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Bachmann L, Vatne S, Mundal IP. Safeguarding patients while implementing mechanical restraints: A qualitative study of nurses and ward staff's perceptions and assessment. J Clin Nurs 2023; 32:438-451. [PMID: 35178794 PMCID: PMC10078747 DOI: 10.1111/jocn.16249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To explore nurses' and ward staff's perceptions and assessments of patient care while implementing mechanical restraints. BACKGROUND To prevent the risks associated with the use of restraints in psychiatry and ensure safe mental health care, it is necessary to know more about how the nursing staff experiences, comprehends and intervenes in managing patients subjected to coercive measures. DESIGN This study employed a qualitative descriptive design, in accordance with the COREQ guidelines. METHODS Semi-structured interviews were conducted with 18 nurses and ward staff aged between 22 and 45 years old, who had experience implementing mechanical restraints. Data were digitally audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted using NVivo 12. RESULTS The participants believed that mechanical restraints should be used as a last resort and that safeguarding patients during implementation is important; however, their assessments of the patients' physical and mental conditions varied. A clear difference emerged in how management qualified professionals handled situations prior to and during the implementation of mechanical coercive measures. CONCLUSIONS The findings emphasise the need to focus on the assessment of patients prior to and during restraint, ensure the quality of safe implementation in a risk-of-harm situation, prioritise competence in education, and practice, and improve management. RELEVANCE TO CLINICAL PRACTICE The findings highlight the importance of assessing the physical and mental condition of patients while implementing restraints, as well as aiding the management, nurses and ward staff in tailoring safety procedures.
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Affiliation(s)
- Liv Bachmann
- Department of Health and Social Sciences, Molde University College, Molde, Norway
| | - Solfrid Vatne
- Department of Health and Social Sciences, Molde University College, Molde, Norway
| | - Ingunn Pernille Mundal
- Department of Health and Social Sciences, Molde University College, Molde, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Ahmed N, Barlow S, Reynolds L, Drey N, Begum F, Tuudah E, Simpson A. Mental health professionals' perceived barriers and enablers to shared decision-making in risk assessment and risk management: a qualitative systematic review. BMC Psychiatry 2021; 21:594. [PMID: 34823487 PMCID: PMC8613998 DOI: 10.1186/s12888-021-03304-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. Shared decision-making in mental health systems is supported by research and advocated in policy. This systematic review (PROSPERO: CRD42016050457) aimed to explore the perceived barriers and enablers to implementing shared decision-making in risk assessment and risk management from mental health professionals' perspectives. METHODS PRISMA guidelines were followed in the conduct and reporting of this review. Medline, CINAHL, EMBASE, PsycINFO, AMED and Internurse were systematically searched from inception to December 2019. Data were mapped directly into the Theoretical Domains Framework (TDF), a psychological framework that includes 14 domains relevant to behaviour change. Thematic synthesis was used to identify potential barriers and enablers within each domain. Data were then matched to the three components of the COM-B model: Capability, Opportunity, and Motivation. RESULTS Twenty studies met the eligibility criteria. The findings of this review indicate that shared decision-making is not a concept commonly used in mental health services when exploring processes of risk assessment and risk management. The key barriers identified were 'power and best interest' (social influences) and 'my professional role and responsibility' (social/professional role and identity). Key enablers were 'therapeutic relationship' (social influences) and 'value collaboration' (reinforcement). The salient barriers, enablers and linked TDF domains matched COM-B components 'opportunity' and 'motivation'. CONCLUSION The review highlights the need for further empirical research to better understand current practice and mental health professionals' experiences and attitudes towards shared decision-making in risk assessment and risk management.
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Affiliation(s)
- Nafiso Ahmed
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Sally Barlow
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Lisa Reynolds
- School of Nursing, Midwifery and Allied Health, Buckinghamshire New University, 106 Oxford Rd, Uxbridge, UB8 1NA UK
| | - Nicholas Drey
- Centre for Health Services Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Fareha Begum
- Centre for Mental Health Research, School of Health Sciences, City University of London, Northampton Square, London, EC1V 0HB UK
| | - Elizabeth Tuudah
- Health Service and Population Research, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
| | - Alan Simpson
- Health Service and Population Research, David Goldberg Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Maudsley Hospital, 111 Denmark Hill, London, SE5 8AZ UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, James Clerk Maxwell Building, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
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Conflict management: A qualitative study of mental health staff's perceptions of factors that may influence conflicts with forensic mental health inpatients. Arch Psychiatr Nurs 2021; 35:407-417. [PMID: 34561053 DOI: 10.1016/j.apnu.2021.06.007] [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: 10/07/2020] [Revised: 03/09/2021] [Accepted: 06/12/2021] [Indexed: 11/23/2022]
Abstract
Internationally, clinical services are under pressure to reduce their use of restrictive practices. The aim was to explore how mental health nurses and nursing assistants perceive conflict and their use of restrictive practices with mental health inpatients in forensic mental health care. A total of 24 semi-structured interviews with forensic mental health staff were conducted and analysed using thematic analysis. The findings propose a dynamic model that explains how tolerance of potential conflict situations changes depending on individual staff members' perceptions of patients and colleagues, and their relationships.
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Coping with Criticism and Embracing Change—Further Reflexions on the Debate on a Mental Health Care System without Coercion. LAWS 2021. [DOI: 10.3390/laws10020022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In August 2019, a manuscript was published in this journal that aimed at imagining a mental health care system that renounces the judicial control to better focus on the will and preferences of those who require support. Alternative scenarios for dealing with risk, inpatient care, and police custody were presented that elicited strong and emotionally laden reactions. This article adds further reflections to this debate, aiming at contributing explanations for this unsettlement. A productive notion of criticism is discussed, and ways to achieve change toward a more human rights-oriented psychiatric practice are outlined.
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Wang R, Ping FM, Liu YM, He JL, Du SF, Shi PZ, Chen S, Shi JY. Effect of competence health cultivation on the prevention and control of inadvertent perioperative hypothermia. Rev Assoc Med Bras (1992) 2020; 66:924-930. [PMID: 32844951 DOI: 10.1590/1806-9282.66.7.924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/19/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the feasibility of health competence cultivation on the prevention and control of Inadvertent Perioperative Hypothermia (IPH). METHODS Patients with expected spinal surgery were divided into group A and group B by the random number method. Group B followed routine IPH management, and health training measures for performance and ability were implemented in Group A. The scores of the health competence questionnaire, the temperature at different times, IPH complications, and hospitalization for the two groups were observed and compared. RESULTS The main evaluation indexes, such as the health competence questionnaire score, temperature fluctuations, and IPH complications, during the perioperative period in group A were significantly better than those in group B (p < 0.05). The indexes of anesthesia, total hospital expenses, and health service satisfaction in group A were also significantly better than those in group B, which shows the advantages of cultivating health capabilities in both doctors and patients. CONCLUSION Through health competence cultivation and feasible health management measures, the medical staff can improve the quality of IPH prevention and management.
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Affiliation(s)
- Ran Wang
- Department of Operative, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
| | - Fu-Min Ping
- Department of Operative, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
| | - Yue-Mei Liu
- 3Department of Pain, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
| | - Jing-Lan He
- 3Department of Pain, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
| | - Shu-Fang Du
- 3Department of Pain, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
| | - Pei-Zhao Shi
- 3Department of Pain, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
| | - Song Chen
- 3Department of Pain, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
| | - Ji-Yue Shi
- Department of Pain, Affiliated Hospital, Hebei University of Engineering, Handan, Hebei, China
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Nielsen LD, Bech P, Hounsgaard L, Gildberg FA. Construct validity of the Mechanical Restraint - Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument. Nord J Psychiatry 2019; 73:331-339. [PMID: 31264926 DOI: 10.1080/08039488.2019.1634757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A new short-term risk assessment instrument, the Mechanical Restraint - Confounders, Risk, Alliance Score (MR - CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists' etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient's readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR - CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR - CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR - CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient's readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR - CRAS among clinicians at closed forensic mental health inpatient units. MR - CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.
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Affiliation(s)
- Lea Deichmann Nielsen
- a Department of Psychiatry , Middelfart , Denmark.,b Nursing Education, University College South , Esbjerg , Denmark.,c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
| | - Per Bech
- e Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen , Hilleroed , Denmark
| | - Lise Hounsgaard
- c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark.,f Institute of Nursing and Health Science, University of Greenland , Nuuk , Greenland.,g University College Lillebaelt , Vejle , Denmark
| | - Frederik Alkier Gildberg
- a Department of Psychiatry , Middelfart , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
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Jackson H, Baker J, Berzins K. Factors influencing decisions of mental health professionals to release service users from seclusion: A qualitative study. J Adv Nurs 2019; 75:2178-2188. [PMID: 31162720 DOI: 10.1111/jan.14086] [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] [Received: 12/21/2018] [Revised: 03/13/2019] [Accepted: 05/01/2019] [Indexed: 11/29/2022]
Abstract
AIM This study aims to explore and understand factors influencing the decisions of mental health professionals releasing service users from seclusion. BACKGROUND Seclusion should only be used as a last resort and for the minimum possible duration. Current evidence outlines which service users are more likely to be secluded, why and what influences professionals' decision to seclude. Little is known about factors professionals consider when releasing service users. DESIGN A qualitative study was undertaken to explore factors which influence decision-making of mental health professionals when terminating episodes of seclusion. METHODS Semi-structured face-to-face interviews with 21 professionals were undertaken between May 2017-January 2018. Framework analysis was used to systematically manage, analyse, and identify themes, while maintaining links to primary data and providing a transparent audit trail. RESULTS Six themes were identified where professionals looked for service users to demonstrate cooperation and compliance before they would be released. Decisions were subjective, being influenced by the experience and composition of the review team, the availability of resources plus the emotional tone and physical environment of the ward. Release could be delayed by policy and protocol. CONCLUSION Professionals should have greater awareness of factors that hinder or facilitate decisions to release service from seclusion and an understanding of how service user views and involves in decisions regarding seclusion should be explored. IMPACT Senior staff should be available to facilitate release at the earliest opportunity. Staff should ensure that policy and procedures do not prolong the time service users remain secluded.
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Affiliation(s)
- Haley Jackson
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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Tingleff EB, Hounsgaard L, Bradley SK, Gildberg FA. Forensic psychiatric patients' perceptions of situations associated with mechanical restraint: A qualitative interview study. Int J Ment Health Nurs 2019; 28:468-479. [PMID: 30341808 DOI: 10.1111/inm.12549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 12/14/2022]
Abstract
To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence-based patient care, we need more knowledge about patients' subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients' perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: 'overt protest reactions', 'silent protest reactions', 'illness-related behaviour', and 'genuinely calm', which together characterize patients' perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: 'pattern of protest' and 'pattern of illness'. Further research is needed to illuminate the associations between patients' perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.
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Affiliation(s)
- Ellen B Tingleff
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Department of Nursing, UCL University College, Vejle, Denmark.,Health Sciences Research Center, UCL University College, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Lise Hounsgaard
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, UCL University College, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark.,Institute of Nursing & Health Science, University of Greenland, Nuuk, Greenland
| | | | - Frederik A Gildberg
- Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
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Jackson H, Baker J, Berzins K. What factors influence the decisions of mental health professionals to release service users from seclusion? Int J Ment Health Nurs 2018; 27:1618-1633. [PMID: 29934973 DOI: 10.1111/inm.12502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 12/11/2022]
Abstract
Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision-making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety. In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection. Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence-based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion.
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Affiliation(s)
- Haley Jackson
- School of Healthcare, University of Leeds, Leeds, UK
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
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