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Efkemann SA, Lickiewicz J, Doedens P, Lantta T, Bali P, Husum TL. A Scoping Review on Staff Attitudes towards the Use of Coercion in Mental Healthcare. Healthcare (Basel) 2024; 12:1552. [PMID: 39201112 PMCID: PMC11354183 DOI: 10.3390/healthcare12161552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
Attitudes of mental health professionals towards the use of coercion are highly relevant concerning its use coercion in mental healthcare, as mental health professionals have to weigh ethical arguments and decide within a legal frame in which situations to use coercion or not. Therefore, assessment of those attitudes is relevant for research in this field. A vital instrument to measure those attitudes towards the use of coercion is the Staff Attitude to Coercion Scale. This scoping review aims to provide a structured overview of the advantages and limitations in the assessment of attitudes toward coercion. We conducted a scoping review in Medline, PsycINFO, CINAHL, and Web of Science, based on the PRISMA-ScR. Inclusion criteria were empirical studies on the attitudes of mental health professionals. We included 80 studies and systematically mapped data about the main results and limitations in assessing attitudes toward coercion. The main results highlighted the relevance and increased interest in staff attitudes towards coercion in mental healthcare. Still, the majority of the included studies relied on a variety of different concepts and definitions concerning attitudes. The data further indicated difficulties in developing new and adapting existing assessment instruments because of the equivocal definitions of underlying concepts. To improve the research and knowledge in this area, future studies should be based on solid theoretical foundations. We identified the need for methodological changes and standardized procedures that take into account existing evidence from attitude research in social psychology, nursing science, and other relevant research fields. This would include an update of the Staff Attitude to Coercion Scale based on the limitations identified in this review.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, 44791 Bochum, Germany
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Paul Doedens
- Department of Psychiatry, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Urban Vitality—Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
| | - Tella Lantta
- Department of Nursing Science, University of Turku, 20014 Turku, Finland;
- Centre for Forensic Behavioural Sciences, Swinburne University of Technology, Melbourne 3122, Australia
| | - Panagiota Bali
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece
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Schürmann J, Wetterauer C, Westermair AL, Trachsel M. [The Basel model of principle-oriented clinical ethics consultation 2.0 : An introduction for psychiatry]. DER NERVENARZT 2024:10.1007/s00115-024-01710-9. [PMID: 39031179 DOI: 10.1007/s00115-024-01710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND The effectiveness of clinical ethics counselling in medicine in terms of satisfaction of the participants, support of ethical decision-making, perceived impact on clinical care, moral competence and quality of communication is now empirically well validated. In psychiatry, more and more institutions have structures for clinical ethics consultation as well; however, there is still a lack of evaluative accompanying research on the benefits and differential indications of the various forms and models of clinical ethics counselling in psychiatry. AIM OF THE WORK The article presents the principles and the step by step application of the principle-oriented clinical ethics consultation according to the Basel model 2.0. MATERIAL AND METHODS The article is based on material and procedures developed at the Clinical Ethics Unit of the University Hospital Basel and the University Psychiatric Clinics Basel for the principle-oriented clinical ethics consultation according to the Basel model 2.0. RESULTS AND DISCUSSION Principle-oriented clinical ethics consultation according to the Basel model 2.0 is suitable for dealing with moral issues and conflicts in psychiatric practice and for their ethical reflection; however, further evaluative accompanying research is needed on the benefits and differential indications of this and other models of clinical ethics support in psychiatry.
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Affiliation(s)
- Jan Schürmann
- Abteilung Klinische Ethik, Universitätsspital Basel (USB), Universitäre Psychiatrische Kliniken Basel (UPK), Universitäre Altersmedizin Felix Platter (UAFP), Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 22, 4031, Basel, Schweiz
| | - Charlotte Wetterauer
- Abteilung Klinische Ethik, Universitätsspital Basel (USB), Universitäre Psychiatrische Kliniken Basel (UPK), Universitäre Altersmedizin Felix Platter (UAFP), Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 22, 4031, Basel, Schweiz
| | - Anna Lisa Westermair
- Abteilung Klinische Ethik, Universitätsspital Basel (USB), Universitäre Psychiatrische Kliniken Basel (UPK), Universitäre Altersmedizin Felix Platter (UAFP), Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 22, 4031, Basel, Schweiz
- Institut für Biomedizinische Ethik und Geschichte der Medizin, Universität Zürich, Zürich, Schweiz
| | - Manuel Trachsel
- Abteilung Klinische Ethik, Universitätsspital Basel (USB), Universitäre Psychiatrische Kliniken Basel (UPK), Universitäre Altersmedizin Felix Platter (UAFP), Universitäts-Kinderspital beider Basel (UKBB), Spitalstrasse 22, 4031, Basel, Schweiz.
- Medizinische Fakultät, Universität Basel, Basel, Schweiz.
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Pedersen ML, Gildberg FA, Baker J, Tingleff EB. A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings. Int J Ment Health Nurs 2024; 33:505-522. [PMID: 38017713 DOI: 10.1111/inm.13267] [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: 08/05/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
Mechanical restraint is a commonly used restrictive practice worldwide, although reducing its use is an international priority. Interventions to reduce mechanical restraint are needed if reducing mechanical restraint is to succeed. Therefore, this systematic review aimed to examine evaluated evidence-based interventions that seek to reduce the incidence of and/or time in mechanical restraint in adult mental health inpatient settings. The JBI framework was used to guide this systematic review. The search strategy included peer-reviewed primary research literature published between 1999 and 2023. Two authors independently conducted the systematic search, selection process and data extraction process. Forty-one studies were included in this review. Using content analysis, we grouped interventions into four categories: (I) calm-down methods, (II) staff resources, (III) legal and policy changes and (IV) changing staff culture. Interventions to reduce mechanical restraint in adult mental health inpatient settings have shown some promise. Evidence suggests that a range of interventions can reduce the incidence of and/or time in mechanical restraint. However, controlled trials were lacking and consensus was lacking across studies. Furthermore, specific findings varied widely, and reporting was inconsistent, hampering the development of interventions for this issue. Further research is needed to strengthen the evidence base for reducing mechanical restraint in mental health inpatient settings.
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Affiliation(s)
- Martin Locht Pedersen
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Ellen Boldrup Tingleff
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
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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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