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Molloy L, Chidarikire S, Pullman J, Havilla S, Patton D, Beckett P. The Impact of Sensory Modulation Interventions on Practice in Acute Inpatient Mental Health Settings: A Meta-Ethnography. Issues Ment Health Nurs 2024; 45:580-588. [PMID: 38810221 DOI: 10.1080/01612840.2024.2341034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
This review explores the transformative impact of sensory modulation interventions in acute inpatient mental health care setting utilising meta-ethnography. The methodology by Noblit & Hare guided the approach to creating the review. Searches of articles published within the previous 10 years were conducted in Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, and PsycINFO. Searches aimed to identify rich qualitative data on the area of sensory modulation interventions and acute inpatient mental health care. Seven articles were selected for inclusion and a reciprocal translation synthesis was undertaken. Sensory modulation interventions emerged as a key alternative to traditional inpatient practices, including seclusion and restraint and the use of PRN psychotropic medication. It introduces a new dimension within care strategies that emphasise individual preferences and care plans that empower individuals. Sensory modulation interventions serve as an effective means to de-escalation that promotes shared responsibility between staff and individuals in care. The review highlights this practice as a departure from coercive practices and biomedical interventions, promoting meaningful therapeutic engagement. Our findings show that sensory modulation interventions have the potential to create a culture shift in acute inpatient mental health settings towards person-centred, recovery-orientated, trauma-informed clinical practice.
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Affiliation(s)
- Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - John Pullman
- Social work, Australian College of Applied Professions, Sydney, Australia
| | - Sizwile Havilla
- Illawarra Shoalhaven Local Health District Mental Health service, Shellharbour, Australia
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Beckett
- School of Nursing and Midwifery, University of Sydney, Sydney, Australia
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2
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Ilioudi M, Wallström S, Steingrimsson S, Lindner P, Thunström AO, Ali L. Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients. BMJ Open 2023; 13:e076285. [PMID: 38101823 PMCID: PMC10729110 DOI: 10.1136/bmjopen-2023-076285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Calm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have enabled virtual reality (VR) equivalents of calm rooms that can be feasibly deployed in psychiatric care settings. While research has shown VR environments to be efficacious in inducing relaxation, little is known how these virtual calm rooms are perceived by patients. The aim of this study was to elucidate patient experiences of using a VR calm room in a psychiatric inpatient setting. DESIGN Qualitative interview study. Semi-structured interviews were analysed using qualitive inductive content analysis, which focuses on the interpretation of texts for making replicable and valid inferences. SETTING Swedish hospital psychiatric inpatient care setting with a wireless, three degrees-of-freedom VR head-mounted display running a calm room application simulating nature environment. PARTICIPANTS 20 adult patients (12 women) with bipolar disorder (n=18) or unipolar depression (n=2). RESULTS Participants experienced the use of the VR calm room as having a positive impact on them, inducing awareness, calmness and well-being. They were thankful to be offered a non-pharmacological alternative for anxiety relief. Participants also expressed that they had some concerns about how they would react emotionally before using the VR device. However, after use, they highlighted that their overall experience was positive. They also expressed that they could see potential for further development of VR technology in psychiatric care. CONCLUSIONS VR technology has the potential to solve pressing logistic issues in offering calm rooms in psychiatric inpatient care. VR calm rooms appear to be appreciated by psychiatric inpatients, who value their accessibility, convenience and variety of modalities offered. Participants perceived an increase in their well-being after use.
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Affiliation(s)
- Maria Ilioudi
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
| | - Sara Wallström
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Forensic Psychiatry, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Almira Osmanovic Thunström
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Lilas Ali
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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3
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Salzmann-Erikson M. An Integrative Review on Psychiatric Intensive Care. Issues Ment Health Nurs 2023; 44:1035-1049. [PMID: 37874667 DOI: 10.1080/01612840.2023.2260478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Psychiatric intensive care units (PICUs) provide care and treatment when psychiatric symptoms and behaviors exceed general inpatient resources. This integrative review aimed to synthesize PICU research published over the past 5 years. A comprehensive search in MEDLINE, PsycINFO, PubMed and Scopus identified 47 recent articles on PICU care delivery, populations, environments, and models. Research continues describing patient demographics, and high rates of challenging behaviors, self-harm, and aggression continue being reported. Research on relatives was minimal. Patients describe restrictive practices incongruent with recovery philosophies, including controlling approaches and sensory deprivation. Some initiatives promote greater patient autonomy and responsibility in shaping recovery, yet full emancipatory integration remains limited within PICU environments. Multidisciplinary collaboration is needed to holistically advance patient-centered, equitable, and integrative PICU care. This review reveals the complex tensions between clinical risk management and emancipatory values in contemporary PICU settings. Ongoing reporting of controlling practices counters the recovery movement progressing in wider mental healthcare contexts. However, care innovations centered on patient empowerment and humane environments provide hope for continued evolution toward more liberation-focused PICU approaches that uphold both patient and provider perspectives.
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Affiliation(s)
- Martin Salzmann-Erikson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Hudon A, Rosca MA, La Charité-Harbec O, Allard JM, Borduas Pagé S. The Use of Alternative Rooms in Forensic and Regular Psychiatric Units: A Scoping Review. Healthcare (Basel) 2023; 11:2432. [PMID: 37685466 PMCID: PMC10487261 DOI: 10.3390/healthcare11172432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
(1) Background: Emotional regulation, distress and relational conflicts often occur during hospitalization and rehabilitation on psychiatric units, especially in patients suffering from severe and persistent mental disorders. While widely used in children and geriatric patients, little literature exists on the use and outcomes of alternative rooms in the context of forensic and regular psychiatric units for adult patients. Considering the scarcity of the literature on alternative use, this study is motivated by the following research question: what are the main uses and outcomes of alternative rooms in the context of forensic and regular psychiatric units? The main objective of this study is to conduct a scoping review of the use and outcomes of alternative rooms for the context of psychiatric inpatients. (2) Methods: A systematic search was performed in the electronic databases of MedLine, Web of Science, PsycNet (PsycINFO) and Google Scholar from their inception dates until 2022. (3) Results: A total of nine studies were analyzed. Sensory, multisensory rooms, Snoezelen, and comfort rooms are the types of alternative rooms discussed in these studies. Distress and anxiety reduction, increase in self-esteem, impact on seclusion rates, patient-staff communication and alliances, heart and respiration rate reduction, and improvement of alexithymia were identified among the main uses and outcomes of these rooms. (4) Conclusions: The scarcity of literature available to draw information from for this review and possible impact on improving patient outcomes and quality of treatment in psychiatric units opens the door to future studies to better understand the efficacy of such rooms. Research into the ideal implementation tactics of such rooms, long-term outcomes, and the influence on diverse patient demographics could be areas of improvement in the use of alternative rooms.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3V2, Canada
| | - Maria Alexandra Rosca
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
| | - Olivier La Charité-Harbec
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
| | - Jeanne-Marie Allard
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
| | - Stéphanie Borduas Pagé
- Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3M5, Canada; (O.L.C.-H.); (J.-M.A.)
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5
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Jurdana MA, Lacambre M, Fovet T. [Soothing spaces and techniques in psychiatry]. REVUE DE L'INFIRMIERE 2023; 72:29-31. [PMID: 37364973 DOI: 10.1016/j.revinf.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
The development of alternatives to seclusion and restraint is a priority for psychiatric care services. Among them, the implementation of soothing spaces is currently experiencing considerable growth.
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Affiliation(s)
| | - Mathieu Lacambre
- Université de Lille, Inserm, U1172 - Lille Neuroscience & Cognition, 59000 Lille, France; Filière de psychiatrie légale, Unité de soins intensifs de psychiatrie, CHU Montpellier, 191 avenue du Doyen Giraud, 34295 Montpellier cedex 5, France
| | - Thomas Fovet
- CHU Lille, Service de Psychiatrie adulte, F-59000 Lille, France; Université de Lille, Inserm, U1172 - Lille Neuroscience & Cognition, 59000 Lille, France; Section psychiatrie légale, Association française de psychiatrie biologique et de neuropsychopharmacologie (AFPBN), BP 60222, 78102 Saint-Germain-en-Laye, France.
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6
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Haig S, Hallett N. Use of sensory rooms in adult psychiatric inpatient settings: A systematic review and narrative synthesis. Int J Ment Health Nurs 2023; 32:54-75. [PMID: 36082841 DOI: 10.1111/inm.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/14/2023]
Abstract
Reducing the use of restrictive interventions within psychiatric inpatient settings is a global priority. There are many strategies which may support the prevention of violence before escalation into more severe incidences. Sensory rooms have been identified as one such intervention, aiding patients to emotionally regulate and reduce distress, with a growing body of academic literature interested in whether sensory rooms can ultimately impact incidences of patient violence and the use of restraint, seclusion, and other restrictive practices. A systematic literature review was conducted to identify how effective sensory rooms are at reducing patient violence and restrictive interventions within adult psychiatric inpatient settings. Eighteen studies met the eligibility criteria and were included in the review. There is a lack of evidence as to whether sensory rooms are effective at reducing seclusion, restraint, or violence. They are, however, likely to support a reduction in patient distress. Patient and staff experiences suggest sensory rooms support emotional regulation, promote self-management, and positively impact the overall patient admission experience and ward environment. Further research is needed to identify what works, for who and in what circumstances in relation to the design of sensory rooms.
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Affiliation(s)
| | - Nutmeg Hallett
- School of Nursing, University of Birmingham, Birmingham, UK
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Baird A, Candy B, Flouri E, Tyler N, Hassiotis A. The Association between Physical Environment and Externalising Problems in Typically Developing and Neurodiverse Children and Young People: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2549. [PMID: 36767909 PMCID: PMC9916018 DOI: 10.3390/ijerph20032549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
The physical environment is of critical importance to child development. Understanding how exposure to physical environmental domains such as greenspace, urbanicity, air pollution or noise affects aggressive behaviours in typical and neurodiverse children is of particular importance given the significant long-term impact of those problems. In this narrative review, we investigated the evidence for domains of the physical environment that may ameliorate or contribute to the display of aggressive behaviours. We have considered a broad range of study designs that include typically developing and neurodiverse children and young people aged 0-18 years. We used the GRADE system to appraise the evidence. Searches were performed in eight databases in July 2020 and updated in June 2022. Additional articles were further identified by hand-searching reference lists of included papers. The protocol for the review was preregistered with PROSPERO. Results: We retrieved 7174 studies of which 67 are included in this review. The studies reported on green space, environmental noise and music, air pollution, meteorological effects, spatial density, urban or rural setting, and interior home elements (e.g., damp/sensory aspects/colour). They all used well validated parent and child reported measures of aggressive behaviour. Most of the studies were rated as having low or unclear risk of bias. As expected, noise, air pollution, urbanicity, spatial density, colour and humidity appeared to increase the display of aggressive behaviours. There was a dearth of studies on the role of the physical environment in neurodiverse children. The studies were heterogeneous and measured a range of aggressive behaviours from symptoms to full syndromes. Greenspace exposure was the most common domain studied but certainty of evidence for the association between environmental exposures and aggression problems in the child or young person was low across all domains. We found a large knowledge gap in the literature concerning neurodiverse children, which suggests that future studies should focus on these children, who are also more likely to experience adverse early life experiences including living in more deprived environments as well as being highly vulnerable to the onset of mental ill health. Such research should also aim to dis-aggregate the underlying aetiological mechanisms for environmental influences on aggression, the results of which may point to pathways for public health interventions and policy development to address inequities that can be relevant to ill health in neurodiverse young people.
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Affiliation(s)
- Alister Baird
- Division of Psychiatry, University College London, London W1T 7BN, UK
| | - Bridget Candy
- Division of Psychiatry, University College London, London W1T 7BN, UK
| | - Eirini Flouri
- Institute of Education, Psychology and Human Development, University College London, London WC1H 0AL, UK
| | - Nick Tyler
- Department of Civil, Environmental and Geomatic Engineering, Faculty of Engineering Science, University College London, London WC1E 6DE, UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London W1T 7BN, UK
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8
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Wright L, Meredith P, Bennett S. Sensory approaches in psychiatric units: Patterns and influences of use in one Australian health region. Aust Occup Ther J 2022; 69:559-573. [PMID: 35706333 PMCID: PMC9796746 DOI: 10.1111/1440-1630.12813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND/AIM Australian guidelines and policies recommend the use of sensory approaches in mental health care. Nevertheless, many Australian psychiatric units report difficulty sustaining these approaches. To inform efforts to close the gap between recommendations and practice, the aim of this study was to understand the patterns of use of sensory approaches and what demographic and clinical factors influence their use, across one health region in Queensland, Australia. METHODS Using a cross-sectional survey design, a custom-designed questionnaire was distributed via email and in paper form to health professionals and peer support workers working in acute, secure, and community care psychiatric units across one health region. Information on demographics and the use of various sensory interventions was gathered utilising both open-ended and Likert scale questions. RESULTS Useable questionnaires were collected from 183 participants from various disciplines (77% nursing). The majority reported using sensory approaches with a limited number of consumers, and almost 9% never used the approach. Activity-based sensory interventions and sensory equipment were most often used, whereas sensory assessments, sensory plans, and sensory groups were least used. Sensory interventions were mainly used to reduce consumer anxiety and agitation and to assist with emotional regulation. Factors positively correlated with frequency of use for all interventions were discipline (occupational therapy); working in an acute inpatient unit; and training in sensory approaches. Age was negatively correlated with frequency of use only for weighted modalities. CONCLUSIONS This study revealed that sensory approaches were used by most staff though with a limited proportion of consumers in psychiatric units in one large metropolitan health service. It provides insights into the factors influencing frequency of use, highlighting the importance of training in sensory approaches and access to occupational therapists. With this knowledge, we can work towards closing the gap between recommendations and the practice of sensory approaches.
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Affiliation(s)
- Lisa Wright
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia,The Prince Charles HospitalMetro North Mental Health Hospital and Health ServicesBrisbaneQueenslandAustralia
| | - Pamela Meredith
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia,School of Health and Behavioural SciencesUniversity of Sunshine CoastSunshine CoastQueenslandAustralia
| | - Sally Bennett
- School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneQueenslandAustralia
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9
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Dawson S, Oster C, Scanlan J, Kernot J, Ayling B, Pelichowski K, Beamish A. A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients. Int J Ment Health Nurs 2022; 31:553-566. [PMID: 34994500 DOI: 10.1111/inm.12971] [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: 09/22/2021] [Revised: 11/19/2021] [Accepted: 12/12/2021] [Indexed: 11/30/2022]
Abstract
Implementing psychosocial approaches into mental health inpatient settings continues to be challenging. This is despite mental health policies prioritizing trauma-informed and recovery-orientated care approaches. This study reports on an interdisciplinary project that implemented and examined the uptake of weighted modalities in a psychiatric inpatient rehabilitation setting. While over-reliance on pro re nata (PRN) medication in these settings has been reported, weighted modalities are a sensory approach that can be self-initiated by consumers as an alternative to use of PRN to manage distress and agitation. A mixed-methods realist approach was used to determine what works, for whom, and in what circumstances weighted modalities were offered by clinicians and used by consumers. Additionally, we were interested in determining whether there was an associated change in PRN use during the trial. Data included in-depth interviews with consumers (n = 12) and clinicians (n = 11), and extraction of PRN medication use preceding, throughout, and following implementation. Statistical analysis revealed a significant increase in PRN rates in the first 3 months of implementation (mean difference from baseline = 29.5, P = 0.047) but a significant decrease in the second three-month period following implementation (mean difference from baseline = -30.7, P = 0.036). Qualitative findings highlighted the key components of successful implementation as being environmental restructuring (availability/accessibility and visibility of weighted modalities) and social influences. Strategies to enhance these components are discussed.
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Affiliation(s)
- Suzanne Dawson
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, Australia.,Mental Health Directorate, Central Adelaide Local Health Network, Adelaide, Australia
| | - Candice Oster
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Justin Scanlan
- Faculty of Medicine and Health, University of Sydney, Adelaide, Australia
| | - Jocelyn Kernot
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Barry Ayling
- Mental Health Directorate, Central Adelaide Local Health Network, Adelaide, Australia
| | - Katarzyna Pelichowski
- Mental Health Directorate, Central Adelaide Local Health Network, Adelaide, Australia
| | - Amelia Beamish
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
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Proterra K, Ehrlich S, Romani PW. Training direct-care staff to implement sensory integration strategies on a psychiatric inpatient unit. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 35:150-156. [PMID: 34689377 DOI: 10.1111/jcap.12357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/09/2021] [Accepted: 10/17/2021] [Indexed: 11/27/2022]
Abstract
PROBLEM Despite the importance of sensory integration therapy on psychiatric inpatient units, there continues to be a paucity of trained providers that can delivery this service to patients. METHOD This study evaluated components of a training program to teach nurses and direct-care staff appropriate use of sensory integration strategies. Using the research team as confederates, we collected data on how three direct-care staff used sensory integration strategies across two conditions and with a patient admitted to the unit. Next, we implemented the didactic-only training, which provided education for when to use different aspects of the sensory room. Finally, we transitioned to a condition in which feedback supplemented the didactic training. FINDINGS Before training and following the Didactic Only Training condition, accuracy was low for all participants. All three participants' accuracy with using sensory integration strategies improved and maintained when they implemented the strategies with a patient after completing the combined intervention. We were able to use the combined intervention to improve two additional direct-care staff's accuracy. CONCLUSIONS Staff training incorporating didactic training plus feedback was most effective for training appropriate use of sensory integration strategies. We also discuss the importance of having performance-based measures to track occurrence of important skills.
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Affiliation(s)
- Katherine Proterra
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Shana Ehrlich
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Patrick W Romani
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado, USA
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11
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Oostermeijer S, Brasier C, Harvey C, Hamilton B, Roper C, Martel A, Fletcher J, Brophy L. Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review. BMJ Open 2021; 11:e046647. [PMID: 34233981 PMCID: PMC8264870 DOI: 10.1136/bmjopen-2020-046647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED Increasing efforts are being made to prevent and/or eliminate the use of seclusion and restraint in mental health facilities. Recent literature recognises the importance of the physical environment in supporting better outcomes in mental health services. This rapid review scoped the existing literature studying what physical design features of mental health facilities can reduce the use of seclusion and physical restraint. DESIGN A rapid review of peer-reviewed literature. METHODS Peer-reviewed literature was searched for studies on architectural design and the use of restraint and seclusion in mental health facilities. The following academic databases were searched: Cochrane Library, Medline, PsycINFO, Scopus and Avery for English language literature published between January 2010 and August 2019. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of included studies. RESULTS We identified 35 peer-reviewed studies. The findings revealed several overarching themes in design efforts to reduce the use of seclusion and restraint: a beneficial physical environment (eg, access to gardens or recreational facilities); sensory or comfort rooms; and private, uncrowded and calm spaces. The critical appraisal indicated that the overall quality of studies was low, as such the findings should be interpreted with caution. CONCLUSION This study found preliminary evidence that the physical environment has a role in supporting the reduction in the use of seclusion and restraint. This is likely to be achieved through a multilayered approach, founded on good design features and building towards specific design features which may reduce occurrences of seclusion and restraint. Future designs should include consumers in a codesign process to maximise the potential for change and innovation that is genuinely guided by the insights of lived experience expertise.
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Affiliation(s)
- Sanne Oostermeijer
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Brasier
- Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia
| | - Carol Harvey
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cath Roper
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Martel
- Melbourne School of Design, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Brophy
- Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia
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Hutton A, Wilson R, Foureur M. Comfort Equals Nurturing: Young People Talk About Mental Health Ward Design. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:258-269. [PMID: 34128422 DOI: 10.1177/19375867211022684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this research was to obtain user perspectives of adolescent patients to inform the redesign of an adolescent mental health inpatient facility ward unit in regional Australia. BACKGROUND It is well established that the consumer will use and understand unit space differently than the health professional, because of their unique positioning and depth of experience. The participation of young people in the design of ward environments and programs is essential. METHODS A combination of focus groups and interviews was undertaken with eight participants. RESULTS This study found that, in its current form, the unit revolves around routines, tasks, and patient safety, which in turn are driven by secure spaces and surveillance of the patients. Due to these routines and tasks, the aspects of individualized patient care and personal impetus and comfort are lost. Adolescent patients are able to identify solutions to enhance their hospital stay in the mental health context without being excessive and unrealistic in their suggestions. CONCLUSIONS When designing an adolescent unit, there needs to be some consideration as to how the group using the unit understands space. Through their role and depth of hospital experience, the adolescent patient will use and understand unit space differently from that of the health professional whose role is a worker. Therefore, it is necessary to gain the perspectives of adolescent patients for efficient and effective functioning of such an environment and to suit the needs of those it is "built for," the adolescent patient.
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Affiliation(s)
| | - Rhonda Wilson
- University of Newcastle, Callaghan, Australia.,Massey University, Palmerston North, New Zealand
| | - Maralyn Foureur
- Hunter New England Local Health, University of Newcastle, Callaghan, Australia
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13
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Ma D, Su J, Wang H, Zhao Y, Li H, Li Y, Zhang X, Qi Y, Sun J. Sensory-based approaches in psychiatric care: A systematic mixed-methods review. J Adv Nurs 2021; 77:3991-4004. [PMID: 33951221 DOI: 10.1111/jan.14884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/18/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS Sensory-based approaches, including sensory room, sensory cart and specific sensory integration programs, feature various sensory stimulations to focus on a particular space or program. This systematic mixed-methods review describes the impact of sensory-based approaches in psychiatric care and summarizes the important components of sensory interventions. DESIGN Systematic mixed-methods review was based on the guidelines by Pluye and Hong for comprehensively searching, appraising and synthesizing research evidence. DATA SOURCES Data were collected from five databases: CINAHL, Embase, Pubmed, Web of Science and Cochrane before March 9, 2020. REVIEW METHODS Qualitative, quantitative, mixed-methods and original studies published in English on sensory-based approaches in psychiatric care were included. The studies were selected by screening titles, abstracts and full texts, and the quality of each study was assessed by two researchers independently. The data were analysed using thematic analysis. RESULTS Sixteen studies were chosen for review. Through data integration, four subthemes with positive effects were formed: (1) calming of the patient's mood; (2) calming of the patient's body; (3) improvement of self-care ability; and (4) improvement of the nurse-patient relationship. The sensory-based approach may also lead to negative effects. CONCLUSIONS Several important components play important roles in the sensory-based approaches: (1) rich, culture-based, personalized sensory stimulation; (2) a quiet, safe, home-based physical environment; (3) a good one-to-one nurse-patient relationship; (4) and the cultivation of patient autonomy and self-management. Sensory-based approaches in a multicultural environment and home environment will be important topics of psychiatric care in the future. IMPACT There is a lack of synthesis of studies on results of sensory-based approaches in psychiatric care. Four components are important to sensory interventions. It is necessary for mental health service centres and home care for the patients with psychotic disorders to use sensory-based approaches for reference.
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Affiliation(s)
- Dongfei Ma
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Jianping Su
- School of Nursing, Jilin University, Jilin, People's Republic of China.,School of Nursing, Xinjiang Medical University, Urumqi, People's Republic of China
| | - Hong Wang
- The First Bethune Hospital of Jilin University, Jilin, People's Republic of China
| | - Yingnan Zhao
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Huanhuan Li
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Yijing Li
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Xu Zhang
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Yicheng Qi
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Jilin, People's Republic of China
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14
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Lakeman R, Hurley J. What mental health nurses have to say about themselves: A discourse analysis. Int J Ment Health Nurs 2021; 30:126-135. [PMID: 32808439 DOI: 10.1111/inm.12778] [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] [Received: 04/14/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 12/28/2022]
Abstract
Mental health nursing is largely invisible within public discourse. When mentioned at all in news media, it is usually a signifier of an occupation connoting where a nurse works. There is rarely a presumption of expertise in any sphere or articulation of a unique skill set or defining features which differentiate the mental health nurse from other nurses. This paper sought to examine the professional discourse around mental health nursing as inferred from a review of papers published in the International Journal of Mental Health Nursing in 2019. A discourse analysis of full-text papers (n = 117) was undertaken exploring references to mental health nurses or nursing and what this communicated about the field. The discourse clustered around three themes: The invisible or absent mental health nurse, ambiguous and blended identities, and a group of low attributed value and sophistication. There were few examples of authors presenting mental health nurses in a way which counters stereotypes of the dominant discourse about mental health nurses as a lesser skilled occupational group. Academics, editors, authors, and practitioners are urged to contribute to the construction of discourse around mental health nursing expertise which differentiates it from other branches of nursing and other distinctive disciplines.
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Affiliation(s)
- Richard Lakeman
- School of Health and Human Sciences, Bilinga, Queensland, Australia
| | - John Hurley
- School of Health and Human Sciences, Coffs Harbour, New South Wales, Australia
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15
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Gerritsen S, Widdershoven G, van der Ham L, van Melle L, Kemper M, Voskes Y. Dealing with care disruption in High and Intensive Care wards: From difficult patients to difficult situations. Int J Ment Health Nurs 2021; 30:317-325. [PMID: 32936986 PMCID: PMC7891438 DOI: 10.1111/inm.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/07/2020] [Accepted: 08/14/2020] [Indexed: 11/28/2022]
Abstract
High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long-term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi-structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards.
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Affiliation(s)
- Sylvia Gerritsen
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Guy Widdershoven
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Lia van der Ham
- Low Vision ResearchOphthalmologyAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
| | - Laura van Melle
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- Institute for Medical Ethics and History of MedicineRuhr University BochumBochumGermany
| | | | - Yolande Voskes
- Department of Medical HumanitiesAmsterdam University Medical CenterVU University Medical CenterAmsterdamThe Netherlands
- GGZ BreburgTilburgThe Netherlands
- Tranzo, Tilburg UniversityTilburgThe Netherlands
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16
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Blake H, Yildirim M, Wood B, Knowles S, Mancini H, Coyne E, Cooper J. COVID-Well: Evaluation of the Implementation of Supported Wellbeing Centres for Hospital Employees during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249401. [PMID: 33333913 PMCID: PMC7768437 DOI: 10.3390/ijerph17249401] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 01/21/2023]
Abstract
Supported Wellbeing Centres have been set up in UK hospital trusts in an effort to mitigate the psychological impact of COVID-19 on healthcare workers, although the extent to which these are utilised and the barriers and facilitators to access are not known. The aim of the study was to determine facility usage and gather insight into employee wellbeing and the views of employees towards this provision. The study included (i) 17-week service use monitoring, (ii) employee online survey with measures of wellbeing, job stressfulness, presenteeism, turnover intentions, job satisfaction, and work engagement, as well as barriers and facilitators to accessing the Wellbeing Centres. Over 17 weeks, 14,934 facility visits were recorded across two sites (peak attendance in single week n = 2605). Facilities were highly valued, but the service model was resource intensive with 134 wellbeing buddies supporting the centres in pairs. 819 hospital employees completed an online survey (88% female; 37.7% working in COVID-19 high risk areas; 52.4% frontline workers; 55.2% had accessed a wellbeing centre). There was moderate-to-high job stress (62.9%), low wellbeing (26.1%), presenteeism (68%), and intentions to leave (31.6%). Wellbeing was higher in those that accessed a wellbeing centre. Work engagement and job satisfaction were high. Healthcare organisations are urged to mobilise access to high-quality rest spaces and psychological first aid, but this should be localised and diversified. Strategies to address presenteeism and staff retention should be prioritised, and the high dedication of healthcare workers should be recognised.
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Affiliation(s)
- Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
- NIHR Nottingham Biomedical Research Centre, Nottingham NG7 2UH, UK
- Correspondence:
| | - Mehmet Yildirim
- School of Health Sciences, University of Nottingham, Nottingham NG7 2HA, UK;
| | - Ben Wood
- Human Resources, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (B.W.); (S.K.); (H.M.)
| | - Steph Knowles
- Human Resources, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (B.W.); (S.K.); (H.M.)
| | - Helen Mancini
- Human Resources, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK; (B.W.); (S.K.); (H.M.)
| | - Emma Coyne
- Clinical Psychology Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
| | - Joanne Cooper
- Nursing and Midwifery, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK;
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