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Sweeting P, Finlayson M, Hartz D. A comparison of inpatient suicides in Australian psychiatric and non-psychiatric hospital units between 2009 and 2018. Psychiatry Res 2023; 327:115363. [PMID: 37523885 DOI: 10.1016/j.psychres.2023.115363] [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: 12/20/2022] [Revised: 07/08/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
Hospitalisation is designed to protect patients from harm; however, patients have been reported to take their own lives during hospital admissions. While a significant healthcare concern, few studies have analysed inpatient suicides in general and psychiatric hospital units. Understanding these deaths is important for informing future prevention initiatives. Here we investigate a national sample (n = 367) of inpatient suicides in general (24%, n = 87) and psychiatric (76%, n = 278) hospital units. Patient characteristics, suicide location, timing, and suicide methods were assessed and compared. Patients who died from suicide were mostly male and admitted into psychiatric units. General hospital patients were less likely to have a known history of mental illness or previous self-harm and were often admitted for mental illness-related presentations. Suicides frequently occurred outside of the hospital by hanging. Patients in psychiatric units were more likely to be on approved leave at their death, and general patients were more likely to have absconded. These results indicate the need to identify risk factors relevant to each setting and address broader system-level factors. Removing obvious ligature points, preventing absconding, and assessing patients before episodes of leave, could contribute to preventing inpatient suicides.
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Affiliation(s)
- Penelope Sweeting
- College of Nursing and Midwifery, Charles Darwin University, Level 10, 815 George street, Haymarket, Sydney, NSW, Australia.
| | - Mary Finlayson
- College of Nursing and Midwifery, Charles Darwin University, Level 10, 815 George street, Haymarket, Sydney, NSW, Australia
| | - Donna Hartz
- College of Health Medicine and Wellbeing, School of Nursing and Midwifery, Newcastle University, Newcastle, NSW, Australia
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2
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Svensson J. Patient Safety Strategies in Psychiatry and How They Construct the Notion of Preventable Harm: A Scoping Review. J Patient Saf 2022; 18:245-252. [PMID: 34347739 PMCID: PMC9359776 DOI: 10.1097/pts.0000000000000885] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The literature on patient safety in psychiatry has not been explored systematically in terms of what interventions are used, how they are used, and what type of (preventable) harm is targeted. The aims of this scoping review are to explore patient safety strategies used in psychiatry and determine how they construct the notion of preventable harm. METHOD A scoping review of literature on patient safety in psychiatry published in English between 2000 and 2019 was conducted using Scopus, MEDLINE, PsycInfo, and CINAHL. Keywords of patient safety strategies and possible outcomes were coded from the results, discussion, or conclusion. Patient safety strategies were inductively categorized into themes according to the focus of the strategy. RESULTS The review introduces 7 focus areas of patient safety strategies identified within the psychiatric literature: "risk management," "healthcare practitioners," "patient observation," "patient involvement," "computerized methods," "admission and discharge," and "security." The result shows that patient safety strategies mainly aim to reduce suicide, self-harm, violence, and falls and present a large diversity of measures, often aimed at reducing variability while increasing standardization. CONCLUSIONS The strategies that are supported in the literature to achieve safer psychiatry mainly arise from linear cause-effect models and rely on staff performance, competence, and compliance. Contemporary safety science acknowledges the performance variability of everyday normal work and sees risk as the dynamic migration of these daily activities. The field of psychiatry has not yet included this view of safety in the strategic actions to reduce preventable harm.
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Affiliation(s)
- Jakob Svensson
- From the Division of Risk Management and Societal Safety, Lund University, Sweden
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3
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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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4
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Kirchebner J, Lau S, Sonnweber M. Escape and absconding among offenders with schizophrenia spectrum disorder - an explorative analysis of characteristics. BMC Psychiatry 2021; 21:122. [PMID: 33663445 PMCID: PMC7931588 DOI: 10.1186/s12888-021-03117-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Escape and absconding, especially in forensic settings, can have serious consequences for patients, staff and institutions. Several characteristics of affected patients could be identified so far, albeit based on heterogeneous patient populations, a limited number of possible factors and basal statistical analyses. The aim of this study was to determine the most important characteristics among a large number of possible variables and to describe the best statistical model using machine learning in a homogeneous group of offender patients with schizophrenia spectrum disorder. METHODS A database of 370 offender patients suffering from schizophrenia spectrum disorder and 507 possible predictor variables was explored by machine learning. To counteract overfitting, the database was divided into training and validation set and a nested validation procedure was used on the training set. The best model was tested on the validation set and the most important variables were extracted. RESULTS The final model resulted in a balanced accuracy of 71.1% (95% CI = [58.5, 83.1]) and an AUC of 0.75 (95% CI = [0.63, 0.87]). The variables identified as relevant and related to absconding/ escape listed from most important to least important were: more frequent forbidden intake of drugs during current hospitalization, more index offences, higher neuroleptic medication, more frequent rule breaking behavior during current hospitalization, higher PANSS Score at discharge, lower age at admission, more frequent dissocial behavior during current hospitalization, shorter time spent in current hospitalization and higher PANSS Score at admission. CONCLUSIONS For the first time a detailed statistical model could be built for this topic. The results indicate the presence of a particularly problematic subgroup within the group of offenders with schizophrenic spectrum disorder who also tend to escape or abscond. Early identification and tailored treatment of these patients could be of clinical benefit.
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Affiliation(s)
- Johannes Kirchebner
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
| | - Steffen Lau
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Martina Sonnweber
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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5
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Psychiatric Care in Acute Care Units with Locked Doors: Nursing Care Providers’ Perceptions and Experiences. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1337:99-106. [DOI: 10.1007/978-3-030-78771-4_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Steinauer R, Krückl JS, Moeller J, Vogel M, Wiesbeck GA, Walter M, Lang UE, Huber CG. Opening the Doors of a Substance Use Disorder Ward-Benefits and Challenges From a Consumer Perspective. Front Psychiatry 2020; 11:580885. [PMID: 33192724 PMCID: PMC7541831 DOI: 10.3389/fpsyt.2020.580885] [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: 07/07/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Open doors in psychiatry have been a subject of controversy in recent years. While some studies postulate the clinical necessity of closed doors, others challenge the theoretical advantages of this setting, mention numerous drawbacks of closed wards, and focus on the advantages of open-door settings. With regard to patients diagnosed with substance use disorders (SUD), other standards may apply. Very little research has been done on this topic. Some studies adopted a consumer perspective (i.e. asking involved parties about their experience of the door status). To the authors' knowledge, no study has so far addressed the ideal setting for the treatment of SUD. With our data from the opening of a specialized SUD ward, we take one step to closing this knowledge gap. Applying a qualitative design, we asked patients and health care professionals (HCP) to report changes following the opening of the ward. The results are mainly in line with the literature on the general psychiatric population. The newly introduced open-door setting was mostly perceived as positive, but some disadvantages were mentioned (e.g. less protection of patients, less control over who enters/leaves the ward, the theoretically increased risk of patients absconding). Moreover, HCP (but not patients) mentioned potentially increased substance use on the ward as an additional disadvantage that could arise. Opening a previously closed ward was generally perceived as a positive and progressive decision. These findings support the trend towards an overall open-door policy in psychiatry.
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Affiliation(s)
- Regine Steinauer
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Jana S Krückl
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Julian Moeller
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland.,Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Marc Vogel
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Gerhard A Wiesbeck
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Marc Walter
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Undine E Lang
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
| | - Christian G Huber
- Universitäre Psychiatrische Kliniken Basel (UPK), Klinik für Erwachsene, Universität Basel, Basel, Switzerland
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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8
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Marhoon A, Al-Shagag A, Cowman S. A Population Study of Safety and Security in Admission Psychiatric Wards in the Kingdom of Bahrain. Issues Ment Health Nurs 2019; 40:1019-1025. [PMID: 31398079 DOI: 10.1080/01612840.2019.1630534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Assaultive behavior is a feature of mental health services. Psychiatric staff may experience significant psychological effects in relation to assaultive behavior and aggression. The international literature highlights a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals. There are no published studies from the Kingdom of Bahrain on safety and security in mental health services. The aim of the study is to describe the safety and security measures currently applied in the 18 psychiatric admission wards of the one and only psychiatric hospital in the Kingdom of Bahrain. A descriptive cross-sectional survey research design was used. Questionnaires were completed by the charge nurse in each psychiatric admission ward in the Kingdom of Bahrain. The instrument has previously been validated and used in Ireland and the UK. There was a response rate of 100%. The results identified deficiencies when compared to established international practice. There was a lack of security features related to the use of a swipe card system, personal panic alarms for staff, metal detectors, and rapid response team always on call. A wide range of differing practices were noted concerning the banning of items including searching of patients on admission and return from leave. The results provide important data and the impetus to guide the development of policy for best practice in safety and security in psychiatric services. Mental health managers must audit and regularly review work safety and security practices and ensure up to date policies and procedures.
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Affiliation(s)
| | - Ali Al-Shagag
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Nursing, Busaiteen, Bahrain
| | - Seamus Cowman
- Royal College of Surgeons in Ireland and Medical University of Bahrain, Nursing, Busaiteen, Bahrain
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9
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Voss I, Bartlett R. Seeking freedom: A systematic review and thematic synthesis of the literature on patients' experience of absconding from hospital. J Psychiatr Ment Health Nurs 2019; 26:289-300. [PMID: 31359573 DOI: 10.1111/jpm.12551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/03/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Absconding refers to patients leaving psychiatric hospitals in an unexpected and/or unauthorized way and is often recognized as a form of challenging behaviour. There is some research about the rates of absconding, risks associated with it and interventions to try and reduce it; however, relatively little is known about the experience from the perspective of patients and this evidence has not previously been systematically reviewed. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients abscond to find relief, to regain power and control over their lives and/or to address unmet needs. Absconding can therefore be viewed as a means of seeking freedom. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses need to be aware that absconding is a positive act from the patient perspective and work collaboratively with them to reduce factors which motivate this behaviour. From the point of admission, nurses have an important role to play in reducing the sense of fear, isolation and powerlessness which motivates patients to abscond. Practical interventions such as giving patients the time and information necessary to be involved in decision-making, or asking about their responsibilities and commitments outside of hospital, may have a significant impact on the experience of admission and reduce the risk of absconding. Abstract Introduction Absconding from psychiatric hospitals is associated with significant risks, but is difficult to assess. It is often considered a form of challenging behaviour for mental health nurses, yet there is little evidence considering the behaviour from the patient perspective. Aim To identify and review evidence pertaining to the experience of patients who abscond from hospital, paying particular attention to their reasons for doing so. Method A systematic review and thematic synthesis of eight peer-reviewed studies. Results The meaning patients associated with absconding is best characterized as an act of seeking freedom. Within this, four sub-themes were identified: 1) seeking freedom to find relief, 2) to regain power and control over their lives, 3) to address unmet needs and 4) opportunistically. Discussion Perspectives on absconding are markedly different between nurses and patients. Nurses may view absconding as challenging or deviant behaviour, whilst patients understand it as a positive experience. This is because the hospital environment is not meeting their needs. Implications for practice Patients decide to abscond from hospital for valid and rational reasons. Mental health nurses are in a position to understand and address the issues underpinning them with a view to reducing absconding. Further research on absconding from hospital, taking the patient's perspective, is needed.
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Affiliation(s)
- Isobel Voss
- South West London and St George's Mental Health NHS Trust, London, UK
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10
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Steinert T, Schreiber L, Metzger FG, Hirsch S. [Open doors in psychiatric hospitals : An overview of empirical findings]. DER NERVENARZT 2019; 90:680-689. [PMID: 31165212 DOI: 10.1007/s00115-019-0738-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue. METHOD Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives. RESULTS A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of "open doors" ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards. DISCUSSION Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies.
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Affiliation(s)
- Tilman Steinert
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau), ZfP Südwürttemberg, Weingartshofer Str. 2, 88214, Ravensburg Weissenau, Deutschland.
| | - Lisa Schreiber
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Florian G Metzger
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Geriatrisches Zentrum, Universitätsklinikum Tübingen, Tübingen, Deutschland.,Vitos Klinik für Psychiatrie und Psychotherapie Haina, Haina, Deutschland
| | - Sophie Hirsch
- Klinik für Psychiatrie und Psychotherapie I der Universität Ulm (Weissenau), ZfP Südwürttemberg, Weingartshofer Str. 2, 88214, Ravensburg Weissenau, Deutschland
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11
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Taghavi Larijani T, Saatchi B. Training of NANDA-I Nursing Diagnoses (NDs), Nursing Interventions Classification (NIC) and Nursing Outcomes Classification (NOC), in Psychiatric Wards: A randomized controlled trial. Nurs Open 2019; 6:612-619. [PMID: 30918711 PMCID: PMC6419136 DOI: 10.1002/nop2.244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/27/2018] [Accepted: 01/07/2019] [Indexed: 11/09/2022] Open
Abstract
AIM To assess the effect of Training NANDA-I Nursing Diagnoses, Nursing Interventions Classification and Nursing Outcomes Classification (The NNN system), on the nursing care related to the patient safety, in psychiatric wards. METHOD In a randomized controlled trial, 80 nurses were selected randomly and assigned into two, Control and Experimental, groups. Nurses documented reports, reviewed and analysed in terms of using the NNN system. The intervention of the study was the training of the NNN system, based on recognition of the signs, symptoms and aetiology of the important phenomena in the psychiatric wards. RESULTS The Control Group used the NNN system (N = 34), both before and after the intervention, while the experimental group usage increased from (N = 26)-(N = 434). Therefore, the NNN system training, can improve the nursing care related to the patient safety in psychiatric wards.
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Affiliation(s)
- Taraneh Taghavi Larijani
- Psychiatric Nursing Department, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Babak Saatchi
- Psychiatric Nursing Department, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
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12
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Lindgren BM, Ringnér A, Molin J, Graneheim UH. Patients' experiences of isolation in psychiatric inpatient care: Insights from a meta-ethnographic study. Int J Ment Health Nurs 2019; 28:7-21. [PMID: 29975446 DOI: 10.1111/inm.12519] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
Abstract
Historically, people with mental ill-health have been isolated from society. Although mental health care has moved from closed to more open forms of care, in many societies care is still provided in locked wards, and people with mental ill-health are sometimes secluded from their fellow patients, families, friends, and visitors. The aim of this study was to illuminate patients' experiences of isolation in psychiatric inpatient care. A systematic review of qualitative research was conducted, and the key findings were subjected to meta-ethnographic synthesis. The findings were twofold: 'being admitted to prison' and 'having access to shelter'. The experience of isolated care as prison-like symbolizes patients' longing for freedom and feeling restricted and limited by rules, stripped of rights, abandoned, controlled, powerless, and unsupported. In contrast, the experience of isolation as shelter symbolizes safety and the opportunity to regain control over one's own situation. A stigmatizing public view holds that people with mental ill-health are dangerous and unpredictable and, therefore, unsafe to themselves and others. Being placed in isolation because these fears contribute to self-stigma among patients. Promoting a sheltered experience in which isolation is used with respect for patients and the reasons are made explicit may encourage recovery. A shift in emphasis in ward culture from observation to engagement is needed to reduce blame, shift patient experiences from prison to shelter, and to support autonomy as a therapeutic intervention.
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Affiliation(s)
| | - Anders Ringnér
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulla H Graneheim
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Health Sciences, University West, Trollhättan, Sweden
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13
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Efkemann SA, Bernard J, Kalagi J, Otte I, Ueberberg B, Assion HJ, Zeiß S, Nyhuis PW, Vollmann J, Juckel G, Gather J. Ward Atmosphere and Patient Satisfaction in Psychiatric Hospitals With Different Ward Settings and Door Policies. Results From a Mixed Methods Study. Front Psychiatry 2019; 10:576. [PMID: 31543830 PMCID: PMC6728825 DOI: 10.3389/fpsyt.2019.00576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/22/2019] [Indexed: 11/22/2022] Open
Abstract
Background: Open-door policies in psychiatry are discussed as a means to improve the treatment of involuntarily committed patients in various aspects. Current research on open-door policies focuses mainly on objective effects, such as the number of coercive interventions or serious incidents. The aim of the present study was to investigate more subjective perceptions of different psychiatric inpatient settings with different door policies by analyzing ward atmosphere and patient satisfaction. Methods: Quantitative data on the ward atmosphere using the Essen Climate Evaluation Scale (EssenCES) and on patient satisfaction (ZUF-8) were obtained from involuntarily committed patients (n = 81) in three psychiatric hospitals with different ward settings and door policies (open, facultative locked, locked). Furthermore, qualitative interviews with each of 15 patients, nurses, and psychiatrists were conducted in one psychiatric hospital with a facultative locked ward comparing treatment in an open vs. a locked setting. Results: Involuntarily committed patients rated the EssenCES' subscale "Experienced Safety" higher in an open setting compared with a facultative locked and a locked setting. The subscale "Therapeutic Hold" was rated higher in an open setting than a locked setting. Regarding the safety experienced from a mental health professionals' perspective, the qualitative interviews further revealed advantages and disadvantages of door locking in specific situations, such as short-term de-escalation vs. increased tension. Patient satisfaction did not differ between the hospitals but correlated weakly with the EssenCES' subscale "Therapeutic Hold." Conclusion: Important aspects of the ward atmosphere seem to be improved in an open vs. a locked setting, whereas patient satisfaction does not seem to be influenced by the door status in the specific population of patients under involuntary commitment. The ward atmosphere turned out to be more sensitive to differences between psychiatric inpatient settings with different door policies. It can contribute to a broader assessment by including subjective perceptions by those who are affected directly by involuntary commitments. Regarding patient satisfaction under involuntary commitment, further research is needed to clarify both the relevance of the concept and its appropriate measurement.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Johannes Bernard
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Janice Kalagi
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ina Otte
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Bianca Ueberberg
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.,LWL-Klinik Dortmund, Psychiatrie, Psychotherapie, Psychosomatische Medizin, Rehabilitation, Dortmund, Germany
| | - Hans-Jörg Assion
- LWL-Klinik Dortmund, Psychiatrie, Psychotherapie, Psychosomatische Medizin, Rehabilitation, Dortmund, Germany
| | - Swantje Zeiß
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, St. Marien Hospital Eickel, Herne, Germany
| | - Peter W Nyhuis
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, St. Marien Hospital Eickel, Herne, Germany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, 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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14
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Slemon A, Jenkins E, Bungay V. Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nurs Inq 2017; 24. [PMID: 28421661 PMCID: PMC5655749 DOI: 10.1111/nin.12199] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/26/2022]
Abstract
The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.
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Affiliation(s)
- Allie Slemon
- School of Nursing, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Vicky Bungay
- School of Nursing, University of British Columbia (UBC), Vancouver, British Columbia, Canada
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15
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Scott R, Meehan T. Critical Incidents During Leave From an Australian Security Hospital - A 12 Year Audit. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2017; 24:47-60. [PMID: 31983938 PMCID: PMC6818218 DOI: 10.1080/13218719.2016.1169572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
All critical incidents between 2003 and 2015 relating to leave episodes from the High Security Inpatient Services, Brisbane, Australia were audited. The audit found that since March 2003, when the High Security Inpatient Service opened, there was a very small number of critical incidents related to over 46,000 leave episodes. Of the 17 patients who went absent without permission over the 12-year study period, only 2 patients re-offended and 1 patient deliberately self-harmed during a leave episode. One patient assaulted his escort nurse during a leave and four patients attempted unsuccessfully to flee their escort nurses during escorted off-ground leave. No patient committed a serious violent offence and no patient committed suicide during an absence from leave. Only 4 of the 17 patients who went absent during leave between 2003 and 2015 remain as inpatients in the High Security Inpatient Service.
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Affiliation(s)
- Russ Scott
- Forensic Psychiatrist, High Security Inpatient Services, The Park, Centre for Mental Health, Treatment and Research, Wacol, Brisbane, Australia
- Correspondence: Russ Scott, The Park, Centre for Mental Health, Treatment and Research, Wacol, Brisbane, Australia.
| | - Tom Meehan
- Associate Professor, Department of Psychiatry, University of Queensland, Director of Service Evaluation and Research, The Park, Centre for Mental Health, Treatment and Research, Wacol, Brisbane, Australia
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16
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Benolkin L, Kinstler D, Delaney KR. Improving Awareness of an Acute Psychiatric Unit's Capacity for Admission. J Psychosoc Nurs Ment Health Serv 2016; 53:30-5. [PMID: 26268479 DOI: 10.3928/02793695-20150720-05] [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: 03/02/2015] [Accepted: 06/16/2015] [Indexed: 11/20/2022]
Abstract
New admissions to psychiatric inpatient units can significantly impact the environment and level of safety. Maintaining safety is a core and critical responsibility of nursing, but nurses are often overlooked in the decision to admit a patient. Missed opportunities for dialogue between nurses and the admitting physician challenge nurses' ability to proactively manage the therapeutic environment. When nurses are limited in this ability, the outcome can be an unpredictable and unstable milieu. In a 25-bed acute psychiatric inpatient unit, a formalized communication system among the multidisciplinary admission team was developed. Data collected over 1 year demonstrated improved safety. Increasing the admitting provider's awareness of the current unit acuity and involving the nursing staff early in the admission process improved collaboration among care team members and reduced risks to maintaining milieu safety.
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17
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Grotto J, Gerace A, O'Kane D, Simpson A, Oster C, Muir-Cochrane E. Risk assessment and absconding: perceptions, understandings and responses of mental health nurses. J Clin Nurs 2014; 24:855-65. [PMID: 25209549 DOI: 10.1111/jocn.12671] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This paper reports mental health nurses' perspectives of absconding. The aims of the study were to explore nurses' perceptions of risk assessment and management practices regarding absconding from acute inpatient psychiatric settings, and their affective responses when patients absconded. BACKGROUND Nurses are directly involved in managing the risk of patients leaving hospital while acutely unwell, as well as dealing with the implications of an absconding event. However, despite their key role, few studies have explored nurses' perceptions of absconding. DESIGN An interpretive inquiry was undertaken using a systematic thematic approach. METHODS Mental health nurses (n = 11) from three acute inpatient mental health units in Australia took part in semi-structured interviews, with a focus on the nurses' experiences of working with patients who had absconded. Data were analysed using systematic thematic coding procedures. RESULTS Nurses' assessment of a patient's risk of absconding involved the use of clinical judgement, focusing on markers of absconding including the patient's history and clinical presentation. The acuity of the perceived risk determined the type of risk management strategy implemented, which could include support, observation and/or the use of containment procedures. Nurses responded with a myriad of affective reactions when patients absconded depending on their assessment of the patient's risk. CONCLUSIONS Support and debriefing is required for mental health nurses following an absconding event. Additional research is vital to identify alternative absconding assessment and management strategies to ensure the best possible outcome for patients and nurses. RELEVANCE TO CLINICAL PRACTICE Mental health nurses play a central role in risk assessment and management for absconding, with fear of repercussions a significant consequence for them. This research highlights the importance of both clinical judgment and standardised instruments in assessing absconding risk. Further research is needed to identify alternative evidence-based absconding management strategies to support nursing practice.
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Affiliation(s)
- Jessica Grotto
- Faculty of Health Sciences, School of Nursing and Midwifery, Flinders University, Adelaide, SA, Australia
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18
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Bowers L, Alexander J, Bilgin H, Botha M, Dack C, James K, Jarrett M, Jeffery D, Nijman H, Owiti JA, Papadopoulos C, Ross J, Wright S, Stewart D. Safewards: the empirical basis of the model and a critical appraisal. J Psychiatr Ment Health Nurs 2014; 21:354-64. [PMID: 24460906 PMCID: PMC4237197 DOI: 10.1111/jpm.12085] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 12/02/2022]
Abstract
ACCESSIBLE SUMMARY In the previous paper we described a model explaining differences in rates of conflict and containment between wards, grouping causal factors into six domains: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. This paper reviews and evaluates the evidence for the model from previously published research. The model is supported, but the evidence is not very strong. More research using more rigorous methods is required in order to confirm or improve this model. ABSTRACT In a previous paper, we described a proposed model explaining differences in rates of conflict (aggression, absconding, self-harm, etc.) and containment (seclusion, special observation, manual restraint, etc.). The Safewards Model identified six originating domains as sources of conflict and containment: the patient community, patient characteristics, the regulatory framework, the staff team, the physical environment, and outside hospital. In this paper, we assemble the evidence underpinning the inclusion of these six domains, drawing upon a wide ranging review of the literature across all conflict and containment items; our own programme of research; and reasoned thinking. There is good evidence that the six domains are important in conflict and containment generation. Specific claims about single items within those domains are more difficult to support with convincing evidence, although the weight of evidence does vary between items and between different types of conflict behaviour or containment method. The Safewards Model is supported by the evidence, but that evidence is not particularly strong. There is a dearth of rigorous outcome studies and trials in this area, and an excess of descriptive studies. The model allows the generation of a number of different interventions in order to reduce rates of conflict and containment, and properly conducted trials are now needed to test its validity.
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Affiliation(s)
- L Bowers
- Section of Mental Health Nursing, Institute of Psychiatry, Kings College London, London, UK
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Characteristics of acute wards associated with the presence of a psychiatric intensive care unit, and transfers of patients to it. ACTA ACUST UNITED AC 2012. [DOI: 10.1017/s174264641200012x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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