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Paul FA, Ganie AUR, Dar DR, Saikia P, Banerjee I. Exploring psychiatric patient restraints: Balancing safety, ethics, and patient rights in mental healthcare. Asian J Psychiatr 2024; 96:104051. [PMID: 38643681 DOI: 10.1016/j.ajp.2024.104051] [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: 02/21/2024] [Revised: 03/26/2024] [Accepted: 04/12/2024] [Indexed: 04/23/2024]
Abstract
Restraint, often linked with limiting an individual's freedom of movement, has become a focal point of extensive discussion and evaluation within the realm of mental healthcare. Striking a delicate balance between ensuring individual safety and minimizing reliance on restraint methods poses a significant challenge. In mental health inpatient settings, the prevalent forms of restraint encompass physical, chemical, environmental, and psychological methods. Paradoxically, the consequences of employing restraint can be severe, ranging from injuries and cognitive decline to sedation and, in extreme cases, fatalities. This paper seeks to offer a nuanced exploration of the landscape surrounding psychiatric patient restraints, considering both global perspectives and specific insights from the Indian context. The guidelines outlined in India's Mental Healthcare Act of 2017, which governs the use of restraint on individuals suffering with mental illnesses, are also examined in detail.
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Affiliation(s)
- Fayaz Ahmad Paul
- Department of Psychiatric Social Work, LGB Regional Institute of Mental Health, Tezpur, Assam, India.
| | - Aasim Ur Rehman Ganie
- Sharda School of Humanities and Social Sciences, Sharda University, Knowledge Park-3, Greater Noida 201310, India.
| | - Danishwar Rasool Dar
- Department of Psychiatric Social Work, LGB Regional Institute of Mental Health, Tezpur, Assam, India.
| | - Priyanka Saikia
- Department of Psychiatric Social Work, LGB Regional Institute of Mental Health, Tezpur, Assam, India.
| | - Indrajeet Banerjee
- Department of Psychiatric Social Work, LGB Regional Institute of Mental Health, Tezpur, Assam, India.
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2
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Gupta S, Bhandari SS, Gautam M, Grover S. Clinical practice guidelines on the environment and mental well-being. Indian J Psychiatry 2024; 66:S372-S390. [PMID: 38445269 PMCID: PMC10911325 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_792_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 03/07/2024] Open
Affiliation(s)
- Snehil Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Samrat Singh Bhandari
- Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India
| | - Manaswi Gautam
- Department of Psychiatry, Gautam Hospital and Institute of Behavioural Sciences, Jaipur, Rajasthan, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India E-mail:
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3
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Napoli G, Cannone M, Garzitto M, Colizzi M, Balestrieri M. Prevalence and Risk Factors for Absconding from an Open-Door, No-Restraint Inpatient Psychiatric Unit: A Single-Center Study in Italy. Behav Sci (Basel) 2023; 13:bs13010058. [PMID: 36661630 PMCID: PMC9854979 DOI: 10.3390/bs13010058] [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: 11/26/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Absconding from inpatient psychiatric services has been associated with poor outcomes, putting the patient and community at risk and prolonging the recovery process. A retrospective study investigated the absconding rates and risk factors among patients admitted to an open-door, no-restraint inpatient psychiatric unit. Overall, the absconding rate was 4.5%, and the relative risk of absconding was higher for male, younger, and non-Caucasian patients as well as for those who had already absconded, were unknown to health services, compulsorily admitted, admitted for substance abuse, and in the first days of hospitalization. The findings of this study may have important public health implications.
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Affiliation(s)
- Giovanni Napoli
- General Hospital Psychiatric Unit (GHPU), Department of Mental Health, Friuli Centrale Health University Authority, 33100 Udine, Italy
| | - Marcella Cannone
- General Hospital Psychiatric Unit (GHPU), Department of Mental Health, Friuli Centrale Health University Authority, 33100 Udine, Italy
| | - Marco Garzitto
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
| | - Marco Colizzi
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
- Correspondence:
| | - Matteo Balestrieri
- Unit of Psychiatry, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
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4
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Oeljeklaus L, Schmid HL, Kornfeld Z, Hornberg C, Norra C, Zerbe S, McCall T. Therapeutic Landscapes and Psychiatric Care Facilities: A Qualitative Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031490. [PMID: 35162518 PMCID: PMC8835684 DOI: 10.3390/ijerph19031490] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/27/2023]
Abstract
The environment in healthcare facilities can influence health and recovery of service users and furthermore contribute to healthy workplaces for staff. The concept of therapeutic landscapes seems to be a promising approach in this context. The aim of this qualitative meta-analysis is to review the effects of therapeutic landscapes for different stakeholders in psychiatric care facilities. A systematic literature search was conducted in the four data bases PubMed, PsycInfo, CINAHL, and Web of Science. Thirteen predominately qualitative studies were included in this qualitative meta-analysis. The methodological quality of these qualitative studies was assessed, using an adapted version of the Journal Article Reporting Standards for Qualitative Research, and a thematic analysis was conducted. The results were categorised into the three main themes of the physical (built and natural), social, and symbolic dimensions of the therapeutic landscape. Given the heterogeneity of the summarised data and an overall methodological quality of the included studies that can be rated as medium, the results should be interpreted with caution. Current findings are based almost exclusively on qualitative studies. Therefore, there is a need for quantitative study designs that investigate the relationship between specific environmental elements and mental health outcomes for different stakeholders in psychiatric facilities.
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Affiliation(s)
- Lydia Oeljeklaus
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Hannah-Lea Schmid
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
| | - Zachary Kornfeld
- LWL-Hospital Paderborn, Psychiatry Psychotherapy Psychosomatic, 33098 Paderborn, Germany; (Z.K.); (C.N.)
- Medical Faculty, Ruhr University Bochum, 44801 Bochum, Germany
| | - Claudia Hornberg
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
| | - Christine Norra
- LWL-Hospital Paderborn, Psychiatry Psychotherapy Psychosomatic, 33098 Paderborn, Germany; (Z.K.); (C.N.)
- Medical Faculty, Ruhr University Bochum, 44801 Bochum, Germany
| | - Stefan Zerbe
- Faculty of Science and Technology, Free University of Bozen-Bolzano, 39100 Bolzano, Italy;
| | - Timothy McCall
- Medical School OWL, Bielefeld University, 33615 Bielefeld, Germany; (L.O.); (H.-L.S.); (C.H.)
- Correspondence: ; Tel.: +49-521-106-67898
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5
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Weber C, Monero Flores V, Wheele TP, Miedema E, White EV. Patients' Health & Well-Being in Inpatient Mental Health-Care Facilities: A Systematic Review. Front Psychiatry 2022; 12:758039. [PMID: 35046849 PMCID: PMC8761847 DOI: 10.3389/fpsyt.2021.758039] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 12/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Previous research indicates that the physical environment of healthcare facilities plays an important role in the health, well-being, and recovery outcomes of patients. However, prior works on mental healthcare facilities have incorporated physical environment effects from general healthcare settings and patient groups, which cannot be readily transferred to mental healthcare settings or its patients. There appears to be a specific need for evidence synthesis of physical environmental effects in mental healthcare settings by psychopathology. Purpose: This review evaluates the state (in terms of extent, nature and quality) of the current empirical evidence of physical environmental on mental health, well-being, and recovery outcomes in mental healthcare inpatients by psychopathology. Method: A systematic review (PRISMA guidelines) was performed of studies published in English, German, Dutch, Swedish, and Spanish, of all available years until September 2020, searched in Cochrane, Ovid Index, PsycINFO, PubMed, and Web of Science and identified through extensive hand-picking. Inclusion criteria were: Adult patients being treated for mental ill-health (common mental health and mood disorders, Cochrane frame); inpatient mental health care facilities; specifications of the physical and socio-physical environment (e.g., design features, ambient conditions, privacy); all types of empirical study designs. Quality assessment and data synthesis were undertaken. Results: The search retrieved 1,068 titles of which 26 met the inclusion criteria. Findings suggest that there is only indicative evidence of the impact of the physical healthcare environment on patients' mental health, well-being, and recovery outcomes. There is significant lack of pathology-specific evidence. Methodological shortcomings and empirical scarcity account for the poor evidence. Conclusion: This review highlights the need for more research using advanced study designs.
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Affiliation(s)
- Clara Weber
- Institute of Facility Management, Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
- Environmental Psychology Department, School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Virna Monero Flores
- Institute of Facility Management, Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Theresa Poppy Wheele
- Institute of Facility Management, Life Sciences and Facility Management, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Elke Miedema
- Architectural Theory and Methods, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Emma Victoria White
- Environmental Psychology Department, School of Psychology, University of Surrey, Guildford, United Kingdom
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6
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Molin J, Strömbäck M, Lundström M, Lindgren BM. It's Not Just in the Walls: Patient and Staff Experiences of a New Spatial Design for Psychiatric Inpatient Care. Issues Ment Health Nurs 2021; 42:1114-1122. [PMID: 34142934 DOI: 10.1080/01612840.2021.1931585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The environment in psychiatric inpatient care is key to patient recovery and staff job satisfaction. In this qualitative study of patient and staff experiences of a new spatial design in psychiatric inpatient care, we analysed data from 11 semi-structured interviews with patients and five focus group discussions with staff using qualitative content analysis. The new design contributed to feelings of safety and recovery, but patients and staff also reported some frustration and added stress. The results lead us to conclude that while the new spatial design improves some conditions for recovery and job satisfaction, the design itself is simply not enough. Changes in care environments require that both patients and staff be informed and involved in the renovation to ensure that patients feel respected and staff feel confident in using the new environment before and during treatment and follow-ups.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden
| | - Maria Strömbäck
- Department of Clinical Sciences, Division of Psychiatry, Umeå University, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Division of Physiotherapy, Umeå University, Umeå, Sweden
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Muir-Cochrane E, Muller A, Oster C. Absconding: A qualitative perspective of patients leaving inpatient psychiatric care. Int J Ment Health Nurs 2021; 30:1127-1135. [PMID: 33817936 DOI: 10.1111/inm.12863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/27/2022]
Abstract
Absconding from inpatient psychiatric care is a complex problem with significant and broad ranging effects for patients, staff, family/carers, and the broader community. Absconding includes leaving the ward without permission and failing to return from leave at an agreed time. This study is a retrospective chart audit of a data set of absconding events from 11 psychiatric wards in a metropolitan Australian city. The data set included both quantitative and qualitative data. The focus of this study is analysis of the qualitative data documenting what happened during events, with quantitative data provided to contextualize the qualitative analysis. A total of 995 absconding events by 488 patients were reported between January 2016 and June 2018, representing a rate of 1.6 per 100 admissions. Two themes were identified in the qualitative analysis. 'Having things to do' encompassed opportunistic absconding and volitional absconding. 'Something changed' represented predisposing events that affected the absconding behaviour, such as being stepped down in care (moving from a more acute to a less acute psychiatric unit), receiving bad news, or interpersonal conflict either between patients or between nursing staff and patients. Results highlight the importance of harm minimization strategies to reduce the incidence of absconding.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Amanda Muller
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Bradley P, Lowell A, Daiyi C, Macklin K, Nagel T, Dunn S. It's a little bit like prison, but not that much: Aboriginal women's experiences of an acute mental health inpatient unit. Int J Ment Health Nurs 2021; 30:917-930. [PMID: 33630404 DOI: 10.1111/inm.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
This research aimed to gain an understanding of the acute mental health inpatient experience as described by Aboriginal women during admission. It recorded for the first time the words of Aboriginal women within the inpatient unit, including their perceptions of factors which may promote or impede a culturally safe environment. Eleven Aboriginal women inpatients gave interviews before discharge from the inpatient unit. Five Aboriginal Reference Group (ARG) members with experience of the inpatient unit also gave interviews, adding 'insider-outsider' perspectives. Interviews were recorded, transcribed, entered into NVivo software, and analysed inductively to raise codes and develop themes. Five interconnecting themes emerged: Social Context: life experience preceding, shaping, and following admission; Connection: with kin, community, and culture. Control: self-determination, legally and physically curtailed; Caring: actions promoting reconnection and self-determination; Communication: conveying caring and supporting agency, reconnection, and return to community. Findings reflected inpatient issues reported in previous studies, adding insights into the cultural concerns of Aboriginal women and offering practical clinical implications for culturally secure service delivery in an inpatient setting. Existing literature offered a basis for developing the model offered here for transcultural interaction for recovery in an inpatient setting. Attention to these findings can enhance Aboriginal women's inpatient experience and promote further research. The article complies with the COREQ-32 checklist for describing qualitative studies.
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Affiliation(s)
- Patricia Bradley
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne Lowell
- Charles Darwin University, Darwin, Northern Territory, Australia
| | - Cherise Daiyi
- Top End Mental Health & AOD Services, Darwin, Northern Territory, Australia
| | - Karen Macklin
- Top End Mental Health & AOD Services, Darwin, Northern Territory, Australia
| | - Tricia Nagel
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Sandra Dunn
- Charles Darwin University, Darwin, Northern Territory, Australia
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Kaggwa MM, Acai A, Rukundo GZ, Harms S, Ashaba S. Patients' perspectives on the experience of absconding from a psychiatric hospital: a qualitative study. BMC Psychiatry 2021; 21:371. [PMID: 34311731 PMCID: PMC8311958 DOI: 10.1186/s12888-021-03382-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Absconding (i.e., escaping) is common among patients with mental illness admitted to psychiatric hospitals. Patients use various strategies to make absconding successful due to the experiences faced during admission. We conducted a study to identify patients' perspectives on the experience of absconding from the psychiatry facility. METHODS We conducted 10 in-depth interviews with patients with a history of absconding from the hospital who were accessing care at the Mbarara Regional Referral Hospital in Mbarara city Uganda. Interviews were audio-recorded, translated when required, transcribed into English, and analyzed thematically to identify relevant themes. RESULTS Participants ranged in age from 18 to 55 and the majority (n = 9) were male. Most had absconded at least twice from a psychiatric facility. We identified different experiences that influenced patients' engagement in absconding from the psychiatry hospital ward. These included: (1) stigma, (2) experiences with caregivers: mixed emotions, (3) poor resources and services, and (4) the influence of mental illness symptoms. The loneliness of stigma, negative emotions associated with the loss of important roles given the nature and framework of caregiving on the psychiatric ward, as well as the stress of limited resources were a salient part of the patient experience as it relates to absconding. CONCLUSION Our findings indicate that absconding is a symptom of a larger problem with a mental health system that perpetuates stigma in its design, isolates patients and makes them feel lonely, and forces patients to rely on caregivers who infantilize them and take away all their freedom in a facility with no basic services. For many patients, this makes absconding the only option. Within such a system, all stakeholders (policymakers, health-care providers, caregivers, and patients) should be involved in rethinking how psychiatric facilities should be operated to make the journey of patient recovery more positive.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Anita Acai
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Sheila Harms
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
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Isobel S, Wilson A, Gill K, Howe D. 'What would a trauma-informed mental health service look like?' Perspectives of people who access services. Int J Ment Health Nurs 2021; 30:495-505. [PMID: 33219725 DOI: 10.1111/inm.12813] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 01/08/2023]
Abstract
Trauma-informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re-traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma-informed. However, how Australian mental health services should deliver trauma-informed care is not well documented. Efforts towards trauma-informed care in any setting require engagement with those who receive care. This qualitative study used an experience-based co-design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question 'what would a trauma-informed mental health service look like?' Focus groups were held with consumers (n = 10) and carers (n = 10). Thematic analysis of transcripts identified that consumers and carers consider that trauma-informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma-informed care across settings.
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Affiliation(s)
- Sophie Isobel
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Allyson Wilson
- Mental Health Services, Mid North Coast Local Health District, Port Macquarie, New South Wales, Australia
| | - Katherine Gill
- Consumer Led Research Network, University of Sydney, Sydney, New South Wales, Australia
| | - Deborah Howe
- NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
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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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Abstract
Patients who abscond from acute inpatient psychiatric wards put themselves and others at risks of variable nature and severity. There is a limited understanding of what motivates them to do so. The research in this area is limited and predominantly outdated. To better understand the characteristics, patterns and predictors of people who abscond from hospital, this study compared absconding and non-absconding patients in a tertiary public hospital. Demographic and clinical characteristics were audited for patients who absconded (n = 159) and who did not abscond (n = 100) throughout a 2-year period. Patients who absconded in the public settings were more likely to be male, have suffered from a psychotic illness, had an increased number of psychiatric comorbidities, had a history of aggression, and used greater numbers of substances. They also had experienced homelessness, were case managed, and were managed as involuntary patients. Predictors were similar, and included involuntary legal status, greater number of substances used, greater numbers of comorbid psychiatric illnesses, polysubstance use, an absence of self-harm history, shorter duration of admission and male sex. This study has implications for the identification of those who are at greater risk of absconding from an inpatient unit. Through enhanced understanding, greater measures can be taken to minimise absconding and its associated risks.
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13
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Cutler NA, Halcomb E, Sim J, Stephens M, Moxham L. How does the environment influence consumers' perceptions of safety in acute mental health units? A qualitative study. J Clin Nurs 2021; 30:765-772. [PMID: 33348440 DOI: 10.1111/jocn.15614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/26/2020] [Accepted: 12/13/2020] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES To explore how the physical and social environment of acute mental health units influences consumers' perception and experience of safety. BACKGROUND Acute mental health units are places in which consumers should feel safe. Not all consumers, however, feel safe in this environment. Little is known about what contributes to consumers' feelings of safety in this setting. DESIGN The study used a qualitative descriptive design, influenced by naturalistic enquiry. Data were analysed using thematic analysis and are reported according to the COREQ checklist. METHODS Fifteen people who had experienced admission to an acute mental health unit were individually interviewed. RESULTS Having a supportive environment enhanced consumers' perception and experience of safety. A supportive environment was experienced when consumers had privacy, felt safe from other consumers and had meaningful activities to participate in within the acute mental health unit. In contrast, having their privacy breached by other consumers made participants feel unsafe. Many participants were fearful of other consumers, and felt unsafe and unable to protect themselves. Lack of meaningful activities led to boredom and contributed to consumers feeling unsafe. CONCLUSIONS Personal spaces should address consumers' privacy needs without compromising staff access. Staff presence enhances consumers' feelings of safety, but this need can be heightened when consumers are unable to alert staff when they feel unsafe. Meaningful activities link consumers to their lives outside of the hospital and can enhance recovery. RELEVANCE TO CLINICAL PRACTICE Understanding how the acute unit environment is perceived by consumers can assist nurses and managers to promote feelings of safety among consumers. Feeling safe can, in turn, optimise recovery.
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Affiliation(s)
- Natalie Ann Cutler
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Moira Stephens
- Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
| | - Lorna Moxham
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health & Medical Research Institute, Wollongong, NSW, Australia
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14
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Sugiura K, Pertega E, Holmberg C. Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 73:101645. [PMID: 33246221 DOI: 10.1016/j.ijlp.2020.101645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/26/2020] [Accepted: 10/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND In involuntary psychiatric admission, used globally, professionals or caretakers decide upon hospitalization regardless of what the person with psychosocial disabilities decides. This raises clinical, ethical, legal, and human rights concerns, and it goes against Convention on the Rights of Persons with Disabilities (CRPD). CRPD mandates that member states respect the autonomy of people with disabilities. Through Article 12, it recognizes full enjoyment of legal capacity for persons with disabilities. Implementation of Article 12 is challenging in every country, and exploring all the stakeholders' experiences at admission decision-making will help us to understand the challenges that the current psychiatry system poses for service users to exercise their autonomy and identify the areas where service users need support to have their rights, will, and preferences respected. AIM To describe the experiences of service users, informal carers, and professionals in involuntary psychiatric admission decision-making and throughout the subsequent involuntary admission. We explored the support that the service users need to have their rights, will, and preferences respected. METHOD A search of twelve databases in medicine, sociology, and law in Danish, English, Japanese, Norwegian, Portuguese, Spanish, and Swedish was conducted in 2017 and 2018, limited to the past 10 years, using terms such as "involuntary," "admission," "mental illness," and "experience". The search identified 682 articles. Four researchers independently reviewed the articles to find those that completed original qualitative or mixed method studies exploring experiences of involuntary psychiatric admission among adults. We added seven publications from the articles' references, contacted experts in the field (no publications were added), and excluded two articles that were in German. Three researchers analyzed the articles' results using Thematic Analysis (PROSPERO registration number CRD42019072874). RESULTS Overall, 37 articles were included from 11 countries; they involved 731 service users, 100 informal carers, and 291 mental health professionals. We identified a lack of communication and a power imbalance among the stakeholders, which was exacerbated by the professionals' attitudes. At admission decision-making, the service users wanted to be heard and wanted to understand the situation. The families felt responsibility for the service users, they were careful not to ruin relationships, and they struggled to obtain support from the mental health system. Professionals believed that threats or harming others should lead to admission regardless of what the service users or their families felt. Professionals sometimes felt that it was not necessary to explain the information to the service users because they would not understand. Professionals were concerned and frustrated with difficulties in coordinating among themselves. During admission, service users struggled with the ward environment and relationship with staff; they most objected to coercion, such as forced medication. Families were frustrated that they were not involved in the treatment planning, especially as the service users moved toward discharge. The professionals often rationalized that coercion was necessary, and they believed that they knew what was best for the service users. CONCLUSIONS A lack of communication and a power imbalance among the stakeholders hindered respect for the service users' rights, will, and preferences. This was exacerbated by professionals rationalizing coercion and assuming that service users were incapable of understanding information. Services that encourage communication and overcome power imbalances (e.g. Crisis Plans, Family Group Conferencing) combined with stronger community mental health support will respect service users' rights, will, and preferences and avoid substituted decision-making on issues such as involuntary admission and forced medication.
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Affiliation(s)
- Kanna Sugiura
- Department of Mental Health, The University of Tokyo, Tokyo, Japan.
| | - Elvira Pertega
- Faculty of Law, University of Technology Sydney, Sydney, Australia
| | - Christopher Holmberg
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
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Cutler NA, Sim J, Halcomb E, Moxham L, Stephens M. Nurses' influence on consumers' experience of safety in acute mental health units: A qualitative study. J Clin Nurs 2020; 29:4379-4386. [DOI: 10.1111/jocn.15480] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie Ann Cutler
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Jenny Sim
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Elizabeth Halcomb
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Lorna Moxham
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
- Illawarra Health and Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Moira Stephens
- School of Nursing University of Wollongong Northfields Ave Wollongong NSW 2522 Australia
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16
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Donnelly J, Kavanagh A, Donohue G. Risky Business? A Year-Long Study of Adult Voluntary Admissions Who Leave Psychiatric in-Patient Care without Informing Staff. Issues Ment Health Nurs 2020; 41:840-845. [PMID: 32421458 DOI: 10.1080/01612840.2020.1725196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients leaving inpatient psychiatric care without informing staff can have serious consequences for patient welfare, their families and staff. Even in cases where there are no serious outcomes and patients return, treatment can be interrupted and staff morale compromised. Given these potential deleterious effects, it is important to have an in-depth understanding of why people leave when they do. The aim of this study is to examine the profile of service-users who leave in-patient psychiatric care without notifying staff and to determine their reasons for doing so, what they did when they left the hospital setting and reasons for returning. This is a prospective descriptive study of service users leaving without notifying staff from a national mental health service in Ireland. It investigated the frequency, timing, and motivations of these absconding events among a sample of in-patients over a 12-month period. This year-long review identified 75 episodes of leaving without notifying staff, 55 of which met this studies criteria. 22% of episodes were from a locked unit, 58.2% were repeated episodes. 89% of service users returned to hospital following the episode and 11% were discharged against medical advice. Although no fatalities, three service users were seen in an emergency department as a result of activity during leave. Upon return from leave, all service users were reviewed and their care plans were updated where necessary.
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Affiliation(s)
- Jennifer Donnelly
- Department of Nursing, St. Patrick's Mental Health Services, Dublin, Ireland
| | - Adam Kavanagh
- Department of Nursing, St. Patrick's Mental Health Services, Dublin, Ireland
| | - Gráinne Donohue
- Trinity Centre for Healthcare and Practice Innovation, School of Nursing and Midwifery, Trinity College, University of Dublin, Ireland
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Weich S, Fenton SJ, Staniszewska S, Canaway A, Crepaz-Keay D, Larkin M, Madan J, Mockford C, Bhui K, Newton E, Croft C, Foye U, Cairns A, Ormerod E, Jeffreys S, Griffiths F. Using patient experience data to support improvements in inpatient mental health care: the EURIPIDES multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
All NHS providers collect data on patient experience, although there is limited evidence about what to measure or how to collect and use data to improve services. We studied inpatient mental health services, as these are important, costly and often unpopular services within which serious incidents occur.
Aims
To identify which approaches to collecting and using patient experience data are most useful for supporting improvements in inpatient mental health care.
Design
The study comprised five work packages: a systematic review to identify evidence-based patient experience themes relevant to inpatient mental health care (work package 1); a survey of patient experience leads in NHS mental health trusts in England to describe current approaches to collecting and using patient experience data in inpatient mental health services, and to populate the sampling frame for work package 3 (work package 2); in-depth case studies at sites selected using the work package 2 findings, analysed using a realist approach (work package 3); a consensus conference to agree on recommendations about best practice (work package 4); and health economic modelling to estimate resource requirements and potential benefits arising from the adoption of best practice (work package 5). Using a realist methodology, we analysed and presented our findings using a framework based on four stages of the patient experience data pathway, for which we coined the term CRAICh (collecting and giving, receiving and listening, analysing, and quality improvement and change). The project was supported by a patient and public involvement team that contributed to work package 1 and the development of programme theories (work package 3). Two employed survivor researchers worked on work packages 2, 3 and 4.
Setting
The study was conducted in 57 NHS providers of inpatient mental health care in England.
Participants
In work package 2, 47 NHS patient experience leads took part and, in work package 3, 62 service users, 19 carers and 101 NHS staff participated, across six trusts. Forty-four individuals attended the work package 4 consensus conference.
Results
The patient experience feedback cycle was rarely completed and, even when improvements were implemented, these tended to be environmental rather than cultural. There were few examples of triangulation with patient safety or outcomes data. We identified 18 rules for best practice in collecting and using inpatient mental health experience data, and 154 realist context–mechanism–outcome configurations that underpin and explain these.
Limitations
The study was cross-sectional in design and we relied on examples of historical service improvement. Our health economic models (in work package 5) were therefore limited in the estimation and modelling of prospective benefits associated with the collection and use of patient experience data.
Conclusions
Patient experience work is insufficiently embedded in most mental health trusts. More attention to analysis and interpretation of patient experience data is needed, particularly to ways of triangulating these with outcomes and safety data.
Future work
Further evaluative research is needed to develop and evaluate a locally adapted intervention based on the 18 rules for best practice.
Study registration
The systematic review (work package 1) is registered as PROSPERO CRD42016033556.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Scott Weich
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah-Jane Fenton
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
| | | | - Charlotte Croft
- Warwick Business School, University of Warwick, Coventry, UK
| | - Una Foye
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Aimee Cairns
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stephen Jeffreys
- Mental Health Foundation, London, UK
- National Survivor User Network, London, UK
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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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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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20
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Martin J, Butler M, Muldowney A, Aleksandrs G. Carers of people from LGBTQ communities interactions with mental health service providers: Conflict and safety. Int J Ment Health Nurs 2019; 28:766-775. [PMID: 30779278 DOI: 10.1111/inm.12581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
This exploratory study examines the experiences of informal/family carers of people from LGBTQ communities living with mental illness, or experiencing a mental health crisis, in relation to conflict and safety in their interactions with mental health service providers. Carers were surveyed to gain an understanding of their experiences of services. The data were analysed according to the six main originating domains in the Safewards model where conflict may arise as well as the nature of the activity in the domain with the addition of new categories of 'carer characteristics' and 'carer modifiers'. The study findings identified the main domains where conflict occurred, as well as modifications to activities undertaken by staff, consumers, and carers that reduced tensions and misunderstandings. Carer responses revealed the interplay between the Safewards domains and activities and the location of much of what was considered conflict with staff reflecting the regulatory environment services were provided in. This study highlights distinctive carer characteristics and the important conflict modifying role of carers. The findings suggest that the expansion of the Safewards model to include carers may be beneficial.
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21
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Staniszewska S, Mockford C, Chadburn G, Fenton SJ, Bhui K, Larkin M, Newton E, Crepaz-Keay D, Griffiths F, Weich S. Experiences of in-patient mental health services: systematic review. Br J Psychiatry 2019; 214:329-338. [PMID: 30894243 DOI: 10.1192/bjp.2019.22] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.AimsTo conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare. METHOD A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review. RESULTS Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care. CONCLUSIONS A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.Declaration of interestK.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
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Affiliation(s)
- Sophie Staniszewska
- Professor of Patient and Public Involvement and Experiences of Care,Division of Health Sciences, Warwick Medical School,University of Warwick,UK
| | - Carole Mockford
- Senior Research Fellow,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Greg Chadburn
- Researcher,Surrey and Sussex Healthcare National Health Service Trust,UK
| | - Sarah-Jane Fenton
- Comparative Social Policy,PGCert Advanced Research Methods and Skills,PhD Social Policy,Research Fellow,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Kamaldeep Bhui
- Professor of Psychiatry,Centre for Psychiatry,Wolfson Institute of Preventive Medicine,Barts and The London School of Medicine and Dentistry,Queen Mary University of London,East London National Health Service Foundation Trust,UK
| | - Michael Larkin
- Reader in Psychology,School of Life and Health Sciences,Aston University,UK
| | - Elizabeth Newton
- Consultant Clinical Psychologist,Research Fellow, School of Psychology,University of Birmingham,UK
| | - David Crepaz-Keay
- Head of Empowerment and Social Inclusion,Mental Health Foundation,UK
| | - Frances Griffiths
- Professor of Medicine in Society,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Scott Weich
- Professor of Mental Health,Division of Health Sciences,Warwick Medical School,University of Warwick;and School of Health and Related Research (ScHARR),University of Sheffield,UK
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22
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Akther SF, Molyneaux E, Stuart R, Johnson S, Simpson A, Oram S. Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2019; 5:e37. [PMID: 31530313 PMCID: PMC6520528 DOI: 10.1192/bjo.2019.19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Understanding patient experiences of detention under mental health legislation is crucial to efforts to reform policy and practice. AIMS To synthesise qualitative evidence on patients' experiences of assessment and detention under mental health legislation. METHOD Five bibliographic databases were searched, supplemented by reference list screening and citation tracking. Studies were included if they reported on patient experiences of assessment or detention under mental health legislation; reported on patients aged 18 years or older; collected data using qualitative methods; and were reported in peer-reviewed journals. Findings were analysed and synthesised using thematic synthesis. RESULTS The review included 56 papers. Themes were generally consistent across studies and related to information and involvement in care, the environment and relationships with staff, as well as the impact of detention on feelings of self-worth and emotional state. The emotional impact of detention and views of its appropriateness varied, but a frequent theme was fear and distress during detention, including in relation to the use of force and restraint. Where staff were perceived as striving to form caring and collaborative relationships with patients despite the coercive nature of treatment, and when clear information was delivered, the negative impact of involuntary care seemed to be reduced. CONCLUSIONS Findings suggest that involuntary in-patient care is often frightening and distressing, but certain factors were identified that can help reduce negative experiences. Coproduction models may be fruitful in developing new ways of working on in-patient wards that provide more voice to patients and staff, and physical and social environments that are more conducive to recovery. DECLARATION OF INTEREST None.
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Affiliation(s)
| | - Emma Molyneaux
- Research Associate and Honorary Lecturer, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London, and Camden and Islington NHS Foundation Trust, UK
| | - Alan Simpson
- Professor of Collaborative Mental Health Nursing, Division of Nursing, School of Health Sciences, City University, UK
| | - Sian Oram
- Lecturer in Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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23
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Pelto-Piri V, Wallsten T, Hylén U, Nikban I, Kjellin L. Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden. Int J Ment Health Syst 2019; 13:23. [PMID: 30996733 PMCID: PMC6452515 DOI: 10.1186/s13033-019-0282-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care. Methods In this qualitative study, interviews with open-ended questions were conducted with 17 adult patients, five women and 12 men, from four settings: one general psychiatric, one psychiatric addiction and two forensic psychiatric clinics. The main question in the interview guide concerned patients' feelings of being safe or unsafe. Thematic content analysis with an inductive approach was used to generate codes and, thereafter, themes and subthemes. Results The main results can be summarized in three themes: (1) Predictable and supportive services are necessary for feeling safe. This concerns the ability of psychiatric and social services to meet the needs of patients. Descriptions of delayed care and unpredictable processes were common. The structured environment was mostly perceived as positive. (2) Communication and taking responsibility enhance safety. This is about daily life in the ward, which was often perceived as being socially poor and boring with non-communicative staff. Participants emphasized that patients have to take responsibility for their actions and for co-patients. (3) Powerlessness and unpleasant encounters undermine safety. This addresses the participants' way of doing risk analyses and handling unpleasant or aggressive patients or staff members. The usual way to act in risk situations was to keep away. Conclusions Our results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe. It seems to be important that staff provide patients with general information about the safety situation at the ward, without violating individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff.
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Affiliation(s)
- Veikko Pelto-Piri
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tuula Wallsten
- 2Centre for Clinical Research, Uppsala University, County Hospital Västerås, Västerås, Sweden
| | - Ulrika Hylén
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Lars Kjellin
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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24
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Fletcher J, Hamilton B, Kinner S, Sutherland G, King K, Tellez JJ, Harvey C, Brophy L. Working towards least restrictive environments in acute mental health wards in the context of locked door policy and practice. Int J Ment Health Nurs 2019; 28:538-550. [PMID: 30516024 DOI: 10.1111/inm.12559] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/29/2022]
Abstract
There has been a shift towards provision of mental health care in community-based settings in Australia. However, hospitals continue to care for people in acute mental health wards. An increasing proportion of the people in wards are admitted involuntarily, subject to restrictions of movement to minimize risk of harm to self and others. In response to concerns about the safety of people absconding from care, Queensland Health introduced a policy requiring all acute mental health wards in the State to be locked. In response, the Queensland Mental Health Commission funded a project to understand the impact of this policy and develop evidence-based recommendations regarding provision of least restrictive, recovery-oriented practices in acute wards. Facilitated forums were conducted with 35 purposively selected participants who identified as consumers, carers, or staff of acute mental health hospital wards, to test the acceptability, feasibility, and face validity of a set of evidence-informed recommendations for providing least restrictive, recovery-oriented practices. Participant responses were recorded, and data were analysed through an inductive, thematic approach. A recovery-oriented approach was supported by all stakeholders. Reducing boredom and increasing availability of peer support workers were considered key to achieving this. Focusing less on risk aversion was reported as central to enabling true Recovery Orientation. This project enabled recognition of the perspectives of consumers, carers, and staff in the consideration of evidence-informed recommendations that could be implemented to provide least restrictive care in the context of locked doors.
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Affiliation(s)
- Justine Fletcher
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- School of Health Sciences, Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart Kinner
- Royal Children's Hospital, Adolescent and Young Adult Health Equity Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Georgina Sutherland
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kylie King
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Juan Jose Tellez
- Melbourne Law School, Melbourne Social Equity Institute Carlton, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carol Harvey
- Department of Psychiatry, Psychosocial Research Centre, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, Centre for Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Mind Australia, Research, Development and Advocacy, Melbourne, Victoria, Australia.,The School of Allied Health, Latrobe University, Melbourne, Victoria, Australia
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25
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Seppänen A, Törmänen I, Shaw C, Kennedy H. Modern forensic psychiatric hospital design: clinical, legal and structural aspects. Int J Ment Health Syst 2018; 12:58. [PMID: 30377440 PMCID: PMC6195744 DOI: 10.1186/s13033-018-0238-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/11/2018] [Indexed: 11/10/2022] Open
Abstract
Forensic psychiatric care must be provided within the least restrictive setting possible, whilst simultaneously maintaining appropriate levels of security. This presents particular challenges for the design of forensic psychiatric hospitals, which are required to provide both a therapeutic and a safe material environment, often for extended periods of treatment and rehabilitation. By taking into consideration variable trends in psychiatric service provision and myriad clinical, legal and ethical issues, interdisciplinary forensic facility design teams are at the very forefront in implementing the latest developments in medical architecture. Also, although there are significant differences in how forensic psychiatric services are organized around the world, the underlying clinical challenges and increasingly research-based treatment principles are similar worldwide; it is therefore becoming less acceptable to operate and develop national forensic services without reference to international standards. Accordingly, we here review the literature on what features of forensic psychiatric facilities best serve the needs of those patients who need to rely on them, and we present a systematic and widely applicable approach to the complex and costly challenge of modern forensic psychiatric hospital design.
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Affiliation(s)
- Allan Seppänen
- Department of Psychoses and Forensic Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Vanha Vaasa Hospital, Vaasa, Finland
| | - Iida Törmänen
- Department of Psychoses and Forensic Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Department of ICT Psychiatry and Psychosocial Treatments, Helsinki University Hospital, Helsinki, Finland
| | | | - Harry Kennedy
- Department of Psychiatry, Trinity College, Dublin, Ireland
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
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26
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Wyder M, Roennfeldt H, Rosello RF, Stewart B, Maher J, Taylor R, Pfeffer A, Bell P, Barringham N. Our Sunshine place: A collective narrative and reflection on the experiences of a mental health crisis leading to an admission to a psychiatric inpatient unit. Int J Ment Health Nurs 2018; 27:1240-1249. [PMID: 29920905 DOI: 10.1111/inm.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2018] [Indexed: 11/27/2022]
Abstract
Acute mental health inpatient units are complex environments where tensions between clinical and personal recovery can be amplified. The focus for mental health staff is often centred on providing clinical care, whereas from the patient perspective, the admission can represent a profound existential crisis. There are very few user-led accounts of their experiences of psychiatric inpatient unit. This project was developed in the traditions of Analytic Auto-Ethnography, a research methodology which provides a systematic process to reflect on our own experience while still producing trustworthy findings. Through this process, a collective narrative and critical reflection of a group of over 20 individuals with experiences of either providing or receiving care in an acute psychiatric inpatient unit was developed. The narrative developed shows that for some the hospital admission was a time of healing; for others, the inpatient unit represented an alien and unsafe environment, which accentuated the strangeness of the experiences of mental ill health. Common themes among the group were that of an overarching need to make sense of what happened leading up to the admissions and to come to terms with the potential impact of the illness on identity and future. This journey can be best described as a process of healing and moving towards 'wholeness'. Safety, connection, autonomy and control were identified as factors which either facilitated or hindered the process of successfully integrating the various experiences.
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Affiliation(s)
- Marianne Wyder
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Helena Roennfeldt
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Rise Faith Rosello
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Bridie Stewart
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - John Maher
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Rosslyn Taylor
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Amanda Pfeffer
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Peter Bell
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
| | - Neil Barringham
- A Place to Belong, Anglicare Southern Queensland, West End, Queensland, Australia
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27
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Ådnanes M, Melby L, Cresswell-Smith J, Westerlund H, Rabbi L, Dernovšek MZ, Šprah L, Sfetcu R, Straßmayr C, Donisi V. Mental health service users' experiences of psychiatric re-hospitalisation - an explorative focus group study in six European countries. BMC Health Serv Res 2018; 18:516. [PMID: 29970098 PMCID: PMC6029175 DOI: 10.1186/s12913-018-3317-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/21/2018] [Indexed: 12/04/2022] Open
Abstract
Background Psychiatric re-hospitalisation is considered costly and disruptive to individuals. The perspective of the mental health service user is largely unexplored in literature. The purpose of our study was to explore service users’ experiences of psychiatric re-hospitalisation across six countries in Europe. Method Eight focus groups were conducted in Romania, Slovenia, Finland, Italy, Austria and Norway. Results A total of 55 service users participated in the study. All participants had been in receipt of mental health services for at least 1 year, and had experienced more than one psychiatric hospitalisation. The experience of re-hospitalisation was considered: (1) less traumatising than the first hospitalisation, (2) to be necessary, and a relief, (3) occurring by default and without progress, (4) part of the recovery process. Conclusions Psychiatric re-hospitalisation was considered inevitable by the study participants, in both positive and negative terms. Striking similarities in service user experiences were found across all of the six countries, the first experience of psychiatric hospitalisation emerging as especially significant. Findings indicate the need for further action in order to develop more recovery and person-centred approaches within hospital care. For psychiatric inpatient care to be a positive part of the recovery process, further knowledge on what therapeutic action during the hospital stay would be beneficial, such as therapy, activities and integration with other services. Electronic supplementary material The online version of this article (10.1186/s12913-018-3317-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Ådnanes
- Department of Health Research, SINTEF Technology and Society, PO Box 4760, 7465, Trondheim, Norway.
| | - L Melby
- Department of Health Research, SINTEF Technology and Society, PO Box 4760, 7465, Trondheim, Norway
| | - J Cresswell-Smith
- Mental Health Unit, National Institute for Health and Welfare (THL), PL 30, 00271, Helsinki, Finland
| | - H Westerlund
- KBT Foundation (Competence center for experiential knowledge and service development), PO Box 934, 7409, Trondheim, Norway
| | - L Rabbi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
| | - M Z Dernovšek
- Institute Karakter, Ježa 90, 1000, Ljubljana, Slovenia
| | - L Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Novi trg 2, 1001, Ljubljana, Slovenia
| | - R Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest (NSPHMPD), Faculty of Psychology and Educational Sciences, SHU Bucharest, Vaselor Street, No 31 Sector 2, 02125, Bucharest, Romania
| | - C Straßmayr
- IMEHPS.research - Forschungsinstitut für Sozialpsychiatrie, Glasergasse 24/23, A-1090, Vienna, Austria
| | - V Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, P.le L.A. Scuro, 10, 37134, Verona, Italy
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28
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Foster K, Isobel S. Towards relational recovery: Nurses' practices with consumers and families with dependent children in mental health inpatient units. Int J Ment Health Nurs 2018; 27:727-736. [PMID: 28721693 DOI: 10.1111/inm.12359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 11/29/2022]
Abstract
Facilitating parent-child and family connections during parental hospitalization provides important opportunities for mental health services to support individual and family recovery. Nurses are often the primary point of contact for families in the inpatient context. They play an integral role in the care provision of consumers and families and in supporting consumers' recovery. The aim of the present qualitative study was to explore nurses' practice with families in inpatient mental health settings in the context of designated family rooms. Three themes were derived from the thematic analysis of semistructured interviews with 20 nurses from four mental health inpatient units. Nurses experienced tensions within their roles in balancing safety and risk, a lack of confidence in family-focused practices in relation to role expectations, and challenges in juggling nursing care ideals with the contemporary realities of inpatient practice. A family-centred relational recovery approach is recommended for mental health services, which is underpinned by family-focused policies and processes, and supported at an organizational, managerial, and local-unit level. At an individual level, nurses need professional development on the models of care they practice in, explicit role clarity on their practice with families, and education on evidence-based brief family interventions.
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Affiliation(s)
- Kim Foster
- School of Nursing, Midwifery, and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Victoria, Australia
| | - Sophie Isobel
- Sydney Local Health District Mental Health Service, Sydney, New South Wales, Australia
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29
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Wilson C, Rouse L, Rae S, Kar Ray M. Mental health inpatients' and staff members' suggestions for reducing physical restraint: A qualitative study. J Psychiatr Ment Health Nurs 2018; 25:188-200. [PMID: 29323442 DOI: 10.1111/jpm.12453] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Restraint has negative psychological, physical and relational consequences for mental health patients and staff. Restraint reduction interventions have been developed (e.g., "Safewards"). Limited qualitative research has explored suggestions on how to reduce physical restraint (and feasibility issues with implementing interventions) from those directly involved. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper explores mental health patients' and staff members' suggestions for reducing physical restraint, whilst addressing barriers to implementing these. Findings centred on four themes: improving communication and relationships; staffing factors; environment and space; and activities and distraction. Not all suggestions are addressed by currently available interventions. Barriers to implementation were identified, centring on a lack of time and/or resources; with the provision of more time for staff to spend with patients and implement interventions seen as essential to reducing physical restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. Fundamental issues related to understaffing, high staff turnover, and lack of time and resources need addressing in order for suggestions to be successfully implemented. ABSTRACT Introduction Physical restraint has negative consequences for all involved, and international calls for its reduction have emerged. Some restraint reduction interventions have been developed, but limited qualitative research explores suggestions on how to reduce physical restraint (and feasibility issues with implementation) from those directly involved. Aims To explore mental health patients' and staff members' suggestions for reducing physical restraint. Methods Interviews were conducted with 13 inpatients and 22 staff members with experience of restraint on adult mental health inpatient wards in one UK National Health Service Trust. Results Findings centred on four overarching themes: improving communication and relationships between staff/patients; making staff-related changes; improving ward environments/spaces; and having more activities. However, concerns were raised around practicalities/feasibility of their implementation. Discussion Continued research is needed into best ways to reduce physical restraint, with an emphasis on feasibility/practicality and how to make time in busy ward environments. Implications for Practice Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. However, fundamental issues related to understaffing, high staff turnover and lack of time/resources need addressing in order for these suggestions to be successfully implemented.
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Affiliation(s)
- C Wilson
- Anglia Ruskin University, Faculty of Health, Social Care and Education, Department of Adult and Mental Health Nursing, Chelmsford, UK
| | - L Rouse
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, UK
| | - S Rae
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, UK
| | - M Kar Ray
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, UK
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30
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McEvedy SM, Furness T, McKenna B. Introduction of a drug-detection dog programme in mental health inpatient units: A mixed-methods study of consumer, staff, and carers' perceptions. Int J Ment Health Nurs 2018; 27:408-421. [PMID: 28589658 DOI: 10.1111/inm.12335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2017] [Indexed: 11/30/2022]
Abstract
Many consumers admitted to mental health inpatient units also use illicit drugs, and some continue to do so while receiving treatment. In an attempt to curb the impact of illicit drug use, one of Australia's largest mental health services introduced a programme of drug-detection dog (DDD) searches. Our aim was to evaluate perceptions of the DDD programme among mental health consumers, staff, and carers. A mixed-methods research design using a concurrent triangulation approach was adopted, involving three focus group discussions with consumer, staff, and carer groups, and a structured survey among 94 consumers who were receiving treatment and 102 staff working in the units at the time of a DDD visit. Data were analysed using thematic analysis, and descriptive and inferential statistics. Major themes were that: (i) drug use in these units is perceived as 'prevalent' and 'destructive'; (ii) the DDD programme is 'beneficial' but 'incongruous' in a health-care setting; (iii) consumers are 'uninformed'; and (iv) consequences should be 'customized' to circumstances. Survey results corroborated qualitative themes, with the exception that although concerns about incongruity do exist, they were not prevalent and were outweighed by positive perceptions of the programme. Most perceptions were consistent between consumers and staff. However, consumers tended to think that, if found, drugs should be confiscated, whereas staff were more strongly in favour of the consumer being discharged. In conclusion, the DDD programme was seen as a positive step towards addressing drug use in mental health units. However, improved dissemination of information to consumers through verbal and written communication is required.
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Affiliation(s)
- Samantha M McEvedy
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia.,NorthWestern Mental Health, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand
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31
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Bell SL, Foley R, Houghton F, Maddrell A, Williams AM. From therapeutic landscapes to healthy spaces, places and practices: A scoping review. Soc Sci Med 2018; 196:123-130. [DOI: 10.1016/j.socscimed.2017.11.035] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/18/2017] [Accepted: 11/17/2017] [Indexed: 10/18/2022]
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32
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Mills PD, Watts BV, Shiner B, Hemphill RR. Adverse events occurring on mental health units. Gen Hosp Psychiatry 2018; 50:63-68. [PMID: 29055232 DOI: 10.1016/j.genhosppsych.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE While the study of suicide on mental health units has a long history, the study of patient safety more generally is relatively new. Our objective was to determine the type and relative frequency of adverse events occurring on Veterans Health Administration (VHA) mental health units; the primary root causes for these events; and make recommendations for abating or mitigating these events. METHODS We searched our national database for any reported adverse event that occurred on an inpatient mental health unit between January 1, 2015 and December 31, 2016. We found 87 Root Cause Analysis (RCA) reports and 9780 safety reports. The safety reports were coded for type of event and the RCAs were further coded for underlying causes and severity. RESULTS Of the 87 RCA reports, there were 31suicide attempts, 16 elopements, 10 assaults, 8 events involving hazardous items on the unit, 7 falls, 6 unexpected deaths, 3 overdoses and 6 cases coded as "other". For the 9780 safety reports falls were the most common event, followed by medication events, verbal assaults, physical assaults, medical problems and hazardous items on the unit. CONCLUSIONS As with medical units, patients on mental health units are at risk for many types of adverse events. The same focus on patient safety is just as important for our mental health patients as for our medical patients. Mental health unit staff should undertake a structured assessment of all risk on their units. This broad approach may be more successful than focusing on a particular event type.
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Affiliation(s)
- Peter D Mills
- The Geisel School of Medicine, Dartmouth College, Hanover, NH, United States; VAMC, 215 N. Main Street, White River Junction, VT 05009, United States.
| | - Bradley V Watts
- The Geisel School of Medicine, Dartmouth College, Hanover, NH, United States; VAMC, 215 N. Main Street, White River Junction, VT 05009, United States
| | - Brian Shiner
- The Geisel School of Medicine, Dartmouth College, Hanover, NH, United States; VAMC, 215 N. Main Street, White River Junction, VT 05009, United States
| | - Robin R Hemphill
- VA National Center for Patient Safety (10E2E), 24 Frank Lloyd Wright Dr., M2100, United States
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33
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Wilson C, Rouse L, Rae S, Kar Ray M. Is restraint a 'necessary evil' in mental health care? Mental health inpatients' and staff members' experience of physical restraint. Int J Ment Health Nurs 2017; 26:500-512. [PMID: 28960742 DOI: 10.1111/inm.12382] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2017] [Indexed: 11/28/2022]
Abstract
Restraint in mental health care has negative consequences, and guidelines/policies calling for its reduction have emerged internationally. However, there is tension between reducing restraint and maintaining safety. In order to reduce restraint, it is important to gain an understanding of the experience for all involved. The aim of the present study was to improve understanding of the experience of restraint for patients and staff with direct experience and witnesses. Interviews were conducted with 13 patients and 22 staff members from one UK National Health Service trust. The overarching theme, 'is restraint a necessary evil?', contained subthemes fitting into two ideas represented in the quote: 'it never is very nice but…it's a necessary evil'. It 'never is very nice' was demonstrated by the predominantly negative emotional and relational outcomes reported (distress, fear, dehumanizing, negative impact on staff/patient relationships, decreased job satisfaction). However, a common theme from both staff and patients was that, while restraint is 'never very nice', it is a 'necessary evil' when used as a last resort due to safety concerns. Mental health-care providers are under political pressure from national governments to reduce restraint, which is important in terms of reducing its negative outcomes for patients and staff; however, more research is needed into alternatives to restraint, while addressing the safety concerns of all parties. We need to ensure that by reducing or eliminating restraint, mental health wards neither become, nor feel, unsafe to patients or staff.
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Affiliation(s)
- Ceri Wilson
- Department of Adult and Mental Health Nursing, Anglia Ruskin University, Essex, UK
| | - Lorna Rouse
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Fulbourn Hospital, Cambridgeshire, UK
| | - Sarah Rae
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Fulbourn Hospital, Cambridgeshire, UK
| | - Manaan Kar Ray
- Cambridgeshire and Peterborough National Health Service Foundation Trust, Fulbourn Hospital, Cambridgeshire, UK
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34
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McKenna B, McEvedy S, Maguire T, Ryan J, Furness T. Prolonged use of seclusion and mechanical restraint in mental health services: A statewide retrospective cohort study. Int J Ment Health Nurs 2017; 26:491-499. [PMID: 28960741 DOI: 10.1111/inm.12383] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 01/09/2023]
Abstract
Seclusion and mechanical restraint are restrictive interventions that should be used only as a last resort and for the shortest possible time, yet little is known about duration of use in the broader context. Adult area mental health services throughout Victoria, Australia, were asked to complete a report form for prolonged episodes of seclusion (>8 hours) and mechanical restraint (>1 hour). The present, retrospective cohort study aimed to understand the individual (age, sex, type of service, duration of intervention) and contextual factors associated with prolonged use of restrictive interventions. Contextual factors describing the reasons for prolonged use of the restrictive interventions were captured qualitatively, and then coded using content analysis. Median duration was compared across individual factors using Mann-Whitney U-tests. During 2014, 690 episodes of prolonged restrictive intervention involving 311 consumers were reported. Close to half (n = 320, 46%) involved mechanical restraint. Seclusion episodes (n = 370) were longer in forensic mental health services compared to adult area mental health services (median: 24 hours and 18 min vs 16 hours and 42 min, P < 0.001). Mechanical restraint episodes (n = 320) were shorter in forensic mental health services compared to adult area mental health services (median: 3 hours and 25 min vs 4 hours and 15 min, P = 0.008). Some consumers were subject to multiple episodes of prolonged seclusion (55/206, 27%) and/or prolonged mechanical restraint (31/131, 24%). The most commonly occurring contextual factor for prolonged restrictive interventions was 'risk of harm to others'. Means for reducing the use of prolonged restrictive interventions are discussed in light of the findings.
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Affiliation(s)
- Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, and Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia
| | - Samantha McEvedy
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia.,Nursing Practice Development Unit, Forensicare, Melbourne, Victoria, Australia
| | - Jo Ryan
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Melbourne, Victoria, Australia.,Nursing Practice Development Unit, Forensicare, Melbourne, Victoria, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Para medicine, Australian Catholic University and North Western Mental Health, Melbourne Health, Melbourne, Victoria, Australia
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35
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Zugai JS, Stein-Parbury J, Roche M. Therapeutic alliance, anorexia nervosa and the inpatient setting: A mixed methods study. J Adv Nurs 2017; 74:443-453. [PMID: 28792604 DOI: 10.1111/jan.13410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2017] [Indexed: 11/30/2022]
Abstract
AIMS The aim of this study was to understand the context of the inpatient setting for the treatment of anorexia nervosa and the implications for the therapeutic alliance between nurses and consumers. BACKGROUND The nature of the therapeutic alliance is dependent on the contextual factors that influence interactions. The inpatient setting for the treatment of anorexia nervosa is one such setting where the therapeutic alliance is operative, yet challenging and poorly understood. DESIGN A two-phase explanatory sequential design was employed. Descriptive statistics from phase one informed phase two interviews. Phase two data were analysed through thematic analysis. METHODS A convenience sample of nurses and consumers were recruited from six wards, in five hospitals. Phase one involved the completion of a survey (N = 128) that measured the strength of the therapeutic alliance, as well as other elements of ward context. Phase two interviews (N = 54) were focused on the therapeutic alliance between nurses and consumers and the implications of the inpatient setting. Data collection occurred between May 2014 - February 2015. RESULTS Anorexia nervosa as an illness carries destructive implications for the quality of the therapeutic alliance. Nurses' intimate position in the inpatient setting and interpersonal capacity is influential in overcoming the obstacles that impede the therapeutic alliance. CONCLUSION Nurses' capacity for developing therapeutic alliances is in part dependent on a supportive ward organization and the adequacy of resources to permit meaningful interactions with consumers with anorexia nervosa. Understanding the contextual factors specific to the inpatient setting enhances nurses' ability to develop therapeutic alliances.
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Affiliation(s)
- Joel S Zugai
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Michael Roche
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW, Australia
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36
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Moreno-Poyato AR, Montesó-Curto P, Delgado-Hito P, Suárez-Pérez R, Aceña-Domínguez R, Carreras-Salvador R, Leyva-Moral JM, Lluch-Canut T, Roldán-Merino JF. The Therapeutic Relationship in Inpatient Psychiatric Care: A Narrative Review of the Perspective of Nurses and Patients. Arch Psychiatr Nurs 2016; 30:782-787. [PMID: 27888975 DOI: 10.1016/j.apnu.2016.03.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 01/22/2016] [Accepted: 03/06/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE To study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital. METHOD Narrative literature review. Content analysis. FINDINGS The significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting. PRACTICE IMPLICATIONS Increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.
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Affiliation(s)
- Antonio R Moreno-Poyato
- Escola Superior d'Infermeria del Mar, Parc de Salut Mar (Pompeu Fabra University Associated Center), Aiguader, 80, Barcelona, Spain.
| | - Pilar Montesó-Curto
- School of Nursing, Rovira i Virgili University, Avda Remolins 13-15, Tortosa, Tarragona, Spain.
| | - Pilar Delgado-Hito
- School of Nursing, University of Barcelona, Feixa Llarga s/n. 08907L'Hospitalet del Llobregat, Spain.
| | - Raquel Suárez-Pérez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. Barcelona, Spain.
| | - Rosa Aceña-Domínguez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. Barcelona, Spain.
| | - Regina Carreras-Salvador
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Pg. Marítim, s/n. Barcelona, Spain.
| | - Juan M Leyva-Moral
- School of Nursing, Autonomous University of Barcelona, Avda. Can Domenech, Edifici M. 08193 Bellaterra (Cerdanyola del Vallès) Barcelona, Spain.
| | - Teresa Lluch-Canut
- School of Nursing, University of Barcelona, Feixa Llarga s/n. 08907L'Hospitalet del Llobregat, Spain.
| | - Juan F Roldán-Merino
- Campus Docent Fundació Privada Sant Joan de Déu. School of Nursing, University of Barcelona, Santa Rosa, 39-57, Esplugues de Llobregat, Spain.
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Seed T, Fox JRE, Berry K. The experience of involuntary detention in acute psychiatric care. A review and synthesis of qualitative studies. Int J Nurs Stud 2016; 61:82-94. [PMID: 27314181 DOI: 10.1016/j.ijnurstu.2016.05.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 04/13/2016] [Accepted: 05/30/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To build on a previous review and updated understanding of how patients experience involuntary detention for their mental health difficulties. DESIGN We provide a narrative synthesis review of qualitative studies. DATA SOURCES Using pre-defined search terms, the following databases were searched covering the period 2006 to March 2014: Psychinfo, Medline, Medline In-Process, Embase, Web of Knowledge, Scopus, Science Direct, British Nursing Index and Cinahl Plus. Three journals were electronically hand-searched. REVIEW METHODS The search resulted in the retrieval of 6230 records which were screened by title. Relevant studies were then screened by abstract and further articles were read for full text. References of articles read for full text were screened using an inclusion and exclusion criteria. A total of fifteen studies were identified and a quality evaluation tool was applied to each study. Themes and constructs from all fifteen studies were coded and synthesised. RESULTS Seven overarching themes emerged. 'Sanctuary', 'loss of normality and perceived independence', 'feeling terrified' and 'fluctuating emotions' illustrate the experiences of involuntary detention. The remaining themes reflect the factors that influence these experiences: 'a continuum of person-centred practice', 'disempowerment' and 'intra-psychic coping'. CONCLUSIONS Participants varied in how they experienced involuntary detention. Some people experienced a sense of sanctuary, whereas others experienced loss, fear and trauma. People's experiences were influenced by the degree of actual or perceived person-centred and empowering care, which also had an impact on their coping style. Development of a therapeutic bond with clinicians was a key factor which influenced positive experiences of involuntary detention. The implications of the findings are discussed with reference to existing literature and recommendations are made for clinical practice. Ideas for future research are identified.
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Affiliation(s)
- Tara Seed
- School of Psychological Sciences, University of Manchester, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - John R E Fox
- School of Psychological Sciences, University of Manchester, Brunswick Street, Manchester M13 9PL, United Kingdom
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester, Brunswick Street, Manchester M13 9PL, United Kingdom.
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Molin J, Graneheim UH, Lindgren BM. Quality of interactions influences everyday life in psychiatric inpatient care--patients' perspectives. Int J Qual Stud Health Well-being 2016; 11:29897. [PMID: 26806313 PMCID: PMC4724788 DOI: 10.3402/qhw.v11.29897] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2015] [Indexed: 11/14/2022] Open
Abstract
Everyday life consists of daily activities that are taken for granted. It forms the foundation for human efforts and contains elements of both comfort and boredom. Because everyday life escapes no one, life in a psychiatric ward will become ordinary while staying there. This study aims to explore everyday life in psychiatric inpatient care based on patients' experiences. We individually interviewed 16 participants with experiences of psychiatric inpatient care and analysed the data in accordance with the methods of grounded theory. Data collection and analysis continued in parallel in accordance with the method. Our results showed that everyday life is linked to the core category quality of interactions influences everyday life, and three constructed categories-staff makes the difference, looking for shelter in a stigmatizing environment, and facing a confusing care content-were related to the core category. Our results highlight the importance of ordinary relationships between staff and patients in psychiatric inpatient care. These results can be used to develop nursing interventions to improve psychiatric inpatient care and might also be used as a basis for reflective dialogues among staff.
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Affiliation(s)
- Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden;
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Hunt IM, Clements C, Saini P, Rahman MS, Shaw J, Appleby L, Kapur N, Windfuhr K. Suicide after absconding from inpatient care in England: an exploration of mental health professionals' experiences. J Ment Health 2016; 25:245-53. [PMID: 27150467 DOI: 10.3109/09638237.2015.1124394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Absconding from inpatient care is associated with suicide risk in psychiatric populations. However, little is known about the real world context of suicide after absconding from a psychiatric ward or the experiences of clinical staff caring for these patients. AIMS To identify the characteristics of inpatients who died by suicide after absconding and to explore these and further key issues related to suicide risk from the perspective of clinical staff. METHODS A mixed-methods study using quantitative data of all patient suicides in England between 1997 and 2011 and a thematic analysis of semi-structured interviews with 21 clinical staff. RESULTS Four themes were identified as areas of concern for clinicians: problems with ward design, staffing problems, difficulties in assessing risk, and patient specific factors. CONCLUSIONS Results suggest that inpatients who died by suicide after absconding may have more complex and severe illness along with difficult life events, such as homelessness. Closer monitoring of inpatients and access points, and improved risk assessments are important to reduce suicide in this patient group.
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Affiliation(s)
- Isabelle M Hunt
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Caroline Clements
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Pooja Saini
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Mohammad Shaiyan Rahman
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Jenny Shaw
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Louis Appleby
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Nav Kapur
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
| | - Kirsten Windfuhr
- a National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, University of Manchester , Manchester , UK
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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.
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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
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Cutcliffe JR, Santos JC, Kozel B, Taylor P, Lees D. Raiders of the Lost Art: A review of published evaluations of inpatient mental health care experiences emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia. Int J Ment Health Nurs 2015; 24:375-85. [PMID: 26300551 DOI: 10.1111/inm.12159] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Forming interpersonal therapeutic relationships with mental health Service Users remains a key aspect of the practice of Psychiatric/Mental Health nurses. Given the omnipresence of the concept within the relevant literature the reader could be forgiven for asking: why would Psychiatric/Mental Health nurses opine about something so basic, so ubiquitous and so central to the theory and practice of our discipline? While the authors could locate no substantive argument that refutes the role or value of such relationships, a sizable, growing and reasonably consistent body of work has emerged, which appears to indicate that this centrality and value is not necessarily reflected in many clinical practice settings. Accordingly, we draw on the published evaluations of mental health care emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia, compare these findings and highlight similarities or/and congruence and discuss a range of issues arising out of the findings. Alas, the findings seem to depict a mental health care inpatient experience that is often devoid of warm therapeutic relationships, respectful interactions, information or choice about treatment and any kind of formal/informal 'talk therapy'. Instead such care experiences are personified by: coercion, disinterest, inhumane practices, custodial and controlling practitioners and a gross over use of pharmacological 'treatments'.
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Affiliation(s)
- John R Cutcliffe
- Centre for Nursing Research, Wright State University, Dayton, Ohio, USA.,University of Ottawa, Ottawa, Canada.,University of Coimbra, Coimbra, Portugal.,University of Malta, Malta
| | | | - Bernd Kozel
- Nursing & Social Education Research Unit, University of Bern Psychiatric Services, Bern, Switzerland.,International Graduate Academy (InGrA), 'Participation as Goal of Nursing and Therapy', Institute of Health and Nursing Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Petrea Taylor
- Horizon HN Addictions/Mental Health, Hobart, Australia
| | - David Lees
- School of Health Sciences, University of Tasmania, Hobart, Australia
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Nicholls D, Kidd K, Threader J, Hungerford C. The value of purpose built mental health facilities: Use of the Ward Atmosphere Scale to gauge the link between milieu and physical environment. Int J Ment Health Nurs 2015; 24:286-94. [PMID: 25975388 DOI: 10.1111/inm.12138] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigated changes in the 'atmosphere' of an acute adult mental health setting following relocation to a new purpose-built facility. The Ward Atmosphere Scale (WAS) was designed and validated for specific use in hospital-based psychiatric facilities, and measures several dimensions of an environment. In this study, the WAS was administered to consumers and staff at periods before and also after their relocation to a new purpose-built acute adult mental health facility. There were significant improvements in the physical atmosphere of the new facility, when compared with the old facility. In terms of ward atmosphere, however, improvements were seen to occur in only a small number of measures and there were minor differences between consumers' and staff perspectives on some indicators. Interestingly, it was found that consumers noted less 'staff control' in the new setting, raising the question of the differences in understanding of control. For staff only, there was a perception of greater levels of consumer 'involvement' in the new facility. Despite the minor differences in perception, the study does confirm that architecture is an important influence on the 'atmosphere' of a health facility, for both staff and consumers.
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Affiliation(s)
- Daniel Nicholls
- School of Nursing & Midwifery, University of Western Sydney, Canberra, Australian Capital Territory, Australia
| | - Kevin Kidd
- Mental Health, Justice Health, Alcohol and Drugs Services, ACT Government Health Directorate, Canberra, Australian Capital Territory, Australia
| | - Jennifer Threader
- Australian National University, Canberra, Australian Capital Territory, Australia
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Isobel S, Foster K, Edwards C. Developing family rooms in mental health inpatient units: an exploratory descriptive study. BMC Health Serv Res 2015; 15:238. [PMID: 26088740 PMCID: PMC4473838 DOI: 10.1186/s12913-015-0914-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 06/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-friendly spaces for children and families to visit inpatient mental health units are recommended in international mental health guidelines as one way to provide service delivery that is responsive to the needs of parent-consumers and families. There is a lack of evidence on the implementation of family-friendly spaces or Family Rooms. This study aimed to explore the development, role, and function of Family Rooms in four mental health inpatient units in a local health district in NSW Australia. METHODS An exploratory descriptive inductive-deductive design using multiple data sources was employed. Methods included Family Room usage and parental status data over a 12 week period, an open-ended questionnaire, and semi-structured interviews with 20 nurses. RESULTS Available parental status data indicated that between 8-14 % of inpatients were parents of dependent children under 18. Family Room usage was multipurpose and used specifically for children & families 29 % of the time. As spaces in the units, Family Rooms were perceived as acknowledging of the importance of family, and providing comfortable, secure spaces for parent-consumers and their children and family to maintain connections. Units did not have local policies or guidelines on the development, maintenance, and/or use of the rooms. CONCLUSIONS Despite long-standing recognition of the need to identify consumers' parental status, there remains a lack of systematic processes for identifying parents in mental health inpatient services nationally. Family Rooms as spaces within inpatient units acknowledge the importance of families and are a step towards provision of family-focused mental health care. Recommendations for establishing and maintaining Family Rooms are outlined.
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Affiliation(s)
- Sophie Isobel
- Nursing Research, Sydney Local Health District, Concord Centre for Mental Health, Hospital Road, Concord, 2139, Australia.
| | - Kim Foster
- Faculty of Health, University of Canberra, Canberra, Australia.
| | - Clair Edwards
- Mental Health Services, Sydney Local Health District, Concord Centre for Mental Health, Hospital Road, Concord, NSW, 2139, Australia.
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Simpson AIF, Penney SR, Fernane S, Wilkie T. The impact of structured decision making on absconding by forensic psychiatric patients: results from an A-B design study. BMC Psychiatry 2015; 15:103. [PMID: 25935745 PMCID: PMC4424885 DOI: 10.1186/s12888-015-0474-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated absconding from forensic hospitals and there are no published studies of interventions aimed at reducing these incidents in forensic settings. We present a study of the impact of a new policy using structured professional judgment and an interdisciplinary team-based approach to granting privileges to forensic patients. We assess the impact of this policy on the rate and type of absconding from a metropolitan forensic facility. METHODS Following concern about the rate of absconding at our hospital, a new policy was implemented to guide the process of granting hospital grounds and community access privileges. Employing an A-B design, we investigated the rate, characteristics, and motivations of absconding events in the 18 months prior to, and 18 months following, implementation of this policy to assess its effectiveness. RESULTS Eighty-six patients were responsible for 188 incidents of absconding during the 42-month study window. The rate of absconding decreased progressively from 17.8% of all patients at risk prior to implementation of the new policy, to 13.8% during implementation, and further to 12.0% following implementation. There was a differential impact of the policy on absconding events, in that the greatest reduction was witnessed in absconsions occurring from unaccompanied passes; this was offset, to some extent, by an increase in absconding occurring from within hospital units or from staff accompanied outings. Seven of the absconding events included incidents of minor violence, and two included the commission of other illegal behaviors. The most common reported motive for absconding across the time periods studied was a sense of boredom or frustration. Discharge rate from hospital was 22.9% prior to the implementation of the policy to 22.7% after its introduction, indicating no change in the rate of patients' eventual community reintegration. CONCLUSIONS A structured and team-based approach to decision making regarding hospital grounds and community access privileges appeared to reduce the overall rate of absconding without slowing community reintegration of forensic patients.
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Affiliation(s)
- Alexander I F Simpson
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada. .,University of Toronto, Toronto, Canada.
| | - Stephanie R Penney
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada. .,University of Toronto, Toronto, Canada.
| | - Stephanie Fernane
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada.
| | - Treena Wilkie
- Complex Mental Illness Program, Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, M6J 1H4, ON, Canada. .,University of Toronto, Toronto, Canada.
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Hu DY, Huang D, Xiong Y, Lu CH, Han YH, Ding XP, Wang SJ, Liu YL. Risk factors and precautions of inpatient suicide from the perspective of nurses: A qualitative study. ACTA ACUST UNITED AC 2015; 35:295-301. [DOI: 10.1007/s11596-015-1427-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 03/02/2015] [Indexed: 10/23/2022]
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Gerace A, Oster C, Mosel K, O'Kane D, Ash D, Muir-Cochrane E. Five-year review of absconding in three acute psychiatric inpatient wards in Australia. Int J Ment Health Nurs 2015; 24:28-37. [PMID: 25444670 DOI: 10.1111/inm.12100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur.
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Affiliation(s)
- Adam Gerace
- School of Nursing & Midwifery, Flinders University of South Australia, Adelaide, South Australia, Australia
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Muir-Cochrane E, Gerace A. People hospitalised on acute psychiatric wards report mixed feelings of safety and vulnerability. Evid Based Nurs 2015; 18:31. [PMID: 24713354 DOI: 10.1136/eb-2013-101709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Eimear Muir-Cochrane
- Department of Nursing and Health Sciences, Faculty of Medicine, Flinders University, Adelaide, Australia
| | - Adam Gerace
- Department of Nursing and Health Sciences, Faculty of Medicine, Flinders University, Adelaide, Australia
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Khammarnia M, Kassani A, Amiresmaili M, Sadeghi A, Karimi Jaberi Z, Kavosi Z. Study of patients absconding behavior in a general hospital at southern region of Iran. Int J Health Policy Manag 2014; 4:137-41. [PMID: 25774367 DOI: 10.15171/ijhpm.2014.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/27/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients' escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. METHODS This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011-3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. RESULTS The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (ORadj= 0.13), gender (ORadj= 2.15), self-employment/unemployed (ORadj= 0.47), emergency/admission (ORadj= 2.14), internal/admission (ORadj= 3.16), insurance status (ORadj= 4.49) and residence expenditure (ORadj= 1.15). CONCLUSION Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital.
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Affiliation(s)
- Mohammad Khammarnia
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Aziz Kassani
- Prevention of Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammadreza Amiresmaili
- Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Sadeghi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Karimi Jaberi
- Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. ; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Department of Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran
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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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Characteristics and motivations of absconders from forensic mental health services: a case-control study. BMC Psychiatry 2014; 14:91. [PMID: 24669758 PMCID: PMC3987103 DOI: 10.1186/1471-244x-14-91] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 03/19/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Absconding from hospital is a significant health and security issue within psychiatric facilities that can have considerable adverse effects on patients, their family members and care providers, as well as the wider community. Several studies have documented correlates associated with absconding events among general psychiatric samples; however, few studies have examined this phenomenon within samples of forensic patients where the perception of threat to public safety in the event of an unauthorized absence from hospital is often higher. METHODS We investigate the frequency, timing, and determinants of absconding events among a sample of forensic psychiatric patients over a 24-month period, and compare patients who abscond to a control group matched along several sociodemographic and clinical dimensions. We explore, in a qualitative manner, patients' motives for absconding. RESULTS Fifty-seven patients were responsible for 102 incidents of absconding during the two year study window. Forensic patients who absconded from hospital were more likely to have a history of absconding attempts, a diagnosed substance use disorder, as well as score higher on a structured professional violence risk assessment measure. Only one of the absconding events identified included an incident of minor violence, and very few included the commission of other illegal behaviors (with the exception of substance use). The most common reported motive for absconding was a sense of boredom or frustration. CONCLUSIONS Using an inclusive definition of absconding, we found that absconding events were generally of brief duration, and that no member of the public was harmed by patients who absconded. Findings surrounding the motivations of absconders suggest that improvements in therapeutic communication between patients and clinical teams could help to reduce the occurrence of absconding events.
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