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Price O, Papastavrou Brooks C, Johnston I, McPherson P, Goodman H, Grundy A, Cree L, Motala Z, Robinson J, Doyle M, Stokes N, Armitage CJ, Barley E, Brooks H, Callaghan P, Carter LA, Davies LM, Drake RJ, Lovell K, Bee P. Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial. Health Technol Assess 2024; 28:1-120. [PMID: 38343036 PMCID: PMC11017147 DOI: 10.3310/fggw6874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training's effectiveness. Objectives Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention's preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Design Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Setting Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. Participants In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Interventions Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Main outcome measures Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient-Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Results Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Conclusions Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Limitations Uncontrolled design and self-selecting sample. Future work Definitive trial determining intervention effects. Trial registration This trial is registered as ISRCTN12826685 (closed to recruitment). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in Health Technology Assessment; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Context Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. 'De-escalation' is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use 'containment' interventions (measures to prevent harm through restricting a person's ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient's concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention.
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Affiliation(s)
- Owen Price
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Isobel Johnston
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter McPherson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Helena Goodman
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Andrew Grundy
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lindsey Cree
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Zahra Motala
- Atherleigh Park Hospital, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Jade Robinson
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Michael Doyle
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Nicholas Stokes
- West London Forensic Service, St Bernard's Hospital, West London Mental Health NHS Trust, Southall, UK
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | | | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Patrick Callaghan
- School of Applied Sciences, London South Bank University, London, UK
| | | | - Linda M Davies
- Division of Population Health, Health Services Research and Primary Care, Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Richard J Drake
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Penny Bee
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Thomson AE, Winsor Murray J. Mental Health Nurses Who Experience Disabilities: Adapting to Workplace Barriers. Issues Ment Health Nurs 2023; 44:1179-1187. [PMID: 38048542 DOI: 10.1080/01612840.2023.2266849] [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] [Indexed: 12/06/2023]
Abstract
Mental health nurses with disabilities experience discrimination and issues with inclusion and accessibility. Ten mental health nurses who self-identified with a disability were interviewed using interpretive description to gain insight into their experiences and to better understand practices that promote inclusion. Participants discussed challenges associated with the mental healthcare system, the need to adapt, and the importance of support and feeling accepted. To improve accessibility and inclusion of mental health nurses, the system requires increased flexibility. This would benefit all nurses and those who are cared for by them.
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Affiliation(s)
- Andrea E Thomson
- Department of Psychiatric Nursing, Faculty of Health Studies, Brandon University, Brandon, Manitoba, Canada
| | - Joanne Winsor Murray
- Department of Psychiatric Nursing, Faculty of Health Studies, Brandon University, Winnipeg, Manitoba, Canada
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3
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Seiler JPH, Zerr K, Rumpel S, Tüscher O. High state boredom vastly affects psychiatric inpatients and predicts their treatment duration. Transl Psychiatry 2023; 13:350. [PMID: 37973905 PMCID: PMC10654381 DOI: 10.1038/s41398-023-02650-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
Boredom is a ubiquitous, aversive human experience typically elicited by low information and monotony. Boredom can occur either as a transient mental state that prompts individuals to adapt their behavior to avoid monotony or as a temporally stable trait, describing a chronic susceptibility to feeling bored. Increased trait boredom was found to correlate with various psychopathologies and indicators of mental burden. However, the role of state boredom in psychopathological conditions and its implications for psychiatric treatment remain elusive. Here, we address this issue by investigating state boredom and trait boredom in a cohort of psychiatric inpatients and a healthy control cohort. We find that in both groups, state boredom, even more than trait boredom, shows remarkable associations with psychopathology. In the inpatient group, state boredom is implicated broadly in multiple mental disorders and shows an association with treatment in closed psychiatric wards. Furthermore, through statistical modeling, we find that high-state boredom during inpatient therapy is predictive of a longer therapy duration. Thus, we show that state boredom constitutes an indicator of mild and severe psychopathology in different mental disorders, affecting the outcome of psychiatric patients. Potential therapeutic interventions are discussed, aiming to enhance information flow in the brain in order to alleviate boredom in clinical settings.
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Affiliation(s)
- Johannes P-H Seiler
- Institute of Physiology, Focus Program Translational Neurosciences, University Medical Center of the Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 19, 55131, Mainz, Germany.
| | - Katharina Zerr
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Leibniz Institute for Resilience Research, Wallstraße 7, 55122, Mainz, Germany
| | - Simon Rumpel
- Institute of Physiology, Focus Program Translational Neurosciences, University Medical Center of the Johannes Gutenberg University Mainz, Hanns-Dieter-Hüsch-Weg 19, 55131, Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Leibniz Institute for Resilience Research, Wallstraße 7, 55122, Mainz, Germany
- Institute of Molecular Biology, Ackermannweg 4, 55128, Mainz, Germany
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4
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López-Ros P, López-López R, Pina D, Puente-López E. User violence prevention and intervention measures to minimize and prevent aggression towards health care workers: A systematic review. Heliyon 2023; 9:e19495. [PMID: 37809629 PMCID: PMC10558594 DOI: 10.1016/j.heliyon.2023.e19495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 10/10/2023] Open
Abstract
Workplace violence in the health care setting is a social problem of great interest both at the health care level and in research in recent decades. The most common type of violence is the one coming from the user towards the professional. Although the bibliography includes multiple preventive actions focused on working with professionals, there are hardly any studies that explore and collect actions aimed at the user. The aim of this study is to analyze the results of the literature to provide an overview of the current evidence. Specifically, it aims to describe the various user-directed strategies or interventions aimed at reducing workplace violence experienced by professionals within the healthcare sector. A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), methodology of publications published up to December 2022 in the main databases. Studies that met the previously established eligibility criteria were identified. A peer review of the risk of bias was performed and the data were extracted from a previously elaborated template. The search yielded 5231 articles of which 11 were finally included in the review. Of these, 3 had a quantitative design, 7 had a qualitative design and one had a combined design. Of these, 38 measures or actions aimed at the user were compiled, grouped into four blocks according to the attitudinal objective pursued: Improvement of communication and creation of links, involvement of the user in joint decisions with the staff, informing and training the user, and other independent proposals. This study makes it possible to explore actions aimed at users with the objective of reducing violence towards health professionals. It collects and makes available to the scientific community a set of measures aimed at making a change of attitude in the perpetrator themselves, with the involvement of the perpetrator in the health system. This set of collected measures provides researchers with a basis to be taken into account for the implementation of future prevention plans according to the new multicomponent prevention models and with the involvement of the perpetrator themselves.
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Affiliation(s)
- Paloma López-Ros
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | - Reyes López-López
- Applied Psychology Service (SEPA), University of Murcia, Murcia, Spain
| | - David Pina
- Applied Psychology Service (SEPA), University of Murcia, Murcia, Spain
- Department of Socio-Sanitary Sciences, University of Murcia, Murcia, Spain
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5
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Pina D, López-Ros P, Luna-Maldonado A, Luna Ruiz-Caballero A, Llor-Esteban B, Ruiz-Hernández JA, García-Jiménez JJ, Puente-López E, Martínez-Jarreta B. Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study. Front Public Health 2022; 9:810014. [PMID: 34976940 PMCID: PMC8717897 DOI: 10.3389/fpubh.2021.810014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Workplace violence is a social problem of special interest in both intervention and research. Among the sectors that most perceive this type of violence, health care professionals stand out. The most common type of violence for this professional group is the one perpetrated by the users or patients themselves. It has been reported that one out of every four acts of violence in the workplace occurs in the healthcare setting. Within the health sector, the Mental Health, Emergency and Primary Care services have been widely reported as being among the most vulnerable, with Primary Care being the least addressed of the three. Although the available literature is extensive, there are hardly any studies that explore from a qualitative perspective what are the sources of conflict in this sector from the perspective of the users, the most common being to work with professionals. Objective: The aim of this study is to examine those aspects derived from the organization, the professionals or the users of Primary Care that, from the users' point of view, cause violent situations and how they think these could be avoided. Method: The sample consisted of 80 users of the Primary Care services of the Health Service of Murcia. For data collection, a qualitative study was conducted through 10 focus groups and a subsequent thematic analysis of the data. Results: The results have allowed us to identify that, from an organizational point of view, the uncertainty in waiting times, the need to adapt the telematic or telephone appointment to the different types of users, or the management of emergencies in Primary Care are the aspects that cause most conflicts between users and professionals. In this sense, suggested improvements are aimed at providing information in the mobile application updated on the opening hours or maintaining the telephone appointment for those who need or request it, among many others. As for the professionals, users point out that the medical staff is perceived as distant and sometimes does not provide enough information on the health status of users. Another professional group widely addressed in the focus groups was the administrative staff, being described as lacking in communication skills, assertiveness, or empathy. Users recognize the existence of a demanding/aggressive profile among users, who makes instrumental use of violence to achieve privileges over users in general. We have also identified the profile of the user who makes use of Primary Care as a way of socializing or managing conflicts of a socioemotional nature. As proposals for this thematic block, users suggest group therapies, the use of audiovisual material complementary to the information provided by professionals or community interventions in psychoeducation. Conclusion: This study allows to explore conflicts between users and professionals from the Primary Care patients' perspective. Our results are complementary to the available evidence that has used the professional's approach to study the phenomenon of workplace violence. The identification of sources of conflict and the assessment and contribution of users on possible ways of improvement can serve as a basis for the design of prevention and intervention plans to improve the work environment in Primary Care centers.
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Affiliation(s)
- David Pina
- Department of Socio-Sanitary Sciences, University of Murcia, Murcia, Spain.,Applied Psychology Service (SEPA), University of Murcia, Murcia, Spain
| | - Paloma López-Ros
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | | | | | - Bartolomé Llor-Esteban
- Applied Psychology Service (SEPA), University of Murcia, Murcia, Spain.,Department of Nursing, University of Murcia, Murcia, Spain
| | - Jose Antonio Ruiz-Hernández
- Applied Psychology Service (SEPA), University of Murcia, Murcia, Spain.,Department of Social Psychology and Psychiatry, University of Murcia, Murcia, Spain
| | | | | | - Begoña Martínez-Jarreta
- Department of Pathological Anatomy, Forensic and Legal Medicine and Toxicology, University of Zaragoza, Zaragoza, Spain
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6
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Fletcher A, Crowe M, Manuel J, Foulds J. Comparison of patients' and staff's perspectives on the causes of violence and aggression in psychiatric inpatient settings: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:924-939. [PMID: 33837640 DOI: 10.1111/jpm.12758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/10/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Aggression and violence are persistent problems in psychiatric inpatient units. Violence preventive factors have been identified from both staff's and patients' perspectives. Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture. The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de-escalating aggression and violence. The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture. Patient-centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion. Patient-centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses. ABSTRACT: Introduction High rates of aggression and violence are a persistent problem in inpatient mental health environments. A comparison of staff's and patients' perceptions of the causes may provide novel insights. Aim This review aimed to compare patients' and staff's perspectives on the causes of aggression and violence in inpatient environments. Method An integrative review of the literature was conducted with a search of Ovid (Medline, Embase, PsycINFO) databases and manual searching. Results Thirty articles met criteria for inclusion. Interactions prior to aggressive or violent incidents were characterized by patients as disrespectful and coercive, and by staff as indicative of the patient's mental state or personality. Both groups identified the importance of patient-centred communication skills. Discussion The review identified that patients and staff have differing perspectives on the causes of violence and aggression. There was an interactional dynamic between staff and patients that was shaped by the culture of the inpatient setting. Implications for Practice Understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings.
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Affiliation(s)
- Alice Fletcher
- Forensicare, Victorian Institute of Forensic Mental Health, Melbourne, Vic., Australia
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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7
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Faccio E, Author A, Rocelli M. It's the way you treat me that makes me angry, it's not a question of madness: Good and bad practice in dealing with violence in the mental health services. J Psychiatr Ment Health Nurs 2021; 28:481-487. [PMID: 32965777 DOI: 10.1111/jpm.12690] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/14/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT The first access to a mental health service is sometimes marked by aggressive behaviours and anger. Forced hospitalization is frequently an occasion for resistance and hostility to the service, which should not be mistaken for psychotic symptoms. If this situation is not dealt with effectively, it can jeopardize the quality of the relationship with staff and compliance with the treatment programme. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE The narrator presents his experience in undergoing voluntary psychiatric treatment, casting light on nurses' good and bad practices: those that increased resistance, and those that helped de-escalate the uncontrolled reaction at the time of access, as well as during the recovery period. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING Practitioners should be able to put in place listening techniques and ways of personalizing the relationship with the patient. When such measures become part of the patient's meaning system, the vicious circle of misunderstood anger that creates more anger may be interrupted and the patient can invest in relationships of trust. ABSTRACT Aggression is often a reason for psychiatric hospitalization and may lead to prolonged hospital stays, and at worst to compulsory treatments. The relationship between mental illness and aggressive behaviour is a source for debate in the literature, while research data suggest that violent behaviour is impacted not only by the mental state of the patient, but also by environmental and relational conditions, hence the importance of an increased awareness of operating methods on the part of psychiatric staff. Alex's story is an effective mirror for rethinking staff conduct and offers many practical suggestions for understanding a patient's point of view in critical episodes and for deescalating relational tension.
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Affiliation(s)
- Elena Faccio
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
| | - Anonymous Author
- Arcobaleno Association, Community of Capodarco, Fermo, Marche, Italy
| | - Michele Rocelli
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Padova, Italy
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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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Marshall CA, McIntosh E, Sohrabi A, Amir A. Boredom in inpatient mental healthcare settings: a scoping review. Br J Occup Ther 2019. [DOI: 10.1177/0308022619876558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Emma McIntosh
- Addiction and Mental Health Services, Kingston, ON, Canada. At the time of this study, Emma McIntosh was a student in the MSc.OT program at Queen's University, Kingston, ON, Canada
| | - Almas Sohrabi
- Addiction and Mental Health Services, Kingston, ON, Canada. At the time of this study, Emma McIntosh was a student in the MSc.OT program at Queen's University, Kingston, ON, Canada
| | - Adam Amir
- At the time of this study, Almas Sohrabi was a student in the MSc.OT program at Queen's University, Kingston, ON
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Välimäki M, Yang M, Vahlberg T, Lantta T, Pekurinen V, Anttila M, Normand SL. Trends in the use of coercive measures in Finnish psychiatric hospitals: a register analysis of the past two decades. BMC Psychiatry 2019; 19:230. [PMID: 31349787 PMCID: PMC6660969 DOI: 10.1186/s12888-019-2200-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 06/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coercive measures is a topic that has long been discussed in the field of psychiatry. Despite global reports of reductions in the use of restraint episodes due to new regulations, it is still questionable if practices have really changed over time. For this study, we examined the rates of coercive measures in the inpatient population of psychiatric care providers across Finland to identify changing trends as well as variations in such trends by region. METHODS In this nationwide registry analysis, we extracted patient data from the national database (The Finnish National Care Register for Health Care) over a 20-year period. We included adult patients admitted to psychiatric units (care providers) and focused on patients who had faced coercive measures (seclusion, limb restraints, forced injection and physical restraints) during their hospital stay. Multilevel logistical models (a polynomial model of quadratic form) were used to examine trends in prevalence of any coercive measures as well as the other four specified coercive measures over time, and to investigate variation in such trends among care providers and regions. RESULTS Between 1995 and 2014, the dataset contained 226,948 inpatients who had been admitted during the 20-year time frame (505,169 treatment periods). The overall prevalence of coercive treatment on inpatients was 9.8%, with a small decrease during 2011-2014. The overall prevalence of seclusion, limb restraints, forced injection and physical restraints on inpatients was 6.9, 3.8, 2.6 and 0.8%, respectively. Only the use of limb restraints showed a downward trend over time. Geographic and care provider variations in specific coercive measures used were also observed. CONCLUSIONS Despite the decreasing national level of coercive measures used in Finnish psychiatric hospitals, the overall reduction has been small during the last two decades. These results have implications on the future development of structured guidelines and interventions for preventing and more effectively managing challenging situations. Clinical guidelines and staff education related to the use of coercive measures should be critically assessed to ensure that the staff members working with vulnerable patient populations in psychiatric hospitals are ethically competent.
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Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland. .,School of Nursing, Hong Kong Polytechnic University, Hong Kong, Hong Kong, Special Administrative Region, People's Republic of China. .,Turku University Hospital, Turku, Finland.
| | - Min Yang
- 0000 0001 0807 1581grid.13291.38West China Research Center for Rural Health Development, Sichuan University Huaxi Medical Center, Sichuan University of China, Administration Building, No 17, Section 3, Ren Ming Nan Lu, Chengdu, Sichuan China
| | - Tero Vahlberg
- 0000 0001 2097 1371grid.1374.1Department of Biostatistics, University of Turku, 20014 University of Turku, Turku, Finland
| | - Tella Lantta
- 0000 0001 2097 1371grid.1374.1Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland
| | - Virve Pekurinen
- 0000 0001 2097 1371grid.1374.1Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland
| | - Minna Anttila
- 0000 0001 2097 1371grid.1374.1Department of Nursing Science, Faculty of Medicine, 20014 University of Turku, Turku, Finland
| | - Sharon-Lise Normand
- 000000041936754Xgrid.38142.3cDepartment of Health Care Policy, Harvard Medical School, Boston, USA ,000000041936754Xgrid.38142.3cDepartment of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA
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11
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Vermeulen JM, Doedens P, Boyette LLNJ, Spek B, Latour CHM, de Haan L. "But I did not touch nobody!"-Patients' and nurses' perspectives and recommendations after aggression on psychiatric wards-A qualitative study. J Adv Nurs 2019; 75:2845-2854. [PMID: 31222795 PMCID: PMC6899923 DOI: 10.1111/jan.14107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
AIMS To gain a deeper understanding of the differences in patients and staff perspectives in response to aggression and to explore recommendations on prevention. DESIGN Qualitative, grounded theory study. METHODS We conducted semi-structured interviews with patients and nurses involved in an aggressive incident. Data collection was performed from May 2016 - March 2017. RESULTS Thirty-one interviews were conducted concerning 15 aggressive incidents. Patients and nurses generally showed agreement on the factual course of events, there was variation in agreement on the perceived severity (PS). Patients' recommendations on prevention were mostly personally focussed, while nurses suggested general improvements. CONCLUSION Patients are often capable to evaluate aggression and give recommendations on prevention shortly after the incident. Patients and nurses differ in the PS of aggression. Recommendations on prevention of patients and nurses are complementary. IMPACT What problem did the study address? Perspectives of patients and nurses differ with respect to aggression, but how is unclear. What were the main findings? Patients and nurses generally described a similar factual course of events concerning the incident, patients often perceive the severity less than nurses. Patients are capable to give recommendations on prevention of aggressive incidents, shortly after the incident. Where and on whom will the research have impact? Factual course of events can be a common ground to start evaluating aggressive incidents and post-incident review should address the severity of incidents. Asking recommendations from patients on how to improve safety and de-escalation can lead to innovative and personal de-escalation strategies and supports patients autonomy.
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Affiliation(s)
- Jentien M Vermeulen
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Doedens
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands.,ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lindy-Lou N J Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Bea Spek
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands
| | - Corine H M Latour
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands.,Arkin, Amsterdam, The Netherlands
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12
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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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13
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Vahidi M, Ebrahimi H, Areshtanab HN, Jafarabadi MA, Lees D, Foong A, Cleary M. Therapeutic Relationships and Safety of Care in Iranian Psychiatric Inpatient Units. Issues Ment Health Nurs 2018; 39:967-976. [PMID: 30204047 DOI: 10.1080/01612840.2018.1485795] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Enhancing therapeutic relationships between patients and staff is of central importance to improve the quality and safety of care in psychiatric inpatient units. However, there is limited evidence as to how therapeutic relationships may be enabled in this specific context. This paper presents findings of a study that explored the link between therapeutic relationships and safety in Iranian psychiatric inpatient units. In this exploratory, descriptive study, seven patients at the point of discharge and 19 staff in psychiatric inpatient units in Iran were interviewed regarding their experiences of care. The quality of staff-patient relationship in providing a safe environment was categorized into two groups of "facilitators" and "inhibitors". Facilitators of a safe environment included "supportive relationship with patients" and "improving patient capacity for self-efficacy/self-control". Inhibitors, on the other hand, included "detachment from patients" and "domination over patients", which ultimately limited safety on the ward. Findings indicate interrelated environmental, patient and staff factors mediating the potential for therapeutic relationships and quality and safety of care. Findings suggest the need for more effective preparation and support for staff working within psychiatric inpatient settings. In addition, environments more conducive to collaborative recovery-oriented practice are required to enhance therapeutic relationships and improve quality and safety of care. Both individual staff responsibility and effective leadership are required to realize change.
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Affiliation(s)
- Maryam Vahidi
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Ebrahimi
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Namdar Areshtanab
- a Department of Psychiatric Nursing, Faculty of Nursing & Midwifery , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Mohammad Asghari Jafarabadi
- b Department of Statistics and Epidemiology, Faculty of Health sciences , Tabriz University of Medical Sciences , Tabriz , Iran
| | - David Lees
- c School of Health Sciences , University of Tasmania , Launceston , Tasmania , Australia
| | - Andrew Foong
- d School of Health Sciences , University of Tasmania , Sydney , New South Wales , Australia
| | - Michelle Cleary
- d School of Health Sciences , University of Tasmania , Sydney , New South Wales , Australia
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14
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Delaney KR, Shattell M, Johnson ME. Capturing the Interpersonal Process of Psychiatric Nurses: A Model for Engagement. Arch Psychiatr Nurs 2017; 31:634-640. [PMID: 29179832 DOI: 10.1016/j.apnu.2017.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 08/04/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022]
Abstract
Staff members' engagement with patients is a critical element of inpatient psychiatric care, essential to safety, the hospitalization experience and the development of a culture of care. Currently broad concerns exist around the amount of time inpatient psychiatric nurses expend in patient engagement and the quality of these interactions. In this paper we present a model of engagement that clarifies necessary skills to support the engagement process. The model is based on Peplau's theory of interpersonal relations, patients' ideas on healing elements of psychiatric hospitalization and research on inpatient therapeutic relationships. We are currently using this model for a web-based teaching/learning course to cultivate interpersonal engagement, and to explicate how through operationalizing their inpatient role, nurses support patients in the development of their mental health and well-being.
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Affiliation(s)
- Kathleen R Delaney
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
| | - Mona Shattell
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
| | - Mary E Johnson
- Department of Community, Systems and Mental Health Nursing, Rush University, College of Nursing, 600 S. Paulina St, Chicago, IL 60612, United States.
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15
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Salzmann-Erikson M, Söderqvist C. Being Subject to Restrictions, Limitations and Disciplining: A Thematic Analysis of Individuals' Experiences in Psychiatric Intensive Care. Issues Ment Health Nurs 2017; 38:540-548. [PMID: 28388251 DOI: 10.1080/01612840.2017.1299265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The aim of this study was to describe individuals' experiences of being hospitalized in psychiatric intensive care units (PICUs). Four participants who had previously been admitted in a PICU were interviewed using open-ended questions. The data were analyzed using thematic analysis. Analysis resulted in a synthesis of the various ways patients experienced limitations: (1) Descriptions of Being Limited in the Environment, (2) Descriptions of being Limited in Interactions with Staff, (3) Descriptions of Being Limited in terms of Access to Information, and (4) Descriptions of Having Limited Freedom and Autonomy. Hospitalization is experienced as a life-changing event that shows a kaleidoscopic view of limitation. We stress that the conceptualization of limitation must be considered due to its historical origins, sociopolitical aspirations, and philosophy of care. Thus, nurse practitioners and nursing leaders are advised to put the patient's experience at the center of care, and to involve and integrate patients throughout the recovery process.
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Affiliation(s)
- Martin Salzmann-Erikson
- a Department of Health and Caring Sciences , Faculty of Health and Occupational Studies, University of Gävle , Gävle , Sweden
| | - Cecilia Söderqvist
- b School of Health, Care and Social Welfare, University of Mälardalen , Västerås , Sweden.,c Centre for Clinical Research, Västmanland County Hospital , Västerås , Sweden
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16
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Välimäki M, Yang M, Normand SL, Lorig KR, Anttila M, Lantta T, Pekurinen V, Adams CE. Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services. BMC Psychiatry 2017; 17:123. [PMID: 28372555 PMCID: PMC5379524 DOI: 10.1186/s12888-017-1266-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND People admitted to psychiatric hospitals with a diagnosis of schizophrenia may display behavioural problems. These may require management approaches such as use of coercive practices, which impact the well-being of staff members, visiting families and friends, peers, as well as patients themselves. Studies have proposed that not only patients' conditions, but also treatment environment and ward culture may affect patients' behaviour. Seclusion and restraint could possibly be prevented with staff education about user-centred, more humane approaches. Staff education could also increase collaboration between patients, family members and staff, which may further positively affect treatment culture and lower the need for using coercive treatment methods. METHODS This is a single-blind, two-arm cluster randomised controlled trial involving 28 psychiatric hospital wards across Finland. Units will be randomised to receive either a staff educational programme delivered by the team of researchers, or standard care. The primary outcome is the incidence of use of patient seclusion rooms, assessed from the local/national health registers. Secondary outcomes include use of other coercive methods (limb restraint, forced injection, and physical restraint), service use, treatment satisfaction, general functioning among patients, and team climate and employee turn-over (nursing staff). DISCUSSION The study, designed in close collaboration with staff members, patients and their relatives, will provide evidence for a co-operative and user-centred educational intervention aiming to decrease the prevalence of coercive methods and service use in the units, increase the functional status of patients and improve team climate in the units. We have identified no similar trials. TRIAL REGISTRATION ClinicalTrials.gov NCT02724748 . Registered on 25th of April 2016.
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Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
- Turku University Hospital, Turku, Finland
| | - Min Yang
- West China Research Center for Rural Health Development, Sichuan University Huaxi Medical Center, Sichuan University of China, Administration Building, No 17,Section 3,Ren Ming Nan Lu, Chengdu, Sichuan China
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
| | - Kate R. Lorig
- Department of Medicine - Med/Immunology & Rheumatology, Stanford University, 1000 WELCH RD. #204, Stanford, CA 94305-5755 USA
| | - Minna Anttila
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Virve Pekurinen
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Clive E. Adams
- Institute of Mental Health, Division of Psychiatry, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB UK
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17
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Kaunomäki J, Jokela M, Kontio R, Laiho T, Sailas E, Lindberg N. Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward. BMC Health Serv Res 2017; 17:26. [PMID: 28077156 PMCID: PMC5225613 DOI: 10.1186/s12913-016-1942-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. METHODS The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients' medical files. Inductive content analysis was used. RESULTS There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. CONCLUSION In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.
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Affiliation(s)
- Jenni Kaunomäki
- Institute of Behavioural Sciences, University of Helsinki, Siltavuorenpenger 1A, P.O. Box 9, 00014, Helsinki, Finland
| | - Markus Jokela
- Institute of Behavioural Sciences, University of Helsinki, Siltavuorenpenger 1A, P.O. Box 9, 00014, Helsinki, Finland
| | - Raija Kontio
- Helsinki University and Helsinki University Hospital, Psychiatry, Välskärinkatu 12 A, 00029, HUS, Helsinki, Finland
| | - Tero Laiho
- Helsinki University and Helsinki University Hospital, Psychiatry, Välskärinkatu 12 A, 00029, HUS, Helsinki, Finland
| | - Eila Sailas
- Kellokoski Hospital, 04500, Kellokoski, Finland
| | - Nina Lindberg
- Helsinki University and Helsinki University Hospital, Forensic Psychiatry, Välskärinkatu 12 A, 00029, HUS, Helsinki, Finland.
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18
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Lantta T, Kontio R, Daffern M, Adams CE, Välimäki M. Using the Dynamic Appraisal of Situational Aggression with mental health inpatients: a feasibility study. Patient Prefer Adherence 2016; 10:691-701. [PMID: 27175069 PMCID: PMC4854232 DOI: 10.2147/ppa.s103840] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This paper aims to explore the acceptability of Dynamic Appraisal of Situational Aggression (DASA) from the perspective of patients, its actual use by mental health nurses, and the predictive validity of the DASA instrument. METHODS A feasibility study design incorporating quantitative and qualitative components was used. The study was conducted in three mental health inpatient units at three hospitals in southern Finland. Quantitative data were used to explore demand (nurses' actual use of the DASA), limited efficacy (predictive validity), and acceptability (measured through patients' participation in the project). Qualitative data were collected to enhance the understanding of acceptability by describing patients' perceptions of the strengths and weaknesses of the DASA. RESULTS Nurses used the DASA for most patient assessments. The predictive validity of the DASA was outstanding or excellent, depending on the type of aggression predicted, although the patient recruitment ratio was low. Patients reported both strengths and weaknesses of the DASA, providing complementary information regarding the instrument's acceptability and clinical application. CONCLUSION The DASA accurately predicts inpatient aggression. The patients' preferences and concerns regarding risk assessment have been noted. More patient involvement in risk assessment research and violence prevention efforts is required.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
- Correspondence: Tella Lantta, Department of Nursing Science, University of Turku, FI-20014 Turku, Finland, Tel +358 2 333 8492, Email
| | - Raija Kontio
- Department of Nursing Science, University of Turku, Turku, Finland
- Helsinki University, Helsinki, Finland
- Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Michael Daffern
- Centre for Forensic Behavioural Science (CFBS), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Clive E Adams
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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19
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Shattell M, Bartlett R, Beres K, Southard K, Bell C, Judge CA, Duke P. How Patients and Nurses Experience an Open Versus an Enclosed Nursing Station on an Inpatient Psychiatric Unit. J Am Psychiatr Nurses Assoc 2015; 21:398-405. [PMID: 26597907 DOI: 10.1177/1078390315617038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The inpatient environment is a critical space for nurses and patients in psychiatric settings. In this article, we describe nurses' and patients' perceptions of the inpatient environment both before the removal of a Plexiglas enclosure around a nurses' station and after its removal. Nurses had mixed feelings about the enclosure, reporting that it provided for confidentiality and a concentrated work space but also acknowledged the challenge of the barrier for communication with their patients. Patients unanimously preferred the nurses' station without the barrier, reporting increased feelings of freedom, safety, and connection with the nurses after its removal. It is important to consider the implications of environmental decisions in inpatient settings in order to promote a healthy workplace and healing environment for all community members.
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Affiliation(s)
- Mona Shattell
- Mona Shattell, PhD, RN, FAAN, DePaul University, Chicago, IL, USA
| | - Robin Bartlett
- Robin Bartlett, PhD, RN, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Kyle Beres
- Kyle Beres, MS, RN, DePaul University, Chicago, IL, USA
| | - Kelly Southard
- Kelly Southard, RN, BSN, MBA, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
| | - Claire Bell
- Claire Bell, MA, East Carolina University, Greenville, NC, USA
| | - Christine A Judge
- Christine A. Judge, RN, BSN, BC, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
| | - Patricia Duke
- Patricia Duke, RN, BC, Cone Health Behavioral Health Hospital, Greensboro, NC, USA
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20
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Abstract
Objective. To examine psychiatric patients' experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients' experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable.
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