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Wullschleger A, Chatton A, Kuenzi N, Baeriswyl R, Kaiser S, Bartolomei J. Experience of violence and attitudes of staff members towards coercion in psychiatric settings: observational study. BJPsych Open 2024; 10:e80. [PMID: 38616714 PMCID: PMC11060063 DOI: 10.1192/bjo.2024.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Among important dimensions related to the use of coercive measures, professionals' attitude towards coercion is of particular interest. Little is known about how experiences of violence in the workplace might influence these attitudes. AIMS The present study aimed to investigate potential correlates of attitudes towards coercion, especially experiences of violence in the workplace. METHOD Mental health professionals were contacted through an online survey to assess their attitudes towards coercion using the Staff Attitude to Coercion Scale (SACS). The three subscales of the SACS (critical, pragmatic and positive attitudes) were analysed in a multivariate multiple linear regression, using a set of covariates including experiences of violence in the workplace. We hypothesised that experience of violence in the workplace would correlate with less critical attitudes of staff members towards coercion. RESULTS A total of 423 professionals were included in the regression analysis. Age, professional category, feeling of insecurity, having witnessed or used coercion, and the emotional burden associated with coercive measures had a joint significant effect on the three SACS subscales. A feeling of insecurity, but not the experience of violence, was associated with a less critical, more positive appraisal of coercive measures. The emotional burden related to the use of coercion was associated with a more critical attitude. CONCLUSIONS The present results highlight the importance of considering staff members' training and well-being regarding their feelings of insecurity when addressing attitudes towards coercion. The experience of patients should be integrated into staff training and coercion reduction programmes.
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Affiliation(s)
| | - Anne Chatton
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Noémie Kuenzi
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Rachel Baeriswyl
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Javier Bartolomei
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Laureano CD, Laranjeira C, Querido A, Dixe MA, Rego F. Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review. Healthcare (Basel) 2024; 12:445. [PMID: 38391820 PMCID: PMC10888148 DOI: 10.3390/healthcare12040445] [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: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.
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Affiliation(s)
- Cláudio Domingos Laureano
- Psychiatric and Mental Health Service, Local Health Unit of the Leiria Region-Hospital of Santo André, Rua das Olhalvas, 2410-197 Leiria, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
| | - Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Maria Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Hotzy F, Spiess M, Ruflin R, Schneeberger A, Traber R, Morandi S, Jaeger M, Theodoridou A. Association between perceived coercion and perceived level of information in involuntarily admitted patients: Results from a multicenter observational study in Switzerland. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101934. [PMID: 37738688 DOI: 10.1016/j.ijlp.2023.101934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/02/2023] [Accepted: 09/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Involuntary admissions (IA) to psychiatric hospitals are controversial because they interfere with people's autonomy. In some situations, however, they appear to be unavoidable. Interestingly, not all patients perceive the same degree of coercion during IA. The aim of this study was to assess whether the level of knowledge about one's own IA is associated with perceived coercion. METHODS This multicenter observational study was conducted on n = 224 involuntarily admitted patients. Interviews were conducted at five study centers from April 2021 to November 2021. The Macarthur Admission Experience Survey was administered to assess perceived coercion. Knowledge of involuntary admission, perceptions of information received, and attitudes towards legal aspects of involuntary admission were also assessed. RESULTS We found that higher levels of knowledge about IA were negatively associated with perceived coercion at admission. Perceived coercion did not differ between study sites. Only half of the patients felt well informed about their IA, and about a quarter found the information they received difficult to understand. DISCUSSION Legislation in Switzerland requires that patients with IA be informed about the procedure. Strategies to improve patients' understanding of the information given to them about IA might be helpful to reduce perceived coercion, which is known to be associated with negative attitudes towards psychiatry, a disturbed therapeutic relationship, avoidance of psychiatry, and the risk of further coercion.
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Affiliation(s)
- Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
| | | | | | | | | | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland; Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Lausanne, Switzerland
| | - Matthias Jaeger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland; Psychiatrie Baselland, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland; Psychiatrie Baselland, Switzerland
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Oerlemans AJM, Stommel WJP, Verhaak CM, De Vries ALC, Cuijpers FAH, Breukelman M, Hillen MA. Uncertainty in complex healthcare settings - The need for a comprehensive approach. PATIENT EDUCATION AND COUNSELING 2023; 112:107721. [PMID: 37012192 DOI: 10.1016/j.pec.2023.107721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/24/2023] [Accepted: 03/29/2023] [Indexed: 05/09/2023]
Abstract
Uncertainty is increasingly recognized as a crucial phenomenon throughout medical practice. Research on uncertainty so far has been scattered across disciplines, leading to a lack of consensus about what uncertainty represents and minimal integration of knowledge obtained within isolated disciplines. Currently, a comprehensive view of uncertainty which does justice to normatively or interactionally challenging healthcare settings is lacking. This impedes research teasing apart when and how uncertainty manifests, how all stakeholders experience and value it, and how it affects medical communication and decision-making. In this paper, we argue that we need a more integrated understanding of uncertainty. We illustrate our argument using the context of adolescent transgender care, in which uncertainty occurs in myriad ways. We first sketch how theories of uncertainty have emerged from isolated disciplines, leading to a lack of conceptual integration. Subsequently, we emphasize why it is problematic that no comprehensive approach to uncertainty has yet been developed, using examples from adolescent transgender care. Finally, we advocate an integrated approach of uncertainty to further advance empirical research and to ultimately benefit clinical practice.
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Affiliation(s)
- Anke J M Oerlemans
- Department IQ healthcare, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Wyke J P Stommel
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud University Medical Center-Amalia Children's Hospital Nijmegen, Nijmegen, the Netherlands
| | - Annelou L C De Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Floor A H Cuijpers
- Department IQ healthcare, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands; Department of Medical Psychology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Mieke Breukelman
- Centre for Language Studies, Radboud University, Nijmegen, the Netherlands; Department of Medical Psychology, Radboud University Medical Center-Amalia Children's Hospital Nijmegen, Nijmegen, the Netherlands
| | - Marij A Hillen
- Department of Medical Psychology, Amsterdam UMC, location Academic Medical Center, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
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Molewijk B, Pedersen R, Kok A, Førde R, Aasland O. Two years of ethics reflection groups about coercion in psychiatry. Measuring variation within employees' normative attitudes, user involvement and the handling of disagreement. BMC Med Ethics 2023; 24:29. [PMID: 37173770 PMCID: PMC10182617 DOI: 10.1186/s12910-023-00909-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Research on the impact of ethics reflection groups (ERG) (also called moral case deliberations (MCD)) is complex and scarce. Within a larger study, two years of ERG sessions have been used as an intervention to stimulate ethical reflection about the use of coercive measures. We studied changes in: employees' attitudes regarding the use of coercion, team competence, user involvement, team cooperation and the handling of disagreement in teams. METHODS We used panel data in a longitudinal design study to measure variation in survey scores from multidisciplinary employees from seven departments within three Norwegian mental health care institutions at three time points (T0-T1-T2). Mixed models were used to account for dependence of data in persons who participated more than once. RESULTS In total, 1068 surveys (from 817 employees who did and did not participate in ERG) were included in the analyses. Of these, 7.6% (N = 62) responded at three points in time, 15.5% (N = 127) at two points, and 76.8% (N = 628) once. On average, over time, respondents who participated in ERG viewed coercion more strongly as offending (p < 0.05). Those who presented a case in the ERG sessions showed lower scores on User Involvement (p < 0.001), Team Cooperation (p < 0.01) and Constructive Disagreement (p < 0.01). We observed significant differences in outcomes between individuals from different departments, as well as between different professions. Initial significant changes due to frequency of participation in ERG and case presentation in ERG did not remain statistically significant after adjustment for Departments and Professions. Differences were generally small in absolute terms, possibly due to the low amount of longitudinal data. CONCLUSIONS This study measured specific intervention-related outcome parameters for describing the impact of clinical ethics support (CES). Structural implementation of ERGs or MCDs seems to contribute to employees reporting a more critical attitude towards coercion. Ethics support is a complex intervention and studying changes over time is complex in itself. Several recommendations for strengthening the outcomes of future CES evaluation studies are discussed. CES evaluation studies are important, since-despite the intrinsic value of participating in ERG or MCD-CES inherently aims, and should aim, at improving clinical practices.
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Affiliation(s)
- Bert Molewijk
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway.
- Department of Ethics, Law and Humanities, Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Almar Kok
- Department of Epidemiology and Data Science and Department of Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
- Aging and Later Life, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Reidun Førde
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Olaf Aasland
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Oslo, Norway
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Feeling coerced during voluntary and involuntary psychiatric hospitalisation: A review and meta-aggregation of qualitative studies. Heliyon 2023; 9:e13420. [PMID: 36820044 PMCID: PMC9937983 DOI: 10.1016/j.heliyon.2023.e13420] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Objective This review aimed to provide an aggregative synthesis of the qualitative evidence on patients' experienced coercion during voluntary and involuntary psychiatric hospitalisation. Design A qualitative review. Data sources The search was conducted, in five bibliographic databases: Embase.com, Ovid MEDLINE(R) ALL, APA PsycINFO Ovid, Web of Science Core Collection and the Cochrane Database of Systematic Reviews. Review methods Following the Joanna Briggs Institute approach, a systematized procedure was applied throughout the review process, from data search to synthesis of results. The reporting of this review was guided by the standards of the PRISMA 2020 statement. The quality of the included studies was critically appraised by two independent reviewers using the JBI Critical Appraisal Checklist. Included findings were synthesized using meta-aggregation. Confidence in the review findings was assessed following the Confidence in the Output of Qualitative research synthesis (ConQual) approach. Results A total of 423 studies were identified through the literature search and 26 were included in the meta-aggregation. Totally, 151 findings were extracted and aggregated into 27 categories and 7 synthesized findings. The synthesized findings focused on: the patients' experience of the hospitalisation and the associated feeling of coercion; the factors affecting this feeling, such as the involvement in the decision-making process, the relationships with the staff and the perception of the hospital treatment as effective and safe; the coping strategies adopted to deal with it and the patients' suggestions for alternatives. All synthesized findings reached an overall confidence score of "moderate". The seven findings were downgraded one level due to dependability limitations of the included studies. Conclusion Based on these findings, seven recommendations for clinical practice where developed, such as fostering care ethics, promoting patients' voice and shared decision-making, and enhancing patients' perceived closeness, respect and fairness. Five recommendations for future research were also prompted, for instance improving the methodological quality and cultural variation of future qualitative studies, and exploring the psychosocial impact of experienced coercion on patients. For these recommendations to be effectively implemented, a profound change in the structure and culture of the mental health system should be promoted. The involvement of patients in the design, development and scientific evaluation of this change is strongly recommended.
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Husum TL, Siqveland J, Ruud T, Lickiewicz J. Systematic literature review of the use of Staff Attitudes to Coercion Scale (SACS). Front Psychiatry 2023; 14:1063276. [PMID: 36824675 PMCID: PMC9941667 DOI: 10.3389/fpsyt.2023.1063276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE Staff's attitudes to the use of coercion may influence the number of coercive interventions employed and staff willingness to engage in professional development projects aimed at reducing the use of coercion itself. The Staff Attitude to Coercion Scale (SACS) was developed to assess the attitudes of mental healthcare staff to the use of coercion in 2008 and has been employed subsequently. This global study systematically reviews and summarizes the use of the scale in research. METHODS Seven databases were searched for studies using SACS in articles published in peer reviewed journals and gray literature. In addition, researchers who have asked for permission to use the scale since its development in 2008 were contacted and asked for their possible results. Extracting of data from the papers were performed in pairs of the authors. RESULTS Of the 82 identified publications, 26 papers with 5,838 respondents were selected for review. A review of the research questions used in the studies showed that the SACS questionnaire was mostly used in studies of interventions aimed at reducing coercion and further explain variation in the use of coercion. CONCLUSION SACS is, to our best of knowledge, the only questionnaire measuring staff's attitudes to the use of coercive interventions in mental health services. Its widespread use indicates that the questionnaire is perceived as feasible and useful as well as demonstrating the need for such a tool. However, further research is needed as the relationship between staff attitudes to coercion and the actual use of coercion remains unclear and needs to be further investigated. Staff attitudes to coercion may be a prerequisite for leaders and staff in mental healthcare to engage in service development and quality improvement projects.
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Affiliation(s)
- Tonje Lossius Husum
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Kraków, Poland
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Dechent F, Moeller J, Huber CG. Meaning Analysis and Alienation: A Method of Immanent Critique in Acute Psychiatry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16194. [PMID: 36498269 PMCID: PMC9735647 DOI: 10.3390/ijerph192316194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
In acute psychiatry, where people with severe mental disorders are frequently treated, there can be contradictions between concepts of illness among, e.g., patients and healthcare professionals, and also between medical and legal aspects. These contradictions do not manifest themselves openly but are immanent in the social practices of the treatment teams as contradictions between the social level and the individual level. They can lead to alienation, which may be reflected in poorer quality of treatment, such as the more frequent use of coercive measures or poorer adherence to therapy in patients. In the normal daily routine of a clinic, these contradictions are mostly hidden by hierarchical structures or by unbalanced concepts of psychiatric illness, or external critique is used to try to solve these contradictions. However, another way of dealing with these contradictions could be to analyze the potential and causes for alienation through systematic analysis and transformation of the whole system of a psychiatric ward to reduce the level of contradiction within it. The aim of this work is to use the concept of meaning elaborated by Luhmann to identify and recognize alienation potentials as concretely as possible and thus make them accessible to immanent critique. Meaning in Luhmann's use of the term serves to reduce complexity in a social context and always opens up consequential possibilities for action. Consequential limited possibilities at the level of action in a rigid social system (which psychiatric wards can be) can-at an individual level-lead to people subordinating themselves to the rigid system to an excessive degree and thus alienating themselves from the system. Thus, a rigid system with a narrowing of consequential possibilities excludes meaningful consequential possibilities. This leads to alienating contradictions and to possibilities of world appropriation being missed. The aim of the current analysis is not to make a general critique of psychiatry but to improve the theoretical basis to better understand the problem of alienation in acute psychiatry as a symptom of system-immanent contradictions and thus open up the possibility of transforming systems, e.g., psychiatric acute care units, by means of immanent critique.
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Affiliation(s)
- Frieder Dechent
- University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, 4055 Basel, Switzerland
| | - Christian G. Huber
- University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
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Linkhorst T, Birkeland SF, Gildberg FA, Mainz J, Torp-Pedersen C, Bøggild H. Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 85:101838. [PMID: 36208564 DOI: 10.1016/j.ijlp.2022.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types. METHODS For coercive episodes reported to the national administrative register for the period 2011-16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex. RESULTS Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint. CONCLUSION The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.
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Affiliation(s)
- Thea Linkhorst
- Odense University Hospital, Region of Southern Denmark, 5000 Odense, Denmark; Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, 5500 Middelfart, Denmark
| | | | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, 5500 Middelfart, Denmark; Department of Psychiatry, Middelfart, Mental Health Services, Region of Southern Denmark, 5500 Middelfart, Denmark.
| | - Jan Mainz
- Department of Psychiatry, North Denmark Region, 9000 Aalborg, Denmark; Danish Center for Clinical Health Services Research (DACS), Aalborg University Hospital, Aalborg University, 9000 Aalborg, Denmark; Department of Community Mental Health, University of Haifa, Mount Carmel, Haifa, Israel; DaCHE, University of Southern Denmark, 5000 Odense, Denmark.
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark; Department of Cardiology, Nordsjællands Hospital, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, E, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, 9000 Aalborg, Denmark.
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Schneeberger AR, Huber CG. Crisis within a crisis - the fragility of acute psychiatric care delivery. World Psychiatry 2022; 21:245-246. [PMID: 35524592 PMCID: PMC9077597 DOI: 10.1002/wps.20969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Andres R Schneeberger
- Department of Adult Psychiatry, Psychiatric Services Grisons, Chur, Switzerland
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric University Clinics, Zurich, Switzerland
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, USA
| | - Christian G Huber
- Department of General Adult Psychiatry, University Psychiatric Clinics, Basel, Switzerland
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11
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Jansen TL, Danbolt LJ, Hanssen I, Hem MH. How may cultural and political ideals cause moral distress in acute psychiatry? A qualitative study. BMC Psychiatry 2022; 22:212. [PMID: 35321674 PMCID: PMC8944013 DOI: 10.1186/s12888-022-03832-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 02/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND There is growing public criticism of the use of restraints or coercion. Demands for strengthened patient participation and prevention of coercive measures in mental health care has become a priority for care professionals, researchers, and policymakers in Norway, as in many other countries. We have studied in what ways this current ideal of reducing the use of restraints or coercion and attempting to practice in a least restrictive manner may raise morals issues and create experiences of moral distress in nurses working in acute psychiatric contexts. METHODS Qualitative interview study, individual and focus group interviews, with altogether 30 nurses working in acute psychiatric wards in two mental health hospitals in Norway. Interviews were recorded and transcribed. A thematic analytic approach was chosen. RESULTS While nurses sense a strong expectation to minimise the use of restraints/coercion, patients on acute psychiatric wards are being increasingly ill with a greater tendency to violence. This creates moral doubt and dilemmas regarding how much nurses should endure on their own and their patients' behalf and may expose patients and healthcare personnel to greater risk of violence. Nurses worry that new legislation and ideals may prevent acutely mentally ill and vulnerable patients from receiving the treatment they need as well as their ability to create a psychological safe climate on the ward. Furthermore, persuading the patient to stay on the ward can cause guilt and uneasiness. Inadequate resources function as external constraints that may frustrate nurses from realising the treatment ideals set before them. CONCLUSIONS Mental health nurses working in acute psychiatric care are involved in a complex interplay between political and professional ideals to reduce the use of coercion while being responsible for the safety of both patients and staff as well as creating a therapeutic atmosphere. External constraints like inadequate resources may furthermore hinder the healthcare workers/nurses from realising the treatment ideals set before them. Caught in the middle nurses may experience moral distress that may lead to physical discomfort, uneasiness and feelings of guilt, shame, and defeat. Pressure on nurses and care providers to reduce or eliminate the use of coercion and reduction of health care spending are incompatible demands.
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Affiliation(s)
- Trine-Lise Jansen
- Norway, MF Norwegian School of Theology, Religion and Society, Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway.
| | - Lars Johan Danbolt
- grid.446080.e0000 0000 8775 4235MF Norwegian School of Theology, Religion and Society, Oslo, Norway
| | - Ingrid Hanssen
- grid.458172.d0000 0004 0389 8311Lovisenberg Diakonale Høgskole (Lovisenberg Diaconal University College), Oslo, Norway
| | - Marit Helene Hem
- grid.463529.f0000 0004 0610 6148VID Specialized University, Oslo, Norway
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12
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Fukasawa M, Miyake M, Kikkawa T, Sueyasu T. Development of the Japanese version of Staff Attitude to Coercion Scale. Front Psychiatry 2022; 13:1026676. [PMID: 36325534 PMCID: PMC9618617 DOI: 10.3389/fpsyt.2022.1026676] [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: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An important factor in proceeding the efforts to reduce coercion in psychiatry is the attitudes of clinical staff toward its use. We aimed to develop the Japanese version of the Staff Attitude to Coercion Scale (SACS) and clarify its psychometric properties. METHODS After the translation and back-translation of the SACS, which includes 15 items consisting of three subscales, we conducted an anonymous self-administered questionnaire survey of clinical staffs working in 17 wards in two psychiatric hospitals. We administered the second survey to some of the participants to confirm the test-retest reliability. Additionally, we obtained information regarding the 17 wards from the institutions. Internal consistency was assessed using Cronbach's alpha coefficients. Test-retest reliability was assessed using intraclass correlation coefficients (ICC). Structural validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). For construct validity, the correlation of the SACS score within wards and its association with the actual use of seclusion/restraints were explored using multilevel multivariate linear regression analyses. RESULTS We used 261 (67.1%) responses, 35 responses of which were also used to examine test-retest reliability. Cronbach's alpha coefficients (0.761) and ICC (0.738) indicated good reliability. The results of CFA based on the original three-dimensional structure did not indicate a good fit (CFA = 0.830, RMSEA = 0.088). EFA suggested a four-factor structure, two of which were almost consistent with the original two subscales. The correlation of the SACS score within wards was confirmed while a positive association with the actual use of seclusion/restraints was not identified. CONCLUSION While the original three-dimensional structure was not replicated, construct validity was partially confirmed. Reliability of the total scale was good. In Japan, although using the subscales was not recommended, using the total scale of SACS seemed acceptable.
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Affiliation(s)
- Maiko Fukasawa
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
| | - Michi Miyake
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takahiro Kikkawa
- Faculty of Nursing, Undergraduate School of Medicine, Tokai University, Isehara, Japan
| | - Tamio Sueyasu
- Department of Nursing, School of Health Sciences, Bukkyo University, Kyoto, Japan
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13
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Husum TL, Ruud T, Lickiewicz J, Siqveland J. Measurement Properties of the Staff Attitude to Coercion Scale: A Systematic Review. Front Psychiatry 2022; 13:744661. [PMID: 35573326 PMCID: PMC9095955 DOI: 10.3389/fpsyt.2022.744661] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The Staff Attitude to Coercion Scale (SACS) was developed to assess mental health care staff's attitudes to the use of coercion in treatment. The staff's attitudes to the use of coercion may also influence their willingness to engage in professional development projects aimed at reducing use of coercion. This study systematically reviews the existing evidence related to the measurement properties of the SACS in papers published since the publication of SACS in 2008. METHODS Seven databases were searched for studies published until October 2021 assessing the measurement properties of SACS or using SACS. All original studies reporting data relevant for the assessment of measurement properties of the SACS were eligible for inclusion. The methodological quality of the studies was assessed and rated using the COnsensus-based Standard for the selection of health Measurement INstruments (COSMIN). RESULTS Of the 81 identified publications, 13 studies with a total of 2,675 respondents met the inclusion criteria. Most studies reported data on structural validity and internal consistency, with high methodological quality, but there were almost no data on any other measurement properties. CONCLUSION We found evidence for adequate structural validity and internal consistency of the SACS, while other important measurement properties were not addressed in any of the reviewed studies. Caution is needed when interpreting results of the SACS in terms of aspects such as reliability, criterion validity and measurement error. The relationship between staff attitudes to coercion and the actual use of coercion also remains unclear and needs to be further investigated. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier: CRD42021239284.
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Affiliation(s)
- Tonje Lossius Husum
- Centre for Medical Ethics, University of Oslo, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Krakow, Poland
| | - Johan Siqveland
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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14
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Simpson N, Steen M, Vernon R, Briley A, Wepa D. Developing conflict resolution strategies and building resilient midwifery students: A mixed methods research protocol. JMIR Res Protoc 2021; 11:e35558. [PMID: 34995202 PMCID: PMC8900901 DOI: 10.2196/35558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Workplace bullying and violence (WBV) are well-documented issues in the midwifery profession. Negative workplace culture, conflict, and bullying are the most common forms of workplace violence experienced by midwives. Workplace violence increases the risk of midwives experiencing burnout, compassion fatigue, psychological trauma, poor mental health, absenteeism, loss of passion for the midwifery profession, job dissatisfaction, and poor job retention. Midwifery students describe workplace violence in the form of physical, emotional, or verbal abuse, and bullying. Therefore, there is a justification to develop conflict resolution strategies and resilience in midwifery students prior to graduation. Objective Our aim is to develop and facilitate a bespoke education program for South Australian midwifery students to enable them to develop skills in conflict resolution, build resilience, and identify self-care strategies. Methods This study will undertake a preparatory phase summarizing the body of literature on midwifery students’ knowledge, understanding, and experiences of WBV. Following this, a 3-phase sequential mixed methods research design study will be undertaken. In Phase 1, quantitative data will be collected via a semistructured questionnaire and a validated conflict measurement tool, before and after attending an education workshop, and will be analyzed using descriptive and inferential statistics. Results from Phase 1 will inform and guide the development of an interview schedule for Phase 2. In Phase 2, qualitative data will be gathered by facilitating one-to-one interviews and a thematic analysis will be undertaken to gain a deeper understanding of midwifery students’ experiences of WBV. In Phase 3, data integration using triangulation will be undertaken and meta-inferences will be developed via the integration of results and findings from Phases 1 and 2. Results The preparatory phase will commence in October 2021. Phase 1 will commence in 2022 with analysis of pre- and posteducation results anticipated to be completed by December 2022. Phase 2 will be developed from findings of the preparatory phase and results of Phase 1. An interpretation of verbatim interview transcripts is estimated to be undertaken by April 2023. Phase 3 of the study is expected to commence in May 2023, and this will involve the analysis of collective evidence gathered from Phases 1 and 2. The anticipated completion date for the study is December 2023. Conclusions The outcomes of this research will provide insights into the prevalence and impact of WBV experienced by midwifery students. The findings of the research will report on levels of knowledge, skills, and confidence, and will assess the impact of a bespoke conflict resolution and resilience education workshop for midwifery students in managing WBV. International Registered Report Identifier (IRRID) PRR1-10.2196/35558
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Affiliation(s)
- Naomi Simpson
- University of South Australia, Crn Frome Road & North Terrace, Adelaide, AU
| | | | - Rachael Vernon
- University of South Australia, Crn Frome Road & North Terrace, Adelaide, AU
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15
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Chumakov E, Petrova N, Vadivel R, Pinto da Costa M, Bhugra D, Ventriglio A. Use of Compulsory Treatment by Early-Career Psychiatrists: An International Survey. Psychiatr Serv 2021; 72:1276-1281. [PMID: 34030455 DOI: 10.1176/appi.ps.202000303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) has been broadly incorporated into national frameworks for compulsory psychiatric treatment. Recently, instructions issued by the UN CRPD Committee discouraged any involuntary treatment and detention of people with mental disabilities, which has sparked clinical, legal, and ethical debates. Early-career psychiatrists (ECPs) are often at the front line of decisions to involuntarily detain psychiatric patients; here, the authors surveyed ECPs to gain insight into their experiences with compulsory psychiatric treatment in clinical practice. METHODS An anonymous, voluntary, online survey among ECPs from 43 countries was conducted between July and August 2019. RESULTS In total, 142 ECPs completed and were eligible to participate in the survey. Most of the survey respondents reported being involved in the practice of compulsory psychiatric care. More than half reported difficulties in providing compulsory psychiatric care, mostly because of the bureaucracy of legal procedures (e.g., legal correspondence with the court) and ethical issues around detention. Most respondents (96%) generally agreed with their country's legal mechanism for compulsory treatment; 43% indicated that it should remain unchanged, and 53% indicated that it should be revised. CONCLUSIONS These findings call for a broader discussion in society and among psychiatrists regarding the practice of compulsory treatment while giving due consideration to the legal, therapeutic, and ethical issues involved. The views of ECPs will be helpful in future revisions of the ethical and operational frameworks of compulsory psychiatric care.
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Affiliation(s)
- Egor Chumakov
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Nataliia Petrova
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Ramya Vadivel
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Mariana Pinto da Costa
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Dinesh Bhugra
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Antonio Ventriglio
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
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Laukkanen E, Kuosmanen L, Louheranta O, Ryynänen OP, Vehviläinen-Julkunen K. A Bayesian network model to identify the associations between the use of seclusion in psychiatric care and nursing managers' attitudes towards containment methods. J Psychiatr Ment Health Nurs 2021; 28:815-828. [PMID: 33547840 DOI: 10.1111/jpm.12736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Seclusion is used frequently in psychiatric care, despite its potential adverse effects. Several programmes aiming to reduce the use of seclusion identify leadership and management as key strategies-however, studies concerning leaders and managers are missing. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Nursing managers' negative attitudes towards seclusion are associated with less use of the measure, and nursing managers' higher age is associated with increased use of seclusion. WHAT ARE THE IMPLICATIONS FOR PRACTICE Nursing managers should be encouraged to guide their staff to reduce the use of seclusion. The negative influences of seclusion and the potential of alternative measures should be highlighted in the education and training of psychiatric nursing managers. ABSTRACT Introduction The use of seclusion in psychiatric care should be reduced. The relationship between nursing management or nursing managers' attitudes and the use of seclusion has not been investigated. Aim To describe the associations between the use of seclusion and psychiatric nursing managers' attitudes to containment methods. Method Register data concerning the use of seclusion in Finnish psychiatric care in 2017 were collected. The Attitudes to Containment Measures Questionnaire was used to illustrate psychiatric nursing managers' attitudes to containment methods. An Augmented Naive Bayes analysis was used to investigate the relationships of the use of seclusion and attitudes. Results Nursing managers' age and their attitudes towards containment methods were related to the use of seclusion. Especially nursing managers' negative perceptions of seclusion were associated with less use of seclusion, and seclusion was used more often on wards with nursing managers who were older than the average. Conclusion Nursing managers' negative attitudes towards seclusion have a potential impact on the use of seclusion, which might even result in a reduction in its use in psychiatric inpatient setting. Implications for practice The results suggest that nursing managers should be encouraged to guide their staff to decrease the use of seclusion.
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Affiliation(s)
- Emilia Laukkanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.,Finnish Medicines Agency Fimea, Kuopio, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Olavi Louheranta
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Olli-Pekka Ryynänen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,General Practice Unit, Kuopio University Hospital, Primary Health Care, Kuopio, Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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17
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Tölli S, Kontio R, Partanen P, Häggman-Laitila A. Conceptual framework for a comprehensive competence in managing challenging behaviour: The views of trained instructors. J Psychiatr Ment Health Nurs 2021; 28:692-705. [PMID: 33295055 DOI: 10.1111/jpm.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/10/2020] [Accepted: 11/30/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: There is body of knowledge available about the harms associated with restrictive interventions used in behaviour management, service users' perceptions of the use of restraints, and staff competence in behaviour management. The staff perspective has been studied in terms of staff exposure, responses to and prevention of aggression, staff-related factors associated with service user aggression, and staff attitudes and perceptions towards violence. The definitions of competence in behaviour management provided in training interventions are fragmented and based on unilateral measurements. Training interventions with the purpose of enhancing staff competence in behaviour management are organized regularly, yet there is a lack of clarity on how effective these interventions are. Inadequate conceptual understanding of behaviour management can weaken the effectiveness of these interventions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Our study produced new knowledge by providing a preliminary conceptual framework that can be used to comprehensively describe and assess competence in managing challenging behaviour and to cover safely the whole care process. Humane care and ethical sensitivity should be the premises of interaction with people in distress. We also pointed out the needs for conceptual clarification of the concepts of confidence, support and restraint. We provide important new insight into the leadership and cultural issues of behaviour management that is relevant for patients, staff members and healthcare organizations. We found that staff members do not consider service user safety and workplace safety as opposing issues. Further, we provide new perspectives for prevention, the risk assessment process and effective communication in the context of behaviour management. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A comprehensive understanding of the competences related to behaviour management will foster universal definitions for "support" and "restraint," which can then be used to ensure that the best practices are used for behaviour management. Organizational culture and participative leadership on behaviour management should be developed with a special focus on safety issues, common understanding of comprehensive competence, risk assessment and prevention, views regarding the use of restraints, and teamwork. ABSTRACT: Introduction Previous research concerning staff views of behaviour management has not considered instructors' views. The definitions of competence in behaviour management are fragmented, which can undermine the effectiveness of training interventions. Aim/Question This study aimed to describe Finnish and British Management of Actual or Potential Aggression instructors' perceptions of safety and behaviour management-related competences and create a conceptual framework for comprehensive competence. Method An explorative-descriptive qualitative approach with purposive sampling (N = 22), semi-structured interviews and abductive content analysis. Results Conceptual framework of comprehensive competence in managing challenging behaviour includes five categories-knowledge, skills, attitude, confidence and ethical sensitivity-and 21 subcategories. Competent staff and supportive leadership ensured safety, while inconsistent risk management culture, the health and behaviour of service users, and inadequate staff orientation endangered safety. Discussion The study produced new knowledge of safety issues and competences from the perspective of the instructors who deliver behaviour management training. Implications for practice Competence to manage challenging behaviour should be developed based on our conceptual framework to provide an effective and safe training. Prevention, the risk assessment process, alternative communication, and the definitions of "confidence," "support" and "restraint" should all be sufficiently addressed in future training.
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Affiliation(s)
- Sirpa Tölli
- University of Eastern Finland, Kuopio, Finland.,Oulu University of Applied Sciences, Oulu, Finland
| | - Raija Kontio
- Director Hyvinkää Hospital, Adjunct Professor Helsinki University, Helsinki, Finland
| | | | - Arja Häggman-Laitila
- University of Eastern Finland, Kuopio, Finland.,Social and Health Care, City of Helsinki, Helsinki, Finland
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18
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Krieger E, Moritz S, Lincoln TM, Fischer R, Nagel M. Coercion in psychiatry: A cross-sectional study on staff views and emotions. J Psychiatr Ment Health Nurs 2021; 28:149-162. [PMID: 32348607 DOI: 10.1111/jpm.12643] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/12/2020] [Accepted: 04/17/2020] [Indexed: 01/03/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort. The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions. Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression. Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil." Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists. Emotions play an important role in decision-making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups. Staff members consider reflective interventions, such as team supervisions or post-seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely. Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions. Structured post-seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. ABSTRACT: Introduction Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post-seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI.
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Affiliation(s)
- Eva Krieger
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord - Wandsbek, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Rabea Fischer
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord - Wandsbek, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord - Wandsbek, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Schleswig-Holstein, Luebeck, Germany
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19
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Coping with Criticism and Embracing Change—Further Reflexions on the Debate on a Mental Health Care System without Coercion. LAWS 2021. [DOI: 10.3390/laws10020022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In August 2019, a manuscript was published in this journal that aimed at imagining a mental health care system that renounces the judicial control to better focus on the will and preferences of those who require support. Alternative scenarios for dealing with risk, inpatient care, and police custody were presented that elicited strong and emotionally laden reactions. This article adds further reflections to this debate, aiming at contributing explanations for this unsettlement. A productive notion of criticism is discussed, and ways to achieve change toward a more human rights-oriented psychiatric practice are outlined.
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20
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[Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain]. Salud Colect 2021; 17:e3045. [PMID: 33822542 DOI: 10.18294/sc.2021.3045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.
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Vandamme A, Wullschleger A, Garbe A, Cole C, Heinz A, Bermpohl F, Mielau J, Mahler L, Montag C. The Role of Implicit and Explicit Staff Attitudes in the Use of Coercive Measures in Psychiatry. Front Psychiatry 2021; 12:699446. [PMID: 34220595 PMCID: PMC8249742 DOI: 10.3389/fpsyt.2021.699446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
Many determinants leading to the use of different coercive measures in psychiatry have been widely studied and it seems that staff attitudes play a crucial role when it comes to the decision-making process about using coercion. However, research results about staff attitudes and their role in the use of coercive measures are inconsistent. This might be due to a focus on self-report studies asking for explicit answers, which involves the risk of bias. This study aimed to expand research on this topic by examining the impact of explicit and implicit staff attitudes on the use of coercive measures in clinical practice. In addition, the influence of gender, profession (nurses, psychiatrists), and years of professional experience as well as their influence on staff attitudes were examined. An adaption of the implicit association measure, the Go/No-Go Association Task (GNAT), with the target category coercion and distracter stimuli describing work load, as well as the explicit questionnaire Staff Attitudes to Coercion Scale (SACS) was completed by staff (N = 149) on 13 acute psychiatric units in 6 hospitals. Data on coercive measures as well as the total number of treated cases for each unit was collected. Results showed that there was no association between staff's implicit and explicit attitudes toward coercion, and neither measure was correlated with the local frequency of coercive measures. ANOVAs showed a significant difference of the GNAT result for the factor gender (F = 9.32, p = 0.003), demonstrating a higher tendency to justify coercion among female staff members (M = -0.23, SD = ±0.35) compared to their male colleagues (M = -0.41, SD = ±0.31). For the SACS, a significant difference was found for the factor profession (F = 7.58, p = 0.007), with nurses (M = 2.79, SD = ±1.40) showing a more positive attitude to the use of coercion than psychiatrists (M = 2.15, SD = ±1.11). No significant associations were found regarding the extent of professional experience. Results indicate a complex interaction between implicit and explicit decision-making processes dependent on specific contexts. We propose future research to include primers for more context-related outcomes. Furthermore, differences in gender suggest a need to direct attention toward occupational safety and possible feelings of anxiety in the workplace, especially for female staff members.
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Affiliation(s)
- Angelika Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Amelie Garbe
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Celline Cole
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lieselotte Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Morandi S, Silva B, Mendez Rubio M, Bonsack C, Golay P. Mental health professionals' feelings and attitudes towards coercion. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 74:101665. [PMID: 33401095 DOI: 10.1016/j.ijlp.2020.101665] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite absence of clear evidence to assert that the use of coercion in psychiatry is practically and clinically helpful or effective, coercive measures are widely used. Current practices seem to be based on institutional cultures and decision-makers' attitudes towards coercion rather than led by recommendations issued from the scientific literature. Therefore, the main goal of our study was to describe mental health professionals' feelings and attitudes towards coercion and the professionals' characteristics associated with them. METHOD Mental health professionals working in the Department of Psychiatry of Lausanne University Hospital, Switzerland, were invited to participate to an online survey. A questionnaire explored participants' sociodemographic characteristics, professional background and current working context, and their feelings and attitudes towards coercion. Exploratory Structural Equation Modelling (ESEM) was used to determine the structure of mental health professionals' feelings and attitudes towards coercion and to estimate to which extent sociodemographic and professional characteristics could predict their underlying dimensions. RESULTS 130 mental health professionals completed the survey. Even if a large number considered coercion a violation of fundamental rights, an important percentage of them agreed that coercion was nevertheless indispensable in psychiatry and beneficial to the patients. ESEM revealed that professionals' feelings and attitudes towards coercion could be described by four main dimensions labelled "Internal pressure", "Emotional impact", "External pressure" and "Relational involvement". The personal as well as the professional proximity with people suffering from mental disorders influences professionals' feeling and attitudes towards coercion. CONCLUSIONS As voices recommend the end of coercion in psychiatry and despite the lack of scientific evidence, many mental health professionals remain convinced that it is a requisite tool beneficial to the patients. Clinical approaches that enhance shared decision making and give the opportunity to patients and professionals to share their experience and feelings towards coercion and thus alleviate stress among them should be fostered and developed.
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Affiliation(s)
- Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland..
| | - Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Monserrat Mendez Rubio
- Service Universitaire de Psychiatrie de l'Âge Avancé, Lausanne University Hospital and University of Lausanne, 1008 Prilly, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
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Lantta T, Varpula J, Cheung T, Wong WK, Cheng PYI, Ng T, Ng CF, Yam CP, Ip G, Bressington D, Välimäki M. Prevention and management of aggressive behaviour in patients at psychiatric hospitals: a document analysis of clinical practice guidelines in Hong Kong. Int J Ment Health Nurs 2020; 29:1079-1091. [PMID: 32602160 DOI: 10.1111/inm.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/01/2023]
Abstract
Patient aggressive behaviour remains a significant public health concern worldwide. The use of restraint and seclusion remains a last resort but not an uncommon practice in clinical psychiatry in the management of aggressive events. There seems to be a paucity of evidenced-based research examining the policy framework guiding the use of restraint and seclusion in Asia contexts. The purpose of this study was to conduct an analysis on the guidelines in psychiatric hospitals in Hong Kong, and to explore the extent to which these guidelines were aligned with the international clinical guidelines for the prevention and management of patient aggression in psychiatry. A descriptive document analysis was used to analyse the guidelines from four psychiatric hospitals in Hong Kong in comparison with the NICE (National Institute of Health and Care Excellence UK) guidelines. Data were collected from December 2017 to June 2018. A total of 91 written documents were retrieved. Preventing violence and aggression has the highest level of agreement (31%,) while the use of restrictive interventions has the lowest level of agreement (12%). The sub-recommendation with most in line with the NICE guidelines were restrictive interventions, de-escalation, and improving service users' experiences. However, for example, staff training, working with police, and reduced use of restrictive interventions seemed to have no agreement with the NICE guidelines. Variation exists between the Asian (Hong Kong) local policy framework/guidelines and the European (UK) national policy framework. There are also large discrepancies in the written guidelines on patient aggressive behaviour when comparing local policy frameworks, cluster-based documents, and departmental practices.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Wai Kit Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Po Yee Ivy Cheng
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Tony Ng
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Chi Fai Ng
- Department of Psychiatry, Tai Po Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Chun Pong Yam
- Department of Psychiatry, Kowloon Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Glendy Ip
- Kwai Chung Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
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24
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Laukkanen E, Kuosmanen L, Selander T, Vehviläinen-Julkunen K. Seclusion, restraint, and involuntary medication in Finnish psychiatric care: a register study with root-level data. Nord J Psychiatry 2020; 74:439-443. [PMID: 32125209 DOI: 10.1080/08039488.2020.1733658] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Despite potentially harmful effects, seclusion, restraint, and involuntary medication continue to be frequently applied in psychiatric care. These restrictive measures are often examined by means of registers, but homogeneous practices in the measurement and description seem to be missing. This nationwide register study aimed to examine the use of seclusion, mechanical and physical restraint, and involuntary medication in Finland.Material and methods: Root-level register data concerning the year 2017 were collected directly from 140 inpatient psychiatric wards within 21 organizations. The data were analyzed statistically.Results: In 2017, the most used restrictive measure in Finnish psychiatric wards was seclusion (4006 episodes), followed by involuntary medication (2187 episodes), mechanical restraint (2113 episodes) and physical restraint (1064 events). Similarly, the duration of seclusion episodes was longer than the duration of restraint episodes. Remarkable variation between wards in the use of seclusion, restraint and involuntary medication was observable. A negative binomial regression model (NB2) was used to analyze the associations between the use of restrictive measures and regional variables concerning demography, health, substance abuse, and socio-economic status, but reliable interpretations were impossible to generate.Conclusion: This study provides detailed and unique data on the use of seclusion, restraint and involuntary medication in Finland. Compared to previous national-level data, this study highlights the importance of collecting root-level data. Future research should use registries and describe the associations between the use of restrictive measures and ward-level factors, patient-level characteristics, and societal factors.
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Affiliation(s)
- Emilia Laukkanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Selander
- Science Service Centre, Kuopio University Hospital, Kuopio, Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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25
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Muir-Cochrane E, Oster C, Grimmer K. International research into 22 years of use of chemical restraint: An evidence overview. J Eval Clin Pract 2020; 26:927-956. [PMID: 31318109 DOI: 10.1111/jep.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non-consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others. Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice. AIMS To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995. METHODS This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures. RESULTS This review identified 311 relevant primary studies (21 RCTs; 46 non-controlled experimental or prospective observational studies; 77 cross-sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross-country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). DISCUSSION A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non-consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non-chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042
| | - Candice Oster
- On-Line Education and Development, Flinders Human Behaviour and Health Research Unit (FHBHRU), College of Medicine and Public Health, Flinders University, South Australia, Australia, 5042
| | - Karen Grimmer
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042.,Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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26
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Morandi S, Silva B, Bonsack C, Golay P. Propensity to decide on involuntary hospitalisation in primary medical care: Dispositional or situational determinants? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 69:101552. [PMID: 32241456 DOI: 10.1016/j.ijlp.2020.101552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The incidence of involuntary hospitalisations varies widely among and within countries. One factor that could account for these variations is the local profile of medical doctors deciding on involuntary admissions. The first goal of this study was to test whether to decide on an involuntary hospitalisation was an individual or a situational disposition. The second goal was to explore doctors' characteristics associated with the use of coercion in specific situations. METHOD Medical doctors of four French-speaking Swiss cantons with the competence, according to cantonal laws, to decide on an involuntary hospitalisation were invited to take part in an online survey. Respondents were asked whether they would decide on an involuntary hospitalisation or not in seven clinical vignettes. Propensity to decide on involuntary hospitalisation was estimated with a two-parameter logistic item response model and latent class analysis. Univariate logistic regression models were used to test whether individual factors were associated with the use of coercion in each situation. RESULTS 192 medical doctors completed the online questionnaire. There was near-zero correlation between vignettes: an involuntary hospitalisation decided on by a doctor in one situation was not related to the use of coercion in another. No subgroup was more prone to generally resort to coercion. However, some individual characteristics were related to the use of coercion in specific situations. CONCLUSIONS Medical doctors' propensity to use coercion for mental health problems was better accounted for by situational rather than dispositional factors. Thus, the use of coercion should be examined as a multidimensional concept.
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Affiliation(s)
- Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland.
| | - Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
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27
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Andersson U, Fathollahi J, Gustin LW. Nurses’ experiences of informal coercion on adult psychiatric wards. Nurs Ethics 2020; 27:741-753. [DOI: 10.1177/0969733019884604] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Informal coercion, that is, situations where caregivers use subtle coercive measures to impose their will on patients, is common in adult psychiatric inpatient care. It has been described as ‘a necessary evil’, confronting nurses with an ethical dilemma where they need to balance between a wish to do good, and the risk of violating patients’ dignity and autonomy. Aim: To describe nurses’ experiences of being involved in informal coercion in adult psychiatric inpatient care. Research design: The study has a qualitative, inductive design. Participants and research context: Semi-structured interviews with 10 Swedish psychiatric nurses were analysed with qualitative content analysis. Ethical considerations: The study was performed in accordance with the Declaration of Helsinki. In line with the Swedish Ethical Review Act, it was also subject to ethical procedures at the university. Findings: Four domains comprise informal coercion as a process over time. These domains contain 11 categories focusing on different experiences involved in the process: Striving to connect, involving others, adjusting to the caring culture, dealing with laws, justifying coercion, waiting for the patient, persuading the patient, negotiating with the patient, using professional power, scrutinizing one’s actions and learning together. Discussion: Informal coercion is associated with moral stress as nurses might find themselves torn between a wish to do good for the patient, general practices and ‘house rules’ in the caring culture. In addition, nurses need to be aware of the asymmetry of the caring relationship, in order to avoid compliance becoming a consequence of patients subordinating to nurse power, rather than a result of mutual understanding. Reflections are thus necessary through the process to promote mutual learning and to avoid violations of patients’ dignity and autonomy. Conclusion: If there is a need for coercion, that is, if the coercion is found to be an ‘unpleasant good’, rather than ‘necessary evil’ considering the consequences for the patient, it should be subject to reflecting and learning together with the patient.
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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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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Pomare C, Churruca K, Ellis LA, Long JC, Braithwaite J. A revised model of uncertainty in complex healthcare settings: A scoping review. J Eval Clin Pract 2019; 25:176-182. [PMID: 30467915 DOI: 10.1111/jep.13079] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/28/2018] [Accepted: 10/29/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Uncertainty is a ubiquitous and dynamic presence throughout healthcare systems and encounters, affecting the quality and safety of care. Although previous research has attempted to categorize varieties of uncertainty, it is not clear if these classifications are applicable across various healthcare settings. OBJECTIVE The purpose of this review was to examine the applicability of the issues of uncertainty delineated in an established taxonomy across diverse healthcare domains, professions, and countries and to consider the complexity of these issues. METHODS Drawing on empirical research from three databases, we conducted a scoping review of the literature to identify types of uncertainty experienced by healthcare professionals. A framework synthesis design was employed to review and synthesize the literature across multiple healthcare settings. RESULTS The search identified 2285 articles, of which 94 met the inclusion criteria. Findings from included studies suggested professional uncertainty in healthcare is complex and pervasive. On the basis of our inability to categorize some studies in the issues of uncertainty outlined in the existing taxonomy, we proposed a revised model of uncertainty for healthcare professionals. CONCLUSIONS The revised model of uncertainty, the model of uncertainty in complex healthcare settings (MUCH-S), is applicable to various healthcare ecosystems and proposes a reflexive archetype that recognizes different issues of uncertainty while establishing that these are often interrelated in healthcare systems. This review offers healthcare professionals greater levels of understanding of this complex phenomenon and may support more informed and reflective decision-making, assisting them to better navigate uncertainties experienced in healthcare workplaces.
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Affiliation(s)
- Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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31
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Laukkanen E, Vehviläinen-Julkunen K, Louheranta O, Kuosmanen L. Psychiatric nursing staffs' attitudes towards the use of containment methods in psychiatric inpatient care: An integrative review. Int J Ment Health Nurs 2019; 28:390-406. [PMID: 30761718 DOI: 10.1111/inm.12574] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/29/2022]
Abstract
One of the international objectives in psychiatric care is reducing the use of coercion. Containment methods are meant to keep patients safe, yet usually include coercion. Nurses play a key role in deciding whether or not containment should be used and, as such, their attitudes towards containment can significantly impact the extent to which these methods are applied. The aim of this integrative review was to identify, analyse, and synthesize the available research on psychiatric nursing staffs' attitudes towards containment methods in inpatient psychiatric care. An electronic search was conducted using the CINAHL, Scopus, and PsycINFO databases. In addition, the citations of identified studies were screened for relevant research. A total of 24 relevant papers published between 2002 and 2017 were selected for further analysis. These studies revealed variation in nursing staffs' attitudes towards the use of containment methods. The use of containment methods seems to be widely accepted and nurses reported rarely considering alternative measures. It appears that attitudes towards containment have continuously become more negative, although the change has not been very pronounced. The concept of attitude was only defined in two studies. Thus, future research should strive to clarify this concept, as a generally accepted definition for attitude within nursing research and the utilization of all dimensions of this concept are both essential to the nursing field. Currently, it would be important to focus on changing attitudes among psychiatric nursing staff to reduce the use of containment methods; this calls for more research on nursing staffs' attitudes.
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Affiliation(s)
- Emilia Laukkanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
| | - Olavi Louheranta
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Lauri Kuosmanen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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32
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An Instrument to Measure Mental Health Professionals' Beliefs and Attitudes towards Service Users' Rights. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16020244. [PMID: 30654510 PMCID: PMC6352182 DOI: 10.3390/ijerph16020244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/16/2022]
Abstract
We aimed at developing and validating a scale on the beliefs and attitudes of mental health professionals towards services users' rights in order to provide a valid evaluation instrument for training activities with heterogeneous mental health professional groups. Items were extracted from a review of previous instruments, as well as from several focus groups which have been conducted with different mental health stakeholders, including mental health service users. The preliminary scale consisted of 44 items and was administered to 480 mental health professionals. After eliminating non-discriminant and low weighting items, a final scale of 25 items was obtained. Exploratory and confirmatory factor analyses produced a four-factor solution consisting of the following four dimensions; system criticism/justifying beliefs, freedom/coercion, empowerment/paternalism, and tolerance/discrimination. The scale shows high concordance with our theoretical model as well as adequate parameters of explained variance, model fit, and internal reliability. Additional work is required to assess the cultural equivalence and psychometrics of this tool in other settings and populations, including health students.
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Reisch T, Beeri S, Klein G, Meier P, Pfeifer P, Buehler E, Hotzy F, Jaeger M. Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin. Front Psychiatry 2018; 9:529. [PMID: 30416459 PMCID: PMC6212593 DOI: 10.3389/fpsyt.2018.00529] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/05/2018] [Indexed: 11/17/2022] Open
Abstract
Background: In clinical psychiatric practice, health care professionals (HCP) must decide in exceptional circumstances after the weighing of interests, which, if any, containment measures including coercion are to be used. Here, the risk for patients, staff, and third parties, in addition to therapeutic considerations, factor into the decision. Patients' preference and the inclusion of relatives in these decisions are important; therefore, an understanding of how patients and next of kin (NOK) experience different coercive measures is crucial for clinical decision making. The aim of this study is to compare how patients, HCP, and NOK assess commonly used coercive measures. Methods: A sample of 435 patients, 372 HCP, and 230 NOK completed the Attitudes to Containment Measures Questionnaire (ACMQ). This standardized self-rating questionnaire assessed the degree of acceptance or rejection of 11 coercive measures. Results: In general, HCPs rated the coercive measures as more acceptable than did NOK and patients. The largest discrepancy in the ratings was found in regard to the application of coercive intramuscular injection of medication (effect size: 1.0 HCP vs. patients). However, the ratings by NOK were significantly closer to the patients' ratings compared to patients and HCP. The only exception was the acceptance of treatment in a closed acute psychiatric ward, which was deemed significantly more acceptable by NOK than by patients. Also, patients who had experienced coercive measures themselves more strongly refused other measures. Conclusion: Patients most firmly rejected intramuscular injections, and the authors agree that these should only be used with reservation considering a high threshold. This knowledge about the discrepancy of the ratings should therefore be incorporated into professional training of HCP.
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Affiliation(s)
- Thomas Reisch
- Hospital of Psychiatry Muensingen, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Simone Beeri
- Hospital of Psychiatry Muensingen, Bern, Switzerland
| | - Georges Klein
- Département de Psychiatrie et Psychothérapie du Centre Hospitalier du Valais Romand, Monthey, Switzerland
| | - Philipp Meier
- Hospital of Psychiatry Muensingen, Bern, Switzerland
| | - Philippe Pfeifer
- Hospital of Psychiatry Muensingen, Bern, Switzerland.,University Hospital of Psychiatry and Psychotherapy, Bern, Switzerland
| | - Etienne Buehler
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Florian Hotzy
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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