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Quinn M, Jutkowitz E, Primack J, Lenger K, Rudolph J, Trikalinos T, Rickard T, Mai HJ, Balk E, Konnyu K. Protocols to reduce seclusion in inpatient mental health units. Int J Ment Health Nurs 2024; 33:600-615. [PMID: 38193620 DOI: 10.1111/inm.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
The use of seclusion to manage conflict behaviours in psychiatric inpatient settings is increasingly viewed as an intervention of last resort. Many protocols have, thus, been developed to reduce the practice. We conducted a systematic review to determine the effectiveness of protocols to reduce seclusion on process outcomes (e.g., seclusion, restraint), patient outcomes (e.g., injuries, aggressive incidents, satisfaction), and staff outcomes (e.g., injuries, satisfaction). We searched Medline, Embase, the Cochrane Register of Clinical Trials, PsycINFO, CINAHL, cairn.info, and ClinicalTrials.gov for protocols to reduce seclusion practices for adult patients on inpatient mental health units (from inception to September 6, 2022). We summarised and categorised reported elements of the protocols designed to reduce seclusion using the Behaviour Change Wheel Intervention Functions and resources needed to implement the protocol in psychiatric units. We assessed risk of bias and determined certainty of evidence using GRADE. Forty-eight reports addressed five approaches to reduce seclusion: hospital/unit restructuring (N = 4), staff education/training (N = 3), sensory modulation rooms (N = 7), risk assessment and management protocols (N = 7), and comprehensive/mixed interventions (N = 22; N = 6 without empirical data). The relationship between the various protocols and outcomes was mixed. Psychiatric units that implement architecturally positive designs, sensory rooms, the Brøset Violence Checklist, and various multi-component comprehensive interventions may reduce seclusion events, though our certainty in these findings is low due to studies' methodological limitations. Future research and practice may benefit from standardised reporting of process and outcome measures and analyses that account for confounders.
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Affiliation(s)
- McKenzie Quinn
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - Eric Jutkowitz
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
| | - Jennifer Primack
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Katherine Lenger
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - James Rudolph
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Thomas Trikalinos
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
| | - Taylor Rickard
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - Htun Ja Mai
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
| | - Ethan Balk
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
| | - Kristin Konnyu
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Välimäki M, Lantta T, Anttila M, Vahlberg T, Normand SL, Yang M. An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2229076. [PMID: 36040740 PMCID: PMC9428738 DOI: 10.1001/jamanetworkopen.2022.29076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Investing in health care staffs' education can change the scope of action and improve care. The effectiveness of staff education remains inconclusive. OBJECTIVE To examine whether an evidence-based educational intervention for nurses decreases the use of seclusion rooms in psychiatric hospitals compared with usual practice. DESIGN, SETTING, AND PARTICIPANTS In this pragmatic, 2-arm parallel, stratified cluster randomized clinical trial, 28 wards in 15 psychiatric hospitals in Finland were screened for eligibility and randomly allocated (1:1). Nurses joined on either intervention (n = 13) or usual practice (n = 15) wards. The intervention was performed from May 1, 2016, to October 31, 2017. The follow-up data for January 1 to December 31, 2017, were collected from hospital registers in 2018. Data analysis was performed October 27, 2021. INTERVENTIONS Evidence-based education delivered during 18 months, including 8 months of active education, followed by a 10-month maintenance period. MAIN OUTCOMES AND MEASURES The primary outcome was the occurrence of patient seclusion (events per total number of patients). RESULTS Of 28 psychiatric hospital wards screened (437 beds and 648 nurses), 27 wards completed the study. A total of 8349 patients were receiving care in the study wards, with 53% male patients and a mean (SD) age of 40.6 (5.7) years. The overall number of seclusions was 1209 (14.5%) in 2015 and 1349 (16.5%) in 2017. In the intervention group, the occurrence rate of seclusion at the ward level decreased by 5.3% from 629 seclusions among 4163 patients (15.1%) to 585 seclusions among 4089 patients (14.3%) compared with a 34.7% increase from 580 seclusions among 4186 patients (13.9%) to 764 seclusions among 4092 patients (18.7%) in the usual practice group. The adjusted rate ratio was 0.86 (95% CI, 0.40-1.82) in 2015 and 0.66 (95% CI, 0.31-1.41) in 2017 (P = .003). However, the number of forced injections increased in the intervention group from 317 events among 4163 patients (7.6%) in 2015 to 486 events among 4089 patients (11.9%) in 2017 compared with an increase in the usual practice group from 414 events among 4186 patients (9.9%) in 2015 to 481 events among 4092 patients (11.8%) in 2017. Seven adverse events were reported. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, the educational intervention had a limited effect on the change of occurrence rate of patient seclusion, whereas the use of forced injections increased. More studies are needed to better understand the reasons for these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02724748.
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Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- Xiangya Nursing School, Xiangya Research Center of Evidence-based Healthcare, Central South University, Hunan, China
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
- Now with Faculty of Health and Education, Department of Nursing, Manchester Metropolitan University, Manchester, UK
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, China
- Faculty of Design, Health, and Art, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Pina D, Peñalver-Monteagudo CM, Ruiz-Hernández JA, Rabadán-García JA, López-Ros P, Martínez-Jarreta B. Sources of Conflict and Prevention Proposals in User Violence Toward Primary Care Staff: A Qualitative Study of the Perception of Professionals. Front Public Health 2022; 10:862896. [PMID: 35784229 PMCID: PMC9240435 DOI: 10.3389/fpubh.2022.862896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Some studies indicate that at least one in four cases of workplace violence occurs in the health sector, with a higher incidence in Emergency Departments, Mental Health Services or Primary Care. Unlike other professional groups, healthcare workers perceive this type of behavior mainly from users or patients. This is the reason why both the detection of conflict between users and professionals and the ways to face and reduce these conflicts has been and is one of the main fields of study in this population. The aim of this study was to delve into the sources of conflict between users and professionals in Primary Care from the perspective of the professionals themselves. In addition, the aim was to explore the proposals for intervention/prevention of this conflict that the professionals perceived as necessary to improve the work environment. Methods This study uses qualitative methodology conducting 8 focus groups with professionals related to Primary Health Care. The final sample was composed of 44 workers who were part of the regional management, labor unions, area coordinators, center coordinators and representatives of the professional groups of these centers (medicine, nursing and administration). Thematic analysis was used to extract topics and subtopics. Results The results are divided into areas of conflict and intervention proposals. The professionals detect a lack of training or education in themselves, absence of functional multidisciplinary teams or competencies to improve the patient-professional relationship, among others. To address these shortcomings, they propose the creation of protocols for action in the face of aggression, the formation of spaces and channels of communication both among the center's own workers and between them and other organizations (e.g., hospitals), fostering a positive relationship with the user community and ongoing training in various topics such as self-safety, management of emotions, empathy or interpersonal communication. Conclusions This study allows to highlight specific areas of user-professional conflict in Primary Care. Furthermore, the inclusion of intervention proposals by the professionals allows to propose starting points for the development of complete plans.
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Affiliation(s)
- David Pina
- Department of Socio-Health Sciences, Faculty of Medicine, University of Murcia, Murcia, Spain
- Applied Psychology Service, University of Murcia, Murcia, Spain
| | | | - José Antonio Ruiz-Hernández
- Applied Psychology Service, University of Murcia, Murcia, Spain
- Department of Psychiatry and Social Psychology, Faculty of Psychology, University of Murcia, Murcia, Spain
| | | | - Paloma López-Ros
- Department of Behavioral Sciences and Health, University Miguel Hernández, Elche, Spain
| | - Begoña Martínez-Jarreta
- Department of Pathological Anatomy, Forensic and Legal Medicine and Toxicology, University of Zaragoza, Zaragoza, Spain
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Välimäki M, Lantta T, Lam YTJ, Cheung T, Cheng PYI, Ng T, Ip G, Bressington D. Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers. BMC Psychiatry 2022; 22:344. [PMID: 35585520 PMCID: PMC9118596 DOI: 10.1186/s12888-022-03974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aggression in psychiatric hospitals has been of interest to researchers. Information on how different stakeholders perceive patient aggression remains equivocal. Even less is known about possible similarities or differences in stakeholders' perceptions of how aggressive behaviour is understood, managed and prevented in psychiatric hospitals. We aimed to explore multiple viewpoints on patient aggression, its possible causes and outcomes, and development ideas for prevention and management. METHODS A qualitative design was adopted. The data were collected using focus group interviews. A thematic approach was used for interpretation. The data were collected on 15 adult wards in two inpatient psychiatric settings in Hong Kong. Participants were nurses working on the psychiatric inpatient wards, patients admitted to the wards, and informal caregivers visiting inpatient wards (N = 94). RESULTS Commonalities between all groups were found on how patient aggression is perceived, and why it occurs. Patients and especially nurses described how patient aggression occurred with no clear reason or forewarning and how patients were physically controlled or restricted after aggressive events. Only nurses and patients expressed experiencing physical burden, while all groups considered psychological burden to be a consequence of aggression. All groups proposed that helpful attitudes among nurses, better communication, structural changes, and better self-management skills would prevent patient aggression. Risk assessment was proposed only by nurses and patients, while safety measures were proposed by nurses and informal caregivers only. The use of restrictive interventions to manage aggressive events was proposed by all groups. CONCLUSIONS Despite the complex diversity of perspectives in different stakeholder groups regarding patient aggression, the findings highlighted that it is possible to achieve some mutual understanding of aggression in psychiatric hospitals and identify areas to be developed. Staffs' attitudes and skills for engagement and communication with patients and informal caregivers should be improved. There is also still room to develop the therapeutic environment and culture toward meaningful activities during the treatment period.
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Affiliation(s)
- Maritta Välimäki
- Xiangya School of Nursing, Xiangya Center for Evidence-Based Practice & Healthcare Innovation, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China. .,Department of Nursing Science, ICT-city, University of Turku, 20014, Turku, Finland.
| | - Tella Lantta
- grid.1374.10000 0001 2097 1371Department of Nursing Science, ICT-city, University of Turku, 20014 Turku, Finland
| | - Yuen Ting Joyce Lam
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Teris Cheung
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Po Yee Ivy Cheng
- grid.417134.40000 0004 1771 4093Community Psychiatric Services, 12/F, Block A, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Tony Ng
- grid.417134.40000 0004 1771 4093Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Glendy Ip
- grid.415585.80000 0004 0469 9664Central Nursing Division, Kwai Chung Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Daniel Bressington
- grid.1043.60000 0001 2157 559XCollege of Nursing and Midwifery, Charles Darwin University, Ellengowan Drive, Casuarine, Darwin, NT 0909 Australia
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Lantta T, Anttila M, Välimäki M. Quality of mental health services and rights of people receiving treatment in inpatient services in Finland: a cross-sectional observational survey with the WHO QualityRights Tool Kit. Int J Ment Health Syst 2021; 15:70. [PMID: 34454537 PMCID: PMC8399820 DOI: 10.1186/s13033-021-00495-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This article aims to review the quality of mental health services and the rights of the people receiving treatment in inpatient hospital care in Finland using the World Health Organization's QualityRights Tool Kit as a part of a randomized controlled trial VIOLIN. So far, reports on the QualityRights Tool Kit have mainly been from low- and middle-income countries or countries lacking resources for health services. Reports from countries with well-resourced health care systems, such as the Nordic countries, are still quite few. METHODS A cross-sectional observational survey was conducted on 13 closed inpatient psychiatric wards (acute, rehabilitation, forensic psychiatric) at eight hospitals in Finland. The data for the survey were gathered through a document review, observations, and group interviews among staff members, service users and family members. The STROBE checklist for cross-sectional studies was followed in the reporting. RESULTS Finnish mental health services are partially or fully achieving the standards set by the WHO QualityRights Tool Kit (final scores: 2.5-2.9 out of 3). The highest final score out of the five themes (2.9/3) was achieved under Freedom from torture or cruel, inhuman or degrading treatment or punishment and from exploitation, violence and abuse. The lowest final score out of the five themes (2.5/3) was achieved under the right to exercise legal capacity and the right to personal liberty and the security of person. CONCLUSIONS According to the findings, Finnish mental health services appear to be of high quality. However, we have identified some gaps in quality, which we have addressed in a national randomized controlled trial VIOLIN. Improvements can be realized through shared decision making and relaying information to service users.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, ICT-City, University of Turku, 20014, Turku, Finland
| | - Minna Anttila
- Department of Nursing Science, ICT-City, University of Turku, 20014, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, ICT-City, University of Turku, 20014, Turku, Finland. .,Xiangya Nursing School, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China.
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Gibbon S, Khalifa NR, Cheung NHY, Völlm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007668. [PMID: 32880104 PMCID: PMC8094166 DOI: 10.1002/14651858.cd007668.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). OBJECTIVES To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies. SELECTION CRITERIA Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.
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Affiliation(s)
- Simon Gibbon
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Najat R Khalifa
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Natalie H-Y Cheung
- Forensic Research, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Lucy McCarthy
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
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Al-Maraira OA, Hayajneh FA. Correlates of psychiatric staff's attitude toward coercion and their sociodemographic characteristics. Nurs Forum 2020; 55:603-610. [PMID: 32497275 DOI: 10.1111/nuf.12476] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A deeper understanding of the nurses' characteristics that influence their positive attitudes toward coercion is necessary if coercive measures rates are to be effectively reduced. AIM To identify the difference in psychiatric staff attitudes toward coercive measures in relation to their sociodemographic characteristics. SETTING The study conducted at the National Center for Mental Health, which is regulated under the authority of the Jordanian Ministry of Health. PARTICIPANTS A total of 85 psychiatric staff recruited from the National Center for Mental Health. METHODS A cross-sectional, descriptive, correlational design was used. Data were collected using a self-administered questionnaire, which consisted of 15 items that focused on assessing a staff's attitude toward coercion. RESULTS The relationship between clinical unit and attitude toward coercion was significant (r = -.30; P = .006). Similarly, the correlations between gender-based units and attitudes toward coercion were significant (r = -.38; P = .002). Another significant correlation was revealed with different years of experience (r = .22; P = .04). CONCLUSION The more years of experience in the field of psychiatric nursing the more positive attitude toward coercion. Moreover, working with male psychiatric patients and in acute psychiatric units increase the risk of coercive measures use.
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Affiliation(s)
- Obay A Al-Maraira
- Nursing Department, Al-Farabi Private College, Jeddah, Kingdom of Saudi Arabia
| | - Ferial A Hayajneh
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
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Al-Maraira OA, Hayajneh FA, Shehadeh JH. Psychiatric staff attitudes toward coercive measures: An experimental design. Perspect Psychiatr Care 2019; 55:734-742. [PMID: 31332798 DOI: 10.1111/ppc.12422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 06/17/2019] [Accepted: 07/05/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of a training program on the attitudes of psychiatric nurses toward using coercive measures. DESIGN AND METHODS A repeated measures time-series design with two-equivalent groups was used. A convenience sample of 48 psychiatric nurses were recruited. Data collection was conducted using the Staff Attitude to Coercion Scale. FINDINGS Results showed the effectiveness of the training program in improving nurses' attitude toward coercive measures. After 4 weeks of the training, nurses in the intervention group demonstrated significant improvements in their attitude mean scores. PRACTICE IMPLICATIONS Equipping the psychiatric nurses with essential clinical knowledge and skills concerning the appropriate application of coercive measures policy were imperative issues that might help the nurses in dealing with these clinical complex situations effectively.
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Al-Maraira OA, Hayajneh FA. Use of Restraint and Seclusion in Psychiatric Settings: A Literature Review. J Psychosoc Nurs Ment Health Serv 2019; 57:32-39. [DOI: 10.3928/02793695-20181022-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/29/2018] [Indexed: 11/20/2022]
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Spencer S, Johnson P, Smith IC. De-escalation techniques for managing non-psychosis induced aggression in adults. Cochrane Database Syst Rev 2018; 7:CD012034. [PMID: 30019748 PMCID: PMC6513023 DOI: 10.1002/14651858.cd012034.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Aggression occurs frequently within health and social care settings. It can result in injury to patients and staff and can adversely affect staff performance and well-being. De-escalation is a widely used and recommended intervention for managing aggression, but the efficacy of the intervention as a whole and the specific techniques that comprise it are unclear. OBJECTIVES To assess the effects of de-escalation techniques for managing non-psychosis-induced aggression in adults in care settings, in both staff and service users. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and 14 other databases in September 2017, plus three trials registers in October 2017. We also checked references, and contacted study authors and authorities in the field to identify additional published and unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing de-escalation techniques with standard practice or alternative techniques for managing aggressive behaviour in adult care settings. We excluded studies in which participants had psychosis. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes just one cluster-randomised study of 306 older people with dementia and an average age of 86 years, conducted across 16 nursing homes in France. The study did not measure any of our primary or secondary outcomes but did measure behavioural change using three measurement scales: the Cohen-Mansfield Agitation Inventory (CMAI; 29-item scale), the Neuropsychiatric Inventory (NPI; 12-item scale), and the Observation Scale (OS; 25-item scale). For the CMAI, the study reports a Global score (29 items rated on a seven-point scale (1 = never occurs to 7 = occurs several times an hour) and summed to give a total score ranging from 29 to 203) and mean scores (evaluable items (rated on the same 7-point scale) divided by the theoretical total number of items) for the following four domains: Physically Non-Aggressive Behaviour, such as pacing (13 items); Verbally Non-Aggressive Behaviour, such as repetition (four items); Physically Aggressive Behaviour, such as hitting (nine items); and Verbally Aggressive Behaviour, such as swearing (three items). Four of the five CMAI scales improved in the intervention group (Global: change mean difference (MD) -5.69 points, 95% confidence interval (CI) -9.59 to -1.79; Physically Non-Aggressive: change MD -0.32 points, 95% CI -0.49 to -0.15; Verbally Non-Aggressive: change MD -0.44 points, 95% CI -0.69 to -0.19; and Verbally Aggressive: change MD -0.16 points, 95% CI -0.31 to -0.01). There was no difference in change scores on the Physically Aggressive scale (MD -0.08 points, 95% CI -0.37 to 0.21). Using GRADE guidelines, we rated the quality of this evidence as very low due to high risk of bias and indirectness of the outcome measures. There were no differences in NPI or OS change scores between groups by the end of the study.We also identified one ongoing study. AUTHORS' CONCLUSIONS The limited evidence means that uncertainty remains around the effectiveness of de-escalation and the relative efficacy of different techniques. High-quality research on the effectiveness of this intervention is therefore urgently needed.
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Affiliation(s)
- Sally Spencer
- Edge Hill UniversityPostgraduate Medical InstituteSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Paula Johnson
- Mersey Care NHS Foundation TrustDepartment of Research and DevelopmentMitton Road, WhalleyLancashireClitheroeLancashireUKBB7 9PE
| | - Ian C Smith
- Lancaster UniversityDivision of Health ResearchBailriggLancasterLancasterUK
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