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Bachmann L, Ødegård A, Mundal IP. A comprehensive examination of research instruments utilized for assessing the attitudes of healthcare professionals towards the use of restraints in mental healthcare: A systematic review. J Adv Nurs 2024; 80:2728-2745. [PMID: 38093475 DOI: 10.1111/jan.16015] [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: 03/20/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 06/13/2024]
Abstract
AIM This systematic review aimed to identify, describe and evaluate questionnaires measuring health professionals' attitudes towards restraints in mental healthcare. DESIGN A systematic review was undertaken in accordance with the COSMIN protocol for systematic review and the relevant sections of the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES OVID Medline, OVID nursing, Psychinfo, Embase and Cinahl were systematically searched from databases inception, with an initial search in December 2021 and updated in April 2022. REVIEW METHODS The inclusion criteria compromised articles reporting on self-reported instruments of attitudes or perceptions, development or validation of instruments and the evaluation of one or more measurement properties. Articles using multiple instruments in one study or not published in English were excluded. Two researchers independently extracted the data and appraised the methodological quality using the COSMIN guidelines and standards (consensus-based standards for the selection of health measurement instrument). A narrative synthesis without meta-analysis was performed. The systematic review was registered in PROSPERO Protocol ID CRD42022308818. RESULTS A total of 23 studies reporting ten instruments were included. The findings revealed a broad variation in the content of the questionnaires, the use of terms/constructs and the context in which the various instruments measure attitudes towards coercive measures. Many studies lacked sufficient details on report of psychometric properties. Finally, the results were not summarized and the evidence not GRADED. CONCLUSIONS There is a need for updated and adapted instruments with origins in theory and clear joint definitions such that attitudes towards coercive measures can be reliably assessed regarding the validity and reliability of instruments, which will be of importance to facilitate the use of instruments in research and clinical settings. IMPACT Reviews addressing surveys, self-reported attitudes towards restraints in mental healthcare and examination of psychometric properties seem limited. We highlight distinct complexity, psychometric limitations and broad variation in the context and content measuring attitudes towards coercive measures, and their various use of terms/constructs in the existing questionnaires. These findings contribute to further research regarding the development of questionnaires and the need of representing the concept well - carefully denoted by the indicators, likewise the importance of applying questionnaires with properly reported measurement properties in terms of validity and reliability to ensure the use in research and clinical settings.
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Affiliation(s)
- Liv Bachmann
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
| | - Atle Ødegård
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
- Habilitation Services, Clinic of Mental Health, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Ingunn Pernille Mundal
- Faculty of Health Science and Social Care, 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, Norway University of Science and Technology (NTNU), Trondheim, Norway
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2
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Pedersen ML, Gildberg FA, Bogh SB, Birkeland S, Tingleff EB. Staff responses to interventions aiming to reduce mechanical restraint in adult mental health inpatient settings: a questionnaire-based survey. Nord J Psychiatry 2024; 78:328-338. [PMID: 38436663 DOI: 10.1080/08039488.2024.2323125] [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: 11/16/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To explore mental health staff's responses towards interventions designed to reduce the use of mechanical restraint (MR) in adult mental health inpatient settings. METHODS We conducted a cross-sectional, questionnaire-based survey. The questionnaire, made available online via REDCap, presented 20 interventions designed to reduce MR use. Participants were asked to rate and rank the interventions based on their viewpoints regarding the relevance and importance of each intervention. RESULTS A total of 128 mental health staff members from general and forensic mental health inpatient units across the Mental Health Services in the Region of Southern Denmark completed the questionnaire (response rate = 21.3%). A total of 90.8% of the ratings scored either 'agree' (45.2%) or 'strongly agree' (45.6%) concerning the relevance of the interventions in reducing MR use. Overall and in the divided analysis, interventions labelled as 'building relationship' and 'patient-related knowledge' claimed high scores in the staff's rankings of the interventions' importance concerning implementation. Conversely, interventions like 'carers' and 'standardised assessments' received low scores. CONCLUSIONS The staff generally considered that the interventions were relevant. Importance rankings were consistent across the divisions chosen, with a range of variance and dispersion being recorded among certain groups.
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Affiliation(s)
- Martin Locht Pedersen
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Søren Bie Bogh
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, /Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Søren Birkeland
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
- OPEN, Odense Patient data Explorative Network, Odense University Hospital, /Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ellen Boldrup Tingleff
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
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3
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Pohatu C, Kake T. The attitudes of nurses towards seclusion: A New Zealand in-patient mental health setting. Int J Ment Health Nurs 2024. [PMID: 38651240 DOI: 10.1111/inm.13341] [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: 04/24/2023] [Revised: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
Seclusion is a form of restraint practised in mental health services world-wide, and has been criticised as unethical and traumatising to patients. Several countries have committed to reducing or eliminating seclusion. In New Zealand, there has been a focus on reducing seclusion of the indigenous Māori population, who experience particularly high rates. Nurses typically lead decisions to place patients in seclusion and their attitudes towards seclusion likely influence this process. This study aimed to address the primary question: what are the attitudes of registered nurses towards the use of seclusion? A mixed methods pragmatic approach was used involving qualitative interviews of nurses working in a high seclusion mental health ward located in the North Island of New Zealand, and a quantitative analysis of the seclusion data from this ward. This report is adherent with COREQ and STROBE. Thirteen nurses were interviewed and four main themes were identified: seclusion is necessary; seclusion is being used unnecessarily; nurse characteristics influence the use of seclusion; nurses perceived their ward culture to be improving in the use of seclusion. However, analysis of seclusion data indicated that rates had been increasing for this ward prior to this study, and the rates for indigenous Māori patients were especially elevated. This pattern of increasing rates was congruent with the 'supportive' attitudes of nurses towards seclusion. Interestingly, during the time of this study, the seclusion rates began to decline, including for Māori patients. This decline may have been partially due to the increased awareness prompted by the study.
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Affiliation(s)
- Carly Pohatu
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Tai Kake
- Faculty of Medical and Health Sciences, School of Nursing, The University of Auckland, Auckland, New Zealand
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4
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Bergem AK, Thorvaldsen NØ, Häikiö K, Olsen-Bergem H. "Some missions can be quite emotionally painful." Paramedic´s experience exercising coercion during assignments-A qualitative study. PLoS One 2024; 19:e0290593. [PMID: 38165987 PMCID: PMC10760701 DOI: 10.1371/journal.pone.0290593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/09/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND More than 70% of respondents in a previous survey among paramedics reported use of coercion or physical force towards patients. Coercion outside hospital is not permitted, and neither routines nor equipment intended for physical restraint is available in the Norwegian ambulance services. Paramedics carry out assignments involving use of force and coercion on unclear legal grounds, with no training in techniques or proper equipment. Attitudes and experiences of healthcare workers regarding incidents involving coercion in mental health care services are frequently reported in the research literature, yet little is known about paramedics' experiences, and which factors contribute to their moral stress. METHODS In the period June-August 2021, almost 400 employees in the ambulance services in a county in the eastern part of Norway were invited to answer a digital questionnaire. One question had an open text field with the question "Can you say something about how you experience transporting patients where force has to be used to secure the patient during transport?". The answers were analyzed using Graneheim and Lundman's content analysis. RESULTS We received eighty-five completed responses (response rate 21%). Force was used by 62 paramedics. Twenty-three left the text field open. The answers showed many unique responses. Content analysis resulted in two overarching themes; 1) lack of routines, equipment, and training regarding use of coercion and force in the ambulance service, and 2) paramedics were confronted with ethical dilemmas, alone and without support from legislation or management. CONCLUSIONS The paramedics experienced discomfort related to the exercise of force and coercion during ambulance assignments due to the experience of unclear legislation, lack of training, routines, and equipment in addition to frequent ethical dilemmas and the concern about lack of support from the employer. A clearer legal basis, adapted equipment in the ambulance and regular training, will contribute to greater security in the performance of the work, which will provide safer and more caring treatment for the patients and less moral stress for the staff. With established routines, the employer will be implicitly obliged, and paramedics will be safer in the performance of their work. Ethical reflection must be offered and put into a system.
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Affiliation(s)
- Anne Kristine Bergem
- Dept of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Nina Øye Thorvaldsen
- Dept of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kristin Häikiö
- Dept of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Heming Olsen-Bergem
- Dept of Oral Surgery and Oral Medicine, Institute for Clinical Dentistry, Oslo University, Oslo, Norway
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5
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Alamri M, Almalki W, Almagthly NT, Al-Harbi KM, Almutairi MH. Assessment of Psychological Consequences of Violence in Psychiatric Nurses. Cureus 2023; 15:e48025. [PMID: 38034249 PMCID: PMC10688189 DOI: 10.7759/cureus.48025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Workplace violence, particularly within psychiatric nursing environments, is an emerging concern globally and has been recognized as a significant occupational stressor with considerable psychological consequences, yet it remains underexplored, warranting an in-depth study. AIM This study aimed to assess the psychological consequences of violence on psychiatric nurses in Jeddah, Saudi Arabia. METHOD A descriptive, cross-sectional design was used. A convenience sampling technique was used to select 198 psychiatric nurses working in two hospitals with psychiatric departments in Jeddah. A self-administered questionnaire and the Impact of Event Scale - Revised (IES-R) were used for data collection. Data were analyzed using SPSS Statistics version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.). RESULTS Out of the 198 psychiatric nurses who participated in the study, 80.8% reported experiencing violence in their workplace, highlighting the need for effective interventions to prevent and manage violence in psychiatric settings. The majority of the participants had a diploma (68.2%), and 54.5% of the nurses had more than 10 years of experience. Among patient-related factors related to violence, drug abuse had the highest mean score of 4.07 (SD=0.89) and was ranked as the most significant factor, while among nursing-related factors, a lower level of experience in psychiatric care had the lowest mean score of 3.43 (SD=1.11) and was ranked as the least important factor. The nurses tended to avoid discussing the traumatic event, as indicated by the highest mean score of 2.10 (SD=1.18) for item 22, "I tried not to talk about it." The mean score for the avoidance subscale of the IES-R was 1.55 (SD=0.78), the highest mean score among the subscales and ranked first in terms of severity. CONCLUSION This study highlighted the significant psychological consequences of violence on psychiatric nurses in Jeddah, Saudi Arabia.
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Affiliation(s)
| | | | - Naif T Almagthly
- Addiction Treatment and Mental Health, Erada and Mental Health Complex, Jeddah, SAU
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6
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Venturini P, Bassi G, Salcuni S, Kotzalidis GD, Telesforo CL, Salustri E, Trevisi M, Roselli V, Tarsitani L, Infante V, Niolu C, Polselli G, Boldrini T. Psychometric properties of the Italian version of the staff attitude to coercion scale: an exploratory factor analysis. Front Psychiatry 2023; 14:1172803. [PMID: 37293405 PMCID: PMC10244557 DOI: 10.3389/fpsyt.2023.1172803] [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: 02/23/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Aims The current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff's attitudes to the use of coercion in treatment. Methods The original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria). Results Results confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 "Coercion as offending" (items: 3, 13, 14, and 15), Factor 2 "Coercion as care and security" (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 "Coercion as treatment" (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach's α and yielded acceptable indexes, ranging from 0.64 to 0.77. Conclusion The present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals' attitudes toward coercion.
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Affiliation(s)
| | - Giulia Bassi
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Georgios D. Kotzalidis
- Department of NESMOS, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy
| | | | | | | | - Valentina Roselli
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Vittorio Infante
- U.O.C. Psichiatria e Psicologia Clinica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- U.O.C. Psichiatria e Psicologia Clinica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | | | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
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7
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Galbert I, Azab AN, Kaplan Z, Nusbaum L. Staff attitudes and perceptions towards the use of coercive measures in psychiatric patients. Int J Ment Health Nurs 2023; 32:106-116. [PMID: 36070221 DOI: 10.1111/inm.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 01/14/2023]
Abstract
The failure of efforts to significantly reduce the use of physical coercive measures (PCMs) in psychiatric hospitals remains a global concern. There is a gap in the understanding of staff's characteristics that may affect their attitudes and perceptions towards PCMs. This study used a cross-sectional design to examine the attitudes and perceptions of staff working at a mental health centre in Israel regarding the use of PCMs and to explore whether staff attitudes differed depending on their professional and demographic background. This study also sought to explore staff willingness to accept a policy of reducing the use of PCMs. The data were collected from 149 staff members (nurses, physicians, and auxiliary staff) working at mental health centre, using a questionnaire developed for this study. The findings indicate a low degree of support for use of PCMs among participants who were older, female, more qualified psychiatric nurses, with longer duration of employment, and those who have not participated in coercive intervention in the past year. The majority of the sample reported a low willingness to reduce the use of PCMs, and a lack of institutional support after participating in a coercive event. High hospital occupancy and insufficient staffing were perceived as contributing factors to coercive incidents. Therefore, availability of trained and experienced staff, elimination of organizational barriers, along with creating and maintaining a safe clinical environment should be a priority. Alternative non-coercive interventions should further be taught and used for managing aggressive and violent behaviour in the psychiatric clinical settings.
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Affiliation(s)
- Ilya Galbert
- Department of Nursing, Recanati School of Community Health Professions, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Abed N Azab
- Department of Nursing, Recanati School of Community Health Professions, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel.,Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Zeev Kaplan
- Beer-Sheva Mental Health Center, Beer-Sheva, Israel.,Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Lika Nusbaum
- Department of Nursing, Recanati School of Community Health Professions, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
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8
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Tolosa-Merlos D, Moreno-Poyato AR, González-Palau F, Pérez-Toribio A, Casanova-Garrigós G, Delgado-Hito P. Exploring the therapeutic relationship through the reflective practice of nurses in acute mental health units: A qualitative study. J Clin Nurs 2023; 32:253-263. [PMID: 35075705 PMCID: PMC10078778 DOI: 10.1111/jocn.16223] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/20/2021] [Accepted: 01/07/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To explore the therapeutic relationship through the reflective practice of nurses in acute mental health units. BACKGROUND In mental health units, the therapeutic relationship is especially relevant for increasing the effectiveness of nursing interventions. Reflective practice is considered an essential aspect for improving nursing care. DESIGN Action and observation stages of a participatory action research project. METHODS Data were collected through reflective diaries designed for the guided description and reflection of practice interactions related to the therapeutic relationship and content analysis was applied. A total of 152 nurses from 18 acute mental health units participated. The COREQ guidelines were used. RESULTS The results were classified into three categories as follows: (i) Nursing attitude as a core of the therapeutic relationship. For the nurses, the attitudinal component was key in the therapeutic relationship. (ii) Nursing practices that are essential to the therapeutic relationship. Nurses identified practices such as creating a conducive environment, using an appropriate verbal approach, offering help and working together with the patient as essential for establishing a therapeutic relationship in practice. (iii) Contextual factors affecting the therapeutic relationship. The nurses considered the patient's condition, the care dynamics of the unit and its regulations, as well as the structure and environment of the unit, as contextual factors involved the establishment of an adequate therapeutic relationship in daily clinical practice. CONCLUSIONS This study has provided knowledge of the importance and role of the nurses' attitude in the context of the nurse-patient therapeutic relationship based on the reflections of nurses in mental health units regarding their own practice. RELEVANCE TO CLINICAL PRACTICE These findings help nurses to increase awareness and develop improvement strategies based on their own knowledge and day-to-day difficulties. Moreover, managers can evaluate strategies that promote motivation and facilitate the involvement of nurses to improve the therapeutic relationship with patients.
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Affiliation(s)
- Diana Tolosa-Merlos
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, 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, Spain.,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Alonso Pérez-Toribio
- Unitat de Salut Mental de l'Hospitalet, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Spain
| | | | - Pilar Delgado-Hito
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.,GRIN-IDIBELL (Nursing Research Group- Bellvitge Biomedical Research Institute), L'Hospitalet de Llobregat, Spain
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9
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Seyer-Forget C, Holmes D, Jacob JD, Bernheim E, Paradis-Gagné É. Intervenir contre le gré du patient : médication pro re nata et vécu phénoménologique du personnel infirmier exerçant en milieu psycholégal. Rech Soins Infirm 2022. [DOI: 10.3917/rsi.150.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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10
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Doedens P, Vermeulen J, Ter Riet G, Boyette LL, Latour C, de Haan L. Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards. Perspect Psychiatr Care 2022; 58:2592-2600. [PMID: 35505593 PMCID: PMC9790403 DOI: 10.1111/ppc.13099] [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: 01/25/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Estimate the effect of nursing, shift, and patient characteristics on patients' aggression. DESIGN AND METHODS Follow-up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression. FINDINGS The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive. PRACTICE IMPLICATIONS These findings could stimulate support for nurses to prevent aggression.
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Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands.,Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Corine Latour
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands.,Arkin, Amsterdam, The Netherlands
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11
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Efkemann SA, Scholten M, Bottlender R, Juckel G, Gather J. Influence of mental health professionals' attitudes and personality traits on decision-making around coercion: Results from an experimental quantitative survey using case vignettes. Acta Psychiatr Scand 2022; 146:151-164. [PMID: 35322402 DOI: 10.1111/acps.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Research on coercion in mental healthcare has recently shifted to the investigation of subjective aspects, both on the side of the people with mental disorders affected and the staff members involved. In this context, the role of personality traits and attitudes of staff members in decision-making around coercion is increasingly being assessed. This study aimed to examine the role of staff attitudes towards coercion and staff members' personality traits in decision-making around coercion in an experimental setting. METHODS We assessed the attitudes towards coercion and (general) personality traits of mental health professionals in psychiatric hospitals with a quantitative survey. Furthermore, we developed case vignettes representing cases in a 'grey zone' and included them in the survey to assess staff members' decisions about coercion in specific situations. RESULTS A general approving attitude towards coercion significantly influenced decisions around coercion in individual cases-resulting in a more likely approval of applying coercion in the cases described in the vignettes. Personality traits did not seem to be relevant in this regard. CONCLUSION Strategies to reduce coercion in mental healthcare institutions should focus more on the role of staff attitudes and encourage staff members to reflect on them critically.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University, Bochum, Germany
| | | | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University, Bochum, Germany
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12
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Manzano-Bort Y, Mir-Abellán R, Via-Clavero G, Llopis-Cañameras J, Escuté-Amat M, Falcó-Pegueroles A. Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study. J Clin Nurs 2022; 31:2142-2153. [PMID: 34459048 DOI: 10.1111/jocn.16027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints. BACKGROUND Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship. DESIGN A qualitative study design with a hermeneutical approach was developed. METHODS A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research. RESULTS Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint. CONCLUSIONS Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints. RELEVANCE FOR CLINICAL PRACTICE Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.
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Affiliation(s)
- Yasmina Manzano-Bort
- Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ramón Mir-Abellán
- Patient Safety Department, Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Gemma Via-Clavero
- Hospital Universitari de Bellvitge, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Nursing Research Group (GRIN-IDIBELL), Barcelona, Spain
| | - Jaime Llopis-Cañameras
- Department of Social and Cultural Anthropology, Autonomous University of Barcelona, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Montserrat Escuté-Amat
- Nursing Management Department, Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- School of Nursing Faculty of Medicine and Healthf Sciences, Consolidated Research Group SGR 269 Quantitative Psychology, University of Barcelona (Spain, Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
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13
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Attitudes of Nursing Staff in Hospitals towards Restraint Use: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127144. [PMID: 35742411 PMCID: PMC9222665 DOI: 10.3390/ijerph19127144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 02/03/2023]
Abstract
The attitude of nursing staff towards restraint use can be decisive for whether restraints are used. So far, nursing staff’s attitudes have been studied primarily in long-term and mental health care settings, while findings from somatic acute care hospital settings are largely lacking. Therefore, we aimed to investigate (a) the attitudes of hospital nursing staff towards restraint use, and (b) the construct validity and reliability of a measurement instrument for use in hospital settings that was developed and validated in long-term care settings (Maastricht Attitude Questionnaire (MAQ)). Using a cross-sectional design, the attitudes of 180 nursing staff towards restraint use were assessed. The data were analysed descriptively and by means of regression analysis and factor analysis. We found that nursing staff in hospitals have a neutral attitude towards restraint use and that the MAQ, with minor adaptations, can be used in hospital settings, although further testing is recommended. Neutral attitudes of nursing staff have also been observed in long-term and mental health care settings, where changing attitudes were found to be challenging. Interventions at the national level (e.g., legal regulations) and management level (e.g., providing alternatives and changing institutional culture) are suggested.
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Flammer E, Hirsch S, Thilo N, Steinert T. "Our Patients Are Different": Predictors of Seclusion and Restraint in 31 Psychiatric Hospitals. Front Psychiatry 2022; 13:791333. [PMID: 35558428 PMCID: PMC9086971 DOI: 10.3389/fpsyt.2022.791333] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/08/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Research in recent years has demonstrated that the use of coercive measures such as seclusion and restraint differs very much between hospitals within a country. In 2015, a central register for all coercive measures in the German federal state of Baden-Wuerttemberg has been established for 32 hospitals treating involuntary patients. The objective of the present study was to identify factors that determine the differences between these hospitals. METHODS Data on coercive measures and diagnoses from the central register in 2015-2017 were linked with structural data of the 32 hospitals and their supply areas. RESULTS On average, coercive measures were applied in 6.7% of cases (SD = 2.8%; Min-Max = 0.35-12.0%). The proportion of affected cases was significantly correlated with the proportion of involuntary patients (r = 0.56), the proportion of cases with affective or neurotic, stress-related and somatoform disorders (r = -0.42), number of hospital beds (r = 0.44), a sheltered home associated with the hospital (r = 0.43) and number of addiction counseling centers per 100,000 inhabitants in the service area (r = -0.39). The final regression model only included the proportion of involuntary cases as a significant predictor (standardized beta = 0.55, adjusted R 2 = 0.27). CONCLUSIONS The predominating part of the considerable variance observed between hospitals could not be explained by structural variables. The proportion of involuntary patients had a significant impact, but a considerable amount of unexplained variance due to different practices within psychiatric hospitals remains.
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Affiliation(s)
- Erich Flammer
- Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany.,Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
| | - Sophie Hirsch
- Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany.,Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
| | - Nancy Thilo
- Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany
| | - Tilman Steinert
- Clinic for Psychiatry and Psychotherapy I, Ulm University, Ulm, Germany.,Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
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15
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Lickiewicz J, Husum TL, Ruud T, Siqveland J, Musiał Z, Makara-Studzińska M. Measuring Staff Attitudes to Coercion in Poland. Front Psychiatry 2021; 12:745215. [PMID: 34867536 PMCID: PMC8635088 DOI: 10.3389/fpsyt.2021.745215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Coercion can be defined as the use of force to limit a person's choices. In Poland, coercive measures may tend to be overused. However, there is limited information regarding the attitudes of nurses toward coercion in psychiatric settings and the factors influencing any decisions to use coercion. Aims: To validate the Staff Attitudes to Coercion Scale (SACS) for a group of psychiatric nurses and psychiatrists, to compare the said with the original Norwegian SACS version, and to compare nurses' attitudes with those displayed by psychiatrists. A second aim was to understand the relationship between self-efficacy and attitudes to coercion. Method: We surveyed 351 psychiatric nurses and psychiatrists rating SACS and GSES (General Self Efficacy Scale). We validated the SACS factor structure using confirmatory principal component factor analysis, calculated the internal consistency of subscales, and analyzed the test-retest reliability and face validity of the subscales themselves. Further, we analyzed the differences in attitudes toward coercion between nurses and psychiatrists, as well as whether there was an association between GSES and the SACS subscales. We compared the means on the SACS items between three countries-Germany, Norway, and Poland. Results: The confirmatory factor analysis of the Polish version of SACS found the same factor structure with three factors as was displayed in the original Norwegian SACS, except that one item was loaded on another factor. Internal consistency was acceptable for the factors on coercion as security and the coercion as offending, and unacceptable for the factor on coercion as treatment. Test-retest reliability was excellent for all the three subscales. Face validity was high for the factor coercion as security, partly present for coercion as offending, and not present for coercion as treatment. The subscale Coercion as Treatment was rated significantly higher by nurses than by psychiatrists, but there was no difference for the two other subscales. There was no significant association between the General Self-Efficacy Scale and any of the SACS subscales. The biggest differences in attitudes toward forms of coercion was noted between Poland and Germany. Discussion: The three-factor structure of SACS was the best solution for the Polish nurses and psychiatrists. The attitudes toward coercion differed between the two groups, but a low correlation was computed for the SACS subscales and self-efficacy. There is a cultural diversity visible amongst the three countries examined. Reduction in the use of coercion is a priority worldwide. More knowledge about the process involved in using coercive measures may contribute to this. The use of coercive interventions may harm patients and threaten patients' rights. Thus, education is needed for pre-service and in-service nurses alike.
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Affiliation(s)
- Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Kraków, Poland
| | - Tonje Lossius Husum
- Centre for Medical Ethics, The University of Oslo, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Torleif Ruud
- Mental Health Service, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, The University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Mental Health Service, Akershus University Hospital, Lørenskog, Norway
| | - Zofia Musiał
- Department of Clinical Nursing, Jagiellonian University Medical College, Krakow, Poland
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16
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Lickiewicz J, Hughes PP, Makara-Studzinska M. Attitudes of psychiatric nurses towards aggression: A polish study. J Psychiatr Ment Health Nurs 2021; 28:856-866. [PMID: 33629500 DOI: 10.1111/jpm.12746] [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: 07/25/2019] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ABOUT THE SUBJECT? (SCIENTIFIC RATIONALE) Mental health care in Poland lags behind that of many other countries, and coercive measures are used on a regular basis. Scant research has been conducted in Poland regarding the treatment of psychiatric patients. The perspectives of Polish psychiatric nurses towards aggression remain unknown. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: The translated and validated Attitude Towards Aggression Scale (ATAS) in Polish will serve as an instrument that gauges Polish nurses' attitudes towards aggression. The Polish nurses have unenlightened and negative attitude towards aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is now an instrument in Polish by which we can gauge the attitudes of mental health nurses, which must precede any educational efforts. Polish nurses showed more restrictive and antiquated attitudes about patient violence than nurses in some other parts of the world. With a shift to more positive attitudes, the use of coercion could be reduced, resulting in improved patient care. INTRODUCTION In Poland, the mode and site of patient treatment have changed little in the past 75 years, despite therapeutic advances worldwide. There is limited information regarding attitudes of nurses towards aggression in psychiatric settings in Poland, nor has there been an instrument in Polish to measure it. AIM To translate and validate the Attitudes Towards Aggression Scale (ATAS) for use in Poland, and to assess the attitudes of three groups of nursing personnel towards aggression. METHOD We surveyed 980 psychiatric and general nurses as well as nursing students. We translated the ATAS into Polish, and validated it using exploratory factor analysis. RESULTS The Polish version of the ATAS showed good psychometric properties. We found that Polish nurses perceived patient aggression extremely negatively. DISCUSSION Polish nurses perceive aggression as destructive, negative and not to be tolerated, leading to use of restraints. Among the three groups, psychiatric nurses showed the most negative attitude towards aggression. Thus, education is needed for preservice and inservice nurses alike to address this issue. WHAT THIS STUDY ADDS TO EXISTING EVIDENCE We now have a validated instrument to assess nurses' attitudes about aggression. We also know that Polish nurses have exceedingly negative attitudes towards aggression. IMPLICATIONS FOR PRACTICE The Polish version of ATAS was found valid and reliable. Therefore, we can now measure the attitudes of Polish nurses towards aggression, which was not possible previously. The baseline data provide a starting point from which to determine effects of educational efforts.
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Affiliation(s)
- Jakub Lickiewicz
- Health Psychology, Jagiellonian University Medical College, Krakow, Poland
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17
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Doedens P, Ter Riet G, Vermeulen J, Boyette LL, Latour C, de Haan L. Influence of nursing staff characteristics on seclusion in acute mental health care-A prospective two-year follow-up study. Arch Psychiatr Nurs 2021; 35:491-498. [PMID: 34561064 DOI: 10.1016/j.apnu.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Seclusion still occurs on mental health wards, despite absence of therapeutic efficacy and high risks of adverse patient effects. Literature on the effect of nursing teams, and the role of psychological characteristics in particular, on frequency of seclusion is scarce. AIM To explore the influence of demographic, professional or psychological, nursing team-level, and shift characteristics on the frequency of use of seclusion. METHODS Prospective two-year follow-up study. RESULTS We found that the probability of seclusion was lower when nursing teams with at least 75% males were on duty, compared to female only teams, odds ratio (OR = 0.283; 95% CrI 0.046-0.811). We observed a trend indicating that teams scoring higher on the openness personality dimension secluded less, (OR = 0.636; 95% CrI 0.292-1.156). DISCUSSION Higher proportions of male nurses in teams on duty were associated with lower likelihood of seclusion. We found an indication that teams with a higher mean openness personality trait tended to seclude less. These findings, if causal, could serve as an incentive to reflect on staff mix if circumstances demand better prevention of seclusion.
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Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands; Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Corine Latour
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands; Arkin, Amsterdam, the Netherlands
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Laukkanen E, Kuosmanen L, Louheranta O, Ryynänen OP, Vehviläinen-Julkunen K. A Bayesian network model to identify the associations between the use of seclusion in psychiatric care and nursing managers' attitudes towards containment methods. J Psychiatr Ment Health Nurs 2021; 28:815-828. [PMID: 33547840 DOI: 10.1111/jpm.12736] [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: 06/23/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Seclusion is used frequently in psychiatric care, despite its potential adverse effects. Several programmes aiming to reduce the use of seclusion identify leadership and management as key strategies-however, studies concerning leaders and managers are missing. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Nursing managers' negative attitudes towards seclusion are associated with less use of the measure, and nursing managers' higher age is associated with increased use of seclusion. WHAT ARE THE IMPLICATIONS FOR PRACTICE Nursing managers should be encouraged to guide their staff to reduce the use of seclusion. The negative influences of seclusion and the potential of alternative measures should be highlighted in the education and training of psychiatric nursing managers. ABSTRACT Introduction The use of seclusion in psychiatric care should be reduced. The relationship between nursing management or nursing managers' attitudes and the use of seclusion has not been investigated. Aim To describe the associations between the use of seclusion and psychiatric nursing managers' attitudes to containment methods. Method Register data concerning the use of seclusion in Finnish psychiatric care in 2017 were collected. The Attitudes to Containment Measures Questionnaire was used to illustrate psychiatric nursing managers' attitudes to containment methods. An Augmented Naive Bayes analysis was used to investigate the relationships of the use of seclusion and attitudes. Results Nursing managers' age and their attitudes towards containment methods were related to the use of seclusion. Especially nursing managers' negative perceptions of seclusion were associated with less use of seclusion, and seclusion was used more often on wards with nursing managers who were older than the average. Conclusion Nursing managers' negative attitudes towards seclusion have a potential impact on the use of seclusion, which might even result in a reduction in its use in psychiatric inpatient setting. Implications for practice The results suggest that nursing managers should be encouraged to guide their staff to decrease the use of seclusion.
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Affiliation(s)
- Emilia Laukkanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Finnish Medicines Agency Fimea, Kuopio, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Olavi Louheranta
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Ryynänen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,General Practice Unit, Kuopio University Hospital, Primary Health Care, Kuopio, Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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19
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Missouridou E, Zartaloudi A, Dafogianni C, Koutelekos J, Dousis E, Vlachou E, Evagelou E. Locked versus open ward environments and restrictive measures in acute psychiatry in Greece: Nursing students' attitudes and experiences. Perspect Psychiatr Care 2021; 57:1365-1375. [PMID: 33258139 DOI: 10.1111/ppc.12699] [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: 07/09/2020] [Revised: 11/09/2020] [Accepted: 11/14/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To examine student nurses' attitudes and experiences of door policies and restrictive measures in acute psychiatric care. METHODS A mixed-method study with 274 third-year students. RESULTS Participants' attitudes towards door locking and other containment measures appeared to be more a matter of custom, practice and tradition at particular units. The therapeutic benefits of open doors was the central organizing element in open units experiences while locked doors appeared to be "invisible" when the locked unit was perceived as a caring environment. PRACTICAL IMPLICATIONS Exploring student nurses' attitudes towards crucial and debatable aspects of mental health practice contributes in cultivating a critical and analytical attitude towards the service they provide necessary for supporting a recovery mental health model and building a strong professional identity.
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Affiliation(s)
- Evdokia Missouridou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Afroditi Zartaloudi
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Chrisoula Dafogianni
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - John Koutelekos
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Evangelos Dousis
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Eugenia Vlachou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
| | - Eleni Evagelou
- Department of Nursing, Faculty of Health and Caring Professions, University of West Attica, Athens, Greece
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20
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Lee TK, Välimäki M, Lantta T. The Knowledge, Practice and Attitudes of Nurses Regarding Physical Restraint: Survey Results from Psychiatric Inpatient Settings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136747. [PMID: 34201597 PMCID: PMC8269370 DOI: 10.3390/ijerph18136747] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 01/24/2023]
Abstract
There is a considerable amount of literature describing how nurses’ knowledge contributes to their attitudes and practices related to patient physical restraint. However, whether or not there have been any improvements in nurses’ knowledge levels, attitudes or practices regarding physical restraint during the past few years is unknown. A survey was conducted on nurses (n = 133) in one psychiatric hospital in Hong Kong (n = 98, response rate = 74%). The data were analyzed using independent t-tests, ANOVA, a Mann–Whitney U test, a Kruskal–Wallis test and Spearman’s rho. In general, nurses had good restraint-related knowledge with satisfactory attitudes and practices, although their knowledge levels, attitudes, and practices regarding restraint varied. Having a higher age, seniority, and education level contributed to a higher restraint-related knowledge level. Male nurses demonstrated more desirable practices (i.e., care of restrained patients), while nurses with a higher education level were more likely to avoid restraint. Nurses’ restraint-related knowledge positively correlated with restraint practices. Although nurses’ knowledge levels, attitudes, and practices regarding restraint were found to be satisfactory, more training efforts should focus on young nurses working in psychiatric settings with less work experience and lower education levels. As some nurses seem to favor the use of restraint with limited reflection, more studies are needed to verify nurses’ emotions and how their emotions influence the use of restrictive practices.
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Affiliation(s)
- Tsz-Kai Lee
- Department of Psychiatry, Tai Po Hospital, Tai Po, New Territories, Hong Kong, China;
- School of Nursing, the Hong Kong Polytechnic University, Kowloon, Hung Hom, Hong Kong, China
| | - Maritta Välimäki
- Xiangya Nursing School, Central South University, Changsha 410013, China
- Department of Nursing Science, University of Turku, 20014 Turku, Finland;
- Correspondence:
| | - Tella Lantta
- Department of Nursing Science, University of Turku, 20014 Turku, Finland;
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21
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Vandamme A, Wullschleger A, Garbe A, Cole C, Heinz A, Bermpohl F, Mielau J, Mahler L, Montag C. The Role of Implicit and Explicit Staff Attitudes in the Use of Coercive Measures in Psychiatry. Front Psychiatry 2021; 12:699446. [PMID: 34220595 PMCID: PMC8249742 DOI: 10.3389/fpsyt.2021.699446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Many determinants leading to the use of different coercive measures in psychiatry have been widely studied and it seems that staff attitudes play a crucial role when it comes to the decision-making process about using coercion. However, research results about staff attitudes and their role in the use of coercive measures are inconsistent. This might be due to a focus on self-report studies asking for explicit answers, which involves the risk of bias. This study aimed to expand research on this topic by examining the impact of explicit and implicit staff attitudes on the use of coercive measures in clinical practice. In addition, the influence of gender, profession (nurses, psychiatrists), and years of professional experience as well as their influence on staff attitudes were examined. An adaption of the implicit association measure, the Go/No-Go Association Task (GNAT), with the target category coercion and distracter stimuli describing work load, as well as the explicit questionnaire Staff Attitudes to Coercion Scale (SACS) was completed by staff (N = 149) on 13 acute psychiatric units in 6 hospitals. Data on coercive measures as well as the total number of treated cases for each unit was collected. Results showed that there was no association between staff's implicit and explicit attitudes toward coercion, and neither measure was correlated with the local frequency of coercive measures. ANOVAs showed a significant difference of the GNAT result for the factor gender (F = 9.32, p = 0.003), demonstrating a higher tendency to justify coercion among female staff members (M = -0.23, SD = ±0.35) compared to their male colleagues (M = -0.41, SD = ±0.31). For the SACS, a significant difference was found for the factor profession (F = 7.58, p = 0.007), with nurses (M = 2.79, SD = ±1.40) showing a more positive attitude to the use of coercion than psychiatrists (M = 2.15, SD = ±1.11). No significant associations were found regarding the extent of professional experience. Results indicate a complex interaction between implicit and explicit decision-making processes dependent on specific contexts. We propose future research to include primers for more context-related outcomes. Furthermore, differences in gender suggest a need to direct attention toward occupational safety and possible feelings of anxiety in the workplace, especially for female staff members.
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Affiliation(s)
- Angelika Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Amelie Garbe
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Celline Cole
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lieselotte Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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22
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Ercis M, Seçkin M, Ayık B, Üçok A. Correlates of Patient Satisfaction in Psychiatric Inpatient Care: A Survey Study from a Tertiary Hospital in Turkey. J Psychosoc Nurs Ment Health Serv 2020; 59:38-47. [PMID: 33301044 DOI: 10.3928/02793695-20201203-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the current study, a questionnaire to evaluate satisfaction levels and related factors upon discharge was completed by 100 patients receiving care for mental illness in a tertiary care hospital in Turkey. The relationships among sociodemographic variables, nonpharmacological interventions, and participants' views about the treatment course and quality of care they received were investigated. Overall satisfaction levels of participants were good. Older participants reported more positive opinions. Involuntary hospitalization, use of restraints/seclusion, or electroconvulsive therapy did not change overall satisfaction. Participants who were hospitalized for the first time were more afraid of other patients, which may imply that this population needs special care from the treatment team. Spending an adequate amount of time and providing necessary information about their treatment plan impact patients' treatment experience positively. [Journal of Psychosocial Nursing and Mental Health Services, 59(4), 38-47.].
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23
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Doedens P, Vermeulen J, Boyette LL, Latour C, de Haan L. Influence of nursing staff attitudes and characteristics on the use of coercive measures in acute mental health services-A systematic review. J Psychiatr Ment Health Nurs 2020; 27:446-459. [PMID: 31876970 PMCID: PMC7508163 DOI: 10.1111/jpm.12586] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Aggressive behaviour is a major problem in clinical practice of mental health care and can result in the use of coercive measures. Coercive measures are dangerous for psychiatric patients and international mental healthcare works on the elimination of these interventions. There is no previous review that summarizes the attitude of nursing staff towards coercive measures and the influence of nursing staff characteristics on attitude towards and the use of coercive measures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The attitude of nurses shifted from a therapeutic paradigm (coercive measures have positive effects on patients) to a safety paradigm (coercive measures are undesirable, but necessary for the wards' safety). Nurses express the need for less coercive interventions to prevent seclusion and restraint, but their perception of intrusiveness is influenced by how often they use specific coercive measures. The knowledge from scientific literature on the influence of nursing staff on coercive measures is highly inconclusive, although the feeling of safety of nurses might prove to be promising for further research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is need for increased attention specifically for the feeling of safety of nurses, to better equip nurses for their difficult work on acute mental health wards. ABSTRACT: Introduction The use of coercive measures generally has negative effects on patients. To help prevent its use, professionals need insight into what nurses believe about coercion and which staff determinants may influence its application. There is need for an integrated review on both attitude and influence of nurses on the use of coercion. Aim To summarize literature concerning attitude of nurses towards coercive measures and the influence of staff characteristics on the use of coercive measures. Method Systematic review. Results The attitude of nurses changed during the last two decades from a therapeutic to a safety paradigm. Nurses currently view coercive measures as undesirable, but necessary to deal with aggression. Nurses express the need for less intrusive interventions, although familiarity probably influences its perceived intrusiveness. Literature on the relation between staff characteristics and coercive measures is inconclusive. Discussion Nurses perceive coercive measures as unwanted but still necessary to maintain safety on psychiatric wards. Focussing on the determinants of perception of safety might be a promising direction for future research. Implications for practice Mental health care could improve the focus on the constructs of perceived safety and familiarity with alternative interventions to protect patients from unnecessary use of coercive interventions.
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Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Corine Latour
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Netherlands
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Hottinen A, Rytilä-Manninen M, Laurén J, Autio S, Laiho T, Lindberg N. Impact of the implementation of the safewards model on the social climate on adolescent psychiatric wards. Int J Ment Health Nurs 2020; 29:399-405. [PMID: 31808286 DOI: 10.1111/inm.12674] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2019] [Indexed: 01/10/2023]
Abstract
The Safewards model was created to reduce conflict and containment in psychiatric inpatient units. The model suggests alternative methods for containment and aims to create a safer hospital experience for both patients and staff. The evaluation of this model has provided evidence that it might be implemented on adolescent psychiatric wards. This study evaluated the impact of the implementation process of the Safewards model on the social climate of adolescent psychiatric inpatient wards by using the Essen Climate Evaluation Schema questionnaire. The study was carried out on six closed wards of one Finnish hospital district. Data were collected at baseline (42 adolescent inpatients and 134 staff members) and after the implementation of the model (39 inpatients and 115 staff members). The data were analysed using the Mann-Whitney U-test. The findings of this preliminary study indicate that inpatients' experience of patient cohesion and therapeutic hold and staff members' experience of safety on adolescent psychiatric wards might be improved by the implementation of the Safewards model on adolescent psychiatric wards.
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Affiliation(s)
- Anja Hottinen
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Minna Rytilä-Manninen
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Jenny Laurén
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Silva Autio
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Tero Laiho
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, HUS, Helsinki, Finland
| | - Nina Lindberg
- Department of Psychiatry, Helsinki University and Helsinki University Hospital, HUS, Helsinki, Finland
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Laukkanen E, Kuosmanen L, Louheranta O, Vehviläinen-Julkunen K. Psychiatric nursing managers' attitudes towards containment methods in psychiatric inpatient care. J Nurs Manag 2020; 28:699-709. [PMID: 32106346 DOI: 10.1111/jonm.12986] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/28/2022]
Abstract
AIMS This research was conducted to examine psychiatric nursing managers' attitudes towards containment methods. BACKGROUND Nursing management is regarded as a key issue in the reduction of coercion and containment. However, there has been little research on managers' attitudes towards containment methods. METHODS This descriptive, cross-sectional study utilized a survey design. Finnish inpatient psychiatric nursing managers (n = 90) completed the Attitudes to Containment Measures Questionnaire (ACMQ). The results were described with statistics, and the associations between attitudes and background variables were analysed using parametric tests. RESULTS Psychiatric nursing managers had the most negative attitude towards net bed and mechanical restraint, and the most positive attitudes towards as necessary medication and intermittent observation. A few associations were discovered between attitudes and background variables such as gender and number of employees. CONCLUSIONS In general, Finnish psychiatric nursing managers' attitudes towards containment methods seem to be quite negative, but more research is needed. IMPLICATIONS FOR NURSING MANAGEMENT This study provides fresh and unique data on the attitudes of psychiatric nursing managers towards containment methods. Managers' attitudes are important because of their ability to encourage investment in coercion reduction by nursing staff.
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Affiliation(s)
- Emilia Laukkanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Olavi Louheranta
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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26
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Efkemann SA, Scholten M, Bottlender R, Juckel G, Gather J. A German Version of the Staff Attitude to Coercion Scale. Development and Empirical Validation. Front Psychiatry 2020; 11:573240. [PMID: 33536947 PMCID: PMC7847975 DOI: 10.3389/fpsyt.2020.573240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Individual staff factors, such as personality traits and attitudes, are increasingly seen as an important factor in the reduction of coercion in mental health services. At the same time, only a few validated instruments exist to measure those factors and examine their influence on the use of coercion. Aim: The present study aimed to develop and validate a German version of the Staff Attitude to Coercion Scale (SACS). Methods: The original English version of the SACS published was translated into German. Subsequently, it was empirically validated on a sample of N = 209 mental health professionals by conducting an exploratory factor analysis. Results: The three-factor structure in the original version of the SACS, consisting of critical, pragmatic and positive attitudes toward the use of coercion, could not be replicated. Instead, the German version revealed one factor ranging from rejecting to approving the use of coercion. Conclusion: The SACS is one of the first instruments created to assess staff attitudes toward coercion in a validated way. The version of the instrument developed in this study allows for a validated assessment of those attitudes in German. Our results highlight the ethical importance of using validated measurements in studies on the role of staff factors in the reduction of coercion.
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Affiliation(s)
- Simone A Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Ronald Bottlender
- Klinik für Psychiatrie und Psychotherapie, Klinikum Lüdenscheid, Märkische Klinken, Lüdenscheid, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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Mötteli S, Hotzy F, Lamster F, Horisberger R, Theodoridou A, Vetter S, Seifritz E, Jäger M. Optimistic recovery expectations are associated with critical attitudes toward coercion among mental health professionals. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2019. [DOI: 10.1080/00207411.2019.1699338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sonja Mötteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Fabian Lamster
- Sanatorium Kilchberg, Private Clinic for Psychiatry and Psychotherapy, Kilchberg, Zurich, Switzerland
| | - Rahel Horisberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jäger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Psychiatrie Baselland, Liestal, Switzerland
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Chieze M, Hurst S, Kaiser S, Sentissi O. Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Front Psychiatry 2019; 10:491. [PMID: 31404294 PMCID: PMC6673758 DOI: 10.3389/fpsyt.2019.00491] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/21/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Determining the clinical effects of coercion is a difficult challenge, raising ethical, legal, and methodological questions. Despite limited scientific evidence on effectiveness, coercive measures are frequently used, especially in psychiatry. This systematic review aims to search for effects of seclusion and restraint on psychiatric inpatients with wider inclusion of outcomes and study designs than former reviews. Methods: A systematic search was conducted following PRISMA guidelines, primarily through Pubmed, Embase, and CENTRAL. Interventional and prospective observational studies on effects of seclusion and restraint on psychiatric inpatients were included. Main search keywords were restraint, seclusion, psychiatry, effect, harm, efficiency, efficacy, effectiveness, and quality of life. Results: Thirty-five articles were included, out of 6,854 records. Studies on the effects of seclusion and restraint in adult psychiatry comprise a wide range of outcomes and designs. The identified literature provides some evidence that seclusion and restraint have deleterious physical or psychological consequences. Estimation of post-traumatic stress disorder incidence after intervention varies from 25% to 47% and, thus, is not negligible, especially for patients with past traumatic experiences. Subjective perception has high interindividual variability, mostly associated with negative emotions. Effectiveness and adverse effects of seclusion and restraint seem to be similar. Compared to other coercive measures (notably forced medication), seclusion seems to be better accepted, while restraint seems to be less tolerated, possibly because of the perception of seclusion as "non-invasive." Therapeutic interaction appears to have a positive influence on coercion perception. Conclusion: Heterogeneity of the included studies limited drawing clear conclusions, but the main results identified show negative effects of seclusion and restraint. These interventions should be used with caution and as a last resort. Patients' preferences should be taken into account when deciding to apply these measures. The therapeutic relationship could be a focus for improvement of effects and subjective perception of coercion. In terms of methodology, studying coercive measures remains difficult but, in the context of current research on coercion reduction, is needed to provide workable baseline data and potential targets for interventions. Well-conducted prospective cohort studies could be more feasible than randomized controlled trials for interventional studies.
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Affiliation(s)
- Marie Chieze
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Othman Sentissi
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
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