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Fricke J, Siddique SM, Douma C, Ladak A, Burchill CN, Greysen R, Mull NK. Workplace Violence in Healthcare Settings: A Scoping Review of Guidelines and Systematic Reviews. TRAUMA, VIOLENCE & ABUSE 2023; 24:3363-3383. [PMID: 36341578 DOI: 10.1177/15248380221126476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Workplace violence in healthcare settings is alarmingly common and represents significant financial and human cost. The aim of this scoping review was to identify and summarize evidence on strategies to prevent and/or manage workplace violence in healthcare settings. Searches were limited to evidence-based clinical practice guidelines and systematic reviews published between 2015 and 2021. Multiple databases were searched and screened. Quality of the included guidelines and reviews was also assessed. Three guidelines and 33 systematic reviews were included. Both the Occupational Safety and Health Administration 2015 and Registered Nurses' Association of Ontario 2019 guidelines provided useful recommendations for building a comprehensive prevention program. Evidence-based risk assessment, prevention and management, and education and training are all central components. Regular reassessment and adjustment is required. Included reviews (n = 33) were grouped into five main categories: violence toward nurses (n = 10); violence toward healthcare workers in general (n = 8); violence in the emergency department (n = 5); violence related to mental health (n = 5); and measurement related to workplace violence (n = 5). Multicomponent interventions were often more effective than those applied in isolation. We found consistent support for certain strategies including education and training, post-incident debriefing, multidisciplinary rapid response teams, and environmental modifications; however, the strength of evidence and certainty of conclusions were limited across reviews. This scoping review found that strong leadership that cultivates and enforces a culture of inclusivity, support, and respect is a prerequisite for a successful workplace violence prevention program. Rigorous comparative effectiveness research testing interventions are needed.
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Affiliation(s)
- Julie Fricke
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Shazia Mehmood Siddique
- University of Pennsylvania Health System, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Caryn Douma
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Alicia Ladak
- University of Pennsylvania Health System, Philadelphia, PA, USA
| | | | - Ryan Greysen
- University of Pennsylvania Health System, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- University of Pennsylvania, Philadelphia, PA, USA
| | - Nikhil K Mull
- University of Pennsylvania Health System, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Pedersen ML, Gildberg FA, Laulund R, Jørgensen K, Tingleff EB. Nurses' clinical decision-making in the use of rapid tranquillization in adult mental health inpatient settings: An integrative review. Int J Ment Health Nurs 2023; 32:1274-1288. [PMID: 37341210 DOI: 10.1111/inm.13181] [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: 03/10/2023] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/22/2023]
Abstract
Rapid tranquillization is a restrictive practice that remains widely used in mental health inpatient settings worldwide. Nurses are the professionals most likely to administer rapid tranquillization in mental health settings. To improve mental health practices, an enhanced understanding of their clinical decision-making when using rapid tranquillization is, therefore, important. The aim was to synthesize and analyse the research literature on nurses' clinical decision-making in the use of rapid tranquillization in adult mental health inpatient settings. An integrative review was conducted using the methodological framework described by Whittemore and Knafl. A systematic search was conducted independently by two authors in APA PsycINFO, CINAHL Complete, Embase, PubMed and Scopus. Additional searches for grey literature were conducted in Google, OpenGrey and selected websites, and in the reference lists of included studies. Papers were critically appraised using the Mixed Methods Appraisal Tool, and the analysis was guided by manifest content analysis. Eleven studies were included in this review, of which nine were qualitative and two were quantitative. Based on the analysis, four categories were generated: (I) becoming aware of situational changes and considering alternatives, (II) negotiating voluntary medication, (III) administering rapid tranquillization and (IV) being on the other side. Evidence suggests that nurses' clinical decision-making in the use of rapid tranquillization involved a complex timeline with various impact points and embedded factors that continuously influenced and/or were associated with nurses' clinical decision-making. However, the topic has received scant scholarly attention, and further research may help to characterize the complexities involved and improve mental health practice.
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Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Regional Health Research, Forensic Mental Health Research Unit Middelfart, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Frederik Alkier Gildberg
- Department of Regional Health Research, Forensic Mental Health Research Unit Middelfart, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | | | - Kim Jørgensen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Ellen Boldrup Tingleff
- Department of Regional Health Research, Forensic Mental Health Research Unit Middelfart, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
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Mullan PC, Jennings AD, Stricklan E, Martinez E, Weeks M, Mitchell K, Vazifedan T, Andam-Mejia R, Spencer DB. Reducing physical restraints in pediatrics: A quality improvement mixed-methods analysis of implementing a clinical debriefing process after behavioural health emergencies in a Children's Hospital. Curr Probl Pediatr Adolesc Health Care 2023; 53:101463. [PMID: 38000959 DOI: 10.1016/j.cppeds.2023.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
INTRODUCTION An increasing number of pediatric patients with mental and behavioral health (MBH) conditions present to Emergency Department (ED) and inpatient settings with behavioral events that require physical restraint (PR). PR usage is associated with adverse outcomes. Clinical debriefing (CD) programs have been associated with improved performance but have not been studied in this population. After implementing an MBH-CD program in our Children's Hospital, we aimed to decrease the baseline (7/2018-3/2021) rate of a second PR episode (2PR) by 50 % in the ED and inpatient settings over two years. METHODS A multidisciplinary team implemented an MBH-CD process in April 2021 for hospital teams to use immediately after behavioral events. We included patients ≤18 years old, with an ED or inpatient discharge MBH diagnosis, between July 2018 and June 2023. Pre- and post-implementation secondary outcomes included the ED median duration of PR and the ED PR time per 1000 h of ED care. ED and inpatient mean length of stay (LOS) and mean monthly visits (MMV) in pre- and post-implementation were also compared. Qualitative analysis identified major themes. RESULTS Post-implementation, the ED significantly decreased 2PR rate by 67 %; in inpatients, no significant change was demonstrated. Median duration of ED PR decreased from 112 to 71 min (p = 0.006) and ED PR time significantly decreased by 82 % (14.8 to 2.7 h per 1000 h). In the post-implementation period, mean LOS (ED and inpatient) and MMV (ED only) were significantly higher. Fifty-one percent of 494 behavioral alerts were debriefed. Median debriefing duration was 6 min (IQR 4,10). Common themes included cooperation and coordination (23 %) and clinical standards (14 %). DISCUSSION Clinical debriefing implementation was associated with significant improvement in ED patient outcomes. Inpatient outcomes were unchanged, but debriefings in both settings should enable frontline teams to continuously identify opportunities to improve future outcomes.
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Affiliation(s)
- Paul C Mullan
- Children's Hospital of the King's Daughters, Norfolk, VA, United States; Eastern Virginia Medical School, Norfolk, VA, United States.
| | - Andrea D Jennings
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Erin Stricklan
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | | | - Monica Weeks
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Karen Mitchell
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | - Turaj Vazifedan
- Children's Hospital of the King's Daughters, Norfolk, VA, United States
| | | | - Daniel B Spencer
- Children's Hospital of the King's Daughters, Norfolk, VA, United States; Eastern Virginia Medical School, Norfolk, VA, United States
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate the effects of post‐incident debriefing after coercive measures for people with schizophrenia or schizophrenia‐type psychosis.
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Manzano-Bort Y, Mir-Abellán R, Via-Clavero G, Llopis-Cañameras J, Escuté-Amat M, Falcó-Pegueroles A. Experience of mental health nurses regarding mechanical restraint in patients with psychomotor agitation: A qualitative study. J Clin Nurs 2022; 31:2142-2153. [PMID: 34459048 DOI: 10.1111/jocn.16027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
AIM To explore mental health nurses' experiences whilst managing a patient with psychomotor agitation, and the factors that influence the decision to use mechanical restraints. BACKGROUND Psychomotor agitation is considered a potentially violent psychiatric emergency. The management of disruptive behaviours includes mechanical restraints as the last resort although its use has consequences for patients, professionals and the therapeutic relationship. DESIGN A qualitative study design with a hermeneutical approach was developed. METHODS A total of 31 nurses were purposively sampled from six short- and medium-stay mental health inpatient units. Data were obtained from semi-structured interviews. A thematic content analysis following the seven steps of Colaizzi's method was performed. Three researchers independently conducted an inductive analysis within a perspective of a hermeneutic paradigm. The COREQ checklist was followed in carrying out this research. RESULTS Four themes emerged from the analysis: 1) Nurses' perceptions of restraint methods, 2) Factors influencing decision-making, 3) Consequences for professionals of the use of mechanical restraint and 4) Alternatives to mechanical restraint. CONCLUSIONS Aspects such as the importance of teamwork, the issue of cognitive dissonance, ethical conflict and barriers to effecting the withdrawal of these measures affect the mental health nurse's decision-making process. The understanding of these aspects is crucial to further reducing its incidence and negative consequences and achieving the elimination of mechanical restraints. RELEVANCE FOR CLINICAL PRACTICE Knowing how nurses feel during the patient's episode of psychomotor agitation and which factors influence the decision on whether to apply coercive methods can guide us on the quality of care offered.
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Affiliation(s)
- Yasmina Manzano-Bort
- Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Ramón Mir-Abellán
- Patient Safety Department, Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Gemma Via-Clavero
- Hospital Universitari de Bellvitge, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Nursing Research Group (GRIN-IDIBELL), Barcelona, Spain
| | - Jaime Llopis-Cañameras
- Department of Social and Cultural Anthropology, Autonomous University of Barcelona, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Montserrat Escuté-Amat
- Nursing Management Department, Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Anna Falcó-Pegueroles
- School of Nursing Faculty of Medicine and Healthf Sciences, Consolidated Research Group SGR 269 Quantitative Psychology, University of Barcelona (Spain, Research Group on Patient Safety, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
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Goulet MH, Lessard-Deschênes C. Le Modèle de prévention de l’utilisation des mesures de contrôle en santé mentale : une revue intégrative. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094149ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Griffin E. Seclusion Reduction on an Adult Inpatient Psychiatric Unit: A Quality Improvement Project. J Psychosoc Nurs Ment Health Serv 2021; 60:27-32. [PMID: 34846230 DOI: 10.3928/02793695-20211118-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Seclusion practices have traditionally been used in psychiatry to maintain patient and staff safety. Despite negative emotional consequences for all involved parties and the movement toward patient-centered care, these practices continue in in-patient psychiatric units across the United States. The purpose of the current quality improvement project was to decrease the rate of seclusion events on an adult inpatient psychiatric unit through the implementation of a standard debriefing process based on the National Association of State Mental Health Program Directors' Six Core Strategies for Reducing Seclusion and Restraint Use. In 2020, the seclusion rates at the project site were above state and national benchmarks. Post-intervention, the seclusion hours per 1,000 patient care hours increased by 16% (0.38 to 0.44); however, the mean duration of each seclusion episode decreased by 10% (158 minutes to 142 minutes). Intervention compliance was low, including interprofessional participation. These findings demonstrate the need to address seclusion practices with an evidence-based solution, such as debriefing, coupled with adequate support from interprofessional leadership. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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Galligan MM, DeBrocco D, Friedlaender E. Debriefing During a Mental Health Crisis. J Hosp Med 2021; 16:440-442. [PMID: 34197311 DOI: 10.12788/jhm.3628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/27/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Meghan M Galligan
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Healthcare Improvement and Patient Safety, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dawn DeBrocco
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eron Friedlaender
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract
BACKGROUND The breast cancer diagnosis causes a high level of suffering and distress in patients who experience difficulties in coping. There is a need to improve knowledge of emotional and spiritual coping in response to the stressful situation of women who must face this diagnosis. OBJECTIVES The aims of this study were to map women's spiritual and emotional coping experiences reported after a breast cancer diagnosis and examine the proposed interventions and suggestions for clinical practice. METHODS A scoping review was performed by searching the Scientific Electronic Library Online, Scopus, Cumulative Index to Nursing and Allied Health Literature, Latin American & Caribbean Health Sciences Literature, Medical Literature Analyses and Retrieval System Online, Spanish Bibliographic Index of Health Sciences, PSYCINFO, and Google Scholar databases using Medical Subject Headings terms. Additional pertinent studies were identified by reviewing the bibliographies of the included studies. Twenty articles were included according to the recommendations for scoping reviews. RESULTS Study findings regarding emotional and spiritual coping with the diagnosis and proposed interventions were synthesized. A thematic list of interventions and recommendations for clinical practice is also provided. CONCLUSIONS The studies demonstrated that women with breast cancer are challenged by their emotions and experiences. The review highlights the importance of spiritual coping for redefining women's meaning in life. In clinical practice, caring for women's inherent needs when they are coping with a diagnosis is important to establish integral care. IMPLICATIONS FOR PRACTICE Nurses can evaluate coping strategies, offer support for adaptation to the disease, provide qualified listening, help women in their search for significance while coping with cancer, and help them identify ways to overcome this stressful situation. Similarly, they can encourage patients to find spiritual comfort and emotional support.
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Hammervold UE, Norvoll R, Vevatne K, Sagvaag H. Post-incident reviews-a gift to the Ward or just another procedure? Care providers' experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study. BMC Health Serv Res 2020; 20:499. [PMID: 32493391 PMCID: PMC7268524 DOI: 10.1186/s12913-020-05370-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context. Methods Within a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process. Results Care providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions. Conclusion Human care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.
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Affiliation(s)
- Unn Elisabeth Hammervold
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Kari Vevatne
- Department of care and ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hildegunn Sagvaag
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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