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Molloy L, Chidarikire S, Pullman J, Havilla S, Patton D, Beckett P. The Impact of Sensory Modulation Interventions on Practice in Acute Inpatient Mental Health Settings: A Meta-Ethnography. Issues Ment Health Nurs 2024; 45:580-588. [PMID: 38810221 DOI: 10.1080/01612840.2024.2341034] [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: 05/31/2024]
Abstract
This review explores the transformative impact of sensory modulation interventions in acute inpatient mental health care setting utilising meta-ethnography. The methodology by Noblit & Hare guided the approach to creating the review. Searches of articles published within the previous 10 years were conducted in Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, and PsycINFO. Searches aimed to identify rich qualitative data on the area of sensory modulation interventions and acute inpatient mental health care. Seven articles were selected for inclusion and a reciprocal translation synthesis was undertaken. Sensory modulation interventions emerged as a key alternative to traditional inpatient practices, including seclusion and restraint and the use of PRN psychotropic medication. It introduces a new dimension within care strategies that emphasise individual preferences and care plans that empower individuals. Sensory modulation interventions serve as an effective means to de-escalation that promotes shared responsibility between staff and individuals in care. The review highlights this practice as a departure from coercive practices and biomedical interventions, promoting meaningful therapeutic engagement. Our findings show that sensory modulation interventions have the potential to create a culture shift in acute inpatient mental health settings towards person-centred, recovery-orientated, trauma-informed clinical practice.
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Affiliation(s)
- Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - John Pullman
- Social work, Australian College of Applied Professions, Sydney, Australia
| | - Sizwile Havilla
- Illawarra Shoalhaven Local Health District Mental Health service, Shellharbour, Australia
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Beckett
- School of Nursing and Midwifery, University of Sydney, Sydney, Australia
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Rodríguez-Labajos L, Kinloch J, Nicol L, Grant S, O'Brien G. Impact of the design of adult mental health inpatient facilities on healthcare staff: a mixed methods systematic review. BMJ Open 2024; 14:e074368. [PMID: 38448069 PMCID: PMC10916155 DOI: 10.1136/bmjopen-2023-074368] [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: 04/11/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES Mental health inpatient facilities are increasingly focusing on creating therapeutic, person-centred care environments. However, research shows that this focus may have unintended consequences for healthcare staff. Designs that do not pay attention to staff needs may risk contributing to stress, burnout, job dissatisfaction and mental exhaustion in the work environment. This systematic review aims to identify and synthesise current research on the design factors of adult mental health inpatient facilities that impact healthcare staff. DESIGN A mixed method systematic review was conducted to search for empirical, peer-reviewed studies using the databases CINAHL, Embase, PsycINFO, PubMed and Web of Science from their inception up to 5 September 2023. The Joanna Briggs Institute's critical appraisal checklists were used to assess the methodological quality of the eligible studies. Data were extracted and grouped based on the facility design factors. RESULTS In our review, we included 29 peer-reviewed empirical studies that identified crucial design factors impacting healthcare staff in adult mental health inpatient facilities. Key factors included layouts providing optimal visibility, designated work and respite areas, and centrally located nursing stations. Notably, mixed perceptions regarding the benefits and challenges of open and glass-enclosed nursing stations suggest areas requiring further research. Facilities in geographically remote locations also emerged as a factor influencing staff dynamics. Additionally, although only supported by a limited number of studies, the significance of artwork, sensory rooms for respite, appropriate furniture and equipment, and access to alarms was acknowledged as contributory factors. CONCLUSION Through the synthesis of existing research, this review identified that the design of mental health facilities significantly impacts staff well-being, satisfaction, performance and perception of safety. Concluding that, in order to create a well-designed therapeutic environment, it is essential to account for both service users and staff user needs. PROSPERO REGISTRATION NUMBER CRD42022368155.
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Affiliation(s)
| | - Joanne Kinloch
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
| | - Louise Nicol
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
| | - Susan Grant
- NHSScotland Assure, Procurement, Commissioning and Facilities, NHS National Services Scotland, Glasgow, UK
| | - Geraldine O'Brien
- NHSScotland Assure, Research Service, NHS National Services Scotland, Glasgow, UK
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Price O, Papastavrou Brooks C, Johnston I, McPherson P, Goodman H, Grundy A, Cree L, Motala Z, Robinson J, Doyle M, Stokes N, Armitage CJ, Barley E, Brooks H, Callaghan P, Carter LA, Davies LM, Drake RJ, Lovell K, Bee P. Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial. Health Technol Assess 2024; 28:1-120. [PMID: 38343036 PMCID: PMC11017147 DOI: 10.3310/fggw6874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training's effectiveness. Objectives Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention's preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Design Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Setting Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. Participants In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Interventions Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Main outcome measures Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient-Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Results Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Conclusions Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Limitations Uncontrolled design and self-selecting sample. Future work Definitive trial determining intervention effects. Trial registration This trial is registered as ISRCTN12826685 (closed to recruitment). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in Health Technology Assessment; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Context Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. 'De-escalation' is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use 'containment' interventions (measures to prevent harm through restricting a person's ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient's concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention.
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Affiliation(s)
- Owen Price
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Isobel Johnston
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter McPherson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Helena Goodman
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Andrew Grundy
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lindsey Cree
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Zahra Motala
- Atherleigh Park Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jade Robinson
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Michael Doyle
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Nicholas Stokes
- West London Forensic Service, St Bernard's Hospital, West London Mental Health NHS Trust, Southall, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Patrick Callaghan
- School of Applied Sciences, London South Bank University, London, UK
| | | | - Linda M Davies
- Division of Population Health, Health Services Research and Primary Care, Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Ilioudi M, Wallström S, Steingrimsson S, Lindner P, Thunström AO, Ali L. Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients. BMJ Open 2023; 13:e076285. [PMID: 38101823 PMCID: PMC10729110 DOI: 10.1136/bmjopen-2023-076285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Calm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have enabled virtual reality (VR) equivalents of calm rooms that can be feasibly deployed in psychiatric care settings. While research has shown VR environments to be efficacious in inducing relaxation, little is known how these virtual calm rooms are perceived by patients. The aim of this study was to elucidate patient experiences of using a VR calm room in a psychiatric inpatient setting. DESIGN Qualitative interview study. Semi-structured interviews were analysed using qualitive inductive content analysis, which focuses on the interpretation of texts for making replicable and valid inferences. SETTING Swedish hospital psychiatric inpatient care setting with a wireless, three degrees-of-freedom VR head-mounted display running a calm room application simulating nature environment. PARTICIPANTS 20 adult patients (12 women) with bipolar disorder (n=18) or unipolar depression (n=2). RESULTS Participants experienced the use of the VR calm room as having a positive impact on them, inducing awareness, calmness and well-being. They were thankful to be offered a non-pharmacological alternative for anxiety relief. Participants also expressed that they had some concerns about how they would react emotionally before using the VR device. However, after use, they highlighted that their overall experience was positive. They also expressed that they could see potential for further development of VR technology in psychiatric care. CONCLUSIONS VR technology has the potential to solve pressing logistic issues in offering calm rooms in psychiatric inpatient care. VR calm rooms appear to be appreciated by psychiatric inpatients, who value their accessibility, convenience and variety of modalities offered. Participants perceived an increase in their well-being after use.
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Affiliation(s)
- Maria Ilioudi
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
| | - Sara Wallström
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Forensic Psychiatry, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Almira Osmanovic Thunström
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Lilas Ali
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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5
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Salzmann-Erikson M. An Integrative Review on Psychiatric Intensive Care. Issues Ment Health Nurs 2023; 44:1035-1049. [PMID: 37874667 DOI: 10.1080/01612840.2023.2260478] [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: 10/26/2023]
Abstract
Psychiatric intensive care units (PICUs) provide care and treatment when psychiatric symptoms and behaviors exceed general inpatient resources. This integrative review aimed to synthesize PICU research published over the past 5 years. A comprehensive search in MEDLINE, PsycINFO, PubMed and Scopus identified 47 recent articles on PICU care delivery, populations, environments, and models. Research continues describing patient demographics, and high rates of challenging behaviors, self-harm, and aggression continue being reported. Research on relatives was minimal. Patients describe restrictive practices incongruent with recovery philosophies, including controlling approaches and sensory deprivation. Some initiatives promote greater patient autonomy and responsibility in shaping recovery, yet full emancipatory integration remains limited within PICU environments. Multidisciplinary collaboration is needed to holistically advance patient-centered, equitable, and integrative PICU care. This review reveals the complex tensions between clinical risk management and emancipatory values in contemporary PICU settings. Ongoing reporting of controlling practices counters the recovery movement progressing in wider mental healthcare contexts. However, care innovations centered on patient empowerment and humane environments provide hope for continued evolution toward more liberation-focused PICU approaches that uphold both patient and provider perspectives.
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Affiliation(s)
- Martin Salzmann-Erikson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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6
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Jurdana MA, Lacambre M, Fovet T. [Soothing spaces and techniques in psychiatry]. REVUE DE L'INFIRMIERE 2023; 72:29-31. [PMID: 37364973 DOI: 10.1016/j.revinf.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The development of alternatives to seclusion and restraint is a priority for psychiatric care services. Among them, the implementation of soothing spaces is currently experiencing considerable growth.
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Affiliation(s)
| | - Mathieu Lacambre
- Université de Lille, Inserm, U1172 - Lille Neuroscience & Cognition, 59000 Lille, France; Filière de psychiatrie légale, Unité de soins intensifs de psychiatrie, CHU Montpellier, 191 avenue du Doyen Giraud, 34295 Montpellier cedex 5, France
| | - Thomas Fovet
- CHU Lille, Service de Psychiatrie adulte, F-59000 Lille, France; Université de Lille, Inserm, U1172 - Lille Neuroscience & Cognition, 59000 Lille, France; Section psychiatrie légale, Association française de psychiatrie biologique et de neuropsychopharmacologie (AFPBN), BP 60222, 78102 Saint-Germain-en-Laye, France.
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7
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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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8
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Iloudi M, Lindner P, Ali L, Wallström S, Thunström AO, Ioannou M, Anving N, Johansson V, Hamilton W, Falk Ö, Steingrimsson S. Physical Versus Virtual Reality-based Calm Rooms for Psychiatric Inpatients: a Quasi-randomized Trial (Preprint). J Med Internet Res 2022; 25:e42365. [DOI: 10.2196/42365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/18/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
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Cavanagh B, Haracz K, Lawry M, Wales K, James C. Changes in emotions and perceived stress following time spent in an artistically designed multisensory environment. MEDICAL HUMANITIES 2021; 47:e13. [PMID: 33483433 DOI: 10.1136/medhum-2020-011876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
Self-management strategies that enhance positive emotions are considered most effective to cope with stress and maintain good mental health and well-being. An artistically designed multisensory environment, The Sensory-Art Space (SAS), was installed in a university in NSW Australia as a new self-management intervention. The design of the SAS was informed by evidence regarding the benefits of viewing art, experiencing nature and accessing sensory rooms.A pilot pre-post intervention study measured changes in affect and perceived stress in 224 participants who spent time in the SAS. Descriptive statistics were completed on the individual affective states, and paired sample t-tests were used to determine changes in Positive and Negative Affect (PANAS-X) and perceived stress (Visual Analogue Scale).The Wilcoxon signed-rank test showed that negative affect reduced, z=-10.23 (p<0.001), and positiveaffect increased, z=-2.57 (p=0.01), following spending time in the SAS. In addition, stress levels reduced after time spent in the SAS, z=-11.29 (p<0.0001).Self-management benefits were found following time in the SAS and future implications for public health and well-being are discussed.
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Affiliation(s)
- Bliss Cavanagh
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kirsti Haracz
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Miranda Lawry
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Kylie Wales
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Carole James
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
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10
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Molin J, Strömbäck M, Lundström M, Lindgren BM. It's Not Just in the Walls: Patient and Staff Experiences of a New Spatial Design for Psychiatric Inpatient Care. Issues Ment Health Nurs 2021; 42:1114-1122. [PMID: 34142934 DOI: 10.1080/01612840.2021.1931585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The environment in psychiatric inpatient care is key to patient recovery and staff job satisfaction. In this qualitative study of patient and staff experiences of a new spatial design in psychiatric inpatient care, we analysed data from 11 semi-structured interviews with patients and five focus group discussions with staff using qualitative content analysis. The new design contributed to feelings of safety and recovery, but patients and staff also reported some frustration and added stress. The results lead us to conclude that while the new spatial design improves some conditions for recovery and job satisfaction, the design itself is simply not enough. Changes in care environments require that both patients and staff be informed and involved in the renovation to ensure that patients feel respected and staff feel confident in using the new environment before and during treatment and follow-ups.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Maria Strömbäck
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Division of Physiotherapy, Umeå University, Umeå, Sweden
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11
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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: 13] [Impact Index Per Article: 4.3] [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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12
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Ma D, Su J, Wang H, Zhao Y, Li H, Li Y, Zhang X, Qi Y, Sun J. Sensory-based approaches in psychiatric care: A systematic mixed-methods review. J Adv Nurs 2021; 77:3991-4004. [PMID: 33951221 DOI: 10.1111/jan.14884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/18/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS Sensory-based approaches, including sensory room, sensory cart and specific sensory integration programs, feature various sensory stimulations to focus on a particular space or program. This systematic mixed-methods review describes the impact of sensory-based approaches in psychiatric care and summarizes the important components of sensory interventions. DESIGN Systematic mixed-methods review was based on the guidelines by Pluye and Hong for comprehensively searching, appraising and synthesizing research evidence. DATA SOURCES Data were collected from five databases: CINAHL, Embase, Pubmed, Web of Science and Cochrane before March 9, 2020. REVIEW METHODS Qualitative, quantitative, mixed-methods and original studies published in English on sensory-based approaches in psychiatric care were included. The studies were selected by screening titles, abstracts and full texts, and the quality of each study was assessed by two researchers independently. The data were analysed using thematic analysis. RESULTS Sixteen studies were chosen for review. Through data integration, four subthemes with positive effects were formed: (1) calming of the patient's mood; (2) calming of the patient's body; (3) improvement of self-care ability; and (4) improvement of the nurse-patient relationship. The sensory-based approach may also lead to negative effects. CONCLUSIONS Several important components play important roles in the sensory-based approaches: (1) rich, culture-based, personalized sensory stimulation; (2) a quiet, safe, home-based physical environment; (3) a good one-to-one nurse-patient relationship; (4) and the cultivation of patient autonomy and self-management. Sensory-based approaches in a multicultural environment and home environment will be important topics of psychiatric care in the future. IMPACT There is a lack of synthesis of studies on results of sensory-based approaches in psychiatric care. Four components are important to sensory interventions. It is necessary for mental health service centres and home care for the patients with psychotic disorders to use sensory-based approaches for reference.
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Affiliation(s)
- Dongfei Ma
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Jianping Su
- School of Nursing, Jilin University, Jilin, People's Republic of China.,School of Nursing, Xinjiang Medical University, Urumqi, People's Republic of China
| | - Hong Wang
- The First Bethune Hospital of Jilin University, Jilin, People's Republic of China
| | - Yingnan Zhao
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Huanhuan Li
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Yijing Li
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Xu Zhang
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Yicheng Qi
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Jilin, People's Republic of China
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13
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Machingura T, Lloyd C, Murphy K, Goulder S, Shum D, Green AH. Views about sensory modulation from people with schizophrenia and treating staff: A multisite qualitative study. Br J Occup Ther 2021. [DOI: 10.1177/0308022620988470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction Current non-pharmacological treatment options for people with schizophrenia are limited. There is, however, emerging evidence that sensory modulation can be beneficial for this population. This study aimed to gain insight into sensory modulation from the user’s and the treating staff’s perspectives. Method A qualitative content analysis design was used. Transcripts from occupational therapists ( n=11) and patients with schizophrenia ( n=13) derived from in-depth semi-structured interviews were analysed for themes using content analysis. Results Five themes emerged from this study: Service user education on the sensory approach is the key; A variety of tools should be tried; Sensory modulation provides a valued treatment option; There are challenges of managing perceived risk at an organisational level; and There is a shortage of accessible and effective training. Conclusion People with schizophrenia and treating staff had congruent perceptions regarding the use of sensory modulation as a treatment option. The findings suggest that sensory modulation can be a valued addition to treatment options for people with schizophrenia. We suggest further research on sensory modulation intervention effectiveness using quantitative methods so these results can be further explored.
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Affiliation(s)
- Tawanda Machingura
- Bond University, Gold Coast, Queensland, Australia
- Griffith University, School of Applied Psychology, Gold Coast Campus, Queensland, Australia
| | - Chris Lloyd
- Griffith University, School of Applied Psychology, Gold Coast Campus, Queensland, Australia
| | - Karen Murphy
- Griffith University, School of Applied Psychology, Gold Coast Campus, Queensland, Australia
| | | | - David Shum
- Griffith University, School of Applied Psychology, Gold Coast Campus, Queensland, Australia
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - and Heather Green
- Griffith University, School of Applied Psychology, Gold Coast Campus, Queensland, Australia
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14
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Andersson H, Sutton D, Bejerholm U, Argentzell E. Experiences of sensory input in daily occupations for people with serious mental illness. Scand J Occup Ther 2020; 28:446-456. [DOI: 10.1080/11038128.2020.1778784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Daniel Sutton
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Ulrika Bejerholm
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
| | - Elisabeth Argentzell
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
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15
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Millard H, Parke S, Wilson C, Qayyum Z, Kim HJ, Van Deusen T. Inpatient Milieu Therapy: Considerations for Adolescent and Transitional Age Youth. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676609666190617150025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background and Goals:
The role of milieu therapy on inpatient treatment has become
more prominent due to the changing landscape of hospital care, with shorter length of
stay, higher patient acuity, and rapid turnover. The modern inpatient unit promotes less individual
psychotherapy with the psychiatrist or therapist, and more milieu and group based
treatment that emphasizes acute stabilization.
Methods:
The authors share some of the core domains that provide the basic framework for
milieu treatment within an acute care setting when working with adolescents and transitional
age youth (TAY), with the aim to share clinical considerations for milieu therapy and offer
practical ideas for implementation in clinical practice.
Discussion:
The therapeutic milieu and collaboration of an interdisciplinary team has a significant
impact on hospital treatment. Considerations for milieu therapy implementation in
an inpatient unit include developmentally informed concepts related to milieu treatment of
adolescents and TAY patients in a hospital setting.
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Affiliation(s)
- Hun Millard
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Susan Parke
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Cynthia Wilson
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Zheala Qayyum
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
| | - Hyun Jung Kim
- Harvard Medical School, Psychiatry, Boston, MA, United States
| | - Timothy Van Deusen
- Yale University School of Medicine, Psychiatry, New Haven, CT, United States
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16
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Barbic SP, Chan N, Rangi A, Bradley J, Pattison R, Brockmeyer K, Leznoff S, Smolski Y, Toor G, Bray B, Leon A, Jenkins M, Mathias S. Health provider and service-user experiences of sensory modulation rooms in an acute inpatient psychiatry setting. PLoS One 2019; 14:e0225238. [PMID: 31751373 PMCID: PMC6874072 DOI: 10.1371/journal.pone.0225238] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sensory modulation rooms (SMRs) are therapeutic spaces that use sensory modulation concepts and strategies to assist service users to self-regulate and modulate arousal levels. SMRs are increasingly being explored as strength-based and person-centered adjuncts to care for people receiving inpatient psychiatry services. The aim of this study is to understand health provider and inpatient service user perceptions on the use of SMRs on acute psychiatric units. METHODS We conducted semi-structured interviews with ten service users and nine health providers (four occupational therapists and five nurses) regarding their experiences of the SMRs located on three acute inpatient units in a large urban tertiary care hospital. We audio recorded and transcribed the focus groups and used thematic analysis to analyze the data. RESULTS Our results suggested four common themes amongst health provider and service user experiences of sensory modulation rooms: (1) service user empowerment through self-management, (2) emotional regulation, (3) an alternative to current practices, and (4) health provider and service user education. CONCLUSION Our study supports the ecological utility of SMRs as person-centred adjunct therapeutic space viewed positively by both service users and health providers. This understanding of SMRs is critical for future service design, research and policy aimed at improving the service user experience and care for this population. Future research is needed to validate the experience of the SMRs with other patient groups and health providers.
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Affiliation(s)
- Skye P Barbic
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada.,Providence Health Care, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada
| | - Nicole Chan
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Amanpreet Rangi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - James Bradley
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Rachal Pattison
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | | | - Sandy Leznoff
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Yojo Smolski
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Gagan Toor
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Blaine Bray
- Providence Health Care, Vancouver, British Columbia, Canada
| | - Adelena Leon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Malcolm Jenkins
- Providence Health Care, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Providence Health Care, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,Foundry, Vancouver, British Columbia, Canada.,Department of Psychiatry, St. Paul's Hospital, Vancouver, British Columbia, Canada
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17
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Hedlund Lindberg M, Samuelsson M, Perseius KI, Björkdahl A. The experiences of patients in using sensory rooms in psychiatric inpatient care. Int J Ment Health Nurs 2019; 28:930-939. [PMID: 30931543 DOI: 10.1111/inm.12593] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Abstract
The use of sensory rooms and similar sensory approaches in psychiatric inpatient settings is becoming increasingly common. In sensory rooms, patients can choose different sensory stimulating items that may help regulate distress and enhance well-being. Outcomes are often measured as effects on patients' self-rated distress and rates of seclusion and restraint. The subjective experiences of patients using sensory rooms have been less explored. This paper presents a qualitative study of the experiences of 28 patients who chose to use sensory rooms on seven different types of psychiatric inpatient wards. Data were collected by individual patient interviews and by texts written by patients. A qualitative content analysis resulted in four categories: emotional calm, bodily calm, empowerment, and unexpected effects. A majority of the participants described several positive experiences, such as enhanced well-being, reduced anxiety, increased self-management, and enhanced self-esteem. Our findings align with previous research that has shown similar positive patient experiences, and support the use of sensory rooms as part of person-centred care.
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Affiliation(s)
- Mathilde Hedlund Lindberg
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Mats Samuelsson
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | | | - Anna Björkdahl
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Huddinge, Sweden.,Stockholm Health Care Services, Stockholm County Council, Psykiatri Södra Stockholm, Stockholm, Sweden
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18
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Lindgren BM, Molin J, Lundström M, Strömbäck M, Salander Renberg E, Ringnér A. Does a new spatial design in psychiatric inpatient care influence patients' and staff's perception of their care/working environment? A study protocol of a pilot study using a single-system experimental design. Pilot Feasibility Stud 2018; 4:191. [PMID: 30607254 PMCID: PMC6307228 DOI: 10.1186/s40814-018-0383-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022] Open
Abstract
Background Research shows that worn-out physical environments are obstacles to psychiatric inpatient care. Patients want better relationships with staff and things to do; staff want an environment that offers hope, a calm atmosphere, and joint activities. A county council in northern Sweden and Philips Healthcare partnered to create solutions to the environmental challenges of psychiatric inpatient care. One ward at a county psychiatric clinic was selected for a pilot project to test solutions that could improve the care environment for patients, staff, and relatives. The aim of the overall project is to evaluate the effects of a newly designed psychiatric inpatient ward on patients and staff in terms of quality of care and stress. In this study, we focus on the feasibility through testing questionnaires and exploring barriers to recruiting staff and patients. Methods This study had a single-system experimental design, comparing a psychiatric unit pre- and post-implementation of the novel spatial design, using repeated measures with the same questionnaires twice a week during baseline and intervention phases. Primary outcomes were quality interactions (patients) and perceived stress (staff). Secondary outcomes were levels of anxiety and depression (patients), and stress of conscience (staff). A process evaluation was aimed to describe contextual factors and participant experiences of the new design. Data was collected using questionnaires and semi-structured individual interviews with patients and focus group discussions with staff. Both visual and statistical methods were used to analyse the quantitative data and content analysis for the qualitative data. Discussion The findings will contribute insights into whether and how a new spatial design might contribute to quality interactions and reduced stress. This is relevant both nationally and internationally, as similar interventions are needed but sparse. The findings will be disseminated through peer-reviewed publications and conference presentations. Trial registration ClinicalTrials.gov, NCT03140618, registered 4 May 2017
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Affiliation(s)
- Britt-Marie Lindgren
- 1Department of Nursing, The Caring Science Building, Umeå University, 901 87 Umeå, SE Sweden
| | - Jenny Molin
- 1Department of Nursing, The Caring Science Building, Umeå University, 901 87 Umeå, SE Sweden
| | - Mats Lundström
- 1Department of Nursing, The Caring Science Building, Umeå University, 901 87 Umeå, SE Sweden
| | - Maria Strömbäck
- 2Division of Psychiatry, Department of Clinical Sciences, Umeå University, Umeå, Sweden.,3Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | | | - Anders Ringnér
- 1Department of Nursing, The Caring Science Building, Umeå University, 901 87 Umeå, SE Sweden
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19
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Forsyth AS, Trevarrow R. Sensory strategies in adult mental health: A qualitative exploration of staff perspectives following the introduction of a sensory room on a male adult acute ward. Int J Ment Health Nurs 2018; 27:1689-1697. [PMID: 29663648 DOI: 10.1111/inm.12466] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 12/01/2022]
Abstract
In recent years, there has been growing interest in the use of sensory techniques to help with emotional regulation in adult mental health populations. This is against a backdrop of international policies aimed at reducing restrictive interventions and improving the effectiveness of de-escalation techniques. A sensory room was designed and implemented on a male adult acute psychiatric ward. Staff perspectives were sought to evaluate the effectiveness of the room in managing emotional distress by exploring staff awareness of a broader range of de-escalation strategies and by exploring what effect the room had on staff behaviours with respect to sensory interventions. A series of semi-structured interviews were carried out, analysed, and grouped into themes. Three themes emerged as follows: enhancing de-escalation, sensory interventions, and impact on staff. Findings showed that increased awareness of sensory processing and use of sensory strategies such as the sensory room were perceived by staff to have a positive impact on reducing distress with male service users. Staff use of the room was also discovered to have benefits that included staff attending to their own emotional needs and the use of the room supporting reflective learning during critical incident debriefing.
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Affiliation(s)
- Angus S Forsyth
- University of Sunderland, Sunderland, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rebecca Trevarrow
- University of Sunderland, Sunderland, UK.,Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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20
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Meredith P, Hutchens S, Kerley L, Taylor M, Slattery M. Educating mental health staff in sensory approaches using an e-learning package: a 3-month follow-up. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.8.425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pamela Meredith
- Professor and Head of Occupational Therapy, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland; Honorary senior lecturer, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Sarah Hutchens
- Student, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Lachlan Kerley
- Student, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Michelle Taylor
- Advanced clinical educator, Insight Training and Education, Metro North Mental Health - Alcohol and Drug Service, Brisbane, Queensland, Australia
| | - Maddy Slattery
- Senior lecturer, Griffith University, Nathan, Queensland, Australia
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21
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Mauras T, Perony A, Yadak J, Velasco A, Goudal P, Marcel JL. [Seclusion and restraint: From prescription to decision]. Encephale 2018; 45:95-97. [PMID: 29402385 DOI: 10.1016/j.encep.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 10/17/2022]
Abstract
Psychiatric care has always included patients in crisis who are potentially dangerous or agitated. Faced with the many issues they may encounter, the therapeutic relationship has always been prioritized over all other considerations. However, the practice of seclusion and restraint has been steadily increasing in the past few decades. Their use is becoming customary rather than exceptional and consequently fosters less thought by the care teams. In the Healthcare System Modernization Act of January 26th, 2016, the lawmakers sought to underline the freedom-destroying nature of these practices and the necessity of their regulation. This law represents a fundamental change in the nature of seclusion and restraint. What was but a simple prescription becomes a conscious decision of depriving someone of her or his freedom and must only be considered as a last resort. The changes in the Law and the recent changes in the recommendations for clinical practice by the French National Institute of Health invite reflection. Many questions remain about the origins of violence, the reasons for the increasing use of seclusion and restraint measures, and the alternatives that have been developed. Many theories suggest that the less stressful and constrained an environment is, the more empowered the patient will be. He is an actor in his own care and is considered a full active participant. The Law is reconciled with caregivers initiating a reflection on the benefits of these measures regarding the violation of fundamental freedoms. Reflection on psychiatric care and the quality of its management must be the focus when caring for patients in crisis.
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Affiliation(s)
- T Mauras
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France.
| | - A Perony
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
| | - J Yadak
- Cochin Psychiatry Department, AP-HP, Cochin Hospital, Paris, France
| | - A Velasco
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
| | - P Goudal
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
| | - J-L Marcel
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
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22
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Yakov S, Birur B, Bearden MF, Aguilar B, Ghelani KJ, Fargason RE. Sensory Reduction on the General Milieu of a High-Acuity Inpatient Psychiatric Unit to Prevent Use of Physical Restraints: A Successful Open Quality Improvement Trial. J Am Psychiatr Nurses Assoc 2018; 24:133-144. [PMID: 29039238 DOI: 10.1177/1078390317736136] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impaired sensory gating in patients with acute mental illness predisposes to overstimulation and behavioral dyscontrol. OBJECTIVE Explore use of sensory reduction interventions on a high-acuity inpatient milieu to reduce high assault/restraint rates. DESIGN A multidisciplinary team using failure mode and effect analysis to explore high restraint use between 4:00 p.m. and 7:00 p.m. observed patient/staff overstimulation contributed to behavioral escalations. The team implemented sensory reduction/integration improvements over a 5-month period to prevent excessive restraint use. RESULTS Restraint rates dropped immediately following light and sound reduction interventions and by 72% at 11 months postimplementation. Mann-Whitney statistics for unpaired 6-month comparisons, 1-year pre- and postintervention showed significant reductions: Assault rates (median pre = 1.37, post = 0.18, U = 4, p = .02); Restraint rates (median pre = 0.50, post = 0.06, U = 0, p = .002). CONCLUSION Sensory reduction during a high-stress time period on a high-acuity psychiatric unit was associated with a reduction in assaults and restraints.
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Affiliation(s)
- Svetlana Yakov
- 1 Svetlana Yakov, MD, University of Alabama at Birmingham, AL, USA
| | - Badari Birur
- 2 Badari Birur, MD, University of Alabama at Birmingham, AL, USA
| | - Melissa F Bearden
- 3 Melissa F. Bearden, MACN, OT/L, University of Alabama at Birmingham, AL, USA
| | - Barbara Aguilar
- 4 Barbara Aguilar, BSN-BC, RN, University of Alabama at Birmingham, AL, USA
| | - Kinjal J Ghelani
- 5 Kinjal J. Ghelani, MD, University of Alabama at Birmingham, AL, USA
| | - Rachel E Fargason
- 6 Rachel E. Fargason, MD, University of Alabama at Birmingham, AL, USA
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23
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Weiland TJ, Ivory S, Hutton J. Managing Acute Behavioural Disturbances in the Emergency Department Using the Environment, Policies and Practices: A Systematic Review. West J Emerg Med 2017; 18:647-661. [PMID: 28611886 PMCID: PMC5468071 DOI: 10.5811/westjem.2017.4.33411] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/04/2017] [Accepted: 04/20/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Effective strategies for managing acute behavioural disturbances (ABDs) within emergency departments (EDs) are needed given their rising occurrence and negative impact on safety, psychological wellbeing, and staff turnover. Non-pharmacological interventions for ABD management generally fall into four categories: environmental modifications; policies; practice changes; and education. Our objective was to systematically review the efficacy of strategies for ABD management within EDs that involved changes to environment, architecture, policy and practice. METHODS We performed systematic searches of CINAHL Plus with Full Text, PsycINFO, MEDLINE, and EMBASE, as well as reference lists of relevant review articles to identify relevant studies published between January 1985 - April 2016. We included studies written in English, which reported management of behavioural disturbances in adults associated with the ED through the use of environmental modifiers (including seclusion, restraint, specialised rooms, architectural changes), policy, and practice-based interventions excepting education-only interventions. Efficacy outcomes of interest included incidence, severity, and duration of ABD, incidence of injuries, staff absenteeism, restraint use, restraint duration, and staff and patient perceptions. Two reviewers independently screened titles and abstracts, and assessed the relevancy and eligibility of studies based on full-text articles. Two authors independently appraised included studies. A narrative synthesis of findings was undertaken. RESULTS Studies reporting interventions for managing ABDs within the ED are limited in number and quality. The level of evidence for efficacy is low, requiring caution in conclusions. While there is preliminary evidence for environmental change in the form of specialised behavioural rooms, security upgrades and ED modifications, these are not supported by evidence from controlled studies. Many of these "common sense" environmental changes recommended in many guidelines have been widely implemented in EDs. CONCLUSION There is an unambiguous gap in the literature regarding the efficacy of interventions for ABD management in EDs involving environmental, policy or practice-based changes. With growing demand on EDs, and with increasing numbers of ABDs, identification of robust evidence-based interventions for safe and effective ABD management is vital.
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Affiliation(s)
- Tracey J. Weiland
- St Vincent’s Hospital Melbourne, Emergency Practice Innovation Centre, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne School of Population and Global Health, Neuroepidemiology Unit, Victoria, Australia
| | - Sean Ivory
- St Vincent’s Hospital Melbourne, Emergency Practice Innovation Centre, Melbourne, Victoria, Australia
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Jennie Hutton
- St Vincent’s Hospital Melbourne, Department of Emergency Medicine, Melbourne, Victoria, Australia
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
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