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Baker J, Kendal S, Bojke C, Louch G, Halligan D, Shafiq S, Sturley C, Walker L, Brown M, Berzins K, Brierley-Jones L, O'Hara JK, Blackwell K, Wormald G, Canvin K, Vincent C. A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-182. [PMID: 38794956 DOI: 10.3310/udbq8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s) Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Limitations Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration This study is registered as ISRCTN14470430. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John Baker
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Sarah Kendal
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Daisy Halligan
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Saba Shafiq
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Lauren Walker
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Mark Brown
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Kathryn Berzins
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Jane K O'Hara
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Gemma Wormald
- Department of Health Sciences, University of York, York, UK
| | - Krysia Canvin
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Charles Vincent
- Social Spider CIC, The Mill (Community Centre), London, UK
- Thrive by Design, Leeds, UK
- University of Oxford Medical Sciences Division, Oxford, UK
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Haig S, Hallett N. Use of sensory rooms in adult psychiatric inpatient settings: A systematic review and narrative synthesis. Int J Ment Health Nurs 2023; 32:54-75. [PMID: 36082841 DOI: 10.1111/inm.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/14/2023]
Abstract
Reducing the use of restrictive interventions within psychiatric inpatient settings is a global priority. There are many strategies which may support the prevention of violence before escalation into more severe incidences. Sensory rooms have been identified as one such intervention, aiding patients to emotionally regulate and reduce distress, with a growing body of academic literature interested in whether sensory rooms can ultimately impact incidences of patient violence and the use of restraint, seclusion, and other restrictive practices. A systematic literature review was conducted to identify how effective sensory rooms are at reducing patient violence and restrictive interventions within adult psychiatric inpatient settings. Eighteen studies met the eligibility criteria and were included in the review. There is a lack of evidence as to whether sensory rooms are effective at reducing seclusion, restraint, or violence. They are, however, likely to support a reduction in patient distress. Patient and staff experiences suggest sensory rooms support emotional regulation, promote self-management, and positively impact the overall patient admission experience and ward environment. Further research is needed to identify what works, for who and in what circumstances in relation to the design of sensory rooms.
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Affiliation(s)
| | - Nutmeg Hallett
- School of Nursing, University of Birmingham, Birmingham, UK
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Wright L, Meredith P, Bennett S. Sensory approaches in psychiatric units: Patterns and influences of use in one Australian health region. Aust Occup Ther J 2022; 69:559-573. [PMID: 35706333 PMCID: PMC9796746 DOI: 10.1111/1440-1630.12813] [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: 09/27/2021] [Revised: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIM Australian guidelines and policies recommend the use of sensory approaches in mental health care. Nevertheless, many Australian psychiatric units report difficulty sustaining these approaches. To inform efforts to close the gap between recommendations and practice, the aim of this study was to understand the patterns of use of sensory approaches and what demographic and clinical factors influence their use, across one health region in Queensland, Australia. METHODS Using a cross-sectional survey design, a custom-designed questionnaire was distributed via email and in paper form to health professionals and peer support workers working in acute, secure, and community care psychiatric units across one health region. Information on demographics and the use of various sensory interventions was gathered utilising both open-ended and Likert scale questions. RESULTS Useable questionnaires were collected from 183 participants from various disciplines (77% nursing). The majority reported using sensory approaches with a limited number of consumers, and almost 9% never used the approach. Activity-based sensory interventions and sensory equipment were most often used, whereas sensory assessments, sensory plans, and sensory groups were least used. Sensory interventions were mainly used to reduce consumer anxiety and agitation and to assist with emotional regulation. Factors positively correlated with frequency of use for all interventions were discipline (occupational therapy); working in an acute inpatient unit; and training in sensory approaches. Age was negatively correlated with frequency of use only for weighted modalities. CONCLUSIONS This study revealed that sensory approaches were used by most staff though with a limited proportion of consumers in psychiatric units in one large metropolitan health service. It provides insights into the factors influencing frequency of use, highlighting the importance of training in sensory approaches and access to occupational therapists. With this knowledge, we can work towards closing the gap between recommendations and the practice of sensory approaches.
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Affiliation(s)
- Lisa Wright
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia,The Prince Charles HospitalMetro North Mental Health Hospital and Health ServicesBrisbaneQueenslandAustralia
| | - Pamela Meredith
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia,School of Health and Behavioural SciencesUniversity of Sunshine CoastSunshine CoastQueenslandAustralia
| | - Sally Bennett
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
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Architecture of Person-Centered Psychiatric Geriatric Hospitals. JOURNAL OF AGING AND ENVIRONMENT 2022. [DOI: 10.1080/26892618.2022.2125476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
BACKGROUND Staff shortages, reduced budgets, and high acuity of violent psychiatric patients can create challenges in psychiatric intensive care units (PICUs). LOCAL PROBLEM Staffing of the psychiatric unit was based on patient census rather than evidence-based practices. METHODS A pre-/postintervention design was used to examine changes in nursing satisfaction and patient outcomes as measured with the National Database of Nursing Quality Indicators (NDNQI) survey results. INTERVENTIONS A psychiatric specific acuity tool was implemented on the PICU of a Veterans Administration hospital. RESULTS After an initial decrease related to the COVID-19 pandemic, total acuity and the total number of nurses remained relatively stable while the unit census declined. NDNQI survey results improved with the largest being a 52-percentile increase for the quality-of-care summary measure. CONCLUSIONS An acuity tool can help standardize practice, determine fair patient assignments among staff, increase nurse satisfaction, and promote best practices for patient safety.
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Goulet MH, Lessard-Deschênes C. Le Modèle de prévention de l’utilisation des mesures de contrôle en santé mentale : une revue intégrative. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094149ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Oostermeijer S, Brasier C, Harvey C, Hamilton B, Roper C, Martel A, Fletcher J, Brophy L. Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review. BMJ Open 2021; 11:e046647. [PMID: 34233981 PMCID: PMC8264870 DOI: 10.1136/bmjopen-2020-046647] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED Increasing efforts are being made to prevent and/or eliminate the use of seclusion and restraint in mental health facilities. Recent literature recognises the importance of the physical environment in supporting better outcomes in mental health services. This rapid review scoped the existing literature studying what physical design features of mental health facilities can reduce the use of seclusion and physical restraint. DESIGN A rapid review of peer-reviewed literature. METHODS Peer-reviewed literature was searched for studies on architectural design and the use of restraint and seclusion in mental health facilities. The following academic databases were searched: Cochrane Library, Medline, PsycINFO, Scopus and Avery for English language literature published between January 2010 and August 2019. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of included studies. RESULTS We identified 35 peer-reviewed studies. The findings revealed several overarching themes in design efforts to reduce the use of seclusion and restraint: a beneficial physical environment (eg, access to gardens or recreational facilities); sensory or comfort rooms; and private, uncrowded and calm spaces. The critical appraisal indicated that the overall quality of studies was low, as such the findings should be interpreted with caution. CONCLUSION This study found preliminary evidence that the physical environment has a role in supporting the reduction in the use of seclusion and restraint. This is likely to be achieved through a multilayered approach, founded on good design features and building towards specific design features which may reduce occurrences of seclusion and restraint. Future designs should include consumers in a codesign process to maximise the potential for change and innovation that is genuinely guided by the insights of lived experience expertise.
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Affiliation(s)
- Sanne Oostermeijer
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Brasier
- Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia
| | - Carol Harvey
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cath Roper
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Martel
- Melbourne School of Design, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Brophy
- Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia
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Castelli C. "Missing in Action" in Psychiatric Nursing History: The Role of Chief Nurse Adele S. Poston and Her Band of Nurses During World War I. J Psychosoc Nurs Ment Health Serv 2021; 59:37-47. [PMID: 34060958 DOI: 10.3928/02793695-20210219-02] [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: 11/20/2022]
Abstract
This is the first nursing journal article to introduce the pioneering work of American psychiatric nurse leader, Adele S. Poston. Poston supervised a team of nurses as they cared for soldiers serving with the American Expeditionary Forces during World War I in France. Poston and her nurses worked in the first American specialized neuropsychiatric hospital in a war. The soldiers they treated primarily had functional nervous disorders described at that time as "shell shock" or "war neuroses." The traumatized officers and enlisted men were considered capable of being cured and returned to active duty based on research done by American psychiatrists among British troops during the first 3 years of the war. The story of Poston's career prior, during, and after the war and her work with other nurses during a global war are significant in psychiatric nursing history. Bringing this hitherto missing piece of psychiatric and nursing history into the light gives us a unique opportunity to recognize Poston and the nurses who served with her, even as today we recognize the nurses who serve during the global COVID-19 pandemic. [Journal of Psychosocial and Mental Health Services, 59(6), 37-47.].
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Banks C, Priebe S. Scales for assessing the therapeutic milieu in psychiatric inpatient settings: A systematic review. Gen Hosp Psychiatry 2020; 66:44-50. [PMID: 32659464 DOI: 10.1016/j.genhosppsych.2020.06.014] [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] [Received: 03/09/2020] [Revised: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The therapeutic milieu is widely regarded as an important factor influencing experiences and outcomes of psychiatric inpatient treatment. Appropriate scales are needed to assess the milieu. The aim of this review is to identify and describe scales established for that purpose. METHOD A systematic search of electronic databases was carried out. Scales used in two or more studies were identified, and data was extracted on key characteristics. RESULTS Scales for assessing the therapeutic milieu were used in 78 studies. Five scales were identified that were used more than once. Four scales originate from 1964 to 1986, one was originally published in 2008. The Ward Atmosphere Scale (WAS) is the most frequently used scale and its psychometric properties have been reported as good. When tested alongside each other, the scales are weakly to moderately correlated. CONCLUSIONS Few scales have been established to assess the therapeutic milieu. All scales capture aspects of relationships on the wards. The most commonly used scale (WAS) has 100 items and was developed more than 50 years ago. Given the changes in the practice of inpatient care over the last 50 years, new, briefer and psychometrically robust scales should be developed.
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Affiliation(s)
- Ciara Banks
- Acute Psychology Department, Newham Centre for Mental Health, East London NHS Foundation Trust, Glen Road, London, UK.
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, London, UK
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Sulaihah S, Khadijah S, Darni D. Analysis of the Restraint Model for Mental Disorder Clients in Health Care Facilities. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.16957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: The reduction or elimination of restraint for psychiatric patients continues to be an area of concern and debate. The lack of accessible alternatives to restraint shows that nurses need to use restraints. The aim of the study was to gain insights from the restraint model used by mental disorder client nurses in health care facilities.Methods: The method used was the identification of interventions in the literature, the identification of the relevant literature by topic and title, obtaining the literature in full-text form and the analysis of the results from the various interventions used in the literature. We systematically searched Scopus, Proquest and Science Direct by including keywords such as ‘restraint models’ and ‘clinical restraint’. The years were limited to 4 (2015-2018).Results: From the 80 potentially relevant articles, 15 met our eligibility criteria with qualitative and quantitative designs; all discussed restraint interventions. The restraint models for mental disorder clients were physical, mechanical and chemical.Conclusion: This study reports on the latest experience that restraint cannot be eliminated from use. Nurses tended to disagree if the restraint method was removed. Restraint with physical, chemical, and mechanical solutions could be tailored to the client's case in health care facilities. The results of this review should be considered when developing interventions aimed at reducing the use of restraint.
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Bachmann L, Michaelsen R, Vatne S. Professional vulnerability in mental healthcare contexts: A focus group study of milieu-therapists' experiences. Nurs Open 2019; 6:1076-1087. [PMID: 31367433 PMCID: PMC6650672 DOI: 10.1002/nop2.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/01/2019] [Accepted: 04/08/2019] [Indexed: 11/09/2022] Open
Abstract
AIMS AND OBJECTIVES To gain insight into how the workplace influences milieu-therapists' vulnerability in the mental healthcare context. BACKGROUND Mental health services have experienced substantial changes. Reduced institutional treatment capacity is replacing the development of locally based treatment. Changes in external conditions in mental health services have influenced the working conditions of nurses and milieu-therapists. DESIGN Qualitative design. The study complied with the COREQ checklist. METHODS Focus group interviews. RESULTS "Vulnerability due to unpredictable and threatening working context" was the common key theme that emerged in both contexts. Two key themes were different and opposite. In municipal mental health care, "Alone and unprotected" and in institutional care, "Together and protected." CONCLUSION The participants from both specialized and community mental health care, experienced vulnerability at different levels interpreted as a contradictory relationship between the healthcare system and their own ideals of what professional practice ought to be. RELEVANCE TO CLINICAL PRACTICE This study contributes to extended knowledge and understanding about the experienced influence of the working environment on professional vulnerability of nurses and milieu-therapists` in mental health services. The impact of contextual conditions on health professionals' working conditions has multi-professional relevance for milieu-therapists and managers of mental health services, and it is an important topic in health and social higher education.
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Affiliation(s)
- Liv Bachmann
- Faculty of Health Sciences and Social CareMolde University College, Specialized University in LogisticsMoldeNorway
| | - Ragnhild Michaelsen
- Faculty of Health Sciences and Social CareMolde University College, Specialized University in LogisticsMoldeNorway
| | - Solfrid Vatne
- Faculty of Health Sciences and Social CareMolde University College, Specialized University in LogisticsMoldeNorway
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Mabala J, van der Wath A, Moagi M. Newly qualified nurses' perceptions of working at mental health facilities: A qualitative study. J Psychiatr Ment Health Nurs 2019; 26:175-184. [PMID: 31099077 DOI: 10.1111/jpm.12525] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/26/2019] [Accepted: 05/14/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Newly qualified nurses often feel overwhelmed by the challenges of the work environment and struggle to transition into healthcare work environments. Nurses require opportunities during the transition period to develop both competence and confidence in their ability to practise independently. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Newly qualified mental health nurses experience fear during their adaptation period, especially when they perceive mental healthcare users as dangerous and the working environment as risky, with little concern for their safety. Nurses new to the mental health environment learn from accepting responsibility, taking on challenges and making adjustments, in order to develop confidence as mental healthcare professionals. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nursing management should ensure a safe and supportive mental healthcare environment. The potential for and consequences of negative stereotyping of patients among mental health nurses should be acknowledged and addressed as it may hinder the smooth adaptation of newly qualified nurses. Although stressful experiences can help mental health nurses to develop confidence and skills to manage future demanding situations, newly qualified nurses need to be given appropriate support and debriefing to ensure challenging situations do not "go the wrong way" and decrease confidence levels. Abstract Introduction Much has been written about the experiences of newly qualified nurses in their first year of employment, yet not much has been heard from the perspectives of newly qualified nurses working in mental health facilities. Aim To explore and describe the adaptation process of newly qualified nurses working in public mental health facilities in South Africa. Method Following a qualitative descriptive design, 11 newly qualified nurses in their first 6-18 months of employment were purposively selected from three public mental health facilities in South Africa. Data collected through unstructured individual interviews were thematically analysed. Results Four themes emerged from the analysis: fear related to the mental healthcare environment; self-doubt upon meeting the expectations of the inter-professional team; ways to adjust to the challenges; and confidence as mental healthcare professionals. Discussion During the adaptation process newly qualified nurses working in mental health facilities need support to overcome their initial fears and develop self-confidence in both managerial and therapeutic realms. Implications for practice Management of mental healthcare facilities needs to be cognisant of the importance of creating a supportive and safe environment that discourages negative stereotyping of patients and fosters newly qualified nurses' adaptation.
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Affiliation(s)
- Jaftaline Mabala
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | | | - Miriam Moagi
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
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Hirsch S, Steinert T. Measures to Avoid Coercion in Psychiatry and Their Efficacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:336-343. [PMID: 31288909 PMCID: PMC6630163 DOI: 10.3238/arztebl.2019.0336] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 08/20/2018] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coercive measures such as seclusion and restraint encroach on the patient's human rights and can have serious adverse effects ranging from emotional trauma to physical injury and even death. At the same time, they may be the only way to avert acute danger for the patient and/or the hospital staff. In this article, we provide an overview of the efficacy of the measures that have been studied to date for the avoidance of coercion in psychiatry. METHODS This review is based on publications retrieved by a systematic search in the Medline and Cinahl databases, supplemented by a search in the reference lists of these publications. We provide a narrative synthesis in which we categorize the interventions by content. RESULTS Of the 84 studies included in this review, 16 had a control group; 6 of these 16 were randomized controlled trials (RCTs). The interventions were categorized by seven different types of content: organization, staff training, risk assessment, environment, psychotherapy, debriefings, and advance directives. Most interventions in each category were found to be effective in the respective studies. 38 studies investigated complex treatment programs that incorporated elements from more than one category; 37 of these (including one RCT) revealed effective reduction of the frequency of coercion. Two RCTs on the use of rating instruments to assess the risk of aggressive behavior revealed a relative reduction of the number of seclusion measures by 27% and a reduction of the cumulative duration of seclusion by 45%. CONCLUSION Complex intervention programs to avoid coercive measures, incorporating elements of more than one of the above categories, seem to be particularly effective. In future, cluster-randomized trials to investigate the individual categories of intervention would be desirable.
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Affiliation(s)
- Sophie Hirsch
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
| | - Tilman Steinert
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
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Hammervold UE, Norvoll R, Aas RW, Sagvaag H. Post-incident review after restraint in mental health care -a potential for knowledge development, recovery promotion and restraint prevention. A scoping review. BMC Health Serv Res 2019; 19:235. [PMID: 31014331 PMCID: PMC6480590 DOI: 10.1186/s12913-019-4060-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/04/2019] [Indexed: 12/03/2022] Open
Abstract
Background Use of physical restraint is a common practice in mental healthcare, but is controversial due to risk of physical and psychological harm to patients and creating ethical dilemmas for care providers. Post-incident review (PIR), that involve patient and care providers after restraints, have been deployed to prevent harm and to reduce restraint use. However, this intervention has an unclear scientific knowledge base. Thus, the aim of this scoping review was to explore the current knowledge of PIR and to assess to what extent PIR can minimize restraint-related use and harm, support care providers in handling professional and ethical dilemmas, and improve the quality of care in mental healthcare. Methods Systematic searches in the MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Science databases were carried out. The search terms were derived from the population, intervention and settings. Results Twelve studies were included, six quantitative, four qualitative and two mixed methods. The studies were from Sweden, United Kingdom, Canada and United States. The studies’ design and quality varied, and PIR s’ were conducted differently. Five studies explored PIR s’ as a separate intervention after restraint use, in the other studies, PIR s’ were described as one of several components in restraint reduction programs. Outcomes seemed promising, but no significant outcome were related to using PIR alone. Patients and care providers reported PIR to: 1) be an opportunity to review restraint events, they would not have had otherwise, and 2) promote patients’ personal recovery processes, and 3) stimulate professional reflection on organizational development and care. Conclusion Scientific literature directly addressing PIR s’ after restraint use is lacking. However, results indicate that PIR may contribute to more professional and ethical practice regarding restraint promotion and the way restraint is executed. The practice of PIR varied, so a specific manual cannot be recommended. More research on PIR use and consequences is needed, especially PIR’s potential to contribute to restraint prevention in mental healthcare.
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Affiliation(s)
- Unn Elisabeth Hammervold
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, NO-4036, Stavanger, Norway.
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Randi W Aas
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, NO-4036, Stavanger, Norway.,Department of Occupational Therapy, Prosthetics and Orthotics, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Hildegunn Sagvaag
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, NO-4036, Stavanger, Norway
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16
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Delaney KR, Lusk P. Potential impact of DNP projects on child mental health services. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2018; 31:46-47. [DOI: 10.1111/jcap.12214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Triplett P, Dearholt S, Cooper M, Herzke J, Johnson E, Parks J, Sullivan P, Taylor KF, Rohde J. The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting. J Am Psychiatr Nurses Assoc 2017; 23:422-430. [PMID: 28754070 DOI: 10.1177/1078390317723709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. OBJECTIVES Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. DESIGN Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. RESULTS The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. CONCLUSIONS The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.
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Affiliation(s)
- Patrick Triplett
- 1 Patrick Triplett, MD, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sandra Dearholt
- 2 Sandra Dearholt, MS, RN, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mary Cooper
- 3 Mary Cooper, MS, RN, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John Herzke
- 4 John Herzke, MBA, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Erin Johnson
- 5 Erin Johnson, BSN, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joyce Parks
- 6 Joyce Parks, MS, RN-BC, PMHCNS-BC, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Patricia Sullivan
- 7 Patricia Sullivan, MS, RN, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Karin F Taylor
- 8 Karin F. Taylor, MS, RN, PMHCNS-BC, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Judith Rohde
- 9 Judith Rohde, ScD, RN, Johns Hopkins Hospital, Baltimore, MD, USA
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