1
|
Whittington R, Aluh DO, Caldas-de-Almeida JM. Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World. Healthcare (Basel) 2023; 11:2834. [PMID: 37957978 PMCID: PMC10650021 DOI: 10.3390/healthcare11212834] [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: 06/28/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action 'FOSTREN' is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.
Collapse
Affiliation(s)
- Richard Whittington
- Centre for Research & Education in Security, Prisons and Forensic Psychiatry, Forensic Department Østmarka, St. Olav’s Hospital, 7030 Trondheim, Norway
- Department of Mental Health, Norwegian University of Science & Technology (NTNU), 7034 Trondheim, Norway
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool L69 3BX, UK
| | - Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, 1169-056 Lisbon, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Jose-Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, 1169-056 Lisbon, Portugal
| |
Collapse
|
2
|
Aguglia A, Corsini GP, Berardelli I, Berti A, Conio B, Garbarino N, Gnecco GB, Magni C, Venturini E, Costanza A, Amerio A, Amore M, Serafini G. Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1847. [PMID: 37893565 PMCID: PMC10607962 DOI: 10.3390/medicina59101847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: mechanical restraint (MR) is a controversial issue in emergency psychiatry and should be better studied to implement other alternative therapeutic interventions. The aim of this study was to estimate the prevalence of MR in an Italian psychiatric unit and identify the sociodemographic and clinical characteristics as well as the pharmacological pattern associated with MR. Materials and Methods: all subjects (N = 799) consecutively admitted to an Italian psychiatric inpatient unit were recruited. Several sociodemographic and clinical characteristics were recorded. Results: The prevalence of MR was 14.1%. Males, a younger age, and a single and migrant status were associated with the MR phenomenon. MR was more prevalent in patients affected by other diagnoses and comorbid illicit substance use, in patients with aggressive behaviors, and those that were involuntary admitted, leading significantly to hospitalization over 21 days. Furthermore, the patients that underwent MR were taking a lower number of psychiatric medications. Conclusions: Unfortunately, MR is still used in emergency psychiatry. Future research should focus on the dynamics of MR development in psychiatry, specifically considering ward- and staff-related factors that could help identify a more precise prevention and alternative intervention strategies.
Collapse
Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Giovanni Pietro Corsini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Andrea Berti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Benedetta Conio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Nicolò Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Giovanni Battista Gnecco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Caterina Magni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Enrico Venturini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service, University Hospitals of Geneva (HUG), 1207 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| |
Collapse
|
3
|
Pedersen ML, Gildberg F, Baker J, Damsgaard JB, Tingleff EB. Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review. Soc Psychiatry Psychiatr Epidemiol 2022; 58:505-522. [PMID: 36454269 PMCID: PMC9713127 DOI: 10.1007/s00127-022-02387-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. METHODS A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. RESULTS Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe (n = 26), Western Pacific (n = 8), Americas (n = 3) and South-East Asia (n = 1). In primary studies, ethnicity was reported according to migrant/national status (n = 16), mixed categories (n = 12), indigenous vs. non-indigenous (n = 5), region of origin (n = 1), sub-categories of indigenous people (n = 1) and religion (n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies (n = 20), multiple restrictive practices studied concurrently (n = 17), mechanical restraint (n = 8), rapid tranquillisation (n = 7) and manual restraint (n = 1). CONCLUSIONS Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers' and clinicians' understanding of the issue. Further research in this field may improve mental health practice.
Collapse
Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark. .,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark.
| | - Frederik Gildberg
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - John Baker
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Baines Wing, Woodhouse Lane, Leeds, LS2 9JT UK
| | - Janne Brammer Damsgaard
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Ellen Boldrup Tingleff
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.10825.3e0000 0001 0728 0170OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 5000 Odense C, Denmark
| |
Collapse
|
4
|
Doedens P, Ter Riet G, Vermeulen J, Boyette LL, Latour C, de Haan L. Influence of nursing staff characteristics on seclusion in acute mental health care-A prospective two-year follow-up study. Arch Psychiatr Nurs 2021; 35:491-498. [PMID: 34561064 DOI: 10.1016/j.apnu.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Seclusion still occurs on mental health wards, despite absence of therapeutic efficacy and high risks of adverse patient effects. Literature on the effect of nursing teams, and the role of psychological characteristics in particular, on frequency of seclusion is scarce. AIM To explore the influence of demographic, professional or psychological, nursing team-level, and shift characteristics on the frequency of use of seclusion. METHODS Prospective two-year follow-up study. RESULTS We found that the probability of seclusion was lower when nursing teams with at least 75% males were on duty, compared to female only teams, odds ratio (OR = 0.283; 95% CrI 0.046-0.811). We observed a trend indicating that teams scoring higher on the openness personality dimension secluded less, (OR = 0.636; 95% CrI 0.292-1.156). DISCUSSION Higher proportions of male nurses in teams on duty were associated with lower likelihood of seclusion. We found an indication that teams with a higher mean openness personality trait tended to seclude less. These findings, if causal, could serve as an incentive to reflect on staff mix if circumstances demand better prevention of seclusion.
Collapse
Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands; Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Corine Latour
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, the Netherlands; Arkin, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Yurtbasi MK, Melvin G, Pavlou C, Gordon M. Nurse and patient factors: Predicting seclusion in adolescent psychiatric units. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:112-119. [PMID: 33393691 DOI: 10.1111/jcap.12306] [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: 10/12/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
PROBLEM Seclusion is considered a necessity when alternatives have failed. There is a consensus that seclusion has no therapeutic benefit, which justifies efforts to reduce the practice. This study aimed to identify nurse and patient variables that are predictive of seclusion on a large adolescent inpatient unit. METHODS Nested case controls were used to compare 72 afternoon shifts on which seclusion occurred to 216 afternoon shifts on which no seclusion occurred, between 2010 and 2013, at an Adolescent Psychiatric Inpatient Unit. FINDINGS Increased seclusion was predicted by a lower nurse to patient ratio, more male nurses on shift, fewer female nurses on shift, the presence of agency/temporary nurses on shift, greater combined years of mental health experience, and lower total HoNOSCA behavior subscale score. Unique predictors that increased risk of seclusion included greater number of male nurses and the presence of agency/temporary nurses, while a greater number of female nurses decreased risk of seclusion. CONCLUSIONS Nurses play a unique role in seclusion outcomes that are separate to patient-factors and act as both protective and risk factors for seclusion. Changes can be made to staffing to reduce seclusion and future research should investigate why these nurse-factors contribute to seclusion.
Collapse
Affiliation(s)
- Miriam K Yurtbasi
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Glenn Melvin
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
| | - Christine Pavlou
- Psychiatric Services at Monash Health, Early in Life Mental Health Service, Monash Children's Hospital, Clayton, Australia
| | - Michael Gordon
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences, Monash University, Clayton, Australia.,Psychiatric Services at Monash Health, Early in Life Mental Health Service, Monash Children's Hospital, Clayton, Australia
| |
Collapse
|
6
|
Askew L, Fisher P, Beazley P. Being in a Seclusion Room: The Forensic Psychiatric Inpatients' Perspective. J Psychiatr Ment Health Nurs 2020; 27:272-280. [PMID: 31755614 DOI: 10.1111/jpm.12576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Existing qualitative research has found inpatient service users to experience seclusion as highly distressing, with feelings of vulnerability, abuse and neglect often featuring in participants' accounts. The physical environment of the seclusion room and the interaction with clinical staff shape service users' personal seclusion experience. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE The majority of research on this topic focuses on seclusion within other restrictive practices. This paper provides new knowledge on one specific component of seclusion, the experience of being in the room, and draws attention to the specific psychological needs of service users during that aspect of their experience. This research provides new knowledge by exclusively exploring forensic inpatients' experience of the seclusion room, an under researched and often stigmatized population. WHAT ARE THE IMPLICATIONS TO PRACTICE The findings support the need for a caring and non-threatening therapeutic interaction with a secluded service user for the duration of time they are in the seclusion room. The findings suggest that necessary nursing procedures, such as observations, should be carried out discretely and sensitively to avoid service users feeling abused and frightened. ABSTRACT Introduction Contemporary qualitative research has explored service users' experience of seclusion and has found it to be a highly distressing and potentially traumatizing experience for service users. The majority of the existing literature has researched seclusion within the context of other restrictive practices, resulting in findings that can only be considered an overview of the experience. The studies also rarely access participants with histories of considerable violence and imprisonment. Question What is forensic psychiatric inpatients' experience of being in a seclusion room? Method Seven inpatients in a medium secure hospital were interviewed, and interpretative phenomenological analysis (IPA) was used to analyse the data. Results Four superordinate themes were identified: "intense fear," 'not getting the care I needed," 'I am being abused" and "power struggle." Discussion While participants were in the seclusion room, they experienced extreme fear. Staff interaction played a considerable role in shaping the participants' experience. Staff actions were interpreted as neglectful and abusive. Participants experienced struggling for power with staff, seeking out power when left in a powerless position. Implications for practice These findings suggested that a carefully tailored therapeutic interaction is required during seclusion in order to safeguard the mental health of forensic inpatients.
Collapse
|
7
|
Narita Z, Inagawa T, Yokoi Y, Stickley A, Maruo K, Yamada Y, Sugawara N. Factors associated with the use and longer duration of seclusion and restraint in psychiatric inpatient settings: a retrospective chart review. Int J Psychiatry Clin Pract 2019; 23:231-235. [PMID: 31035799 DOI: 10.1080/13651501.2019.1607878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To examine factors that may affect the use and duration of seclusion and restraint (SR) in psychiatric inpatient settings. Methods: First, multivariable logistic regression analysis was used to examine factors associated with the use of SR in an unmatched case-control study, comparing SR cases and controls. Second, for patients that underwent SR, multivariable linear regression analysis was used to determine factors contributing to the duration of SR. Results: Out of 213 patients, 58 underwent SR. An F00 diagnosis, a history of epilepsy, antipsychotics usage and antidepressants usage were significantly associated with the use of SR (odds ratio = 7.98; 95% CI = 1.11-57.50, odds ratio = 4.89; 95% CI = 1.12-21.36, odds ratio = 4.59; 95% CI = 1.54-13.68 and odds ratio = 0.29; 95% CI = 0.10-0.86, respectively). An F00 and F32 diagnosis significantly extended the duration of SR (coefficient = 13.10; 95% CI = 2.11-24.11 and coefficient = 20.52; 95% CI = 9.68-31.37, respectively). Conclusions: A variety of factors are associated with the use and longer duration of SR. Given the potentially harmful effects of these practices, further studies with larger samples and a wider range of quantitative outcome measures are warranted. Key points An F00 diagnosis, a history of epilepsy and antipsychotics usage may increase the use of SR. Antidepressants may decrease the use of SR. An F00 and F32 diagnosis may extend the duration of SR.
Collapse
Affiliation(s)
- Zui Narita
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Takuma Inagawa
- Department of Psychiatry, National Centre Hospital, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Yuma Yokoi
- Department of Psychiatry, National Centre Hospital, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Andrew Stickley
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba , Tsukuba , Japan
| | - Yuji Yamada
- Department of Psychiatry, National Centre Hospital, National Centre of Neurology and Psychiatry , Kodaira , Japan
| | - Norio Sugawara
- Department of Clinical Epidemiology, Translational Medical Centre, National Centre of Neurology and Psychiatry , Kodaira , Japan
| |
Collapse
|
8
|
Barr L, Wynaden D, Heslop K. Promoting positive and safe care in forensic mental health inpatient settings: Evaluating critical factors that assist nurses to reduce the use of restrictive practices. Int J Ment Health Nurs 2019; 28:888-898. [PMID: 30916443 DOI: 10.1111/inm.12588] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2019] [Indexed: 11/28/2022]
Abstract
Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia's mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty-two nurses were recruited from one Australian forensic mental health service. Data were collected using semi-structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high-risk patient cohort.
Collapse
Affiliation(s)
- Lesley Barr
- State Forensic Mental Health Service, Western Australia, (NMHS-MH), Perth, Western Australia, Australia
| | - Dianne Wynaden
- Curtin University (Nursing & Midwifery), Perth, Western Australia, Australia
| | - Karen Heslop
- Curtin University (Nursing & Midwifery), Perth, Western Australia, Australia
| |
Collapse
|
9
|
Lai J, Jury A, Long J, Fergusson D, Smith M, Baxendine S, Gruar A. Variation in seclusion rates across New Zealand's specialist mental health services: Are sociodemographic and clinical factors influencing this? Int J Ment Health Nurs 2019; 28:288-296. [PMID: 30120873 DOI: 10.1111/inm.12532] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2018] [Indexed: 12/01/2022]
Abstract
Rates of seclusion vary across New Zealand's publicly funded district health board (DHB) adult mental health inpatient services as indicated by national data. Anecdotally, this variation has been attributed to a range of factors directly relating to the people admitted to acute inpatient services. This study examined the extent to which variation in seclusion rates could be explained by the sociodemographic and clinical differences between populations admitted into adult mental health inpatient services. Retrospective data were obtained from the Programme for the Integration of Mental Health Data (PRIMHD). A logistic regression model was fitted to these data, with seclusion (yes/no) as the dependent variable and DHB groups as the independent variable. The DHBs were classified into four groups based on their seclusion rates. The model adjusted for ethnicity, age, number of bed nights, total Health of the Nation Outcome Scales (HoNOS) scores, and compulsory treatment status. Odds ratios remained virtually unchanged after adjustment for sociodemographic and clinical factors. People admitted to DHB Group 4 (highest secluding DHBs) were 11 times more likely to be secluded than people in Group 1 (lowest secluding DHBs), adjusted OR = 11.1, 95% CI [7.5,16.4], P < 0.001. Results indicate DHB variation in seclusion rates cannot be attributed to the sociodemographic and clinical factors of people admitted into DHB adult mental health inpatient services. Instead, this variation may be explained by differences in service delivery models and practice approaches. A model of system improvements aimed at reducing seclusion is discussed.
Collapse
Affiliation(s)
| | - Angela Jury
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | - Jenny Long
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | - David Fergusson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Mark Smith
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | | | | |
Collapse
|
10
|
Jury A, Lai J, Tuason C, Koning A, Smith M, Boyd L, Swanson C, Fergusson D, Gruar A. People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores. Int J Ment Health Nurs 2019; 28:199-208. [PMID: 30010239 DOI: 10.1111/inm.12521] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/27/2022]
Abstract
The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.
Collapse
Affiliation(s)
- Angela Jury
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | | | | | | | - Mark Smith
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | - Lois Boyd
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | | | - David Fergusson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Khatib A, Ibrahim M, Roe D. Re-building Trust after Physical Restraint During Involuntary Psychiatric Hospitalization. Arch Psychiatr Nurs 2018; 32:457-461. [PMID: 29784230 DOI: 10.1016/j.apnu.2018.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/31/2017] [Accepted: 01/01/2018] [Indexed: 10/18/2022]
Abstract
This study attempted to identify the elements which might best minimize the negative consequences of restriction of inpatients and rebuild therapeutic alliance and trust. Through in depth interviews with 15 psychiatric patients who had experience restrained during the last involuntary psychiatric hospitalization. Analysis of the data revealed three major themes with regard to trust between restrained patient and restraining staff members during restriction of the patient's freedom. Duration of Restriction, Contact with a Staff Member while Restrained, Supportive Interactions and Staff's Response to Restricted Patients' Needs were reported by patients as crucial in determining the way restrained is experienced and its later impact. Physical restraint in psychiatric hospitalizations generates many negative feelings and can even be traumatic. The patients interviewed help us learn how to provide more human and therapeutic interactions even in extreme situations of restrain which can be crucial to rebuild therapeutic alliance and trust.
Collapse
Affiliation(s)
- Anwar Khatib
- Department of Community Mental Health, University of Haifa, POB 5010, Jedeide Maker Village, 2510500, Israel; Department of Social Work, Zefat Academic College, POB 5010, Jedeide Maker Village, 2510500, Israel.
| | - Mahajne Ibrahim
- Social work department, Zefat Academic College, New shikon st, POB 453, Mu'awiya 30010, Israel.
| | - David Roe
- Department of Community Mental Health, University of Haifa, Israel.
| |
Collapse
|
13
|
The experience of restraint-use among patients with violent behaviors in mental health hospital. ENFERMERIA CLINICA 2018. [DOI: 10.1016/s1130-8621(18)30173-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
Maguire T, Daffern M, Bowe SJ, McKenna B. Predicting aggressive behaviour in acute forensic mental health units: A re-examination of the dynamic appraisal of situational aggression's predictive validity. Int J Ment Health Nurs 2017; 26:472-481. [PMID: 28960740 DOI: 10.1111/inm.12377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
Abstract
In the present study, we explored the predictive validity of the Dynamic Appraisal of Situational Aggression (DASA) assessment tool in male (n = 30) and female (n = 30) patients admitted to the acute units of a forensic mental health hospital. We also tested the psychometric properties of the original DASA bands and novel risk bands. The first 60 days of each patient's file was reviewed to identify daily DASA scores and subsequent risk-related nursing interventions and aggressive behaviour within the following 24 hours. Risk assessments, followed by documented nursing interventions, were removed to preserve the integrity of the risk-assessment analysis. Receiver-operator characteristics were used to test the predictive accuracy of the DASA, and generalized estimating equations (GEE) were used to account for repeated risk assessments, which occurs when analysing short-term risk-assessment data. The results revealed modest predictive validity for males and females. GEE analyses suggested the need to adjust the DASA risk bands to the following (with associated odds ratios (OR) for aggressive behaviour): 0 = low risk; 1, 2, 3 = moderate-risk OR, 4.70 (95% confidence interval (CI): 2.84-7.80); and 4, 5, 6, 7 = high-risk OR, 16.13 (95% CI: 9.71-26.78). The adjusted DASA risk bands could assist nurses by prompting violence-prevention interventions when the level of risk is elevated.
Collapse
Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Deakin University, Melbourne, Victoria, Australia
| | - Brian McKenna
- Department of Health Sciences, Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| |
Collapse
|
15
|
Khalil AI, Al Ghamdi MAM, Al Malki S. Nurses’ knowledge, attitudes, and practices toward physical restraint and seclusion in an inpatients’ psychiatric ward. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17542863.2017.1329330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amal Ibrahim Khalil
- Faculty of Nursing, Menoufyia University, Egypt
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | - Sarah Al Malki
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| |
Collapse
|
16
|
Allan JA, Hanson GD, Schroder NL, O'Mahony AJ, Foster RMP, Sara GE. Six years of national mental health seclusion data: the Australian experience. Australas Psychiatry 2017; 25:277-281. [PMID: 28375028 DOI: 10.1177/1039856217700298] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Reducing or eliminating seclusion from mental health care settings has been a national priority for Australia since 2005. This paper describes Australia's national seclusion data collection, and summarises changes in seclusion rates in Australian public mental health services. METHODS Seclusion events per 1000 patient days were calculated from 2009-2010 to 2014-2015 utilising state and territory administrative data sources. Combined national data were used to calculate results for a number of service characteristics, such as target population and location of the service. RESULTS The rate of seclusion events decreased by 43% over the 6 years. Child and adolescent services reported consistently higher rates of seclusion, but a shorter duration of seclusion episodes, compared with other service types. There is high variation in seclusion rates between individual services (range 0.0-53.0 seclusion events per 1000 bed days in 2014-2015). CONCLUSIONS Seclusion event rates in Australia's specialised public acute mental health hospital services are declining. The use of existing administrative data was instrumental in establishing a national data source to facilitate the monitoring and reporting of progress of seclusion reduction strategies.
Collapse
Affiliation(s)
- John A Allan
- Chief Psychiatrist, Department of Health Queensland and Chair, Safety and Quality Partnership Standing Committee, Herston, QLD, Australia
| | - Gary D Hanson
- Unit Head, Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Nicole L Schroder
- Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | - Anna J O'Mahony
- Australian Institute of Health and Welfare, Canberra, ACT, Australia
| | | | - Grant E Sara
- Sydney Medical School, University of Sydney, Sydney, NSW, and; Chair, Mental Health Information Strategy Standing Committee, NSW, Australia
| |
Collapse
|
17
|
Bradley P, Cunningham T, Lowell A, Nagel T, Dunn S. Secondary analysis of data can inform care delivery for Indigenous women in an acute mental health inpatient unit. Int J Ment Health Nurs 2017; 26:77-87. [PMID: 28000422 DOI: 10.1111/inm.12289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/30/2022]
Abstract
There is a paucity of research exploring Indigenous women's experiences in acute mental health inpatient services in Australia. Even less is known of Indigenous women's experience of seclusion events, as published data are rarely disaggregated by both indigeneity and gender. This research used secondary analysis of pre-existing datasets to identify any quantifiable difference in recorded experience between Indigenous and non-Indigenous women, and between Indigenous women and Indigenous men in an acute mental health inpatient unit. Standard separation data of age, length of stay, legal status, and discharge diagnosis were analysed, as were seclusion register data of age, seclusion grounds, and number of seclusion events. Descriptive statistics were used to summarize the data, and where warranted, inferential statistical methods used SPSS software to apply analysis of variance/multivariate analysis of variance testing. The results showed evidence that secondary analysis of existing datasets can provide a rich source of information to describe the experience of target groups, and to guide service planning and delivery of individualized, culturally-secure mental health care at a local level. The results are discussed, service and policy development implications are explored, and suggestions for further research are offered.
Collapse
Affiliation(s)
- Pat Bradley
- School of Health, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Teresa Cunningham
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Anne Lowell
- School of Health, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Sandra Dunn
- School of Health, Charles Darwin University, Casuarina, Northern Territory, Australia
| |
Collapse
|
18
|
Oster C, Gerace A, Thomson D, Muir-Cochrane E. Seclusion and restraint use in adult inpatient mental health care: An Australian perspective. Collegian 2016. [DOI: 10.1016/j.colegn.2015.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Wharewera-Mika JP, Cooper EP, Wiki NR, Field TR, Haitana J, Toko M, Edwards E, McKenna BRBMHSP. Strategies to reduce the use of seclusion with tāngata whai i te ora (Māori mental health service users). Int J Ment Health Nurs 2016; 25:258-65. [PMID: 27219838 DOI: 10.1111/inm.12219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/03/2015] [Accepted: 01/06/2016] [Indexed: 11/27/2022]
Abstract
Māori, the indigenous people of New Zealand, have the highest crude population-based rate of seclusion events reported internationally (McLeod et al. ). This qualitative study explored Māori clinical, cultural and consumer perspectives on potential strategies and initiatives considered likely to facilitate prevention of, and reduction in, the use of seclusion, with tāngata whai i te ora (Māori mental health service users) in mental health inpatient services. A hui (gathering) over 2 days was held with 16 Māori participants with high levels of clinical, cultural and consumer expertise. The gathering was taped and the tapes transcribed. A thematic analysis of the hui data generated three key categories: Te Ao Māori (access to a Māori worldview); Te Ao Hurihuri (transforming practice); and Rangatiratanga (leadership, power, and control). The findings of this study align with the "six core strategies" for best practice to reduce the use of seclusion (Huckshorn ). A comprehensive approach to the reduction of the use of seclusion with tāngata whai i te ora is required, which is clearly based on a Māori model of care and a vision for transformation of practice in mental health inpatient services, which involves Māori leadership.
Collapse
Affiliation(s)
| | | | - Nick Rn Wiki
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Trudie Rn Field
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Jason Haitana
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Mike Toko
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Erika Edwards
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Brian Rn Ba MHSc PhD McKenna
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand.,School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
20
|
One-year incidence and prevalence of seclusion: Dutch findings in an international perspective. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1857-69. [PMID: 26188503 DOI: 10.1007/s00127-015-1094-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 06/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Netherlands started a nationwide coercion reduction program in 2007. In 2011, accurate registration of coercive measures became obligatory by law. OBJECTIVE The aim of this study was to compare number and duration of coercive measures in the Netherlands with international data. METHODS 2011 data on coercive measures were collected, using a system developed in Germany. To understand determinants of coercion, multilevel logistic regression was performed. RESULTS 12.0 % (n = 5169) of patients (n = 42.960) in 2011 experienced at least one coercive measure. Exposure to coercion was comparable to other countries, and duration was higher. Medication use seemed to half average times in seclusion. In the Netherlands, coercion mainly constituted of seclusion and occurred in bipolar and psychotic disorders. In Germany, coercion was mostly mechanical restraint and occurred in organic disorders and schizophrenia. CONCLUSIONS Gathering comprehensive data allows comparisons between countries, increasing our understanding of the impact of different cultures, legislation and health care systems on coercion. In the Netherlands, seclusion is still the main type of coercion, despite significant improvements in the last few years. It is shorter when applied in combination with enforced medication.
Collapse
|
21
|
Bradley P, Dunn S, Lowell A, Nagel T. Acute mental health service delivery to Indigenous women: What is known? Int J Ment Health Nurs 2015; 24:471-7. [PMID: 26370896 DOI: 10.1111/inm.12161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The Australian College of Mental Health Nurses directs that mental health nurses must 'enable cultural safety in practice, taking into account age, gender, spirituality, ethnicity and health values'. The present study is a review of the existing literature undertaken in order to identify current knowledge and knowledge gaps regarding the experience of Indigenous women in acute mental health inpatient facilities. In particular, studies that identified environments and practices promoting the development of culturally-safe healing spaces for Indigenous women, and studies that identified women's experience of seclusion, were sought. The results showed that there is little literature directly relevant to Indigenous women's experiences of inpatient mental health units in Australia. The present study consolidates existing knowledge and knowledge gaps, and advances the argument for gender-disaggregated future research. Implications for professional practice and service development are also noted.
Collapse
Affiliation(s)
- Pat Bradley
- School of Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Sandra Dunn
- School of Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Lowell
- School of Health, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| |
Collapse
|
22
|
Ward L, Gwinner K. “It Br
o
ke O
u
r H
ea
rts”: Understanding Parents’ Lived Experiences of Their Child’s Admission to an Acute Mental Health Care Facility. J Psychosoc Nurs Ment Health Serv 2014; 52:24-9. [DOI: 10.3928/02793695-20140324-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/30/2014] [Indexed: 11/20/2022]
|
23
|
van de Sande R, Noorthoorn E, Wierdsma A, Hellendoorn E, van der Staak C, Mulder CL, Nijman H. Association between short-term structured risk assessment outcomes and seclusion. Int J Ment Health Nurs 2013; 22:475-84. [PMID: 23841809 DOI: 10.1111/inm.12033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research findings indicate that the symptoms and behaviour of acute psychiatric patients can fluctuate drastically within hours, and that structured daily risk assessments can reduce the risk of aggressive incidents and the duration of seclusion. The aim of this study was to investigate the validity of two structured observation tools, the Brøset Violence Checklist (BVC) and the Kennedy Axis V), as an aid in seclusion-related clinical decision-making. In this study, 7403 day-to-day risk assessments were collected over 10 725 admission days (72% of the maximum number of structured assessments). A total of 7055 daily assessment scores from 301 acute psychiatric patients were used for the multilevel analysis. The sample demonstrated that dynamic and static factors were related to seclusion. Dynamic factors included dysfunctional scores on the item 'confusion' of the Brøset Violence Checklist, and psychological impairment and impairment of social skills on the Kennedy Axis V. Static factors included non-Western descent, male sex, age less than 35 years, unmarried, and to some extent, a personality disorder. McFadden's pseudo R(2) value showed that most of the final model was related to the dynamic factors. We concluded that the incorporation of the BVC and the Kennedy Axis V into standard practice was helpful in identifying patients at high risk of seclusion.
Collapse
Affiliation(s)
- Roland van de Sande
- Department of Health, Utrecht University of Applied Science, Utrecht, Netherlands; Acute Psychiatric Care, ParnassiaGroep, Capelle aan den Ijsel, Netherlands
| | | | | | | | | | | | | |
Collapse
|
24
|
Sambrano R, Cox L. 'I sang Amazing Grace for about 3 hours that day': understanding Indigenous Australians' experience of seclusion. Int J Ment Health Nurs 2013; 22:522-31. [PMID: 23419020 DOI: 10.1111/inm.12015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Research shows that Indigenous Australians' suspicion and fear of being 'locked up' may influence mental health service avoidance. Given this, the aim of this study was to explore, by qualitative analysis of in-depth interviews (n = 3), how three Indigenous people experienced the controversial practice of seclusion. Hans-Georg Gadamer's phenomenology guided analysis of the material, and allowed narrated experiences to be understood within their cultural and historical context. Participants viewed seclusion negatively: police involvement in psychiatric care; perceptions of being punished and powerless; occasions of extreme use of force; and lack of care were prominent themes throughout the interviews. While power imbalances inherent in seclusion are problematic for all mental health clients, the distinguishing factor in the Indigenous clients' experience is that seclusion is continuous with the discriminatory and degrading treatment by governments, police, and health services that many Indigenous people have experienced since colonization. The participants' experiences echoed Goffman's findings that institutional practices act to degrade and dehumanize clients whose resulting conformity eases the work of nursing staff. While some nurses perceive that seclusion reduces clients' agitation, one must ask at what cost to clients' dignity, humanity, and basic human rights.
Collapse
Affiliation(s)
- Rachel Sambrano
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | | |
Collapse
|
25
|
Noda T, Sugiyama N, Sato M, Ito H, Sailas E, Putkonen H, Kontio R, Joffe G. Influence of patient characteristics on duration of seclusion/restrain in acute psychiatric settings in Japan. Psychiatry Clin Neurosci 2013; 67:405-11. [PMID: 23941159 DOI: 10.1111/pcn.12078] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 12/06/2012] [Accepted: 12/08/2012] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study was to investigate the current state of duration of seclusion/restraint in acute psychiatric settings in Japan and the effect of patient characteristics on duration of seclusion/restraint. METHODS During an 8-month period starting from November 2008, duration of seclusion/restraint and patient characteristics were investigated in 694 psychiatric inpatients who experienced seclusion/restraint in three emergency and three acute wards at four psychiatric hospitals. Reasons for starting seclusion/restraint were also assessed. Analysis was performed using generalized linear models, with the duration of seclusion/restraint as the dependent variable and patient characteristics and reasons for starting seclusion/restraint as independent variables. RESULTS Of the patients secluded/restrained, 58.6% had a primary diagnosis of schizophrenia (F20-F29) and a large proportion (37.9%) were secluded/restrained due to hurting others. Median hours ofseclusion/restraint were 204 and 82 h, respectively. The duration of seclusion was longer for patients with F20-F29 than those with disorders due to psychoactive substance use (F10-F19) or other diagnoses (F40-F99), and when the reason was danger of hurting others. In contrast, the duration of restraint in female patients and in patients with F10-F19 diagnosis was shorter. CONCLUSION The duration of seclusion/restraint at acute psychiatric care wards in Japan are much longer than those reported by previous overseas studies. Although Japanese structure issues such as more patients per ward and a lower ratio of nurses need to be considered, skills for dealing with patients with primary diagnosis of F20-F29 secluded due to danger posed to others should be improved.
Collapse
Affiliation(s)
- Toshie Noda
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Happell B, Dares G, Russell A, Cokell S, Platania-Phung C, Gaskin CJ. The relationships between attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism in a district health service. Issues Ment Health Nurs 2012; 33:329-36. [PMID: 22545640 DOI: 10.3109/01612840.2011.644028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The main purpose of this study was to investigate the relationships between attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Staff at one district health service inpatient unit (n = 54) completed surveys on their attitudes toward seclusion and levels of burnout, staff satisfaction, and therapeutic optimism. Several moderately large correlations were found between perceiving the patients as feeling punished by seclusion and intrinsic satisfaction (r(s) = -.45, p = .001), and between patients asking to go to the seclusion room and personal accomplishment (r(s) = -.39, p = .002). In general, however, most correlations were small or negligible in size. The influence of nurses on the practice of seclusion was clear, with 72% of participants indicating it was nurses who most often make decisions regarding seclusion. Some participants appear to have a broad interpretation of when seclusion should be used, raising doubts about whether it is being employed solely as a measure of last resort. Given their high level of involvement in seclusions, nurses need to be actively involved in organisation-wide initiatives to reduce the use of this practice.
Collapse
Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, and School of Nursing and Midwifery, CQ University Australia, Rockhampton, Queensland, Australia.
| | | | | | | | | | | |
Collapse
|
27
|
Happell B, Hoey W, J Gaskin C. The characteristics of consumers receiving case management in the community: a review of literature. Issues Ment Health Nurs 2012; 33:145-8. [PMID: 22364425 DOI: 10.3109/01612840.2011.627107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Mental health nurses increasingly provide care for consumers in the community who once would have received treatment in psychiatric inpatient units. The purpose of this review is to determine the characteristics of these consumers. We searched electronic databases and obtained information on some of the characteristics of community mental health consumers. For some nurses, over half of their caseloads are consumers with schizophrenia. Up to about one-third of consumers may be involuntary, but this proportion varies considerably. Impairments of health and social functioning appear common among consumers of community mental health services. This study identifies the need for greater interrogation of national databases to enhance understanding of community caseloads.
Collapse
Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, and School of Nursing and Midwifery, CQ University Australia, Rockhampton, Queensland, Australia.
| | | | | |
Collapse
|
28
|
Abstract
Seclusion has become a contentious practice and initiatives have commenced to reduce or eliminate its use. This paper presents the initiatives that were introduced during a seclusion reduction project that was undertaken at an Australian forensic hospital. These initiatives are based on the six core strategies that have been successfully used in North America to reduce seclusion. However, there are challenges (patient characteristics, prisoner culture and ensuring safety) and opportunities (longer admissions, higher staff-patient ratio, staff confidence, sound risk assessment and management) that can influence projects to reduce seclusion in a forensic hospital. During this project, the frequency (mainly multiple seclusions of patients) and duration of seclusion events were reduced but there was less reduction in the number of patients that were secluded. It is possible that the strategies were successfully supported by the identified opportunities to reduce the frequency and duration of seclusion but the challenges were significantly powerful in the early period of admission to prompt the need for seclusion. Reducing seclusion in a forensic hospital is a complex undertaking as nurses must provide a safe environment while dealing with volatile patients and may have little alternative at present but to use seclusion after exhausting other interventions.
Collapse
Affiliation(s)
- T Maguire
- Victorian Institute of Forensic Mental Health, Fairfield, Australia.
| | | | | |
Collapse
|
29
|
Kontio R, Joffe G, Putkonen H, Kuosmanen L, Hane K, Holi M, Välimäki M. Seclusion and restraint in psychiatry: patients' experiences and practical suggestions on how to improve practices and use alternatives. Perspect Psychiatr Care 2012; 48:16-24. [PMID: 22188043 DOI: 10.1111/j.1744-6163.2010.00301.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study explored psychiatric inpatients' experiences of, and their suggestions for, improvement of seclusion/restraint, and alternatives to their use in Finland. METHODS The data were collected by focused interviews (n= 30) and were analyzed with inductive content analysis. RESULTS Patients' perspectives received insufficient attention during seclusion/restraint processes. Improvements (e.g., humane treatment) and alternatives (e.g., empathetic patient-staff interaction) to seclusion/restraint, as suggested by the patients, focused on essential parts of nursing practice but have not been largely adopted. PRACTICE IMPLICATIONS Patients' basic needs have to be met, and patient-staff interaction has to also continue during seclusion/restraint. Providing patients with meaningful activities, planning beforehand, documenting the patients' wishes, and making patient-staff agreements reduce the need for restrictions and offer alternatives for seclusion/restraint. Service users must be involved in all practical development.
Collapse
Affiliation(s)
- Raija Kontio
- Department of Psychiatry, University of Turku, Department of Nursing Science, Turku, Finland.
| | | | | | | | | | | | | |
Collapse
|
30
|
Exploring patterns of seclusion use in Australian mental health services. Arch Psychiatr Nurs 2011; 25:e1-8. [PMID: 21978809 DOI: 10.1016/j.apnu.2011.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/19/2011] [Accepted: 04/02/2011] [Indexed: 01/01/2023]
Abstract
Seclusion has remained a common practice in mental health services. In Australia, recent mental health policy has reflected a desire to reduce (and, if possible, eliminate) the use of seclusion. The collection and analysis of data on the use of seclusion have been identified as an important component of the success of reduction initiatives. A cross-sectional design was used in the collection of inpatient unit data on seclusions that occurred in 11 mental health services in Australia over a 6-month period. During this time, there were 4,337 episodes of care. One or more seclusions occurred in 6.8% of episodes of care, with consumers being secluded, on average, 2.32 times and with 44% of them having been secluded more than once. The average length of the seclusions was 2 hours 52 minutes, with 51.4% of seclusions being less than 2 hours. These rates were lower than those reported in previous research studies. The practice of seclusion occurred more commonly on the first 2 days following admission, on weekdays than weekends, and between the hours of 9:00 a.m. and midnight. An understanding of seclusion data can provide fundamental information from which strategies to reduce seclusion can be developed.
Collapse
|