 55:1165-1169. [PMID: 31482670 DOI: 10.1111/jpc.14607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 12/19/2022]
Abstract
Patient restraint in health care is currently under intense review. There are two disparate groups that should be considered. First, infants and young children are commonly restrained while undergoing simple medical procedures such as venepuncture or immunisation, and this practice may be better framed as 'hugging' not 'holding'. Second, there is a distinct but significant group of children and adolescents with serious psychiatric or organic illness with behavioural disturbances necessitating restraint, who are the primary focus of this paper. Nevertheless, the balance between restraining any young person in health care and causing preventable harm is delicate: any form of child restraint, whether physical, chemical or seclusion, merits ethical reflection and should be undertaken judiciously. All clinicians should prioritise the dignity and privacy of the young person while weighing the vulnerability of this cohort of patients.
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Affiliation(s)
- Anne Preisz
- Clinical Ethics, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame Sydney, Sydney, New South Wales, Australia
| | - Paul Preisz
- School of Medicine, University of Notre Dame Sydney, Sydney, New South Wales, Australia.,Department of Emergency Medicine, St Vincent's Hospital, Sydney, New South Wales, Australia
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33
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Narita Z, Inagawa T, Yokoi Y, Stickley A, Maruo K, Yamada Y, Sugawara N. Factors associated with the use and longer duration of seclusion and restraint in psychiatric inpatient settings: a retrospective chart review. Int J Psychiatry Clin Pract 2019; 23:231-235. [PMID: 31035799 DOI: 10.1080/13651501.2019.1607878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To examine factors that may affect the use and duration of seclusion and restraint (SR) in psychiatric inpatient settings. Methods: First, multivariable logistic regression analysis was used to examine factors associated with the use of SR in an unmatched case-control study, comparing SR cases and controls. Second, for patients that underwent SR, multivariable linear regression analysis was used to determine factors contributing to the duration of SR. Results: Out of 213 patients, 58 underwent SR. An F00 diagnosis, a history of epilepsy, antipsychotics usage and antidepressants usage were significantly associated with the use of SR (odds ratio = 7.98; 95% CI = 1.11-57.50, odds ratio = 4.89; 95% CI = 1.12-21.36, odds ratio = 4.59; 95% CI = 1.54-13.68 and odds ratio = 0.29; 95% CI = 0.10-0.86, respectively). An F00 and F32 diagnosis significantly extended the duration of SR (coefficient = 13.10; 95% CI = 2.11-24.11 and coefficient = 20.52; 95% CI = 9.68-31.37, respectively). Conclusions: A variety of factors are associated with the use and longer duration of SR. Given the potentially harmful effects of these practices, further studies with larger samples and a wider range of quantitative outcome measures are warranted. Key points An F00 diagnosis, a history of epilepsy and antipsychotics usage may increase the use of SR. Antidepressants may decrease the use of SR. An F00 and F32 diagnosis may extend the duration of SR.
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Affiliation(s)
- Zui Narita
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Takuma Inagawa
- Department of Psychiatry, National Centre Hospital, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Yuma Yokoi
- Department of Psychiatry, National Centre Hospital, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba , Tsukuba , Japan
| | - Yuji Yamada
- Department of Psychiatry, National Centre Hospital, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Norio Sugawara
- Department of Clinical Epidemiology, Translational Medical Centre, National Centre of Neurology and Psychiatry , Kodaira , Japan
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34
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Eblin A. Reducing seclusion and restraints on the inpatient child and adolescent behavioral health unit: A quality improvement study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:122-128. [DOI: 10.1111/jcap.12248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Amanda Eblin
- Medical University of South Carolina Charleston South Carolina
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Verret C, Massé L, Lagacé-Leblanc J, Delisle G, Doyon J. The impact of a schoolwide de-escalation intervention plan on the use of seclusion and restraint in a special education school. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019. [DOI: 10.1080/13632752.2019.1628375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Claudia Verret
- Département des sciences de l’activité physique, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Line Massé
- Department of psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Jeanne Lagacé-Leblanc
- Department of psychoeducation, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Gaëlle Delisle
- Department of Special and Complementary Educational Services, Commission scolaire des Affluents, Repentigny, Québec, Canada
| | - Johanne Doyon
- Department of Special and Complementary Educational Services, Commission scolaire des Affluents, Repentigny, Québec, Canada
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Puyat JH, Kamieniecki R, Vaughan B, Mihic T, Bonnie K, Danielson J, Williams S. Characterizing the inpatient care of young adults experiencing early psychosis: A medical record review. Early Interv Psychiatry 2019; 13:224-230. [PMID: 28758344 DOI: 10.1111/eip.12468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/12/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
AIM To characterize the inpatient care received by individuals experiencing early psychotic episodes in an inner city hospital. METHOD Medical records of patients admitted between April 01, 2013, and March 31, 2015, to a psychiatric ward at an inner city hospital were retrospectively examined. Included in the study are patients who were 25 years of age or younger and were hospitalized for psychotic symptoms. Demographics and health service use were summarized using descriptive statistics. RESULTS A total of 73 inpatients (mean age = 22; males =78%; Caucasian = 41%) met the study inclusion criteria with a combined total of 102 care episodes and an average length of stay of 32.6 days. Monitoring of vital signs (VS) and mental status examinations (MSE) were performed in most care episodes although these were not performed regularly (daily VS checks-31%; MSE every nursing shift-18.6%). In 49% of the care episodes, patients were discharged on long-acting injectable antipsychotics. Even when indicated, not all care episodes had follow-up appointments (82.8%) in the community. The use of seclusion was higher in the wards (32%) than in the emergency department (21%), whereas the use of restraints was higher in the emergency department (16%) than in the wards (<1%). CONCLUSIONS There is wide variation in the rate at which various clinical care processes are performed and in the provision of inpatient care to younger adults experiencing episodes of early psychosis. Consistent standards of care are needed to reduce variations and improve treatment outcomes and experiences.
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Affiliation(s)
- Joseph H Puyat
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Renata Kamieniecki
- Mental Health Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Brenda Vaughan
- Mental Health Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tamara Mihic
- Mental Health Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Kofi Bonnie
- Mental Health Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jeffrey Danielson
- Mental Health Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Sierra Williams
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Montreuil M, Thibeault C, McHarg L, Carnevale FA. Children's moral experiences of crisis management in a child mental health setting. Int J Ment Health Nurs 2018; 27:1440-1448. [PMID: 29446553 DOI: 10.1111/inm.12444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2018] [Indexed: 12/01/2022]
Abstract
The experiences of children related to conflict and crisis management in child mental health settings, especially those aged 12 and below, have been rarely studied. This study examined the moral experiences of children related to conflict and crisis management and the related use of restraint and seclusion in a child mental health setting. A 5-month focused ethnography using a participatory hermeneutic framework was conducted in a day hospital programme for children with severe disruptive disorders within a mental health institute. Children considered restraints and seclusion could help them feel safe in certain instances, for example if another child was being aggressive towards them or in exceptional cases to prevent self-injury. However, their own experiences of being restrained were predominantly negative, especially if not knowing the reason for their use, which they then found unfair. Some of the children emphasized the punitive nature of the use of restraints and seclusion, and most children disagreed with these practices when used as a punishment. Children's perspectives also highlighted the limits of the use of a uniform de-escalation approach by the staff to manage crises. Children considered discussing with the staff and developing a relationship with them as more helpful in case of a crisis then the use of a de-escalation approach or coercive strategies.
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Affiliation(s)
| | - Catherine Thibeault
- Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario, Canada
| | - Linda McHarg
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Franco A Carnevale
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, Montreal, Quebec, Canada
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Hallman IS, O'Connor N, Hasenau S, Brady S. Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 30:175-180. [DOI: 10.1111/jcap.12191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ilze S. Hallman
- Clinical Nurse Specialist, Psychiatry; University of Michigan and Health Centers; Ann Arbor Michigan USA
| | - Nancy O'Connor
- Professor and Chair, Nursing Graduate Program; Madonna University; Livonia Michigan USA
| | - Susan Hasenau
- Professor, Nursing Graduate Program; Madonna University; Livonia Michigan USA
| | - Stephanie Brady
- Vice-President-Care Continuum; St. John-Providence Health System; Southfield Michigan USA
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Khalil AI, Al Ghamdi MAM, Al Malki S. Nurses’ knowledge, attitudes, and practices toward physical restraint and seclusion in an inpatients’ psychiatric ward. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17542863.2017.1329330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amal Ibrahim Khalil
- Faculty of Nursing, Menoufyia University, Egypt
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | - Sarah Al Malki
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
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40
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Allan JA, Hanson GD, Schroder NL, O'Mahony AJ, Foster RMP, Sara GE. Six years of national mental health seclusion data: the Australian experience. Australas Psychiatry 2017; 25:277-281. [PMID: 28375028 DOI: 10.1177/1039856217700298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Reducing or eliminating seclusion from mental health care settings has been a national priority for Australia since 2005. This paper describes Australia's national seclusion data collection, and summarises changes in seclusion rates in Australian public mental health services. METHODS Seclusion events per 1000 patient days were calculated from 2009-2010 to 2014-2015 utilising state and territory administrative data sources. Combined national data were used to calculate results for a number of service characteristics, such as target population and location of the service. RESULTS The rate of seclusion events decreased by 43% over the 6 years. Child and adolescent services reported consistently higher rates of seclusion, but a shorter duration of seclusion episodes, compared with other service types. There is high variation in seclusion rates between individual services (range 0.0-53.0 seclusion events per 1000 bed days in 2014-2015). CONCLUSIONS Seclusion event rates in Australia's specialised public acute mental health hospital services are declining. The use of existing administrative data was instrumental in establishing a national data source to facilitate the monitoring and reporting of progress of seclusion reduction strategies.
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Affiliation(s)
- John A Allan
- Chief Psychiatrist, Department of Health Queensland and Chair, Safety and Quality Partnership Standing Committee, Herston, QLD, Australia
| | - Gary D Hanson
- Unit Head, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Nicole L Schroder
- Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Anna J O'Mahony
- Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | | | - Grant E Sara
- Sydney Medical School, University of Sydney, Sydney, NSW, and; Chair, Mental Health Information Strategy Standing Committee, NSW, Australia
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41
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Kirwan L, Coyne I. Use of restraint with hospitalized children: A survey of nurses' perceptions of practices. J Child Health Care 2017; 21:46-54. [PMID: 27638180 DOI: 10.1177/1367493516666730] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Restraint is often perceived as necessary to ensure that medical procedures are carried out safely. The limited research into nurses' perceptions of restraint practices with hospitalized children hinders understanding the extent of the problem. A survey design was used to investigate nurses' perceptions of restraint use from five units in one children's hospital in Ireland. Findings revealed that restraint is a common practice, with physical and psycho- logical restraints most commonly used and newborn to 4-year-old children most likely to be restrained. Restraint was most often used for cannulation and latterly for administering medication and preventing interference to intravenous lines. To promote the use of thera- peutic holding for the safe delivery of procedures, nurses require education and skills training. Restraint should only be used as a last resort and in all situations, nurses should assess the need to use restraint and explore any alternatives in order to gain the child's cooperation. More research is needed into the situational variables that can lead to restraint usage in order to identify learning needs and promote the use of alternative interventions.
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Affiliation(s)
- Lisa Kirwan
- 1 Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Imelda Coyne
- 2 School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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42
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Faay MDM, Valenkamp MW, Nijman H. Warning Signs prior to Aggressive Behavior in Child Psychiatric Units. Arch Psychiatr Nurs 2017; 31:43-47. [PMID: 28104057 DOI: 10.1016/j.apnu.2016.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
This study aims at detecting and categorizing early warning signs of aggressive behavior in child psychiatric units. We analyzed 575 violent incident report forms and developed a coding scheme consisting of 16 warning signs. From the 575 incident report forms, a total of 1087 signs were coded. Most common warning signs were 'restlessness' (21.2%), 'not listening' (15.2%) and 'anger' (9.8%). These were also the most prevalent warning signs for the severe incidents. Although warning signs differ for each individual child, this study indicates that there are common warning signs for imminent aggressive incidents in child psychiatric facilities.
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Affiliation(s)
- Margo D M Faay
- Brain Center Rudolf Magnus, department of Psychiatry, University Medical Center Utrecht, The Netherlands.
| | - Marije W Valenkamp
- Erasmus Medical Center Sophia Children's Hospital, department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; VanMontfoort Consultancy, Woerden, The Netherlands
| | - Henk Nijman
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands; Aventurijn - Fivoor, Den Dolder, The Netherlands
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43
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Furre A, Falk RS, Sandvik L, Friis S, Knutzen M, Hanssen-Bauer K. Characteristics of adolescents frequently restrained in acute psychiatric units in Norway: a nationwide study. Child Adolesc Psychiatry Ment Health 2017; 11:3. [PMID: 28096898 PMCID: PMC5234258 DOI: 10.1186/s13034-016-0136-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/06/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of restraints in adolescent psychiatric settings requires particular professional, ethical, and legal considerations. The purpose of this study was to investigate whether the number of restraint episodes per patient was related to any of several characteristics of the adolescents. METHODS In this nationwide study, we included all adolescents restrained during the period 2008-2010 (N = 267) in Norwegian adolescent acute psychiatric inpatient units. They constitute 6.5% of the adolescents hospitalized in these units in the same period of time. We collected data on the number of restraint episodes they experienced during the study period; Poisson regression was then used to analyze the impact of gender, social, mental health, and treatment characteristics on the frequency of restraint. We developed a risk index for the likelihood of experiencing multiple restraint episodes. RESULTS We found a skewed distribution of restraint episodes in which a small group (18%) of restrained adolescents experienced a majority (77%) of the restraint episodes. A large percentage of the restrained adolescents (36%) experienced only one restraint episode. Risk factors for multiple restraint episodes were female gender, lower psychosocial functioning (Children's Global Assessment Scale below 35), more and longer admissions, and concomitant use of pharmacological restraint. Except for gender, we used these variables to develop a risk index that was moderately associated with multiple restraint episodes. CONCLUSIONS As a small group of patients accounted for a large percentage of the restraint episodes, future research should further investigate the reasons for and consequences of multiple restraint episodes in patients at acute adolescent psychiatric units, and evaluate preventive approaches targeted to reduce their risk for experiencing restraint.
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Affiliation(s)
- Astrid Furre
- Division of Mental Health and Addiction, Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway ,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway
| | - Leiv Sandvik
- Oslo Centre for Epidemiology and Biostatistics, Oslo University Hospital, Oslo, Norway
| | - Svein Friis
- Division of Mental Health and Addiction, Department of Research and Development, Oslo University Hospital, Oslo, Norway
| | - Maria Knutzen
- Division of Mental Health and Addiction, Centre for Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Ketil Hanssen-Bauer
- Division of Mental Health Services, Akershus University Hospital, Lorenskog, Norway ,Division of Health Service Research and Psychiatry, University of Oslo, Oslo, Norway
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45
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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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46
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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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Andrassy BM. Feelings Thermometer: An Early Intervention Scale for Seclusion/Restraint Reduction Among Children and Adolescents in Residential Psychiatric Care. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:145-7. [PMID: 27633435 DOI: 10.1111/jcap.12151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PROBLEM Restraints and/or seclusions (R/S) are events that have the potential to cause patient injury, staff injury, re-traumatization, and even death. There is a gap in available data regarding alternative strategies for reducing R/S. METHOD A 140-bed children and adolescent residential treatment hospital implemented a "Feelings Thermometer Scale" on each unit. The "Feelings Thermometer" allowed the resident to point to a face on the scale to rate how they were feeling from "Cool" to "On Fire!" Once the resident identified with a feeling and rating, options were offered for alternative cool down locations corresponding to each level of escalation. Data were analyzed 6 weeks before and 6 weeks after implementation of the "Feelings Thermometer." FINDINGS There were 129 R/S during the 6-week period prior to the implementation of the "Feelings Thermometer." There were a total of 91 R/S during the 6-week period postimplementation of the "Feelings Thermometer." Overall, a 29.1% decrease in R/S was experienced throughout the hospital. CONCLUSION The findings of this study suggest that further investigation may be warranted to promote alternative R/S reduction strategies.
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48
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A nationwide study of why and how acute adolescent psychiatric units use restraint. Psychiatry Res 2016; 237:60-6. [PMID: 26921053 DOI: 10.1016/j.psychres.2016.01.067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/20/2015] [Accepted: 01/27/2016] [Indexed: 12/28/2022]
Abstract
The purpose of this study was to examine the type, reason, and duration of restraint episodes in acute adolescent psychiatric units. In a retrospective design we included data from paper-based protocols on all episodes of restraint and data from electronic patient records during 2008-2010 in all acute adolescent psychiatric in-patient units in Norway (N=16). The episodes of restraint included mechanical and pharmacological restraint, seclusion and physical holding that was not part of the implementation of forced feeding. Six-and-a-half per cent of all 4099 adolescents admitted to the acute units experienced restraint. Of the 2277 episodes, 13.4% were mechanical restraint, 1.6% were pharmacological restraint, 5.9% were seclusion and 78.7% were physical holding. The median number of restraint episodes per patient was two, the range was 1-171 and 47 patients (18%) experienced ≥10 episodes. The most common reason for using restraint was harming others. The median duration of the mechanical restraint episodes was 3.5h. The median duration of seclusion was 30min and the median duration of physical holding was 10min.
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49
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Jacob T, Sahu G, Frankel V, Homel P, Berman B, McAfee S. Patterns of Restraint Utilization in a Community Hospital's Psychiatric Inpatient Units. Psychiatr Q 2016; 87:31-48. [PMID: 25899518 DOI: 10.1007/s11126-015-9353-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Restraint use in psychiatry has been a topic of clinical and ethical debate for years. As much as the medical community desires to attain the goal of a restraint-free environment, there are not many alternatives available when it comes to protecting the safety of violent patients and those around them. Our objective was to examine patterns of restraint use and analyze the factors leading to its use in adult psychiatric inpatient units. We conducted a retrospective review of restraint orders from January 2007 to December 2012, for inpatient units at a community mental health hospital, examining-unit, patient gender, number and duration of restraint episodes, time of day, and whether medications and/or verbal redirection were used. For the 6-year period studied, a total of 1753 restraint order-sheets were filed for 455 patients. Mixed-model regression found significant differences in duration of restraint episodes depending on: patient gender, unit, medication use, verbal redirection and AM/PM shifts. These differences were consistent over time with no significant interactions with years and remained significant when included together in an overall multivariate model. We elucidate variable patterns of restraint utilization correlating with elements such as patient gender, time of day and staff shift, medication use, and attempts at verbally redirecting the patient. Besides providing much needed data on the intricate dynamics influencing restraint use, we suggest steps to implement hospital-wide restraint-reduction initiatives including cultural changes related to restraint usage, enhanced staff-training in conflict de-escalation techniques and personalized treatment plans for foreseeable restraint episodes.
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Affiliation(s)
- Theresa Jacob
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
| | - Geetanjali Sahu
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Violina Frankel
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Peter Homel
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Bonnie Berman
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - Scot McAfee
- Department of Psychiatry, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
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50
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Green-Hennessy S, Hennessy KD. Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents. Psychiatr Q 2015; 86:545-54. [PMID: 25733324 DOI: 10.1007/s11126-015-9352-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study identified predictors of seclusion or restraint use among licensed and/or accredited residential treatment centers (RTCs) for children and youth in the United States responding to a federally-sponsored survey of mental health services. 693 licensed and/or accredited child and adolescent RTCs responded to questions about the demographic and admission status of clients served on an identified date, services offered, size, ownership, funding, and their use of seclusion or restraint practices within the preceding 12 months. Logistic regression was used to determine factors predicting facility use of seclusion or restraint. A large majority of licensed and/or accredited child and adolescent RTCs (82 %) reported using seclusion or restraint in the prior year. Contrary to prior research, individual patient characteristics (percent of males, minorities, and involuntary admissions) did not predict the use of coercive techniques. Instead facility and funding variables accounted for approximately 27 % of the variance in the use of seclusion or restraint. Larger, privately-owned RTC's funded primarily through public monies and which offered medication and programming for SED youth were more likely to endorse having used seclusion or restraint in the previous year. Despite visible policy and advocacy efforts to reduce seclusion and restraint use over the past decade, a majority of licensed and/or accredited RTCs for children and adolescents report using such practices. Findings emphasize the importance of examining facility-level variables in predicting their use, and highlight the disconnect between nationally espoused goals and current practices regarding coercive techniques in child and adolescent RTCs.
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Affiliation(s)
| | - Kevin D Hennessy
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1 Choke Cherry Road, Rockville, MD, 20857, USA
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