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Cañabate Ros M, Almodóvar Fernández I, Martínez Madrigal M, Benito Delegido A, Luna Ibañez C, Haro G. Relationship of sociodemographic and clinical characteristics to mechanical restraint used in a psychiatric hospital in Spain. J Adv Nurs 2024. [PMID: 39046147 DOI: 10.1111/jan.16305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Coercive measures have been applied in mental health fields throughout history, denying people with mental illness the ability to decide, even though there is increasing evidence that these measures bring few benefits to these individuals. OBJECTIVE The objective of this study was to analyse the sociodemographic and clinical characteristics most likely associated with the use of mechanical restraints (MRs) in psychiatric hospital settings. DESIGN, SETTINGS AND PARTICIPANTS This was a descriptive, comparative and analytical cross-sectional study in people with mental disorders who were hospitalized in two hospitals in the Autonomous Valencian Community (Spain). We included a total of 91 participants who completed the Scale to Assess Unawareness of Mental Disorder (SUMD), Positive and Negative Syndrome Scale (PANSS), Barrat's Impulsiveness Scale and the Hamilton Anxiety Scale. RESULTS The results we collected indicated that the patients most likely to be mechanically restrained were younger people with less awareness of their symptoms and disease, previous admissions to a psychiatric hospital and cohabitation with parents and/or family. In addition, having been admitted involuntarily, previously having had MRs applied, presenting more positive psychotic symptoms and habitual caffeine consumption all predicted the use of MRs. CONCLUSIONS The variables that were able to predict MR were involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Evaluation of the sociodemographic and clinical characteristics of patients can help health professionals, especially nurses, to recognize patients who are at risk of requiring MR. This allows mental health practitioners to take these factors into account during interventions or when implementing programmes designed to reduce the use of coercive measures in psychiatric hospital settings. IMPACT What problem did the study address? Coercive measures have been applied in mental health fields throughout history, with no benefits to these patients. What were the main findings? There are studies that relate some variables to MR in psychiatric settings, but we have been able to find variables capable of predicting MR such as involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Where and on whom will the research have an impact? The findings of this study allow for the reduction of MRs in psychiatric units. The sociodemographic and clinical characteristics found to be related to MR will help professionals identify when a patient is admitted in order to use specific interventions aimed at preventing the use of MRs during admission. This is the first study to indicate a relationship between caffeine consumption and the use of MRs. Further studies will be necessary to verify if controlled caffeine supplementation during admission to psychiatric units could become an additional strategy contributing to preventing the application of MR specifically in individuals who habitually consume coffee or caffeine-containing beverages daily. REPORTING METHOD We have adhered to relevant EQUATOR guidelines using the STROBE reporting method. PATIENT CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Montserrat Cañabate Ros
- Mental Health Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- Nursing Department, UCV Universities, Valencia, Spain
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
| | - Isabel Almodóvar Fernández
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Nursing Department, Jaume I University, Castellón de la Plana, Spain
- Villarreal CF, Villa-Real, Castellón, Spain
| | | | - Ana Benito Delegido
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Torrente Mental Health Unit, Hospital General Universitario de Valencia, Torrente, Spain
| | | | - Gonzalo Haro
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
- Mental Health Department, Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
- Medicine Department, Universidad Cardenal Herrera-CEU, CEU Universities, Castellón de la Plana, Spain
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Dauriac-Le Masson V, El-Khoury Lesueur F, Lahaye J, Launay C, Christodoulou A, Boiteux C, Maman J, Bonnemaison X, Perquier F, Vacheron MN. Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group. Front Psychiatry 2024; 15:1296356. [PMID: 38445090 PMCID: PMC10913196 DOI: 10.3389/fpsyt.2024.1296356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Methods Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. Results For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. Discussion S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.
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Affiliation(s)
| | - Fabienne El-Khoury Lesueur
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Sorbonne Universite, INSERM UMRS_1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Paris, France
| | - Justine Lahaye
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Corinne Launay
- Pôle Psychiatrie Précarité, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | | | - Florence Perquier
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
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Miodownik C, Friger MD, Teitelbaum A, Demchuk N, Zhuk A, Agababa T, Sokolik S, Lerner PP, Calfon N, Lerner V. Risk factors for coercion length at psychiatric hospitals in Israel: Relationship with staff. Indian J Psychiatry 2024; 66:36-42. [PMID: 38419935 PMCID: PMC10898533 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_814_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/27/2023] [Accepted: 11/11/2023] [Indexed: 03/02/2024] Open
Abstract
Background Coercive interventions continue to be applied frequently in psychiatric care when patients are at imminent risk of harming themselves and/or others. Aim The purpose of this study was to demonstrate the relationship between the length of coercion and a variety of factors, including the sociodemographic background of patients, their diagnoses and the characteristics of hospital staff. Methods This is a one-year cross-sectional retrospective study, including records of 298 patients who underwent restraint and/or seclusion interventions in male acute, closed wards in two psychiatric hospitals in Israel. Results A higher proportion of academic nurses to nonacademic nurses on duty leads to a shorter coercion time (P < 0.000). The number of male staff on duty, without any relation to their level of education, also leads to the shortening of the coercion time. Conclusion The presence of registered, academic female nurses, male staff on duty and the administration of medication before coercive measures can reduce the length of restriction.
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Affiliation(s)
- Chanoch Miodownik
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Michael D. Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Natalya Demchuk
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Tsipora Agababa
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Shmuel Sokolik
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | | | - Vladimir Lerner
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Cusack P, McAndrew S, Duckworth J, Cusack F, McKeown M. Experiencing restraint: A dialogic narrative inquiry from a service user perspective. Int J Ment Health Nurs 2023; 32:1724-1734. [PMID: 37605304 DOI: 10.1111/inm.13212] [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: 06/15/2023] [Revised: 07/14/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
In recent decades concerns about violence and programs for the minimization of physical restraint, amongst other restrictive practices, have proliferated within mental health policy and practice. Whilst nurses are often called upon when violence occurs within mental health care settings, they often find themselves having the conflicting roles of caring and controlling. Within such situations it is service users, who are experts by experience, who perhaps can offer more meaningful insight into being restrained and thus provide a more appropriate approach in dealing with mental distress. This paper presents the findings of a narrative study of individuals' experiences of physical restraint within the mental health care system. In total 11 mental health service users, who had experienced physical restraint, were interviewed. Frank's (2010, Letting stories breathe: a socio-narratology) guiding questions were used to undertake a dialogical narrative analysis of each story. For the purpose of this paper, four of the 11 stories are presented as these are representative of Frank's 'quest narrative'. However, whilst studies from the service user perspective regarding restraint are scarce, findings are discussed in relation to the grand narrative of restraint. The dialogical relationship between individual stories and the dominant grand narrative implies that the former has the capacity to shape and review the latter within mental health care. Adding to the growing body of evidence of restraint from service users' perspectives could enable nurses to provide more appropriate and meaningful mental health care in times of mental distress. [238].
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Maguire T, Willetts G, McKenna B, Daffern M, Garvey L. Developing entrustable professional activities to enhance application of an aggression prevention protocol. Nurse Educ Pract 2023; 73:103827. [PMID: 37948918 DOI: 10.1016/j.nepr.2023.103827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
AIM The research aim of this study was to seek feedback from prevention of aggression training experts about the suitability of Entrustable Professional Activities (EPAs) as an assessment tool for an Aggression Prevention Protocol. The protocol was designed to structure intervention to prevent aggression and reduce the use of restrictive practices following risk assessment using a validated instrument (the Dynamic Appraisal of Situational Aggression). BACKGROUND Preventing aggression and limiting the use of restrictive practices are key priorities for inpatient mental health services. Assessing clinical activities using a competence framework has limitations, particularly when determining complex interventions. EPAs could provide a suitable method for assessing complex clinical activities like de-escalation and limit setting, which comprise some of the interventions in the Aggression Prevention Protocol. EPAs are new to forensic mental health nursing; therefore, feedback was sought regarding the utility of EPAs to assess aggression prevention interventions. METHODS Data were collected via focus groups including 11 aggression prevention experts from Australia and New Zealand. A thematic analysis, comparative analysis and a Strength, Weakness, Opportunity and Threats analysis was conducted. RESULTS Three themes were interpreted from the data: 1) Frameworks such as the APP are needed to work towards elimination of restrictive practices; 2) APP-EPAs afford an opportunity to set the standard for practice; and 3) 'who watches the watchers', were identified by the experts as well as areas to enhance EPAs prior to introduction into practice. CONCLUSIONS EPAs address a practice-gap and offer a framework to assist movement towards elimination of restrictive practices, while prompting best-practice, self-reflection and practice improvement guidance.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Australia; The Victorian Institute of Forensic Mental Health (Forensicare), Australia.
| | - Georgina Willetts
- Institute Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
| | - Brian McKenna
- Auckland University of Technology, New Zealand; Centre for Forensic Behavioural Science, Swinburne University of Technology, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Australia; The Victorian Institute of Forensic Mental Health (Forensicare), Australia
| | - Loretta Garvey
- Institute Health and Wellbeing, Federation University Australia, Melbourne, Victoria, Australia
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Chong Y, Wang C, Zhi T, Fang S, Min H, Zhang L, Wu X, Wang Y. Psychiatric Nurses' Knowledge, Attitudes, and Practice Regarding Physical Restraint in China: A Multicentre Cross-Sectional Study. J Multidiscip Healthc 2023; 16:1475-1489. [PMID: 37274425 PMCID: PMC10237330 DOI: 10.2147/jmdh.s412485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
Background Physical restraint is widely used in mental health services to address safety concerns. However, studies have shown that improper physical restraint can result in adverse effects. Nurses are the main practitioners of physical restraint and play a crucial role in physical restraint decisions and nursing. In China, there is a lack of large-scale investigations into the current status of psychiatric physical restraint use. Aim This study aims to explore the situation and influencing factors of the psychiatric nurses' knowledge, attitudes and practices regarding physical restraint in China. Methods A cross-sectional multicenter descriptive study was conducted from December 2022 to February 2023, consecutively. A convenience sampling method was used to recruit 345 staff from three psychiatric hospitals in Shanghai. A psychiatric nurses' physical restraint use status questionnaire was administered to examine their knowledge, attitude, and practice regarding physical restraint. The data were analyzed using the Mann-Whitney U-test and the Kruskal-Wallis test. Multivariate linear stepwise regression analysis was used for multi-factor analysis. Results Overall, nurses had a good level of knowledge with positive attitudes and adequate practices. However, they had some misunderstandings and undesirable practices. Multiple linear regression analysis revealed that educational background, position and training experience were the main factors influencing physical restraint knowledge, attitudes and practice among psychiatric nurses (p<0.05). Conclusion This study highlights some important misconceptions and improper practices of psychiatric nurses about using physical restraint. It is necessary to strengthen education and training on physical restraint for nursing staff to reduce unnecessary physical restraint use.
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Affiliation(s)
- Yue Chong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Can Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Tingting Zhi
- Shanghai Psychological Consultation Center, Shanghai Baoshan Mental Health Center, Shanghai, 201900, People’s Republic of China
| | - Shihan Fang
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People’s Hospital, Hangzhou, 310005, People’s Republic of China
| | - Haiying Min
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Lei Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
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Guzmán-Parra J, Aguilera-Serrano C, Huizing E, Bono Del Trigo A, Villagrán JM, Hurtado Melero V, García-Sanchez JA, Mayoral-Cleries F. Factors associated with prolonged episodes of mechanical restraint in mental health hospitalization units in Andalusia. J Psychiatr Ment Health Nurs 2022; 29:873-882. [PMID: 35088924 DOI: 10.1111/jpm.12824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/05/2022] [Accepted: 01/20/2022] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Risk factors associated with prolonged episodes of mechanical restraint and other coercive measures are understudied. There have been no studies of this phenomenon in the context of the Andalusian public health system. Knowledge about factors associated with prolonged episodes is essential to increase the understanding of this phenomenon and develop strategies to reduce its occurrence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at the level of the units could be necessary to prevent prolonged episodes of mechanical restraint. The results suggest the need for stricter control during the shifts on which restraint starts, especially in the first days after the patient's admission. Preventive risk assessment considering clinical and sociodemographic risk factors could help to reduce prolonged restraint. ABSTRACT: Introduction Factors associated with prolonged episodes of mechanical restraint and other coercive interventions are not clearly established and have been not studied in Andalusia (Spain). Aim To study factors associated with prolonged episodes of mechanical restraint. Method We analysed retrospectively episodes of mechanical restraint (N = 6267, prolonged episode >9.5 hours) in all public mental health hospitalization units (N = 20, 535 beds) that offer health coverage for the autonomous community of Andalusia. The data came from clinical records. A multivariable mixed logistic regression was used. Results In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. Discussion The results provide evidence that prolonged episodes largely depend on the unit where they occur and that stricter control and regulation are necessary to prevent prolonged episodes. Implications for practice Interventions at the level of the unit are necessary. Stricter control in the shifts during which there is more risk of prolonged restraint may be necessary, especially in the first days following admission.
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Affiliation(s)
- José Guzmán-Parra
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
| | - Carlos Aguilera-Serrano
- South Health Management Area of Granada, Community Mental Health Unit of Motril, Motril, Spain
| | | | | | | | - Verónica Hurtado Melero
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
| | - Juan Antonio García-Sanchez
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Málaga, Spain
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Pérez-Toribio A, Moreno-Poyato AR, Roldán-Merino JF, Nash M. Spanish mental health nurses' experiences of mechanical restraint: A qualitative descriptive study. J Psychiatr Ment Health Nurs 2022; 29:688-697. [PMID: 35856924 DOI: 10.1111/jpm.12860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 10/17/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Mechanical restraint is a common practice in mental healthcare settings in Spain, despite controversy. Mechanical restraint is perceived as a negative experience for nurses and service users. Mechanical restraint damages the nurse-patient therapeutic relationship, which is essential in providing quality care and promoting recovery. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The negative experiences of service users and mental health nurses arising from use of mechanical restraint affects both parties involved and results in trauma. Using mechanical restraint can provoke a moral injury in mental health nurses which can negatively impact on the establishment of trust within the therapeutic nurse-patient relationship. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses must be aware of the negative effects that mechanical restraint use has on both their practice and their day-to-day lives. Post-mechanical restraint debriefing is required to repair the damage to the trust aspect of the nurse-patient relationship. Involving service users in co-producing a debriefing framework may be a way to rebuild trust through constructive dialogue. ABSTRACT INTRODUCTION: Mechanical restraint is an intervention that causes harm to service users and nurses, yet continues to be used in many countries, including Spain. However, there is a lack of research exploring Spanish mental health nurses' experiences of using mechanical restraint. AIM To describe the experiences of mental health nurses who have used mechanical restraint in practice. METHODS A qualitative descriptive methodology was used and a purposive sample of 10 Spanish mental health nurses were interviewed about their experiences of using mechanical restraint. Thematic analysis was then employed to analyse interview data. RESULTS Participants' experiences of using mechanical restraint were mostly negative. Three main themes arose from the analysis of interview transcripts, (i) symmetrical trauma, (ii) moral injury and (iii) broken trust. DISCUSSION The use of restrictive practices, which can be perceived as counter-therapeutic, exposes nurses to risks such as moral injury and service users to broken trust in the therapeutic nurse patient relationship. Avoiding empathy in order to use mechanical restraint is counterproductive, in the understanding that empathy is key to reducing this intervention. IMPLICATIONS FOR PRACTICE Reducing or eliminating use of mechanical restraints should be a policy and practice priority due to the symmetrical harms it causes both nurses and service users. The trust aspect of the therapeutic nurse-patient relationship is a significant casualty when mechanical restraint is used, therefore involving service users in co-production of post-mechanical restraint debriefing can be an avenue for restoring this trust through dialogue.
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Affiliation(s)
- Alonso Pérez-Toribio
- Unitat de Salut Mental de l'Hospitalet, Servei d'Atenció Primària Delta de Llobregat/Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Barcelona, Spain
| | - Antonio R Moreno-Poyato
- Departament of Public Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, Barcelona, Spain
| | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Michael Nash
- School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
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Maguire T, Garvey L, Ryan J, Olasoji M, Willets G. Using the Nominal Group Technique to determine a nursing framework for a forensic mental health service: A discussion paper. Int J Ment Health Nurs 2022; 31:1030-1038. [PMID: 35591773 PMCID: PMC9321579 DOI: 10.1111/inm.13023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 11/29/2022]
Abstract
The Nominal Group Technique is a method used to explore issues, generate ideas, and reach consensus on a topic. The Nominal Group Technique includes individual and group work and is designed to ensure participants have the same opportunity to engage and provide their opinions. While the technique has been used for around six decades to assist groups, in industry, and government organizations to examine issues and make decisions, this technique has received limited attention in nursing research, particularly in mental health. This discussion paper describes the use of a modified Nominal Group Technique for a study designed to determine a nursing decision-making framework for a state-wide forensic mental health service. Modifications were made to the traditional technique, to enable participants to make an informed and collective decision about a suitable framework for the novice to expert nurses, across secure inpatient, prison, and community forensic mental health settings. The Nominal Group Technique generated rich data and offered a structured approach to the process. We argue that the Nominal Group Technique offers an exciting and interactive method for nursing research and can increase opportunity for minority group members to participate. This technique also offers a time efficient way to engage busy clinical nurses to participate in research, with the advantage of members knowing the decision on the day of the group. Consideration, however, needs to be given to the duration and effect on participant concentration, and if not actively managed by facilitators, the possible emergence of group dynamics affecting individuals' decisions.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.,The Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
| | - Loretta Garvey
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Jo Ryan
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.,The Victorian Institute of Forensic Mental Health (Forensicare), Melbourne, Australia
| | - Michael Olasoji
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Georgina Willets
- School of Health, Federation University Australia, Melbourne, Australia
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Välimäki M, Lam YTJ, Hipp K, Cheng PYI, Ng T, Ip G, Lee P, Cheung T, Bressington D, Lantta T. Physical Restraint Events in Psychiatric Hospitals in Hong Kong: A Cohort Register Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6032. [PMID: 35627570 PMCID: PMC9140463 DOI: 10.3390/ijerph19106032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 12/22/2022]
Abstract
The need to better monitor coercion practices in psychiatric hospitals has been recognised. We aim to describe how physical restraint events occur in psychiatric hospitals and identify factors associated with physical-restraint use. A cohort register study was used. We analyzed physical restraint documents among 14 wards in two psychiatric hospitals in Hong Kong (1 July and 31 December 2018). In total, 1798 incidents occurred (the rate of physical restraint event 0.43). Typically, physically restrained patients were in early middle-age, of both genders, diagnosed with schizophrenia-spectrum and other psychotic disorders, and admitted voluntarily. Alternate methods for physical restraint were reported, such as an explanation of the situation to the patients, time-out or sedation. A longer period of being physically restrained was associated with being male, aged ≥40 years, having involuntary status, and neurodevelopmental-disorder diagnosis. Our findings support a call for greater action to promote the best practices in managing patient aggression and decreasing the use of physical restraint in psychiatric wards. The reasons for the use of physical restraint, especially for those patients who are admitted to a psychiatric hospital on a voluntary basis and are diagnosed with neurodevelopmental disorders, needs to be better understood and analysed.
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Affiliation(s)
- Maritta Välimäki
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation, Central South University, Changsha 410083, China
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
| | - Yuen Ting Joyce Lam
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China;
| | - Kirsi Hipp
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
| | - Po Yee Ivy Cheng
- Community Psychiatric Services, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China; (P.Y.I.C.); (T.N.)
| | - Tony Ng
- Community Psychiatric Services, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China; (P.Y.I.C.); (T.N.)
| | - Glendy Ip
- Central Nursing Division, Kwai Chung Hospital, Kwai Chung, Hong Kong SAR, China;
| | - Paul Lee
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China;
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, Larrakia Country, Darwin NT 0810, Australia;
| | - Tella Lantta
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
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11
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Pérez-Toribio A, Moreno-Poyato AR, Lluch-Canut T, Molina-Martínez L, Bastidas-Salvadó A, Puig-Llobet M, Roldán-Merino JF. Relationship between nurses' use of verbal de-escalation and mechanical restraint in acute inpatient mental health care: a retrospective study. Int J Ment Health Nurs 2022; 31:339-347. [PMID: 34837275 DOI: 10.1111/inm.12961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Abstract
Although the use of verbal de-escalation in nursing has been shown to be an effective tool for controlling agitation and avoiding mechanical restraint, there is scarce evidence supporting the use of de-escalation by nurses and factors related to the patients who ultimately receive mechanical restraint. This retrospective study sought to examine the relationship between the use of verbal de-escalation by nurses and the clinical profile of patients who had received mechanical restraint at an acute mental health unit. This study analysed the records of patients who had received mechanical restraint between the years 2012 and 2019. A bivariate analysis was initially performed, followed by multiple logistic regression analysis. A total of 493 episodes of restraint were recorded. Of these, in almost 40% of cases, no prior use of verbal de-escalation was noted. The factors associated with the use of verbal de-escalation by nurses were patients with a history of restraint episodes and patients who previously had been administered medication. Furthermore, episodes of mechanical restraint that occurred later during the admission were also associated with the use of de-escalation. These findings confirm the relevance of early nurse interventions. Consequently, it is important to establish an adequate therapeutic relationship from the start of hospitalization to facilitate getting to know the patient and to enable the timely use of verbal de-escalation, thus avoiding the use of mechanical restraint.
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Affiliation(s)
- Alonso Pérez-Toribio
- Unitat de Salut Mental de l'Hospitalet, Servei d'Atenció Primària Delta de Llobregat / Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Molina-Martínez
- Programa Atención Domiciliaria Intensivo (PADI), Associació d'Higiene Mental Nou Barris, Barcelona, Spain
| | | | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L´Hospitalet de Llobregat, Barcelona, Spain
| | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
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12
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El-Abidi K, Moreno-Poyato AR, Toll Privat A, Corcoles Martinez D, Aceña-Domínguez R, Pérez-Solà V, Mané A. Determinants of mechanical restraint in an acute psychiatric care unit. World J Psychiatry 2021; 11:854-863. [PMID: 34733647 PMCID: PMC8546761 DOI: 10.5498/wjp.v11.i10.854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential.
AIM To determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR.
METHODS Descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration.
RESULTS Of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05).
CONCLUSION The presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint.
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Affiliation(s)
- Khadija El-Abidi
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
| | - Antonio R Moreno-Poyato
- Public Health, Mental and Maternal and Child Health, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona 08907, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
| | - Alba Toll Privat
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
| | - David Corcoles Martinez
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
| | - Rosa Aceña-Domínguez
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
| | - Victor Pérez-Solà
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona 08003, Spain
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
| | - Anna Mané
- Biomedical Research, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona 08003, Spain
- Biomedical Research, Center for Biomedical Research in Mental Health Network, Barcelona 08003, Spain
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Centre Fòrum, Barcelona 08019, Spain
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13
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Maguire T, Ryan J, McKenna B. Benchmarking to reduce restrictive practices in forensic mental health services: a Delphi study. Australas Psychiatry 2021; 29:384-388. [PMID: 32772716 DOI: 10.1177/1039856220946634] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Forensic mental health services (FMHS) have higher rates, duration and frequency of restrictive practices (seclusion, physical restraint and mechanical restraint). Data generated by services can be used to set targets (benchmarks) with like services to reduce or eliminate restrictive practices. The aim of this study was to develop restrictive practice benchmarks for Australian and New Zealand FMHS. METHOD A participatory action research methodology was used by conducting a Delphi study. FMHS experts provided de-identified service-specific restrictive practice data, which was used to stimulate reflection towards the development of restrictive practice benchmarks. RESULTS Consensus decision-making was reached on benchmarks for the rate, duration and frequency of seclusion and physical restraint. Mechanical restraint was found to be a rare event, requiring event specific review in each service. CONCLUSIONS Benchmarking with FMHS may assist in working to reduce restrictive practices and encourage the scrutiny of service practice. Establishment of a FMHS network might assist to embed the proposed benchmarks.
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Affiliation(s)
- Tessa Maguire
- Forensicare, Victoria, Australia.,Centre for Forensic Behavioural Science, Australia
| | - Jo Ryan
- Forensicare, Australia.,Centre for Forensic Behavioural Science, Australia
| | - Brian McKenna
- Centre for Forensic Behavioural Science, Australia.,Auckland University of Technology, New Zealand.,Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, New Zealand
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14
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Walker H, Tulloch L. A "Necessary Evil": Staff Perspectives of Soft Restraint Kit Use in a High-Security Hospital. Front Psychiatry 2020; 11:357. [PMID: 32477174 PMCID: PMC7241439 DOI: 10.3389/fpsyt.2020.00357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/08/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Forensic mental health nurses working at the forefront of services can intermittently face enduring and somewhat harrowing or stressful situations. Enclosed is an example of the use of mechanical restraints (Soft Restraint Kit) for a two month period. Staff experience of working under such circumstances is an under reported area. METHODS The experience of nursing a patient under extreme conditions was captured through use of a qualitative study, using semi structured interviews with a purposive sample of (n = 10) staff nurses and nursing assistants in a high-security hospital. RESULTS Thematic analysis was undertaken generating four themes: sense of responsibility, aptitude, enablers/inhibitors, and consequence. Conclusions suggest that Soft Restraint Kits provide a useful method of containment, although prolonged use presents considerable challenges for staff. The importance of preparation and training cannot be underestimated and continued support and supervision are absolutely essential.
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Affiliation(s)
- Helen Walker
- Department of Health and Life Sciences, University of the West of Scotland, Paisley, United Kingdom
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15
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Panagiotou A, Mafreda C, Moustikiadis A, Prezerakos P. Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16-year retrospective study. Int J Ment Health Nurs 2019; 28:1078-1089. [PMID: 31169358 DOI: 10.1111/inm.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 11/28/2022]
Abstract
Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental-organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well-trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.
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Affiliation(s)
- Aspasia Panagiotou
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Sparta, Greece
| | | | | | - Panagiotis Prezerakos
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Sparta, Greece
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16
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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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17
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Hilton NZ, Ham E, Seto MC. Assessment of Risk for Seclusion Among Forensic Inpatients: Validation and Modification of the Risk of Administrative Segregation Tool (RAST). INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2019; 63:1424-1445. [PMID: 31064294 DOI: 10.1177/0306624x18823621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Seclusion is used in psychiatric care to protect patients and staff or to manage aggression but may have adverse effects. The ability to identify at-risk patients could help reduce seclusion. This study tested the Risk of Administrative Segregation Tool's (RAST) ability to predict any seclusions among 229 male forensic inpatients followed for up to 1 year of hospitalization, and days spent secluded, controlling for length of stay. RAST scores were lower than in correctional samples. The RAST did not predict seclusions in Year 1, but modification of three items to fit the forensic population (RAST-F) offered a small improvement. Among 62 patients hospitalized for more than 1 year, the RAST significantly predicted seclusions in Year 2, and the modifications improved prediction. The present modest findings support the RAST's potential to help identify patients most in need of clinical efforts to avert seclusion. Replication in larger samples, including female patients, is needed.
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Affiliation(s)
- N Zoe Hilton
- 1 Waypoint Research Institute, Penetanguishene, Ontario, Canada
| | - Elke Ham
- 1 Waypoint Research Institute, Penetanguishene, Ontario, Canada
| | - Michael C Seto
- 2 Institute for Mental Health Research, Ottawa, Ontario, Canada
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18
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Gerace A, Muir-Cochrane E. Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey. Int J Ment Health Nurs 2019; 28:209-225. [PMID: 30019798 PMCID: PMC7818138 DOI: 10.1111/inm.12522] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Abstract
Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma-informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use.
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Affiliation(s)
- Adam Gerace
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Adelaide, South Australia, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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19
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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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20
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Green R, Shelly C, Gibb J, Walker T. Implementing seclusion in forensic mental health care: A qualitative study of staff decision making. Arch Psychiatr Nurs 2018; 32:764-768. [PMID: 30201206 DOI: 10.1016/j.apnu.2018.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/27/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Abstract
Forensic mental health nursing is a complex role and there is a tension between maintaining safety and promoting a therapeutic and patient centred approach. The use of restrictive practises such as seclusion is an issue. Two focus groups with registered nurses exploring attitudes and factors used in decision-making about seclusion use were analysed using interpretive description. Participants described the need to reduce the use of seclusion and the problematic nature of its utility as an ongoing intervention in contemporary mental healthcare. It was clear that there were complexities and competing variables involved in the decision-making process.
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Affiliation(s)
- Rachel Green
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich Hospital, Bury New Rd, Manchester, M25 3BL, United Kingdom.
| | - Catriona Shelly
- Manchester Metropolitan University, Department of Psychology, 53 Bonsall Street, Manchester M15 6GX, United Kingdom.
| | - Jonathan Gibb
- University of Manchester, Division of Psychology and Mental Health, School of Medical Sciences, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Tammi Walker
- The University of Huddersfield, Human and Health Sciences, Queensgate, Huddersfield HD1 3DH, United Kingdom.
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