1
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Hartnett Y, Thekiso TB, Kowalska-Beda P, Maher T, McLoughlin DM, Kennedy N. Predictors of inpatient suicide in an Irish psychiatric service, a longitudinal case-control study. Suicide Life Threat Behav 2024; 54:620-631. [PMID: 38517159 DOI: 10.1111/sltb.13073] [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: 03/03/2023] [Revised: 10/01/2023] [Accepted: 02/23/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE Inpatient suicide remains difficult to predict. This study aimed to identify individual patient predictors to help identify those at greater risk. METHODS This case-control study was undertaken in an independent mental health service in Ireland. Cases were drawn from all admissions to the service between March 2004 and February 2019. Controls were matched for date of admission. Univariate and multivariate analyses were conducted. RESULTS Thirty-three cases of inpatient suicide were compared to 132 controls. The inpatient suicide rate was 76.2 per 100,000 admissions. The rate of inpatient suicide fell in line with national rates despite less restrictive practices being implemented in the service. Males accounted for 66% of cases. Hanging was the most common method of suicide overall and among male patients, and drowning was the most common among females. Male gender, tertiary referral, an adverse psychosocial event during admission, a period of absence without leave and expressing hopelessness were identified as independent risk factors for inpatient suicide. Substance use, involuntary detention, family history of suicide, and number of previous admissions were not significant. CONCLUSIONS While not highly sensitive, a period of absence without leave, tertiary referral and hopelessness are important predictors of inpatient suicide risk that treating teams should consider in care planning.
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Affiliation(s)
| | | | | | - Tom Maher
- St Patrick's University Hospital, Dublin, Ireland
| | - Declan M McLoughlin
- St Patrick's University Hospital, Dublin, Ireland
- Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Noel Kennedy
- St Patrick's University Hospital, Dublin, Ireland
- Highfield Healthcare, Dublin, Ireland
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2
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Anstee L, Chifamba D, Loothfaully W, Suleiman S, Shah C, Littlechild B, Zia A. Stakeholder perspectives on continuous observation in inpatient psychiatric wards. J Psychiatr Ment Health Nurs 2024. [PMID: 38922777 DOI: 10.1111/jpm.13072] [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: 12/06/2023] [Revised: 05/08/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Continuous observation is often used in mental health wards to support the safety of service users, where they will be constantly watched by a member of staff. Evidence suggests that continuous observations may be unhelpful and restrictive, but not enough is known about the practice or the best ways to improve it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This evaluation integrates the perspectives of service users, informal carers and staff to explore current continuous observation experiences and inform future improvements. While previous research highlights the importance of therapeutic engagement, this study additionally emphasizes how the observation procedure could be adapted to individual needs. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Continuous observations could be more beneficial if they are therapeutic, proportional to the level of risk and co-developed with the service user, informal carer and staff. Further training about communication could support staff engagement and the observation process could be formalized to ensure regular collaborative reviews. ABSTRACT INTRODUCTION: Continuous observation is a frequently used tool to manage high levels of risk on psychiatric wards. However, there is little previous research on its use in practice. AIM This qualitative service evaluation aims to explore the continuous observation experiences of service users, informal carers and staff in a local NHS Mental Health Trust, informing suggested future improvements to current practice. METHOD Five service users, three informal carers and seven healthcare staff completed semi-structured interviews, which were thematically analysed to create four themes. RESULTS Positive interaction and engagement in activities were critical for a therapeutic approach to observations, supporting service users and staff to minimize the unproductive behaviours that can arise. Difficulties balancing safety with privacy could suggest the importance of proportionate and tailored observation procedures for each service user. Ensuring the voices of service users and informal carers remain central to decisions regarding care could further improve the observation experience. IMPLICATIONS FOR PRACTICE This study highlights therapeutic, proportionate and co-produced observations as key characteristics to improve practice. Further training and formalization of the observation process could foster cultural changes towards more long-term approaches to risk management.
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Affiliation(s)
- Lottie Anstee
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Denford Chifamba
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Wasim Loothfaully
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Suleiman Suleiman
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Chetan Shah
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | | | - Asif Zia
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
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3
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Sweeting P, Finlayson M, Hartz D. A Review of Modifiable Health Care Factors Contributing to Inpatient Suicide: An Analysis of Coroners' Reports Using the Human Factors Analysis and Classification System for Healthcare. Jt Comm J Qual Patient Saf 2024:S1553-7250(24)00168-5. [PMID: 38944573 DOI: 10.1016/j.jcjq.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Inpatient suicides have devastating and long-lasting consequences for patients, families, and health care organizations, posing a major challenge for hospitals. Although many studies have identified patient risk factors for inpatient suicide, the modifiable health care factors are less understood. Failure to understand these modifiable factors weakens organizations' ability to design and implement effective prevention strategies. METHODS The Human Factors Analysis and Classification System for Healthcare (HFACS-Healthcare) was used to classify and analyze modifiable health care factors that contributed directly or indirectly to inpatient suicides in Australian hospitals between 2009 and 2018. Comparisons were made between general and psychiatric hospital units to identify context-specific recommendations. RESULTS Of the 367 cases, 216 (58.9%) had enough information to analyze the contributing factors, and 214 (58.3%) included unit location information. Multiple modifiable health care factors were identified in the cases as contributing to the patients' suicides. Commonly, cases reported decision errors made by individuals (57.4%), problems with the physical environment (56.0%), and unit-level operational decision-making errors (that is, planned inappropriate operations) (48.6%). An association was found between unit type and problems with coordination, mental state, tasks, physical environment, planned inappropriate operations, and organizational culture (p < 0.05). CONCLUSION General prevention initiatives may not be effective in addressing inpatient suicides across specialty units. HFACS-Healthcare enabled a deeper understanding of inpatient suicide and the identification of priority areas that, if addressed, could help reduce the number of preventable suicides in hospitals. Hospital suicide prevention initiatives need to be tailored to specific units and target individual and system vulnerabilities to improve safety and reduce inpatient suicide rates.
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4
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Myhre MØ, Kildahl AT, Astrup H, Bergsager D, Walby FA. Suicide in services for mental health and substance use: A national hybrid registry surveillance system. Health Informatics J 2023; 29:14604582231167439. [PMID: 36989536 DOI: 10.1177/14604582231167439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Suicide is strongly associated with mental health and substance use disorders, which makes mental health- and substance misuse services important areas for suicide prevention. The aim of The Norwegian Surveillance System for Suicide in Mental Health and Substance Use Services is to describe all suicide deaths in Norway that occur within one year after contact with mental health and substance misuse services. The study uses a hybrid registry case series design. It consists of a yearly linkage between the Norwegian Cause of Death Registry and the Norwegian Patient Registry, which is linked with a questionnaire. The linkage is conducted by using a cryptographic hash function of the deceased's personal id, thus ensuring that the project can link data across sources without the use of directly identifiable information. This indirect linkage ensures the deceased's confidentiality. Moreover, the The Norwegian Surveillance System for Suicide shows how administratively collected data can be harnessed and used for surveillance. Both use of hybrid registry designs and linkage through cryptographic hash functions might contribute to the development of health informatics as well as quality improvement in health care.
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Affiliation(s)
- Martin Ø Myhre
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, 6305University of Oslo, Oslo, Norway
| | - Anine T Kildahl
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, 6305University of Oslo, Oslo, Norway
| | - Helene Astrup
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, 6305University of Oslo, Oslo, Norway
| | - Dagfinn Bergsager
- University Centre for Information Technology, 6305University of Oslo, Oslo, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute for Clinical Medicine, 6305University of Oslo, Oslo, Norway
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5
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Zarate D, Sonn C, Fisher A, Stavropoulos V. Suicidal behaviors in the entertainment industry: a preliminary exploration of the interplay between work scheduling, social support, and wellbeing in Australia. BMC Psychiatry 2022; 22:754. [PMID: 36456910 PMCID: PMC9714765 DOI: 10.1186/s12888-022-04376-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Workers of the Australian entertainment industry exhibit disproportionately high rates of impaired psychological wellbeing and suicidal behaviors, with such rates being exacerbated by the negative impact of working long and odd hours (Work Scheduling Impact; WSI). Nonetheless, stable and secure social support networks may buffer the risks associated with such systemic difficulties. METHODS The responses of 1302 Australian entertainment industry workers (50.3% females, Mage 38.39 years) on the Multidimensional Scale of Perceived Social Support, the Short Form Health Survey, WSI, and suicidal behaviors questions were examined via moderation analyses. RESULTS Higher social support and lower WSI appeared to reduce the suicidal ideation of those experiencing poorer mental health, while lower WSI further enhanced social support's positive effect. CONCLUSIONS Findings highlight the likely detrimental effect of WSI regarding the suicidal ideation reported by vulnerable Australian entertainment industry workers and stress the importance of the social support they experience. PUBLIC HEALTH IMPLICATIONS Interventions attempting to increase social support could improve inherent conditions associated with the Australian entertainment industry. Similarly, the negative effect of working long and odd hours on workers' mental health and suicidal behaviors indicates the need to regulate the industry appropriately.
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Affiliation(s)
- Daniel Zarate
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Christopher Sonn
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Adrian Fisher
- grid.1019.90000 0001 0396 9544Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Vasileios Stavropoulos
- Institute for Health and Sport, Victoria University, Melbourne, Australia. .,University of Athens, Athens, Greece.
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6
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Obegi JH. Hazards of Using Constant Observation With Suicidal Patients. J Psychiatr Pract 2022; 28:485-491. [PMID: 36355588 DOI: 10.1097/pra.0000000000000668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Constant observation is a necessary albeit controversial procedure. Although widely used in psychiatric hospitals to maintain the safety of patients experiencing acute suicidality, constant observation is associated with many medicolegal hazards. Some hazards threaten patients directly, others undermine the effectiveness of treatment, and still others challenge clinical decision-making and suicide risk assessment. Nevertheless, clinicians can take proactive steps to minimize potentially adverse effects of constant observation on patients, preserve the integrity of treatment, and limit legal exposure.
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Affiliation(s)
- Joseph H Obegi
- OBEGI: California Department of Corrections and Rehabilitation, California Correctional Health Care Services, Statewide Mental Health Program, Elk Grove, CA
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7
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Lawrence RE, Krumheuer A, Loh R, Stanley B, Simpson SA. Persons Who Engage in Self-Harm While in the Emergency Department: A Case-Control Analysis. J Nerv Ment Dis 2022; 210:736-740. [PMID: 36179373 PMCID: PMC9525888 DOI: 10.1097/nmd.0000000000001528] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT Some patients engage in self-harm behaviors while in the emergency department. Risk factors for self-harm have been described for inpatient and outpatient/community settings, but not among emergency department patients. Authors conducted case-control, retrospective reviews of medical records and incident reports for emergency department patients in two academic medical centers. Variables were analyzed using conditional logistic regression. There were 113 individuals who engaged in self-harm while in the emergency department and 226 individuals who did not. Four variables were significant in the final model: a history of nonsuicidal self-harm (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.95-9.41), opioid use in the prior 2 weeks (OR, 2.89; CI, 1.19-7.02), current manic episode (OR, 3.59; CI, 1.33-9.70), and a history of seizures (OR, 4.19; CI, 1.16-15.14). Risk of self-harm while in the emergency department may be mitigated with interventions that support adaptive coping skills, promptly address pain and withdrawal symptoms, and treat mania.
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Affiliation(s)
- Ryan E Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Aaron Krumheuer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ryan Loh
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
| | - Barbara Stanley
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
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8
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Berg SH, Rørtveit K, Walby FA, Aase K. Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis. BMC Health Serv Res 2022; 22:967. [PMID: 35906685 PMCID: PMC9336074 DOI: 10.1186/s12913-022-08282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention. Methods A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review. Results Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring. Conclusion Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced. Trial registration https://doi.org/10.1136/bmjopen-2016-012874
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Affiliation(s)
- Siv Hilde Berg
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, N-4036, Stavanger, Norway. .,Clinics of Adult Mental Health Care, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
| | - Kristine Rørtveit
- Milieu Therapy and Mental Health Nursing Research Group, Clinics of Adult Mental Health Care, Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.,Life Phenomena and Caring Research Group, Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, N-4036, Stavanger, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, Building 12, N-0320, Oslo, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholmsgate 43, N-4036, Stavanger, Norway
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9
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Christl J, Schröder N, Mennicken R, Jänner M, Supprian T. Inpatient Suicides in Late Life: A Retrospective Analysis of a Hospital Group with Nine Psychiatric Clinics. Arch Suicide Res 2022; 26:1436-1446. [PMID: 34006203 DOI: 10.1080/13811118.2021.1922107] [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: 10/21/2022]
Abstract
OBJECTIVE Inpatient suicides are rare incidents; however, the impacts of such events on associated families and hospital staff are severe. Therefore, preventive strategies need to focus on risk factors. Clinical management in a hospital setting must integrate the home environment and social life of patients. Nevertheless, home leaves require careful preparation. METHODS Suicides were reported systematically from all psychiatric departments of the Landschaftsverband Rheinland (an assembly of municipalities) using a structured form during two periods (1995-2004, 2005-2014). From these reports we extracted data on suicide methods and sociodemographic and clinical variables. Only patients 65 years and older were included. RESULTS From a total of 551 reports on suicides in the period of 1995-2014, 103 patients 65 years and older (60 women, 43 men) died by suicide. In contrast to the general trend in Germany during this period, no decline in overall suicide rates was found. Most patients were treated because of depression (73.8%); schizophrenic psychosis was diagnosed in 11.7%; and dementia was only diagnosed in 1.9%. The most frequent suicide method was hanging (40%). All suicides within the hospital were hangings. The majority of suicides occurred outside the hospital during approved home leaves. Only 7% of suicides occurred when patients left the hospital without permission. Almost half of the patients (n = 44) died by suicide during the first month of treatment. With longer duration of hospitalization, the risk of suicide decreased. There were no significant trends with regard to suicide methods between the two periods. CONCLUSIONS In the first weeks of hospitalizations the patients are most endangered to die by suicide. Therefore, home leaves need careful consideration.
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10
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Hospital-Based Suicides: Challenging Existing Myths. Psychiatr Q 2022; 93:1-13. [PMID: 33169312 DOI: 10.1007/s11126-020-09856-w] [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] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
Abstract
Myths are widely held and often based on false beliefs. To improve patient safety and speed the translation of research to clinical practice, we highlight and then debunk 10 common myths regarding the assessment, treatment, and management of hospitalized patients at risk for suicide. Myths regarding hospital-based suicides are examined and empirical evidence that counters each myth is offered. Ten common myths regarding hospital-based suicides are found to be untrue or unsupported based on existing empirical evidence. Rethinking common beliefs and practices that lack empirical support and seeking alternatives based on research evidence is consistent with an emphasis on evidence-based practices leading to improved patient care and protection.
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11
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Lawrence RE, Fuchs B, Krumheuer A, Perez-Coste M, Loh R, Simpson SA, Stanley B. Self-harm During Visits to the Emergency Department: A Qualitative Content Analysis. J Acad Consult Liaison Psychiatry 2021; 63:225-233. [PMID: 34695618 PMCID: PMC9023582 DOI: 10.1016/j.jaclp.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/02/2021] [Accepted: 10/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some patients engage in self-harm behaviors while in the emergency department, both suicidal and nonsuicidal self-harm. Little is known about what motivates these behaviors. This gap in the empirical literature limits efforts to develop early identification and risk mitigation strategies. OBJECTIVE To describe methods and motivations when patients self-harm in the emergency department. METHOD Authors reviewed self-harm incident reports and medical records from two academic urban emergency departments. Event timing and self-harm methods were extracted. Authors performed a qualitative content analysis of self-harm narratives to examine the question, "Which factors motivate patients to engage in deliberate (nonaccidental) self-harm in the emergency department?" RESULTS The sample included 184 self-harm incidents involving 118 unique patients. A wide variety of self-harm methods were present in the data. Suicidal intent was present in a minority of incidents. Other motives included psychosis, intoxication, aggression, managing distress, communication, and manipulation. CONCLUSIONS Self-harm behaviors in the emergency department encompassed a variety of methods and motivations. These findings suggest risk mitigation strategies that emphasize suicide screening, reducing environmental hazards, and increasing observation are unlikely to achieve the goal of zero harm. Strategies focusing on engagement may create more fruitful opportunities to improve patient safety.
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Affiliation(s)
- Ryan E Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY.
| | - Brian Fuchs
- Department of Psychiatry, Columbia University, New York, NY
| | - Aaron Krumheuer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | | | - Ryan Loh
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, CO
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, CO
| | - Barbara Stanley
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY
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12
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Stallman HM, Allen A. Acute suicide prevention: A systematic review of the evidence and implications for clinical practice. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Nawaz RF, Reen G, Bloodworth N, Maughan D, Vincent C. Interventions to reduce self-harm on in-patient wards: systematic review. BJPsych Open 2021; 7:e80. [PMID: 33858560 PMCID: PMC8086389 DOI: 10.1192/bjo.2021.41] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Incidents of self-harm are common on psychiatric wards. There are a wide variety of therapeutic, social and environmental interventions that have shown some promise in reducing self-harm in in-patient settings, but there is no consensus on the most appropriate means of reducing and managing self-harm during in-patient admissions. AIMS To review interventions used to reduce self-harm and suicide attempts on adolescent and adult psychiatric in-patient wards. METHOD A systematic literature search was conducted between 14 March 2019 and 25 January 2021 using PsycINFO and Medline (PROSPERO ID: CRD42019129046). A total of 23 papers were identified for full review. RESULTS Interventions fell into two categories, therapeutic interventions given to individual patients and organisational interventions aimed at improving patient-staff communication and the overall ward milieu. Dialectical behaviour therapy was the most frequently implemented and effective therapeutic intervention, with seven of eight studies showing some benefit. Three of the six ward-based interventions reduced self-harm. Two studies that used a combined therapeutic and ward-based approach significantly reduced self-harm on the wards. The quality of the studies was highly variable, and some interventions were poorly described. There was no indication of harmful impact of any of the approaches reported in this review. CONCLUSIONS A number of approaches show some promise in reducing self-harm, but the evidence is not strong enough to recommend any particular approach. Current evidence remains weak overall but provides a foundation for a more robust programme of research aimed at providing a more substantial evidence base for this neglected problem on wards.
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Affiliation(s)
- Rasanat Fatima Nawaz
- Department of Experimental Psychology, University of Oxford, UK; Patient Safety Collaborative, Oxford Academic Health Science Network, UK; and Department of Psychiatry, University of Cambridge, UK
| | - Gurpreet Reen
- Department of Experimental Psychology, University of Oxford, UK; and Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
| | - Natasha Bloodworth
- Department of Experimental Psychology, University of Oxford, UK; and Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
| | - Daniel Maughan
- Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, UK; and Oxford Healthcare Improvement Centre, Oxford Health NHS Foundation Trust, UK
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14
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Novak C, Packer E, Paterson A, Roshi A, Locke R, Keown P, Watson S, Anderson KN. Feasibility and utility of enhanced sleep management on in-patient psychiatry wards. BJPsych Bull 2020; 44:255-260. [PMID: 32329430 PMCID: PMC7684772 DOI: 10.1192/bjb.2020.30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS AND METHOD Sleep disturbance is common in psychiatry wards despite poor sleep worsening mental health. Contributory factors include the ward environment, frequent nightly checks on patients and sleep disorders including sleep apnoea. We evaluated the safety and feasibility of a package of measures to improve sleep across a mental health trust, including removing hourly checks when safe, sleep disorder screening and improving the ward environment. RESULTS During the pilot there were no serious adverse events; 50% of in-patients were able to have protected overnight sleep. Hypnotic issuing decreased, and feedback from patients and staff was positive. It was possible to offer cognitive-behavioural therapy for insomnia to selected patients. CLINICAL IMPLICATIONS Many psychiatry wards perform standardised, overnight checks, which are one cause of sleep disruption. A protected sleep period was safe and well-tolerated alongside education about sleep disturbance and mental health. Future research should evaluate personalised care rather than blanket observation policies.
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Affiliation(s)
- Chloe Novak
- Department of Psychology, Newcastle University, UK
| | - Emma Packer
- Department of Psychology, Newcastle University, UK
| | - Alastair Paterson
- Department of Psychology, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Ambrina Roshi
- Department of Psychology, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Rosie Locke
- Department of Psychology, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Patrick Keown
- Department of Psychology, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Stuart Watson
- Department of Psychology, Newcastle University, UK.,Department of Psychology, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, UK
| | - Kirstie N Anderson
- Department of Psychology, Newcastle University, UK.,Regional Sleep Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, UK
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15
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Ahn SI, Lee W, Song DH. A Descriptive Study on the Civil Lawsuits of Medical Malpractice Occurred during Psychiatric Ward Treatment. Psychiatry Investig 2020; 17:865-870. [PMID: 32853519 PMCID: PMC7538241 DOI: 10.30773/pi.2019.0350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/01/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Medical accidents have resulted in actual harm for patients, been costly for health care system, and diminished trust for both patients and practitioners. The present study analyzed malpractice claims related to accidents in psychiatric inpatient units. METHODS This study analyzed defendants, cases and plaintiffs or patients characteristics, degrees of injury, and types of accidents in 85 civil malpractice suits filed from 2005 to 2015 with a focus on the methods and locations of suicides. RESULTS Most defendants were psychiatrists (n=43). Of the 85 cases, 56 (65.9%) were decided in favor of the plaintiff, most commonly on the grounds of negligence and violation of sound facility management principles. The most common diagnosis of patients was schizophrenia (n=31). The damages were deaths in 52 cases and injuries or other damages in the remaining 33 cases. The most common accident was suicide (n=28), followed by escape attempts (n=15). The most common suicide method was hanging (n=21), which was usually committed in the private room using objects like door handles. CONCLUSION To reduce medical accidents, medical staff should monitor high-risk patients closely and constantly. Sufficient numbers of well-trained personnel are required to meet this standard. Reducing environmental hazards such as removing anchor points and installing door locking systems will improve patient safety.
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Affiliation(s)
- Song Ii Ahn
- Graduate School, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Lee
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Dong Ho Song
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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16
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Berg SH, Rørtveit K, Walby FA, Aase K. Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study. BMC Psychiatry 2020; 20:316. [PMID: 32560682 PMCID: PMC7304097 DOI: 10.1186/s12888-020-02689-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Safe clinical practice for patients hospitalised in mental health care during a suicidal crisis is situated within a dynamic, non-linear and uncertain context. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care. This study aimed to explore safe clinical practice for suicidal patients hospitalised in mental health wards through understanding healthcare professionals' (HCPs') capacities to adapt to challenges and changes in clinical care. METHODS This study applied a qualitative design with focus group and individual interviews. Twenty-five HCPs participated in the focus groups, and 18 participated in individual interviews. The study was conducted in open and locked wards in a university hospital in Norway providing specialised mental health services for patients with mental illness. RESULTS HCPs described their adaptive capacities for clinical practice relative to three themes. 1) HCPs used expertise to make sense of suicidal behaviour to support complex decision making. Their strategies included setting aside forms and checklists to prioritise trust and making judgements based on more than just patients' spoken words. They improved their understanding by seeking others' perspectives through collaborative sense-making processes involving the healthcare team and patient. 2) HCPs individualised the therapeutic milieu to address the diversity of patients with suicidal behaviour by creating individual clinical pathways, making trade-offs between under- and over-protection and adjusting observations. 3) HCPs described managing uncertainty as necessary for providing safe clinical practice. They managed uncertainty as a team by developing mutual collegial trust and support and creating a shared understanding. CONCLUSION HCPs' adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacities to adapt to challenges and changes in clinical care. HCPs cannot easily ensure safe clinical practice by following standards; safe clinical practice depends on HCPs' adaptations. Ward systems that ensure collegial trust and support, as well as arenas that foster shared understanding and situational awareness, are needed.
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Affiliation(s)
- Siv Hilde Berg
- Division of Adult Mental Health, Sandnes DPS, Stavanger University Hospital, Postveien 181, N-4307 Sandnes, Norway
| | - Kristine Rørtveit
- Nursing and Health Care Research Group, Department of Research, Stavanger University Hospital, P.O. Box 8100, N-4068 Stavanger, Norway
| | - Fredrik A. Walby
- National Centre for Suicide Research and Prevention, Faculty of Medicine, University of Oslo, Sognsvannsveien 21, Building 12, N-0320 Oslo, Norway
| | - Karina Aase
- Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, N-4036 Stavanger, Norway
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Reen GK, Bailey J, Maughan DL, Vincent C. Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards. Int J Ment Health Nurs 2020; 29:372-386. [PMID: 32048785 DOI: 10.1111/inm.12696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2020] [Indexed: 11/29/2022]
Abstract
Constant observation is frequently conducted on inpatient psychiatric units to manage patients at risk of harming themselves or others. Despite its widespread use, there is little evidence of the efficacy of the practice or of its impact on patients and nursing staff. Unnecessary use of this practice can be restrictive and distressing for all involved and can cause considerable strain on healthcare resources. We sought to review interventions aiming to improve the quality and safety of constant observation or to reduce unnecessary use of this restrictive practice on adult inpatient psychiatric wards. A systematic search conducted in December 2018 using PubMed, PsycINFO, CINAHL, EMBASE and Google Scholar identified 24 studies with interventions related to constant observation. Only 16 studies evaluated a total of 13 interventions. The most common intervention components were changes to team, education and training for staff, changes to record keeping and assessment, and involving patients in care. A range of outcome measures were used to evaluate interventions. Over half of the interventions showed some positive impact on constant observation. One study recorded patient feedback. All interventions were targeted towards mental health nurses. Overall, there is no consensus on how best to improve the safety and quality of constant observations or reduce its unnecessary use. Studies vary widely in design, intervention and outcome measures. Existing research does however suggest that teamwork interventions can improve the patient experience of constant observation and safely reduce their degree and frequency. Priorities for future research on constant observations are highlighted.
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Affiliation(s)
- Gurpreet K Reen
- University of Oxford & Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jill Bailey
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Charles Vincent
- University of Oxford & Oxford Health NHS Foundation Trust, Oxford, UK
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18
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Elrefaay SMM, Soltis-Jarrett V. Suicide Prevention Education for Psychiatric Inpatient Nurses in Egypt. J Psychosoc Nurs Ment Health Serv 2020; 58:32-38. [DOI: 10.3928/02793695-20200305-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/17/2020] [Indexed: 12/11/2022]
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19
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Taylor P. System Entrapment: Dehumanization While Help-Seeking for Suicidality in Women Who Have Experienced Intimate Partner Violence. QUALITATIVE HEALTH RESEARCH 2020; 30:530-546. [PMID: 31303117 DOI: 10.1177/1049732319857671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Attention to power imbalances when seeking help for suicidality after having been controlled within intimate partner violence (IPV) is crucial in improving health care delivery. Well documented in the literature is the correlation between suicidality and IPV and that help-seeking for each is difficult; however, a gap exists when both intersect. The process of women's help-seeking is explored in this feminist grounded theory and photovoice multiple qualitative method study. Analysis of interviews with 32 women from New Brunswick, Canada, and photovoice meetings with seven women revealed a basic psycho-social problem. System Entrapment or being dehumanized while seeking help for suicidality occurred as a result of perceived invalidation from health care providers' lack of empathy. Further harm while providing services to women feeling suicidal can be prevented with a shift from an individualist model toward a trauma and violence informed approach. Understanding the contextual factors influencing women's suicidality may reduce victim blaming.
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Affiliation(s)
- Petrea Taylor
- Faculty of Nursing, University of New Brunswick, Riverview, New Brunswick, Canada
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20
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Chu S, Lambert K, Baker A. What to look for during constant observations: Expert consensus and a tool for observations recording. J Psychiatr Ment Health Nurs 2020; 27:77-86. [PMID: 31381244 DOI: 10.1111/jpm.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 07/08/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Supportive observations is the practice of closely monitoring patients who are acutely unwell in order to keep them safe. There are no formal guidelines for nursing staff on what to observe during observations. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A consensus of expert opinion suggests that the clinically meaningful behaviours in supportive observations focus on six factors: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: These aspects of patient presentation should be a part of the decision-making discussions about observations. The Mersey Care Supportive Observations Recording Tool that emerged from this consensus may assist with recording the relevant information. Abstract Introduction Supportive observations are common in mental health care but there are no guidelines on best practice or what should be documented in observations records. Aim To develop expert consensus on the important aspects of patient presentation that inform clinical decision-making about observations and to develop a recording tool from this consensus. Method A Delphi methodology was used to consult an expert panel of mental health clinicians and academics to agree on what aspects of patient presentation during constant observations are important in informing clinical decisions. Thematic analysis was applied to the agreed item set to extract common aspects of presentation and behaviour. Results The panel considered 118 individual items across three rounds of consultation and agreed that 51 items were important to clinical decisions about observations. Thematic analysis found six man themes: agitation, self-harm and suicide, violence, negative influence, disengagement and positive behaviour. Subthemes were used to create the MerseyCare Supportive Observations Recording Tool (MSORT). Discussion These data represent the first expert consensus on the aspects of patient presentation that are important to clinical decisions. Implications for practice Consensus items should be recorded in observations records and be considered in decision-making about observations. The MSORT may aid observations recording.
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Affiliation(s)
- Simon Chu
- Ashworth Research Centre, Ashworth Hospital, Mersey Care NHS Foundation Trust, Liverpool, UK.,School of Psychology, University of Central Lancashire, Preston, UK
| | - Katie Lambert
- Ashworth Research Centre, Ashworth Hospital, Mersey Care NHS Foundation Trust, Liverpool, UK.,School of Psychology, University of Central Lancashire, Preston, UK
| | - Alison Baker
- Ashworth Research Centre, Ashworth Hospital, Mersey Care NHS Foundation Trust, Liverpool, UK
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21
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Harrington A, Darke H, Ennis G, Sundram S. Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit. Int J Ment Health Nurs 2019; 28:1099-1109. [PMID: 31206989 DOI: 10.1111/inm.12621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/24/2022]
Abstract
Despite their widespread use, typical visual observation practices are not evidence-based and adverse events - such as self-harm and absconding - still occur even under the most intense forms of observation. This study aimed to (i) develop and implement an engagement-focused systematized model of clinical risk management in an adult acute psychiatric inpatient unit; and (ii) prospectively evaluate its effect on rates of violence, self-harm, absconding, sexually inappropriate behaviour, and seclusion. A new model of engagement-focused clinical risk management was developed using a participatory action research framework and implemented in an adult acute psychiatric inpatient unit. Using a mirror-image design, rates of violence/aggression, self-harm, absconding, sexually inappropriate behaviour, and seclusion were compared before and after implementation, and staff satisfaction levels were measured. The clinical engagement-based model was introduced, and 1087 admissions before implementation (24 months) were compared with 965 admissions post-implementation (18 months). The new model was associated with significantly reduced rates of absconding (pre: 10.5/1000 occupied bed days, 95% CI [9.0, 12.1] compared with post: 6.5/1000 occupied bed days [5.2, 8.1], P < 0.001) and seclusion (pre: 43.7/1000 occupied bed days, 95% CI [40.6, 46.9] compared with post: 30.9/1000 occupied bed days [27.9, 34.1], P < 0.0001). Rates of aggression, deliberate self-harm, and sexually inappropriate behaviour were non-significantly decreased. Findings suggest that this engagement-focused model of clinical risk management in an adult psychiatric inpatient unit significantly reduced adverse patient events and was preferred by staff over current practice. Other psychiatric inpatient facilities may see a reduction in adverse events following the introduction of this well-tolerated risk management model.
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Affiliation(s)
| | - Hayley Darke
- Psychiatry Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Gary Ennis
- North Western Mental Health, Melbourne, Victoria, Australia.,Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, Rockhampton, Queensland, Australia.,School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Suresh Sundram
- North Western Mental Health, Melbourne, Victoria, Australia.,Psychiatry Monash Health, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Adult Psychiatry, Monash Health, Melbourne, Victoria, Australia
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Blume A, Snellgrove B, Steinert T. [Staffing levels and patient-related outcomes : Systematic literature review on international evidence]. DER NERVENARZT 2019; 90:40-44. [PMID: 30238232 DOI: 10.1007/s00115-018-0621-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of this study was to systematically review the international literature with respect to significant links between staffing levels or qualification on the one hand and patient-related outcomes on the other. Of the initial 7778 abstracts identified by means of a complex search strand in PubMed and CINAHL, 51 could finally be included in a qualitative synthesis. A total of nine different patient-related outcome categories with significant associations on an at least ordinally scaled level were distinguished. None of the studies included had a (quasi-)experimental research design. Despite, in some instances, high numbers of cases at multiple sites and efforts to control obvious confounding variables by regression analysis, no evidence-based conclusions for health policy or clinical practice can be drawn from the available observational studies. There is therefore a considerable need for prospective randomized or at least quasi-experimental studies also as accompanying research on novel models of financing.
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Affiliation(s)
- A Blume
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau, ZfP Südwürttemberg, Weingartshofer Str. 2, 88214, Ravensburg, Deutschland.
| | - B Snellgrove
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau, ZfP Südwürttemberg, Weingartshofer Str. 2, 88214, Ravensburg, Deutschland
| | - T Steinert
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau, ZfP Südwürttemberg, Weingartshofer Str. 2, 88214, Ravensburg, Deutschland
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23
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Veale D. Against the stream: intermittent nurse observations of in-patients at night serve no purpose and cause sleep deprivation. BJPsych Bull 2019; 43:174-176. [PMID: 30739621 PMCID: PMC6642991 DOI: 10.1192/bjb.2018.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 11/23/2022] Open
Abstract
This paper argues that intermittent nursing observations of in-patients at night do not reduce the risk of suicide or severe self-harm. Suicides between 23.00 h and 07.00 h are rare, and these overwhelmingly occur under intermittent observations. Such observation is purely a defensive intervention to document that a patient is safe at a particular time, as there is no engagement. For the large majority of in-patients, it has the unintended consequence of causing sleep deprivation. The intervention may cause harm to in-patients by making their disorder worse and increase their risk during the day. If patients are judged to be at immediate risk, then they should be placed on constant observation. If they are not, then optimising sleep is important for treating a psychiatric disorder and they should be placed on general observations.Declaration of interestNone.
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Affiliation(s)
- David Veale
- South London and Maudsley NHS Trust
- Institute of Psychiatry, Psychology and Neuroscience
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24
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Lienhardt A, Rabenschlag F, Panfil EM. [The practice of special observation in adults in the German-speaking part of Switzerland - a descriptive cross-sectional study]. Pflege 2018; 31:255-265. [PMID: 29882731 DOI: 10.1024/1012-5302/a000621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The practice of special observation in adults in the German-speaking part of Switzerland - a descriptive cross-sectional study Abstract. INTRODUCTION Psychiatric Special Observation (PSO) is an intervention often used by nurses to prevent service users of harming themselves or to protect others. The intervention ranges between control and therapy and is resource intensive. Despite the widespread use of PSO, there is still no data on the practice of the intervention in Switzerland. AIM What is the current practice of PSO in adults in psychiatric hospitals in the German-speaking part of Switzerland? METHOD Descriptive cross-sectional study. Nurses from inpatient psychiatric services in the German-speaking part of Switzerland completed a questionnaire based on a concept analysis of PSO. RESULTS 538 questionnaires were analysed. PSO was more often conducted intermittent than as constant observation. In more than one out of four cases, suicidality reasoned as a cause for prescription. Nurses generally used standardized instruments to assess the risk of harming oneself or others. The duration of PSO lasted eight hours or more in three out of four cases. In every fifth case, there was no validation of the need of the intervention taking place during one shift. Nurses have a neutral attitude towards the intervention and are experiencing no or weak negative feelings during performance of PSO. CONCLUSIONS The results suggest that there is an inconsistent performance of PSO in Switzerland as well as in other countries. The validation of the need of the intervention is insufficient. To facilitate PSO as a justified performance, the preparation of an interprofessional guideline is recommended.
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Affiliation(s)
| | - Franziska Rabenschlag
- 2 Abteilung Entwicklung & Forschung Pflege, MTD, Soziale Arbeit Universitäre Psychiatrische Kliniken Basel
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