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Bachmann L, Ødegård A, Mundal IP. A comprehensive examination of research instruments utilized for assessing the attitudes of healthcare professionals towards the use of restraints in mental healthcare: A systematic review. J Adv Nurs 2024; 80:2728-2745. [PMID: 38093475 DOI: 10.1111/jan.16015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 06/13/2024]
Abstract
AIM This systematic review aimed to identify, describe and evaluate questionnaires measuring health professionals' attitudes towards restraints in mental healthcare. DESIGN A systematic review was undertaken in accordance with the COSMIN protocol for systematic review and the relevant sections of the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES OVID Medline, OVID nursing, Psychinfo, Embase and Cinahl were systematically searched from databases inception, with an initial search in December 2021 and updated in April 2022. REVIEW METHODS The inclusion criteria compromised articles reporting on self-reported instruments of attitudes or perceptions, development or validation of instruments and the evaluation of one or more measurement properties. Articles using multiple instruments in one study or not published in English were excluded. Two researchers independently extracted the data and appraised the methodological quality using the COSMIN guidelines and standards (consensus-based standards for the selection of health measurement instrument). A narrative synthesis without meta-analysis was performed. The systematic review was registered in PROSPERO Protocol ID CRD42022308818. RESULTS A total of 23 studies reporting ten instruments were included. The findings revealed a broad variation in the content of the questionnaires, the use of terms/constructs and the context in which the various instruments measure attitudes towards coercive measures. Many studies lacked sufficient details on report of psychometric properties. Finally, the results were not summarized and the evidence not GRADED. CONCLUSIONS There is a need for updated and adapted instruments with origins in theory and clear joint definitions such that attitudes towards coercive measures can be reliably assessed regarding the validity and reliability of instruments, which will be of importance to facilitate the use of instruments in research and clinical settings. IMPACT Reviews addressing surveys, self-reported attitudes towards restraints in mental healthcare and examination of psychometric properties seem limited. We highlight distinct complexity, psychometric limitations and broad variation in the context and content measuring attitudes towards coercive measures, and their various use of terms/constructs in the existing questionnaires. These findings contribute to further research regarding the development of questionnaires and the need of representing the concept well - carefully denoted by the indicators, likewise the importance of applying questionnaires with properly reported measurement properties in terms of validity and reliability to ensure the use in research and clinical settings.
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Affiliation(s)
- Liv Bachmann
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
| | - Atle Ødegård
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
- Habilitation Services, Clinic of Mental Health, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - Ingunn Pernille Mundal
- Faculty of Health Science and Social Care, Molde University College, Molde, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norway University of Science and Technology (NTNU), Trondheim, Norway
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Tully J, Hafferty J, Whiting D, Dean K, Fazel S. Forensic mental health: envisioning a more empirical future. Lancet Psychiatry 2024:S2215-0366(24)00164-0. [PMID: 38945145 DOI: 10.1016/s2215-0366(24)00164-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 05/03/2024] [Accepted: 05/14/2024] [Indexed: 07/02/2024]
Abstract
Forensic mental health services provide crucial interventions for society. Such services provide care for people with mental disorders who commit violent and other serious crimes, and they have a key role in the protection of the public. To achieve these goals, these services are necessarily expensive, but they have been criticised for a high-cost, low-volume approach, for lacking consistent standards of care, and for neglecting human rights and other ethical considerations. A key concern is an insufficient evidence base to justify common practices, such as restricting leave from hospital and detaining patients for long periods. There is also insufficient quality evidence for core interventions, including psychological therapies, pharmacotherapy, and seclusion and restraint. The causes for this evidence deficit are complex but include insufficient investment in research infrastructure and fragmentation and isolationism of services, both nationally and internationally. In this Personal View, we highlight some of the major gaps in the forensic mental health evidence base and the challenges in addressing these gaps. We suggest solutions with implications at clinical, societal, and public health policy levels.
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Affiliation(s)
- John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.
| | | | - Daniel Whiting
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK; Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Seena Fazel
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Kim J, Nam SH. Experiences of restrictive interventions in psychiatric health care from the perspectives of patients and health care professionals: Meta-synthesis of qualitative evidence. J Psychiatr Ment Health Nurs 2024. [PMID: 38924291 DOI: 10.1111/jpm.13076] [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: 12/01/2023] [Revised: 05/20/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT Following their experience, patients with physical restraints often experienced traumatic sensations. The experiences of healthcare professionals' (HCPs') are primarily concerned with moral distress or conflicts between loyalty to the treatment and oppression of the patient's freedom when implementing RIs. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE Improving the competency of HCPs can help establish therapeutic relationships rooted in compassionate care and facilitate appropriate assessments to determine whether and how often RIs are necessary. Furthermore, fostering an environment that guarantees patient safety and dignity, assuring a sufficient staffing ratio, and providing opportunities to share RI experiences can help improve the quality of care and build safe environments for RIs. WHAT ARE THE IMPLICATIONS FOR PRACTICE Effective interaction between HCPs and patients, thorough patient assessment, and compassionate patient care may improve competency of HCPs intervene RIs procedures. Creating a safe therapeutic environment, including improvements to structural environments, increasing the staff-to-patient ratio, establishing organizational policies that guarantee staff debriefing, provide emotional support, provide appropriate training programs to HCPs to their coping skills during RIs also reduce the use of RIs and improve the quality of mental health care. ABSTRACT INTRODUCTION: Restrictive interventions (RIs) are used in psychiatric inpatient units for ensuring safety. However, few studies have comprehensively reviewed physical restraint and seclusion experiences from the perspectives of both patients and healthcare professionals' (HCPs'). This study aims to gain an in-depth understanding of the RI experiences of mental health inpatients and HCPs. METHODS A meta-synthesis was undertaken of qualitative studies exploring the RI experiences. Five electronic databases were searched and additional manual searches were performed for studies published within the last decade. Twelve articles were included, and a thematic analysis was conducted. The Critical Appraisal Skills Program (CASP) checklist was used to assess data quality. FINDINGS Two main subthemes were identified: 'Competency of HCPs' (three subthemes: interaction between patients and HCPs, assessment methods, and care) and 'systems' (three subthemes: environment, protocols with training, and debriefing), including both positive and negative experiences. DISCUSSION The Competency of HCPs and the ward environment are critical factors related to patients' unmet needs. Effective interactions between HCPs and patients, thorough patient assessments, and compassionate patient care are important elements of RI implementation. CONCLUSION An environment that guarantees safety and care with dignity, sufficient staffing ratios, and opportunities to share RI experiences may improve quality of care and create safe environments for RIs.
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Affiliation(s)
- Jiu Kim
- Department of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Soo-Hyun Nam
- Department of Nursing, Andong National University, Andong, Republic of Korea
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Anstee L, Chifamba D, Loothfaully W, Suleiman S, Shah C, Littlechild B, Zia A. Stakeholder perspectives on continuous observation in inpatient psychiatric wards. J Psychiatr Ment Health Nurs 2024. [PMID: 38922777 DOI: 10.1111/jpm.13072] [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: 12/06/2023] [Revised: 05/08/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Continuous observation is often used in mental health wards to support the safety of service users, where they will be constantly watched by a member of staff. Evidence suggests that continuous observations may be unhelpful and restrictive, but not enough is known about the practice or the best ways to improve it. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This evaluation integrates the perspectives of service users, informal carers and staff to explore current continuous observation experiences and inform future improvements. While previous research highlights the importance of therapeutic engagement, this study additionally emphasizes how the observation procedure could be adapted to individual needs. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Continuous observations could be more beneficial if they are therapeutic, proportional to the level of risk and co-developed with the service user, informal carer and staff. Further training about communication could support staff engagement and the observation process could be formalized to ensure regular collaborative reviews. ABSTRACT INTRODUCTION: Continuous observation is a frequently used tool to manage high levels of risk on psychiatric wards. However, there is little previous research on its use in practice. AIM This qualitative service evaluation aims to explore the continuous observation experiences of service users, informal carers and staff in a local NHS Mental Health Trust, informing suggested future improvements to current practice. METHOD Five service users, three informal carers and seven healthcare staff completed semi-structured interviews, which were thematically analysed to create four themes. RESULTS Positive interaction and engagement in activities were critical for a therapeutic approach to observations, supporting service users and staff to minimize the unproductive behaviours that can arise. Difficulties balancing safety with privacy could suggest the importance of proportionate and tailored observation procedures for each service user. Ensuring the voices of service users and informal carers remain central to decisions regarding care could further improve the observation experience. IMPLICATIONS FOR PRACTICE This study highlights therapeutic, proportionate and co-produced observations as key characteristics to improve practice. Further training and formalization of the observation process could foster cultural changes towards more long-term approaches to risk management.
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Affiliation(s)
- Lottie Anstee
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Denford Chifamba
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Wasim Loothfaully
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Suleiman Suleiman
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Chetan Shah
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | | | - Asif Zia
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
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Rogers JP, Lewis G, Lobo M, Wyke C, Meaburn A, Harding F, Garvey R, Irvine J, Yahya AS, Kornblum D, Cullen AE, Mirfin D, Lewis G. Identifying predictors of adverse outcomes after termination of seclusion in psychiatric intensive care units. BJPsych Open 2024; 10:e120. [PMID: 38773812 DOI: 10.1192/bjo.2024.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Seclusion is a restrictive practice that many healthcare services are trying to reduce. Previous studies have sought to identify predictors of seclusion initiation, but few have investigated factors associated with adverse outcomes after seclusion termination. AIMS To assess the factors that predict an adverse outcome within 24 h of seclusion termination. METHOD In a cohort study of individuals secluded in psychiatric intensive care units, we investigated factors associated with any of the following outcomes: actual violence, attempted violence, or reinitiation of seclusion within 24 h of seclusion termination. Among the seclusion episodes that were initiated between 29 March 2018 and 4 March 2019, we investigated the exposures of medication cooperation, seclusion duration, termination out of working hours, involvement of medical staff in the final seclusion review, lack of insight, and agitation or irritability. In a mixed-effects logistic regression model, associations between each exposure and the outcome were calculated. Odds ratios were calculated unadjusted and adjusted for demographic and clinical variables. RESULTS We identified 254 seclusion episodes from 122 individuals (40 female, 82 male), of which 106 (41.7%) had an adverse outcome within 24 h of seclusion termination. Agitation or irritability was associated with an adverse outcome, odds ratio 1.92 (95% CI 1.03 to 3.56, P = 0.04), but there was no statistically significant association with any of the other exposures, although confidence intervals were broad. CONCLUSIONS Agitation or irritability in the hours preceding termination of seclusion may predict an adverse outcome. The study was not powered to detect other potentially clinically significant factors.
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Affiliation(s)
| | | | - Maria Lobo
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Fiona Harding
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rebecca Garvey
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jenny Irvine
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daisy Kornblum
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexis E Cullen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - David Mirfin
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, UK
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Välimäki M, Lantta T, Kontio R. Risk assessment for aggressive behaviour in schizophrenia. Cochrane Database Syst Rev 2024; 5:CD012397. [PMID: 38695777 PMCID: PMC11064887 DOI: 10.1002/14651858.cd012397.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
BACKGROUND Aggressive or violent behaviour is often associated with people with schizophrenia in common perceptions of the disease. Risk assessment methods have been used to identify and evaluate the behaviour of those individuals who are at the greatest risk of perpetrating aggression or violence or characterise the likelihood to commit acts. Although many different interventions have been developed to decrease aggressive or violent incidences in inpatient care, staff working in inpatient settings seek easy-to-use methods to decrease patient aggressive events. However, many of these are time-consuming, and they require intensive training for staff and patient monitoring. It has also been recognised in clinical practice that if staff monitor patients' behaviour in a structured manner, the monitoring itself may result in a reduction of aggressive/violent behaviour and incidents in psychiatric settings. OBJECTIVES To assess the effects of structured aggression or violence risk assessment methods for people with schizophrenia or schizophrenia-like illnesses. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ISRCTN registry, ClinicalTrials.gov, and WHO ICTRP, on 10 February 2021. We also inspected references of all identified studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing structured risk assessment methods added to standard professional care with standard professional care for the evaluation of aggressive or violent behaviour among people with schizophrenia. DATA COLLECTION AND ANALYSIS At least two review authors independently inspected citations, selected studies, extracted data, and appraised study quality. For binary outcomes, we calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference (MD) and its 95% CI. We assessed risk of bias in the included studies and created a summary of findings table using the GRADE approach. MAIN RESULTS We included four studies in the review. The total number of participants was not identifiable, as some studies provided number of participants included, and some only patient days. The studies compared a package of structured assessment methods with a control group that included routine nursing care and drug therapy or unstructured psychiatric observations/treatment based on clinical judgement. In two studies, information about treatment in control care was not available. One study reported results for our primary outcome, clinically important change in aggressive/violent behaviour, measured by the rate of severe aggression events. There was likely a positive effect favouring structured risk assessment over standard professional care (RR 0.59, 95% CI 0.41 to 0.85; 1 RCT; 1852 participants; corrected for cluster design: RR 0.59, 95% CI 0.37 to 0.93; moderate-certainty evidence). One trial reported data for the use of coercive measures (seclusion room). Compared to standard professional care, structured risk assessment may have little or no effect on use of seclusion room as days (corrected for cluster design: RR 0.92, 95% CI 0.27 to 3.07; N = 20; low-certainty evidence) or use of seclusion room as secluded participants (RR 1.83, 95% CI 0.39 to 8.7; 1 RCT; N = 20; low-certainty evidence). However, seclusion room may be used less frequently in the standard professional care group compared to the structured risk assessment group (incidence) (corrected for cluster design: RR 1.63, 95% CI 0.49 to 5.47; 1 RCT; N = 20; substantial heterogeneity, Chi2 = 0.0; df = 0.0; P = 0.0; I2 = 100%; low-certainty evidence). There was no evidence of a clear effect on adverse events of escape (RR 0.2, 95% CI 0.01 to 4.11; 1 RCT; n = 200; very low-certainty evidence); fall down (RR 0.33, 95% CI 0.04 to 3.15; 1 RCT; n = 200; very low-certainty evidence); or choking (RR 0.2, 95% CI 0.01 to 4.11; 1 RCT; n = 200; very low-certainty evidence) when comparing structured risk assessment to standard professional care. There were no useable data for patient-related outcomes such as global state, acceptance of treatment, satisfaction with treatment, quality of life, service use, or costs. AUTHORS' CONCLUSIONS Based on the available evidence, it is not possible to conclude that structured aggression or violence risk assessment methods are effective for people with schizophrenia or schizophrenia-like illnesses. Future work should combine the use of interventions and structured risk assessment methods to prevent aggressive incidents in psychiatric inpatient settings.
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Affiliation(s)
- Maritta Välimäki
- School of Public Health, University of Helsinki, Helsinki, Finland
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Raija Kontio
- Department of Nursing Science, University of Turku, Turku, Finland
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Sánchez-Gómez V, Verdugo MÁ, Crespo M, San Román A. A Pioneer Tool to Reduce Restrictive Practices toward People with Intellectual and Developmental Disabilities. Behav Sci (Basel) 2024; 14:344. [PMID: 38667140 PMCID: PMC11047515 DOI: 10.3390/bs14040344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/12/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
Reducing restrictive practices toward individuals with intellectual and developmental disabilities is a globally recognized imperative and human rights priority. This paper presents a novel tool called LibRe for assessing and reducing restrictive practices. This tool involved an instrumental multistage design and collaboration between professionals, individuals with disabilities, family members, and experts from different fields. It addresses diverse restrictive practices in five key domains: physical or mechanical, chemical or pharmacological, structural, relational, and practices related to contexts and supports. It addresses practices that are pertinent to the Spanish context and that existing tools have not covered. Embedded as a step within an organizational approach, LibRe fosters organizational transformation and provides resources to achieve outcomes within reduction plans for restrictive practices. In total, 156 teams comprising 585 professionals, 64 people with disabilities, and 44 family members responded to the tool. In terms of evidence for internal structure validity, the oblique five-factor model exhibited an adequate fit through confirmatory factor analysis, along with satisfactory reliability indices, according to ordinal alpha and omega. Users positively appraised the tool's usefulness and identified its strengths and challenges. Although further research is needed, preliminary evidence frames LibRe as a useful resource for practice and research.
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Affiliation(s)
- Victoria Sánchez-Gómez
- Institute for Community Inclusion (INICO), University of Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (M.C.)
| | - Miguel Ángel Verdugo
- Institute for Community Inclusion (INICO), University of Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (M.C.)
- Department of Personality, Assessment, and Psychological Treatments, University of Salamanca, 37005 Salamanca, Spain
| | - Manuela Crespo
- Institute for Community Inclusion (INICO), University of Salamanca, 37005 Salamanca, Spain; (M.Á.V.); (M.C.)
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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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Aragonés-Calleja M, Sánchez-Martínez V. Evidence synthesis on coercion in mental health: An umbrella review. Int J Ment Health Nurs 2024; 33:259-280. [PMID: 37908175 DOI: 10.1111/inm.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
Coercion in mental healthcare is ubiquitous and affects the physical health, recovery and psychological and emotional well-being of those who experience it. Numerous studies have explored different issues related to coercion, and the present umbrella review aims to gather, evaluate and synthesise the evidence found across systematic reviews. The protocol, registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42020196713), included 46 systematic reviews and meta-analyses of primary studies whose main theme was coercion and which were obtained from databases (Medline/PubMed, PsycINFO, EMBASE and CINAHL) and repositories of systematic reviews following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. All the reviews were subjected to independent assessment of quality and risk of bias and were grouped in two categories: (1) evidence on specific coercive measures (including Community Treatment Orders, forced treatment, involuntary admissions, seclusion and restriction and informal coercion), taking into account their prevalence, related factors, effectiveness, harmful effects and alternatives to reduce their use; and (2) experiences, perceptions and attitudes concerning coercion of professionals, mental health service users and their caregivers or relatives. This umbrella review can be useful to professionals and users in addressing the wide variety of aspects encompassed by coercion and the implications for professionals' daily clinical practice in mental health units. This research received funding from two competitive calls.
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Affiliation(s)
- Miriam Aragonés-Calleja
- Mental Health Department, Hospital Padre Jofre, Valencia, Spain
- Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
| | - Vanessa Sánchez-Martínez
- Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
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10
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Baggio S, Kaiser S, Wullschleger A. Effect of Seclusion on Mental Health Status in Hospitalized Psychiatric Populations: A Trial Emulation using Observational Data. Eval Health Prof 2024; 47:3-10. [PMID: 36898680 PMCID: PMC10858627 DOI: 10.1177/01632787231164489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
The use of coercive practices, i.e., interventions against a person's will, is controversial. Recent observational studies highlighted their potential detrimental effects on patients' mental health, but this topic remains understudied. This study investigated the effect of a common coercive practice, seclusion (i.e., being locked in a closed room), on mental health using a trial emulation of observational data to allow causal inference. We used data from 1200 psychiatric inpatients, classified as being either secluded or non-secluded during their hospital stay. Inverse probability of treatment weighting was used to emulate the random assignment to the intervention. The primary outcome was the Health of the Nations Outcome Scales (HoNOS). The secondary outcome was the first item of the HoNOS, which focuses on overactive, aggressive, disruptive, or agitated behavior. Both outcomes were assessed at hospital discharge. There was a significant effect of seclusion with increases in both total HoNOS score (p = .002) and item 1 of the HoNOS (p = .01). Seclusion may have a negative causal effect of patients' mental health status and should therefore be avoided in mental health care settings. Training efforts should raise the awareness of the medical staff about potential adverse effects instead of therapeutic benefits.
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Affiliation(s)
- Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandre Wullschleger
- Adult Psychiatry Division, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Dauriac-Le Masson V, El-Khoury Lesueur F, Lahaye J, Launay C, Christodoulou A, Boiteux C, Maman J, Bonnemaison X, Perquier F, Vacheron MN. Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group. Front Psychiatry 2024; 15:1296356. [PMID: 38445090 PMCID: PMC10913196 DOI: 10.3389/fpsyt.2024.1296356] [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: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Methods Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. Results For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. Discussion S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.
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Affiliation(s)
| | - Fabienne El-Khoury Lesueur
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Sorbonne Universite, INSERM UMRS_1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Paris, France
| | - Justine Lahaye
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Corinne Launay
- Pôle Psychiatrie Précarité, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | | | - Florence Perquier
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
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Rowsell KA, Akinbola A, Hancock M, Nyambayo T, Jackson Z, Hunt DF. Reducing use of seclusion on a male medium secure forensic ward. BMJ Open Qual 2024; 13:e002576. [PMID: 38365432 PMCID: PMC10875490 DOI: 10.1136/bmjoq-2023-002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients' feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice.Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration (outcome measure) and frequency (balancing measure) of the use of seclusion by 10% over 6 months. Following the analysis of our local data systems and feedback from both patients and staff, we identified the high levels of use of seclusion, and reluctance to terminate it. These included a lack of awareness of the effective and appropriate use of such a facility, a hesitancy to use de-escalation techniques and an over-reliance on multidisciplinary team and consultant decision making.We subsequently designed and implemented three tests of change which reviewed seclusion processes, enhanced de-escalation skills and improved decision making. Our tests of change were applied over a 6-month period. During this period, we surpassed our original target of a reduction of frequency and duration by 10% and achieved a 33% reduction overall. Patients reported feeling safer on the ward, and the team reported improvements in relationships with patients.Our project highlights the importance of relational security within the secure setting and provides a template for other wards wishing to reduce the frequency and duration of seclusions.
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Affiliation(s)
- Kathryn Amy Rowsell
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ayodele Akinbola
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mark Hancock
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Tsitsi Nyambayo
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Zoe Jackson
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - David Francis Hunt
- School of Psychology, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
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Billé V, Lessard-Deschênes C, Sergerie-Richard S, Désilets M, Tansey J, Goulet MH. Informal coercion in inpatient mental healthcare: a scoping review protocol. BMJ Open 2024; 14:e079549. [PMID: 38365297 PMCID: PMC10875533 DOI: 10.1136/bmjopen-2023-079549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/07/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Comprehending informal coercion, which encompasses a wide range of phenomena characterised by subtle and non-legalised pressures, can be complex. Its use is underestimated within the continuum of coercion in mental health, although its application may have a negative impact on the persons involved. A better understanding of informal coercion is crucial for improving mental healthcare and informing future research. This scoping review aims to explore the nature, extent and consequences of informal coercion in mental health hospitalisation to clarify this phenomenon, establish its boundaries more clearly and identify knowledge gaps. METHODS AND ANALYSIS Following the methodological framework from the Joanna Briggs Institute, this scoping review will encompass 10 key steps. Literature searches will be conducted in electronic databases, including CINAHL, PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and ProQuest Dissertation and Theses. Then, a search in grey literature sources (Open Grey, Grey Guide), psychiatric and mental health journals, government agencies and among the references of selected studies will be conducted. The research will include all literature focusing on informal coercion with inpatients aged 18 and above. Data will be extracted and analysed descriptively, mapping the available knowledge and identifying thematic patterns. The quality of included studies will be assessed using appropriate appraisal tools. An exploratory search was conducted in November 2023 and will be updated in December 2023 when the selection of relevant evidence will begin. ETHICS AND DISSEMINATION Ethical approval is not required as this study involves the analysis of existing published literature. The findings will be disseminated through a peer-reviewed publication and presentations at relevant conferences. They will be shared with people living with mental disorders and professionals working in mental healthcare.
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Affiliation(s)
- Vincent Billé
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire en sante mentale de Montréal, Montréal, Québec, Canada
| | - Clara Lessard-Deschênes
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire en sante mentale de Montréal, Montréal, Québec, Canada
| | - Sophie Sergerie-Richard
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire en sante mentale de Montréal, Montréal, Québec, Canada
| | - Marie Désilets
- Institut universitaire en santé mentale de Montréal, Montréal, Québec, Canada
| | - Julie Tansey
- Association Vox Québec, Saint-Mathieu-de-Beloeil, Québec, Canada
| | - Marie-Hélène Goulet
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche de l'Institut universitaire en sante mentale de Montréal, Montréal, Québec, Canada
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14
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Aluh DO, Ayilara O, Onu JU, Pedrosa B, Silva M, Grigaitė U, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Use of coercion in mental healthcare services in Nigeria: Service providers' perspective. J Ment Health 2024; 33:75-83. [PMID: 36850036 DOI: 10.1080/09638237.2023.2182426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/02/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND There is increasing advocacy to reduce coercive practices in mental healthcare. Little research has been done on the topic in developing countries. AIMS To explore what mental health professionals in Nigeria think about coercion, why it is used, and what contextual factors influence its use in mental healthcare services. METHODS Semi-structured interviews were carried out with 16 doctors and 14 nurses from two psychiatric hospitals in two regions of Nigeria. The audio-recorded interviews were analyzed thematically with the aid of MAXQDA software. RESULTS Three broad categories relating to the perception of, reasons for, and barriers/facilitators to the use of coercion were derived. Coercion was viewed as being for the best interests of patients, a means to an end, and effective for achieving desired outcomes. Safety was both a reason to use a coercive measure and a deterrent to using specific coercive measures thought to be unsafe. The socio-cultural context, obsolete mental health legislation, staff shortages, and attitudes were factors influencing the use of coercion in mental healthcare. CONCLUSION Coercion was perceived to be ultimately beneficial in mental health practice. There is need for a new mental health legislation and more resources for mental health care in Nigeria to address the problem of coercion.
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Affiliation(s)
- Deborah Oyine Aluh
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria
| | - Olaniyi Ayilara
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Uselu, Edo state, Nigeria
| | - Justus Uchenna Onu
- Department of Mental Health, Nnamdi Azikiwe University- Nnewi Campus, Awka, Anambra State, Nigeria
| | - Barbara Pedrosa
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Manuela Silva
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Ugnė Grigaitė
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Margarida Santos-Dias
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
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15
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Visaggio N, Phillips KE, McElhinney J. The restraint chair: A qualitative study of the patient experience. Arch Psychiatr Nurs 2024; 48:7-12. [PMID: 38453285 DOI: 10.1016/j.apnu.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/13/2023] [Accepted: 01/01/2024] [Indexed: 03/09/2024]
Abstract
Despite initiatives to eliminate restraint from acute psychiatric care, there remain times when violent episodes threaten the safety of patients and/or staff. The restraint chair may be used in these moments and provide an alternative to four-point restraint. The purpose of this study was to examine the patient experience of the restraint chair. Patients who had an episode of restraint in the restraint chair during their hospital stay were interviewed about the experience. Participants described the experience as "unpleasant," with the majority preferring the restraint chair to other methods of restraint they had experienced. Participants indicated they could "understand" why the restraint had occurred and felt staff were "helpful" and "create safety." Finally, participants stated the hospital experience was "positive." Although the goal remains to eliminate restraint, psychiatric settings may want to consider the restraint chair as an alternative to four-point restraint for situations requiring mechanical restraint. Nurses' presence and communication with patients during the restraint process is important to the patient experience. More research is needed to verify these results.
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Affiliation(s)
- Nicole Visaggio
- McLean Hospital, 115 Mill St., Belmont, MA 02478, United States of America.
| | - Kathryn E Phillips
- Fairfield University, 1073 N. Benson Rd., Fairfield, CT 06824, United States of America.
| | - Jeanne McElhinney
- McLean Hospital, 115 Mill St., Belmont, MA 02478, United States of America.
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16
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van der Helm GHPP, Roest JJ, Dekker AL, van Miert VSL, Kuiper CHZ, Stams GJJM. Group Climate in Residential Youth Care: Development and Validation of the Group Climate Instrument-Revised. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024:306624X231219984. [PMID: 38229466 DOI: 10.1177/0306624x231219984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Group climate in residential youth care is considered to be essential for treatment of youth and young adults. Various instruments exist to measure quality of living group climate, but some are lengthy, use complicated wording, which make them difficult to fill out by youth and individuals with a mild intellectual disability. The present study describes the development and rationale for the Group Climate Instrument-Revised (GCI-R). Construct validity and reliability of the GCI-R were examined by means of Confirmatory Factor Analysis (CFA) in a two-step validation process using a construction sample (n = 190 youth, representing 41 groups) and a validation sample (n = 207 youth, representing 42 groups). Results indicated a good fit of a five-factor model (Support, Growth, Physical Environment, Peer interactions, and Repression). Reliability of the scales was good. These findings indicate that the GCI-R can be used as a parsimonious, valid, and reliable instrument to assess perceptions of group climate in youth. Recommendations for future research and practice are suggested.
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Affiliation(s)
- G H P Peer van der Helm
- University of Applied Sciences Leiden, The Netherlands
- University of Amsterdam, The Netherlands
| | - Jesse J Roest
- University of Applied Sciences Leiden, The Netherlands
| | | | | | - Chris H Z Kuiper
- University of Applied Sciences Leiden, The Netherlands
- University of Amsterdam, The Netherlands
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17
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Savage MK, Lepping P, Newton-Howes G, Arnold R, Staggs VS, Kisely S, Hasegawa T, Reid KS, Noorthoorn EO. Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies. BJPsych Open 2024; 10:e26. [PMID: 38205597 PMCID: PMC10790218 DOI: 10.1192/bjo.2023.613] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices. AIMS We determined rates of coercive practices and compared them across countries. METHOD We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports. RESULTS The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints. CONCLUSIONS We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.
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Affiliation(s)
- Martha K. Savage
- School of Geography, Environment and Earth Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Peter Lepping
- Centre for Mental Health and Society, Wrexham Academic Unit, Bangor University, Bangor, UK
| | | | - Richard Arnold
- School of Mathematics and Statistics, Victoria University of Wellington, Wellington, New Zealand
| | - Vincent S. Staggs
- University of Missouri-Kansas City and Children's Mercy Research Institute, Kansas City, Missouri, USA (now at IDDI Inc, Raleigh, North Carolina, USA)
| | | | - Toshio Hasegawa
- Department of Occupational Therapy, Faculty of Health Sciences, Kyorin University, Mitaka, Japan
| | - Keith S. Reid
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK; and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eric O. Noorthoorn
- Radboud University Nijmegen, Nijmegen, the Netherlands; and Ggnet Mental Health Trust Warnsveld, Warnsveld, The Netherlands
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18
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Gill N, Drew N, Rodrigues M, Muhsen H, Morales Cano G, Savage M, Pathare S, Allan J, Galderisi S, Javed A, Herrman H, Funk M. Bringing together the World Health Organization's QualityRights initiative and the World Psychiatric Association's programme on implementing alternatives to coercion in mental healthcare: a common goal for action. BJPsych Open 2024; 10:e23. [PMID: 38179597 PMCID: PMC10790219 DOI: 10.1192/bjo.2023.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Stakeholders worldwide increasingly acknowledge the need to address coercive practices in mental healthcare. Options have been described and evaluated in several countries, as noted recently in major policy documents from the World Health Organization (WHO) and World Psychiatric Association (WPA). The WHO's QualityRights initiative promotes human rights and quality of care for persons with mental health conditions and psychosocial disabilities. A position statement from the WPA calls for implementation of alternatives to coercion in mental healthcare. AIMS We describe the engagement of both the WHO and WPA in this work. We discuss their mutual aim to support countries in improving human rights and quality of care, as well as the differences between these two organisations in their stated goals related to coercion in mental healthcare: the WHO's approach to eliminate coercion and the WPA's goal to implement alternatives to coercion. METHOD We outline and critically analyse the common ground between the two organisations, which endorse a similar range of rights-based approaches to promoting non-coercive practices in service provision, including early intervention in prevention and care and other policy and practice changes. RESULTS Advocacy and action based on an agreed need to find practical solutions and advances in this area have the power to build consensus and unify key actors. CONCLUSIONS We conclude that persons with lived experience, families, mental health professionals and policy makers are now coming together in several parts of the world to work toward the common goals of improving quality, promoting human rights and addressing coercion in mental health services.
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Affiliation(s)
- Neeraj Gill
- School of Medicine and Dentistry, Griffith University, Australia; Mental Health Policy Unit, Health Research Institute, University of Canberra, Australia; and Mental Health and Specialist Services, Gold Coast Health, Australia
| | - Natalie Drew
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Maria Rodrigues
- Community Works, Docklands, Australia; and Kindred Collaborative, Brisbane, Australia
| | - Hassan Muhsen
- School of Medicine and Dentistry, Griffith University, Australia; and Mental Health and Specialist Services, Gold Coast Health, Australia
| | | | - Martha Savage
- School of Geography, Environment and Earth Science, Victoria University of Wellington, New Zealand
| | - Soumitra Pathare
- Centre for Mental Health Law and Policy, Indian Law Society, Pune, India
| | - John Allan
- Mayne Academy of Psychiatry, School of Medicine, University of Queensland, Australia
| | - Silvana Galderisi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Italy
| | - Afzal Javed
- Pakistan Psychiatric Research Centre, Fountain House Institute, Lahore, Pakistan
| | - Helen Herrman
- Orygen, Parkville, Australia; and Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Michelle Funk
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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Hempeler C, Braun E, Faissner M, Gather J, Scholten M. Preferences of Individual Mental Health Service Users Are Essential in Determining the Least Restrictive Type of Restraint. AJOB Neurosci 2024; 15:19-22. [PMID: 38207191 DOI: 10.1080/21507740.2023.2292502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
| | | | | | - Jakov Gather
- Ruhr University Bochum
- LWL University Hospital, Ruhr University Bochum
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20
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Miodownik C, Friger MD, Teitelbaum A, Demchuk N, Zhuk A, Agababa T, Sokolik S, Lerner PP, Calfon N, Lerner V. Risk factors for coercion length at psychiatric hospitals in Israel: Relationship with staff. Indian J Psychiatry 2024; 66:36-42. [PMID: 38419935 PMCID: PMC10898533 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_814_22] [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: 12/17/2022] [Revised: 06/27/2023] [Accepted: 11/11/2023] [Indexed: 03/02/2024] Open
Abstract
Background Coercive interventions continue to be applied frequently in psychiatric care when patients are at imminent risk of harming themselves and/or others. Aim The purpose of this study was to demonstrate the relationship between the length of coercion and a variety of factors, including the sociodemographic background of patients, their diagnoses and the characteristics of hospital staff. Methods This is a one-year cross-sectional retrospective study, including records of 298 patients who underwent restraint and/or seclusion interventions in male acute, closed wards in two psychiatric hospitals in Israel. Results A higher proportion of academic nurses to nonacademic nurses on duty leads to a shorter coercion time (P < 0.000). The number of male staff on duty, without any relation to their level of education, also leads to the shortening of the coercion time. Conclusion The presence of registered, academic female nurses, male staff on duty and the administration of medication before coercive measures can reduce the length of restriction.
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Affiliation(s)
- Chanoch Miodownik
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Michael D. Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Natalya Demchuk
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | - Tsipora Agababa
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Shmuel Sokolik
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | | | | | - Vladimir Lerner
- Be’er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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Antonsson H, Dahliavy L, Mouline H, Molin J. Struggling with unnecessary suffering-Registered nurses' experiences of delayed decisions on treatment without consent in forensic psychiatric inpatient care. Int J Ment Health Nurs 2023; 32:1681-1690. [PMID: 37458217 DOI: 10.1111/inm.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/26/2023] [Accepted: 07/08/2023] [Indexed: 11/22/2023]
Abstract
Chemical restraints are used in forensic psychiatric inpatient care, however with caution as it can feel like an assault against patients' integrity. When waiting for decisions on treatment without consent, nursing staff are expected to care for patients with severe mental ill-health without the use of medical treatment, often with a feeling of already having tried all other available means. Knowledge about how registered nurses experience such situations is sparse but could contribute to the development of both teamwork and nursing approaches that could mean reduced suffering for patients. The aim of this study was to describe registered nurses' experiences of delayed decisions on treatment without consent in forensic psychiatric inpatient care. Eleven semi-structured interviews were conducted with registered nurses working in forensic psychiatric units in Sweden. Data were analysed through qualitative content analysis. The result showed that experiences of treatment without consent were about striving to protect patients from harm, striving for collaboration during difficult circumstances and striving to do good. This was interpreted as a struggle with unnecessary suffering. For registered nurses to be able to handle such challenging situations and relieve suffering for patients, experience and master-level education in mental health nursing are highlighted. Another aspect that is highlighted is the importance of having consultants familiar with the circumstances at the unit. A method for joint reflection is suggested, to promote an open-minded work culture with a well-functioning decision-making process and ensure that both consultants and nursing staff have support.
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Affiliation(s)
| | - Liv Dahliavy
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Jenny Molin
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Clinical Science, Division of Psychiatry, Umeå University, Umeå, Sweden
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22
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Shetty SR, Burke S, Timmons D, Kennedy HG, Tuohy M, Terkildsen MD. Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study. J Psychiatr Ment Health Nurs 2023. [PMID: 37929765 DOI: 10.1111/jpm.12979] [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: 12/22/2022] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 11/07/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.
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Affiliation(s)
- Shobha Rani Shetty
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
- School of Nursing Midwifery and Health Systems, University College Dublin (UCD), Dublin, Ireland
| | - Shauna Burke
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - David Timmons
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Harry G Kennedy
- Forensic Psychiatry, Trinity College Dublin, Dublin, Ireland
- Forensic Psychiatry, Aarhus University, Dublin, Ireland
- Forensic Psychiatry, University of Bari 'Aldo Moro', Dublin, Ireland
| | - Mary Tuohy
- National Forensic Mental Health Service, Central Mental Hospital, Dublin, Ireland
| | - Morten Deleuran Terkildsen
- Department of Forensic Psychiatry, Centre for Forensic Psychiatric Research and Development (CerF), Aarhus University Hospital Psychiatry, Aarhus N, Denmark
- DEFACTUM, Central Denmark Region, Aarhus N, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
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Aguglia A, Corsini GP, Berardelli I, Berti A, Conio B, Garbarino N, Gnecco GB, Magni C, Venturini E, Costanza A, Amerio A, Amore M, Serafini G. Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1847. [PMID: 37893565 PMCID: PMC10607962 DOI: 10.3390/medicina59101847] [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: 08/30/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: mechanical restraint (MR) is a controversial issue in emergency psychiatry and should be better studied to implement other alternative therapeutic interventions. The aim of this study was to estimate the prevalence of MR in an Italian psychiatric unit and identify the sociodemographic and clinical characteristics as well as the pharmacological pattern associated with MR. Materials and Methods: all subjects (N = 799) consecutively admitted to an Italian psychiatric inpatient unit were recruited. Several sociodemographic and clinical characteristics were recorded. Results: The prevalence of MR was 14.1%. Males, a younger age, and a single and migrant status were associated with the MR phenomenon. MR was more prevalent in patients affected by other diagnoses and comorbid illicit substance use, in patients with aggressive behaviors, and those that were involuntary admitted, leading significantly to hospitalization over 21 days. Furthermore, the patients that underwent MR were taking a lower number of psychiatric medications. Conclusions: Unfortunately, MR is still used in emergency psychiatry. Future research should focus on the dynamics of MR development in psychiatry, specifically considering ward- and staff-related factors that could help identify a more precise prevention and alternative intervention strategies.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Giovanni Pietro Corsini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Andrea Berti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Benedetta Conio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Nicolò Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Giovanni Battista Gnecco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Caterina Magni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Enrico Venturini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service, University Hospitals of Geneva (HUG), 1207 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
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Wullschleger A, Vandamme A, Mielau J, Heinz A, Bermpohl F, Mahler L, Montag C. Relationship between perceived coercion and perceived justification of coercive measures - secondary analysis of a randomized-controlled trial. BMC Psychiatry 2023; 23:712. [PMID: 37784077 PMCID: PMC10546675 DOI: 10.1186/s12888-023-05192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients' appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients' appraisal of the justification of coercive measures and their level of perceived coercion. METHODS This study presents a secondary analysis of the results of a multi-center RCT conducted to evaluate the effects of post-coercion review. Patients who experienced at least one coercive measure during their hospital stay were included in the trial. Participants' appraisal of the justification of coercive measures was categorized into patient-related and staff-related justifications. Subjective coercion was assessed using the Coercion Experience Scale (CES) and used as dependent variable in a multivariate regression model. RESULTS 97 participants who completed the CES were included in the analysis. CES scores were significantly associated with the perception of the coercive measure as justified by staff-related factors (B = 0,540, p < 0,001), as well as with higher level of negative symptoms (B = 0,265, p = 0,011), and with mechanical restraint compared to seclusion (B=-0,343, p = 0,017). CONCLUSIONS Patients' perceptions of coercive measures as justified by staff-related factors such as arbitrariness or incompetence of staff are related to higher levels of perceived coercion. Multiprofessional efforts must be made to restrict the use of coercive measures and to ensure a transparent and sustainable decision-making process, particularly with patients showing high levels of negative symptoms. Such key elements should be part of all coercion reduction programs.
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Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany.
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Ch. Du Petit-Bel-Air 2, Thônex, 1226, Switzerland.
| | - Angelika Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Lieselotte Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, 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, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
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Cassivi C, Sergerie-Richard S, Saint-Pierre B, Goulet MH. Crisis plans in mental health: A scoping review. Int J Ment Health Nurs 2023; 32:1259-1273. [PMID: 37098744 DOI: 10.1111/inm.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023]
Abstract
Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full-text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.
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Affiliation(s)
- Christine Cassivi
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
| | - Sophie Sergerie-Richard
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Institut universitaire en santé mentale de Montréal (IUSMM), Québec, Montréal, Canada
| | - Benoît Saint-Pierre
- Centre intégré universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Québec, Montréal, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
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26
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Tang AS, Shieh MS, Pekow PS, Prentiss KA, Lindenauer PK, Westafer LM. Treatment of pediatric behavioral health patients with intravenous and intramuscular chemical restraints: Results from a nationwide sample of emergency departments. Acad Emerg Med 2023; 30:1029-1038. [PMID: 37259900 PMCID: PMC11075781 DOI: 10.1111/acem.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Behavioral health crises in pediatric emergency department (ED) patients are increasingly common. Chemical restraints can be utilized for patients who present imminent danger to self or others. We sought to describe the use of intravenous (IV)/intramuscular (IM) chemical restraints for pediatric behavioral health ED patients across a nationwide sample of hospitals and describe factors associated with restraint use. METHODS This was a retrospective study of patients ages 8-17 treated at 822 EDs contributing data to the Premier Healthcare Database between January 1, 2018, and December 31, 2020, with a behavioral health discharge diagnosis. The primary outcome was the use of IV/IM chemical restraint medication. We developed a hierarchical model to examine patient and hospital-level factors associated with treatment with IV/IM chemical restraint medications. RESULTS Of 630,384 cases, 4.8% received IV/IM chemical restraint. Patient factors associated with higher odds of chemical restraint were older age (ages 13-17 years [adjusted odds ratio {AOR} 1.53, 95% confidence interval {CI} 1.48-1.58]), anxiety disorders (AOR 1.69, 95% CI 1.64-1.74), disruptive disorders (AOR 1.61, 95% CI 1.53-1.69), suicide/self-injury (AOR 1.3, 95% CI 1.26-1.34), substance use (AOR 1.24, 95% CI 1.20-1.28), and bipolar disorder (AOR 1.23, 95% CI 1.17-1.30). Participants with complex comorbidities were more likely to receive chemical restraint (AOR 1.32, 95% CI 1.26-1.39). After patient and hospital factors were adjusted for, the median OR indicating the influence of the individual hospital on the odds of chemical restraint was 1.43 (95% CI 1.40-1.47). CONCLUSIONS We found that age and certain behavioral health diagnoses were associated with receipt of IV/IM chemical restraint during pediatric behavioral health ED visits. Additionally, whether a patient was treated with chemical restraints was strongly influenced by the hospital to which they presented for treatment.
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Affiliation(s)
- Andrew S Tang
- Pediatric Emergency Medicine, Rady Children's Hospital, San Diego, California, USA
- Pediatric Emergency Medicine, University of California-San Diego, San Diego, California, USA
| | - Meng-Shiou Shieh
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Penelope S Pekow
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA
| | - Kimball A Prentiss
- Department of Emergency Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
| | - Peter K Lindenauer
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Division of Hospital Medicine, Baystate Medical Center, Springfield, Massachusetts, USA
- Department of Population and Quantitative Health Science, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Lauren M Westafer
- Department of Healthcare Delivery & Population Science, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
- Department of Emergency Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts, USA
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27
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van der Post LFM, Nusselder KJ, Peen J, Nabitz U, Dekker JM. Effect of coercive measures on treatment outcome in involuntarily admitted patients in Amsterdam. Front Psychiatry 2023; 14:1240129. [PMID: 37810601 PMCID: PMC10556454 DOI: 10.3389/fpsyt.2023.1240129] [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: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Objective The prevalence of involuntary admissions rose the last forty years in European countries, including the Netherlands. Involuntary admissions result in seclusion, physical restraint and forced medication in approximately 40% of patients. We looked at whether treatment outcomes differ in patients with and without coercive measures. Methods Using The Health of the Nation Outcome Scales (HoNOS) to measure treatment outcomes, we studied the files of 786 patients admitted involuntarily to an Amsterdam clinic. We applied Generalised Linear Models to determine whether the use, or not, of coercive measures during treatment was associated with a difference in outcomes. Results 19% of the cohort were secluded in a High Security Room (HSR); 24% were secluded in their own room and/or received forced medication. After adjustment for the influence of diagnosis, disorder severity (initial HoNOS score) and treatment duration, the HSR group had, on average, a HoNOS difference score that was 2.4 points lower than patients without coercive measures (CI -4.0 to -0.8.; p 0.003). In the seclusion in own room group, this score was 2.6 points lower (CI -4.0 to -1.1; p 0.001), corresponding to an effect size of 0.35 and 0.40, respectively. Conclusion Seclusion, whether or not in combination with forced medication, was applied to two-fifths of patients. The HoNOS scores of the group without coercion improved by nearly two and a half points more on average than those of the two groups with coercion. A causal relationship between coercion and treatment outcome could neither be confirmed nor excluded on the basis of our results.
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Affiliation(s)
| | - K. J. Nusselder
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
| | - J. Peen
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
| | - U. Nabitz
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
| | - J. M. Dekker
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
- Department of Psychology, Faculty of Psychology and Pedagogy, Vrije Universiteit, Amsterdam, Netherlands
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28
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Aluh DO, Onu JU, Ayilara O, Pedrosa B, Silva M, Grigaitė U, Dias M, Cardoso G, Caldas-de-Almeida JM. A qualitative integrative analysis of service users' and service providers' perspectives on ways to reduce coercion in mental health care. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1353-1363. [PMID: 36781485 DOI: 10.1007/s00127-023-02435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE The movement to develop and implement non-coercive alternatives in the provision of mental health care is gaining momentum globally. To strengthen the basis of potential interventions that will be contextually relevant, and to complement the body of literature which is largely from high-income settings, the current study sought to explore the suggestions of service users and providers in Nigeria on how to reduce the use of coercive measures in mental health settings. METHODS Semi-structured interviews with 30 mental health professionals and four focus group discussions among 30 service users from two psychiatric hospitals in Nigeria were conducted. The data were analyzed thematically with the aid of MAXQDA. RESULTS The suggestions proposed by service users and mental health professionals were within the broad themes of communication, policies and legislation, and increased resources. Service users felt that improved communication, home consultations, non-legal advocates and clear rules and legislation would reduce the use of coercion, while service providers suggested increased public mental health literacy, better interpersonal relationships with patients, increased resources for mental health care, more research on the topic and regulation of coercive measures. CONCLUSION Many of the suggestions from this study reinforce strategies already in place to decrease coercion in other settings. However, additional recommendations that are relevant to the study setting, such as enhancing public mental health literacy, mental health legislation reform and increasing access to mental health services, deserve further consideration.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal.
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria, Nsukka, Nigeria.
| | - Justus Uchenna Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Awka, Anambra State, Nigeria
| | - Olaniyi Ayilara
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Uselu, Edo State, Nigeria
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Manuela Silva
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Margarida Dias
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- NOVA Medical School, Comprehensive Health Research Centre (chrc), NOVA University of Lisbon, Lisbon, Portugal
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Kodua M, Duxbury J, Eboh WO, Asztalos L, Tweneboa J. Healthcare staff's experiences of using manual physical restraint: A meta-synthesis review. Nurs Health Sci 2023; 25:271-289. [PMID: 37563098 DOI: 10.1111/nhs.13045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/18/2023] [Accepted: 07/28/2023] [Indexed: 08/12/2023]
Abstract
Manual restraint is a hands-on type of physical restraint used to prevent harm to service users and staff, and to administer necessary treatments. This article reports on a review and meta-synthesis of the qualitative literature on healthcare staff's experiences of using manual restraint. Three electronic databases (CINAHL Complete, MEDLINE, and PsycINFO) were systematically searched, and 19 studies were included. Thematic synthesis was used to synthesize the findings. The Critical Appraisal Skills Programme (CASP) checklist was used to appraise study quality. The synthesis generated one overarching interpretive theme, "unpleasant but necessary," and five subthemes: "maintaining safety triumphs all," "emotional distress," "significance of coping," "feeling conflicted," and "depletion." Seven studies indicated that, from staff perspectives, manual restraint was not always used as a last resort. Healthcare staff experience manual restraint as a psychologically and physically unpleasant practice, yet paradoxically deem its use to be sometimes necessary to keep themselves and service users safe from harm. The findings indicate a need for healthcare staff support, post-restraint debriefing meetings with service users, and the implementation of manual restraint minimization programs in healthcare settings.
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Affiliation(s)
- Michael Kodua
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Joy Duxbury
- Faculty of Health & Education, Manchester Metropolitan University, Manchester, UK
| | | | - Lilla Asztalos
- School of Health and Social Care, University of Essex, Colchester, UK
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Feeney L, Bonner N, McAndrew J. Restrictive interventions on a psychiatric admission ward before and after COVID-19. Ir J Psychol Med 2023; 40:430-436. [PMID: 35388786 DOI: 10.1017/ipm.2022.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Restrictive interventions (seclusion, restraint and special observations) are used on psychiatric wards when there are no other means available to keep a patient or others safe. These measures can be traumatic, and the Mental Health Commission and the Health Service Executive are focused on minimising their use. We set out to determine whether, following a COVID related reduction in bed numbers on a high dependency psychiatric ward in St John of God Hospital in Dublin, there was a change in their incidence. METHODS Data on restrictive interventions and challenging behaviours were gathered for 9-month periods before and after March 2020 when COVID related ward changes took place. Figures were also collected on seclusion and restraint for the previous 18 months for a longer-term view. Ward and hospital occupancy levels were also recorded. RESULTS Between the two time periods, episodes of seclusion fell by 53% and episodes of restraint by 56%. The hours devoted to special observation declined by 30% and incidents of challenging behaviours fell by 26%. Ward occupancy levels fell by only 5%. The longer-term comparison of figures for seclusion and restraint point towards a downward trend from mid-2019 that was accentuated in the post-COVID period. CONCLUSIONS The changes found may relate to reduced crowding on the ward or other COVID related factors such as the emphasis on social distancing and a shared sense of purpose on the ward. The longer-term trend points towards an emerging cultural shift. The challenge now is to sustain and build upon these changes.
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Affiliation(s)
- L Feeney
- Cluain Mhuire Community Services, Newtownpark Avenue, Blackrock, Co., Dublin, Dublin, Ireland
| | - N Bonner
- Department of Nursing, St. John of God Hospital, Stillorgan, Co., Dublin, Dublin, Ireland
| | - J McAndrew
- Cluain Mhuire Community Services, Newtownpark Avenue, Blackrock, Co., Dublin, Dublin, Ireland
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31
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Martinelli L, Siegrist-Dreier S, Schlup N, Hahn S. ["If certain tensions are present, it affects everyone": Multiple case study on processes of coercive measures.]. Pflege 2023; 36:319-325. [PMID: 37594227 DOI: 10.1024/1012-5302/a000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
"If certain tensions are present, it affects everyone": Multiple case study on processes of coercive measures. Abstract: Background: There is an urgent need to reduce coercive measures in psychiatric care. The interaction between patients, nursing staff and medical professionals influences the course of a coercive measure. Aim: The interaction before, during and after coercive measures will be described and compared from the perspectives of the parties involved in order to identify a potential for prevention and quality improvement. Methods: A multiple case study of three coercive measures was conducted, each consisting of interviews with three participants, case documentation, photos, and observation. The data material was analysed thematically with subsequent single-case and cross-case analysis. Results: The thematic analysis revealed three areas of tension: tension and relaxation, humaneness and dehumanisation, as well as safety and autonomy. The stage before coercion was characterised by interacting tensions and the influence of emotions and stress. In all cases, a verbal communication gap was present. During the coercive measure, the quality of interactions between patients and nurses determined their experience. After coercion, the impacts of the measure on the persons and their relationships as well as reflections were the focus. Conclusions: De-escalation techniques turn out to be a key issue, whereby special attention should be paid to emotional and nonverbal aspects in the future. The results underline the relevance of empathy and respect throughout the process for prevention as well as for quality of care. Debriefings of coercive measures should be conducted routinely.
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Affiliation(s)
| | | | - Nanja Schlup
- Universitäre Psychiatrische Dienste Bern, Schweiz
| | - Sabine Hahn
- Angewandte Forschung & Entwicklung Pflege, Berner Fachhochschule, Schweiz
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32
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Meroni G, Sentissi O, Kaiser S, Wullschleger A. Treatment without consent in adult psychiatry inpatient units: a retrospective study on predictive factors. Front Psychiatry 2023; 14:1224328. [PMID: 37636826 PMCID: PMC10447976 DOI: 10.3389/fpsyt.2023.1224328] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Coercion is one of the most important challenges in mental health. In Switzerland, forced medication can be applied during an emergency (Art. 435 of the Civil Code) or over a longer period in case of endangerment of others or oneself (Art. 434). We aimed to analyze the predictors of this specific treatment without consent. Methods Forced medication prescriptions in the Division of Adult Psychiatry of the Geneva University Hospitals between 2018 and 2021 were retrospectively analyzed. Medication under Article 434 was the main outcome variable. Age, gender, admission mode, main diagnosis, and the Health of the Nation Outcome Scales (HoNOS) score at admission were considered as potential predictors. T-test and Pearson's chi-square test were used to compare continuous and categorical variables. A logistic regression was performed to find significant predictors of forced medication. Results Seventy-one out of 4,326 inpatients were subjected to forced medication under Art. 434. HoNOS global scores at admission were not significantly different in the forced medication group compared to the control group. Aggressive behavior was lower in the former at the univariate level. Forced medication was associated at the multivariate level with female gender, involuntary admission, and psychosis. Conclusion Women suffering from psychosis are more at risk of receiving involuntary and repeated medication. The risk of deterioration in psychosocial functioning or behavioral disorganization seems to be the main argument for this coercive measure. Future studies should focus on the patient's perception of this coercion to prevent it and improve adherence to care. Follow-up after discharge might be useful to evaluate a long-term benefit.
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Affiliation(s)
- Giulia Meroni
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Schoeller F. Primary states of consciousness: A review of historical and contemporary developments. Conscious Cogn 2023; 113:103536. [PMID: 37321024 DOI: 10.1016/j.concog.2023.103536] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023]
Abstract
Primary states of consciousness are conceived as phylogenetically older states of consciousness as compared to secondary states governed by sociocultural inhibition. The historical development of the concept in psychiatry and neurobiology is reviewed, along with its relationship to theories of consciousness. We suggest that primary states of consciousness are characterized by a temporary breakdown of self-control accompanied by a merging of action, communication, and emotion (ACE fusion), ordinarily segregated in human adults. We examine the neurobiologic basis of this model, including its relation to the phenomenon of neural dedifferentiation, the loss of modularity during altered states of consciousness, and increased corticostriatal connectivity. By shedding light on the importance of primary states of consciousness, this article provides a novel perspective on the role of consciousness as a mechanism of differentiation and control. We discuss potential differentiators underlying a gradient from primary to secondary state of consciousness, suggesting changes in thalamocortical interactions and arousal function. We also propose a set of testable, neurobiologically plausible working hypotheses to account for their distinct phenomenological and neural signatures.
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Affiliation(s)
- Felix Schoeller
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States; Massachusetts Institute of Technology, Cambridge, MA, United States.
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Jones N, Decker VB, Houston A. De-Escalation Training for Managing Patient Aggression in High-Incidence Care Areas. J Psychosoc Nurs Ment Health Serv 2023; 61:17-24. [PMID: 36853038 DOI: 10.3928/02793695-20230221-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Health care personnel who have close, face-to-face patient contact experience more workplace violence (WPV) than employees in other fields. Certain health care departments (i.e., high-incidence care areas) have elevated rates of WPV that can have adverse emotional, physical, and financial consequences for patients, employees, and institutions. Health care workers need de-escalation training to efficiently manage patient aggression while also safeguarding patients' dignity and patient-provider trust. The current Plan, Do, Study, Act quality improvement project used insights from an in-depth literature review to create a 1-hour, evidence-based, in-service de-escalation training for personnel from high-incidence care areas. A pre/post design was used to evaluate participants' responses to the Confidence Coping with Patient Aggression Instrument. Post-training, participants reported significantly increased feelings of safety regarding potential patient aggression (p = 0.001) and more efficacy regarding their aggression management techniques (p = 0.039). Based on the training's results, recommendations were made for future institutional de-escalation initiatives. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 17-24.].
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Wullschleger A, Gonçalves L, Royston M, Sentissi O, Ambrosetti J, Kaiser S, Baggio S. Admissions to psychiatric inpatient services and use of coercive measures in 2020 in a Swiss psychiatric department: An interrupted time-series analysis. PLoS One 2023; 18:e0289310. [PMID: 37498908 PMCID: PMC10374153 DOI: 10.1371/journal.pone.0289310] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The CoVID pandemic and the associated lockdown had a significant impact on mental health services. Inpatient services faced the challenge of offering acute psychiatric while implementing strict infection control measures. There is, however, a lack of studies investigating the use of coercive measures during the pandemic and their relation to hospitalizations and symptom severity. AIMS To investigate the effects of the CoVID outbreak on psychiatric admissions, use of seclusion and symptom severity. METHOD Using routine data from 2019 and 2020 gathered in the Department of Psychiatry at the Geneva University Hospitals, we performed an interrupted time series analysis. This included the number of psychiatric hospitalizations, the proportion of people who experienced seclusion and the average severity of symptoms as measured by the Health of Nations Outcome Scale (HoNOS). Dependent variables were regressed on the time variable using regression model with bootstrapped standard errors. RESULTS Hospitalizations decreased over time (b = -0.57, 95% CI: -0.67; -0.48, p < .001). A structural break in the data (supremum Wald test: p < .001) was observed in the 12th week of 2020. There was an inverse relationship between the number of admissions and the proportions of people subject to seclusion (b = 0.21, 95% CI: -0.32; -0.09, p < .001). There was a statistically marginally significant inverse relationship between HoNOS scores at admission and the number of psychiatric hospitalizations (b = -1.28, 95% CI: -2.59, 0.02, p = .054). CONCLUSION Our results show that the CoVID pandemic in 2020 was associated with a significant decrease in the number of hospital admissions. This decrease was correlated with a greater use of seclusion. The higher burden of symptoms and the difficult implementation of infection control measures might explain this higher use of coercion.
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Affiliation(s)
| | - Leonel Gonçalves
- Division of Prison Health, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - Maya Royston
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Othman Sentissi
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Julia Ambrosetti
- Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Kaiser
- Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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McDonnell AA, O’Shea MC, Bews-Pugh SJ, McAulliffe H, Deveau R. Staff training in physical interventions: a literature review. Front Psychiatry 2023; 14:1129039. [PMID: 37564241 PMCID: PMC10411725 DOI: 10.3389/fpsyt.2023.1129039] [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: 12/21/2022] [Accepted: 05/30/2023] [Indexed: 08/12/2023] Open
Abstract
Background Restrictive practices are used frequently by frontline staff in a variety of care contexts, including psychiatric hospitals, children's services, and support services for older adults and individuals with intellectual and developmental disabilities. Physical restraint has been associated with emotional harm, physical injury to staff and consumers, and has even resulted in death of individuals in care environments. Various interventions have been implemented within care settings with the intention of reducing instances of restraint. One of the most common interventions is staff training that includes some physical intervention skills to support staff to manage crisis situations. Despite physical intervention training being used widely in care services, there is little evidence to support the effectiveness and application of physical interventions. This review will examine the literature regarding outcomes of staff training in physical interventions across care sectors. Method A systematic search was conducted following PRISMA guidelines using Cochrane Database, Medline EBSCO, Medline OVID, PsychINFO, and the Web of Science. Main search keywords were staff training, physical intervention, physical restraint. The MMAT was utilised to provide an analytical framework for the included studies. Results and discussion Seventeen articles have been included in this literature review. The included studies take place in a range of care settings and comprise a wide range of outcomes and designs. The training programmes examined vary widely in their duration, course content, teaching methods, and extent to which physical skills are taught. Studies were of relatively poor quality. Many descriptions of training programmes did not clearly operationalise the knowledge and skills taught to staff. As such, it is difficult to compare course content across the studies. Few papers described physical interventions in sufficient detail. This review demonstrates that, although staff training is a 'first response' to managing health and safety in care settings, there is very little evidence to suggest that staff training in physical intervention skills leads to meaningful outcomes.
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Affiliation(s)
| | | | | | | | - Roy Deveau
- Tizard Centre, University of Kent, Canterbury, United Kingdom
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Aluh DO, Aigbogun O, Ukoha-Kalu BO, Silva M, Grigaitė U, Pedrosa B, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care. Healthcare (Basel) 2023; 11:1986. [PMID: 37510426 PMCID: PMC10379438 DOI: 10.3390/healthcare11141986] [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: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Osaro Aigbogun
- Department of Management, Marketing and Digital Business, Curtin University, Miri 98009, Malaysia
| | | | - Manuela Silva
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Margarida Santos-Dias
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
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Abstract
ABSTRACT The emergency department can be a particularly challenging environment for the care of pediatric patients presenting with acute agitation. Agitation is a behavioral emergency requiring prompt intervention. Timely recognition of agitation and proactive implementation of de-escalation strategies are critical for safe and effective management of agitation, as well as prevention of recurrent episodes. This article reviews the definition of agitation, explores the domains of verbal de-escalation, and considers multidisciplinary management strategies for children with acute agitation.
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Affiliation(s)
| | - Carl R Baum
- Professor, Section of Pediatric Emergency Medicine, Departments of Pediatrics and of Emergency Medicine, Yale School of Medicine, New Haven, CT
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Lantta T, Duxbury J, Haines-Delmont A, Björkdahl A, Husum TL, Lickiewicz J, Douzenis A, Craig E, Goodall K, Bora C, Whyte R, Whittington R. Models, frameworks and theories in the implementation of programs targeted to reduce formal coercion in mental health settings: a systematic review. Front Psychiatry 2023; 14:1158145. [PMID: 37398581 PMCID: PMC10311067 DOI: 10.3389/fpsyt.2023.1158145] [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: 02/03/2023] [Accepted: 05/29/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Implementation models, frameworks and theories (hereafter tools) provide researchers and clinicians with an approach to understand the processes and mechanisms for the successful implementation of healthcare innovations. Previous research in mental health settings has revealed, that the implementation of coercion reduction programs presents a number of challenges. However, there is a lack of systematized knowledge of whether the advantages of implementation science have been utilized in this field of research. This systematic review aims to gain a better understanding of which tools have been used by studies when implementing programs aiming to reduce formal coercion in mental health settings, and what implementation outcomes they have reported. Methods A systematic search was conducted using PubMed, CINAHL, PsycINFO, Cochrane, Scopus, and Web of Science. A manual search was used to supplement database searches. Quality appraisal of included studies was undertaken using MMAT-Mixed Methods Appraisal Tool. A descriptive and narrative synthesis was formed based on extracted data. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed in this review. Results We identified 5,295 references after duplicates were removed. Four additional references were found with a manual search. In total eight studies reported in nine papers were included in the review. Coercion reduction programs that were implemented included those that were holistic, and/or used professional judgement, staff training and sensory modulation interventions. Eight different implementation tools were identified from the included studies. None of them reported all eight implementation outcomes sought from the papers. The most frequently reported outcomes were acceptability (4/8 studies) and adaptation (3/8). With regards to implementation costs, no data were provided by any of the studies. The quality of the studies was assessed to be overall quite low. Discussion Systematic implementation tools are seldom used when efforts are being made to embed interventions to reduce coercive measures in routine mental health care. More high-quality studies are needed in the research area that also involves perspectives of service users and carers. In addition, based on our review, it is unclear what the costs and resources are needed to implement complex interventions with the guidance of an implementation tool. Systematic review registration [Prospero], identifier [CRD42021284959].
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Joy Duxbury
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Alina Haines-Delmont
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Anna Björkdahl
- Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden
| | - Tonje Lossius Husum
- Department of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Krakow, Poland
| | - Athanassios Douzenis
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elaine Craig
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Katie Goodall
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Christina Bora
- Second Psychiatry Department, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Rachel Whyte
- Department of Nursing, Manchester Metropolitan University, Manchester, United Kingdom
| | - Richard Whittington
- Centre for Research and Education in Security, Prisons and Forensic Psychiatry, Forensic Department Østmarka, St. Olav's Hospital, Trondheim, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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40
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Shields MC, Hollander MA. Complaints, Restraint, and Seclusion in Massachusetts Inpatient Psychiatric Facilities, 2008-2018. J Patient Exp 2023; 10:23743735231179072. [PMID: 37323757 PMCID: PMC10265359 DOI: 10.1177/23743735231179072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
There has been limited research on the quality of inpatient psychiatry, yet policies to expand access have increased, such as the use of Medicaid Section 1115 waivers for treatment in "Institutions for Mental Disease" (IMD). Using data from public records requests, we evaluated complaints, restraint, and seclusion from inpatient psychiatric facilities in Massachusetts occurring from 2008 to 2018, and compared differences in the rates of these events by IMD status. There were 17,962 total complaints, with 48.9% related to safety and 19.9% related to abuse (sexual, physical, verbal), and 92,670 episodes of restraint and seclusion. On average, for every 30 census days in a given facility, restraint, and seclusion occurred 7.47 and 1.81 times, respectively, and a complaint was filed 0.94 times. IMDs had 47.8%, 68.3%, 276.9%, 284.8%, 183.6%, and 236.1% greater rates of restraint, seclusion, overall complaints, substantiated complaints, safety-related complaints, and abuse-related complaints, respectively, compared to non-IMDs. This is the first known study to describe complaints from United States inpatient psychiatric facilities. Policies should strengthen the implementation of patients' rights and patient-centeredness, as well as external critical-incident-reporting systems.
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Affiliation(s)
| | - Mara A.G. Hollander
- Department of Public Health Sciences, University of North Carolina Charlotte, Charlotte, USA
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41
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Chong Y, Wang C, Zhi T, Fang S, Min H, Zhang L, Wu X, Wang Y. Psychiatric Nurses' Knowledge, Attitudes, and Practice Regarding Physical Restraint in China: A Multicentre Cross-Sectional Study. J Multidiscip Healthc 2023; 16:1475-1489. [PMID: 37274425 PMCID: PMC10237330 DOI: 10.2147/jmdh.s412485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
Background Physical restraint is widely used in mental health services to address safety concerns. However, studies have shown that improper physical restraint can result in adverse effects. Nurses are the main practitioners of physical restraint and play a crucial role in physical restraint decisions and nursing. In China, there is a lack of large-scale investigations into the current status of psychiatric physical restraint use. Aim This study aims to explore the situation and influencing factors of the psychiatric nurses' knowledge, attitudes and practices regarding physical restraint in China. Methods A cross-sectional multicenter descriptive study was conducted from December 2022 to February 2023, consecutively. A convenience sampling method was used to recruit 345 staff from three psychiatric hospitals in Shanghai. A psychiatric nurses' physical restraint use status questionnaire was administered to examine their knowledge, attitude, and practice regarding physical restraint. The data were analyzed using the Mann-Whitney U-test and the Kruskal-Wallis test. Multivariate linear stepwise regression analysis was used for multi-factor analysis. Results Overall, nurses had a good level of knowledge with positive attitudes and adequate practices. However, they had some misunderstandings and undesirable practices. Multiple linear regression analysis revealed that educational background, position and training experience were the main factors influencing physical restraint knowledge, attitudes and practice among psychiatric nurses (p<0.05). Conclusion This study highlights some important misconceptions and improper practices of psychiatric nurses about using physical restraint. It is necessary to strengthen education and training on physical restraint for nursing staff to reduce unnecessary physical restraint use.
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Affiliation(s)
- Yue Chong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Can Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Tingting Zhi
- Shanghai Psychological Consultation Center, Shanghai Baoshan Mental Health Center, Shanghai, 201900, People’s Republic of China
| | - Shihan Fang
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People’s Hospital, Hangzhou, 310005, People’s Republic of China
| | - Haiying Min
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Lei Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
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Brune S, Killam L, Camargo-Plazas P. Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper. Issues Ment Health Nurs 2023; 44:437-452. [PMID: 37167098 DOI: 10.1080/01612840.2023.2205502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.
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Affiliation(s)
- Sara Brune
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- Nursing (BSN) Program, University of the Fraser Valley, Chilliwack, British Columbia, Canada
| | - Laura Killam
- School of Nursing, Queen's University, Kingston, Ontario, Canada
- School of Health Sciences and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
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Gallen K, Sonnenberg J, Loughran C, Smith MJ, Sheppard M, Schuster K, Kaufman E, Song JS, Hall EC. Health Effects of Policing in Hospitals: a Narrative Review. J Racial Ethn Health Disparities 2023; 10:870-882. [PMID: 35267188 DOI: 10.1007/s40615-022-01275-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Law enforcement activity, in the form of outside agencies or hospital security forces, is increasingly common in American healthcare. Little is known about the potential effects of this prevalent, modifiable exposure on hospital staff and patient health. This narrative review characterizes existing evidence on the direct and indirect health effects of law enforcement activity in hospitals. OBSERVATIONS Law enforcement activity in hospitals can affect health outcomes through four mechanisms: (1) physical health effects related to workplace violence, restraint use, excessive force, and weapon use; (2) mental health effects involving perceptions of safety and psychological distress; (3) social effects related to the patient-provider relationship, mistrust, and bias and discrimination; and (4) legal and ethical considerations affecting overall well-being. CONCLUSIONS AND RELEVANCE Unchecked law enforcement activity in hospitals may risk patient physical and mental health, reduce patient trust, result in bias and discrimination, and contribute to legal and ethical rights violations. Importantly, law enforcement activity in hospitals may also contribute to staff perceptions of safety. To fill knowledge gaps on the measurable impact of law enforcement activity in the hospital on staff and patients, hospitals should collect and publicly share robust data on law enforcement activity in their facilities, create and adopt patient-centered policies to ensure safety and protect patient health and privacy, and implement evidence-based interventions that safely reduce law enforcement involvement with patients.
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Affiliation(s)
- Kate Gallen
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Jake Sonnenberg
- University of California San Francisco School of Medicine, San Francisco, CA, USA
| | | | | | - Mildred Sheppard
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Kirsten Schuster
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Elinore Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ji Seon Song
- School of Law, University of California, Irvine, CA, USA
| | - Erin C Hall
- Division of Trauma, Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA.
- Community Violence Intervention Program, MedStar Washington Hospital Center, Washington, DC, 20010, USA.
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Flemmerer M, Bühling-Schindowski F, Baumgardt J, Bechdolf A. Predictors of the use of restraint in inpatient psychiatric care among patients admitted via the emergency department. J Psychiatr Res 2023; 162:37-43. [PMID: 37086605 DOI: 10.1016/j.jpsychires.2023.03.043] [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: 12/21/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Coercive measures are associated with negative consequences for both patients and hospital staff. The aim of the study was to identify predictors for the use of restraints in the emergency department and in subsequent inpatient care. METHOD Retrospective routine clinical data of all patients admitted to the psychiatric departments of Vivantes Klinikum Am Urban in Berlin via the emergency department in 2019 was examined case-wise (n = 2584) as well as patient-wise (n = 2118). RESULTS Of all cases admitted via the emergency department, 195 cases (7.5%) experienced restraints and restraints combined with drug sedation during their inpatient treatment. Of the 2584 cases admitted via the emergency department, 195 cases (7.5%) experienced restraints and restraints combined with drug sedation during their inpatient treatment. These 195 cases experienced a total of 358 restraints and were distributed across 159 individuals. Multivariate regression analyses on patient-level show that age (p < .001), judicial placement (p < .001), and police referral in the presence of others (p < .001) had a statistically significant effect on the use of restraint. DISCUSSION The results indicate that certain patient characteristics increase the risk of restraints. A majority of the findings of this study underline previous research findings. However, ICD-10 diagnosis and gender do not prove to be significant variables, contrary to expectations based on previous.
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Affiliation(s)
- Maria Flemmerer
- Medical School Berlin, Germany; Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Felix Bühling-Schindowski
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Berlin, Germany
| | - Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Berlin, Germany; Research Institute of the Local Health Care Funds (WIdO), Berlin, Germany.
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban und Vivantes Hospital im Friedrichshain, Berlin, Germany; Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Germany
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45
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Bakola M, Peritogiannis V, Stuckler D, Kitsou KS, Gourzis P, Hyphantis T, Jelastopulu E. Who is coercively admitted to psychiatric wards? Epidemiological analysis of inpatient records of involuntary psychiatric admissions to a University General Hospital in Greece for the years 2008-2017. Int J Soc Psychiatry 2023; 69:267-276. [PMID: 35232289 DOI: 10.1177/00207640221081793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Involuntary psychiatric admissions are a widely used practice despite ethical concerns about coercion. There are particular concerns that vulnerable groups, such as single, unemployed or racial minorities, may be more subjected to such practices. AIM We aimed to investigate the social patterns of involuntary psychiatric admissions from 2008 to 2017 at University General Hospital in Ioannina, Greece. METHOD We retrospectively assessed inpatient records from 2008 to 2017 of patients admitted to the Department of Psychiatry of the Ioannina University General Hospital, Northwestern Greece. Alternative patients of alternative years were selected for inclusion; this yielded 332 patients involuntarily admitted, corresponding to 28.5% of total involuntary psychiatric admissions. RESULTS Over the 10-year period, the overall numbers of annual involuntary psychiatric admissions remained relatively stable, as did the length of hospital stay (mean = 23.8 days). The most common disorder upon admission was schizophrenia spectrum disorders, accounting for approximately two-thirds of all admissions, followed by mood disorders (about 20%). There was evidence that people who lacked social support or experienced financial hardship were more greatly represented among those admitted: 70.2% of admitted patients were single and 64.8% were unemployed. Most patients had been admitted to the psychiatric ward in the past (64.2%). CONCLUSION Our study indicates potentially worrisome evidence that patients who are in vulnerable positions are at elevated likelihood of being involuntarily admitted to psychiatric wards. Future research is needed to evaluate the socio-demographic patterning of involuntary admissions in other European countries.
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Affiliation(s)
- Maria Bakola
- Postgraduate Program of Public Health, Medical School, University of Patras, Greece
| | - Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - David Stuckler
- Department of Social and Political Sciences, University of Bocconi, Milan, Italy
| | | | - Philippos Gourzis
- Department of Psychiatry, Medical School, University of Patras, Greece
| | - Thomas Hyphantis
- Department of Psychiatry, Division of Medicine, School of Health Sciences, University of Ioannina, Greece
| | - Eleni Jelastopulu
- Department of Public Health, Medical School, University of Patras, Greece
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46
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Tully SM, Bucci S, Berry K. "My life isn't my life, it's the systems": A qualitative exploration of women's experiences of day-to-day restrictive practices as inpatients. J Psychiatr Ment Health Nurs 2023; 30:110-122. [PMID: 35771190 PMCID: PMC10084424 DOI: 10.1111/jpm.12855] [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: 08/06/2021] [Revised: 05/01/2022] [Accepted: 06/16/2022] [Indexed: 01/13/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Sometimes someone needs to be in hospital because they are struggling with their mental health and need some extra support but being in hospital can also be a difficult experience. There are a lot of restrictions in place in hospital, like locked doors, rules to follow and not much choice about what happens to you. Other research has found that these restrictions can feel difficult and stressful for people and so more research is needed about this. We wanted to know what being in hospital felt like for women in particular. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We interviewed women who were in hospital because of their mental health about what it was like for them in hospital. The women told us that they felt powerless while they were in hospital. They sometimes felt like they were being punished and this could affect their mood and could lead to them hurting themselves. They also said that they were not always listened to by staff, and they found it difficult being away from their family and friends while they were in hospital. The women also told us that being in hospital could sometimes help them to feel safe. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Women should be looked after in hospital in a way that helps them to feel in control of what happens to them. They should be supported to be able to go outside the hospital on leave, to keep in touch with their family and friends, and they should be listened to by staff. A project called "safewards" has suggested some ways for helping to make hospital wards safer. They have suggested that everyone should be clear about what the rules are when they go into hospital and ways that staff could communicate more clearly with the people they are working with. Our research supports using these techniques. ABSTRACT: Introduction Inpatient care often involves restrictive interventions such as seclusion and restraint and restrictive practices that limit the person's freedom, rights and daily activities. Restrictive practice has not been the explicit focus in previous research; however, it often appears as an important theme, with participants identifying it can have a detrimental effect on their well-being. More research specifically on this topic in an inpatient setting is, therefore, needed. Women might be particularly vulnerable to adverse effects of restrictive practices compared to men as women generally occupy less powerful positions in society and more often experience abuse. Aims The study aimed to explore women's experiences of routine restrictive practices in mental health inpatient settings. Methods Twenty-two women who were currently inpatients on mental health wards were interviewed about their experiences of restrictive practices in hospital. Interviews were analysed using thematic analysis. Results An overarching theme emerged of powerlessness. Four key sub-themes were also identified: restrictions perceived as punitive, having no voice, impact of restrictions on relationships and restrictions providing safety and support. Discussion Although restrictive practices were found to provide the women with a sense of safety, they were also found to impact upon the women's well-being, leading to increases in self-harm and over-reliance on restrictions. Implications for practice This research highlights the importance of gender-informed inpatient services for women that foster independence, empowerment and allow women to have their voices heard. Safewards interventions such as clear mutual expectations and soft words could contribute to mitigating the impact of restrictive practices.
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Affiliation(s)
- Sarah Michelle Tully
- School of Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- School of Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- School of Health Sciences, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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47
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Smith GM, Altenor A, Altenor RJ, Davis RH, Steinmetz W, Adair DK, Ashbridge DM, Deegan J, Clement K, Hepner M, Markley DB, Smith EW. Effects of Ending the Use of Seclusion and Mechanical Restraint in the Pennsylvania State Hospital System, 2011-2020. Psychiatr Serv 2023; 74:173-181. [PMID: 35855620 DOI: 10.1176/appi.ps.202200004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Pennsylvania State Hospital System's use of containment procedures has been studied for >30 years. This prospective study assessed the effects of ending the use of seclusion and mechanical restraint in the system's six civil hospitals and two forensic centers from 2011 to 2020. The study examined the effect of this change on key safety measures: physical restraint, assaults, aggression, and self-injurious behavior. In total, 68,153 incidents, including 9,518 episodes of physical restraint involving 1,811 individuals, were entered into a database along with patients' demographic and diagnostic information. All data were calculated per 1,000 days to control for census changes. During the study, mechanical restraint was used 128 times and seclusion four times. Physical restraint use decreased from a high of 2.62 uses per 1,000 days in 2013 to 2.02 in 2020. The average length of time a person was held in physical restraint was reduced by 64%, from 6.6 minutes in 2011 to 2.4 minutes in 2020 (p<0.001). All safety measures improved or were unchanged. Use of unscheduled medication did not change. The hospital system safely ended the use of mechanical restraint and seclusion by using a recovery approach and by following the six core strategies for seclusion and restraint reduction.
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Affiliation(s)
- Gregory M Smith
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Aidan Altenor
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Roberta J Altenor
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Robert H Davis
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - William Steinmetz
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Dale K Adair
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Donna M Ashbridge
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - John Deegan
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Kristen Clement
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Marcia Hepner
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - David B Markley
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Elizabeth W Smith
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
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48
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Galbert I, Azab AN, Kaplan Z, Nusbaum L. Staff attitudes and perceptions towards the use of coercive measures in psychiatric patients. Int J Ment Health Nurs 2023; 32:106-116. [PMID: 36070221 DOI: 10.1111/inm.13064] [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] [Accepted: 08/21/2022] [Indexed: 01/14/2023]
Abstract
The failure of efforts to significantly reduce the use of physical coercive measures (PCMs) in psychiatric hospitals remains a global concern. There is a gap in the understanding of staff's characteristics that may affect their attitudes and perceptions towards PCMs. This study used a cross-sectional design to examine the attitudes and perceptions of staff working at a mental health centre in Israel regarding the use of PCMs and to explore whether staff attitudes differed depending on their professional and demographic background. This study also sought to explore staff willingness to accept a policy of reducing the use of PCMs. The data were collected from 149 staff members (nurses, physicians, and auxiliary staff) working at mental health centre, using a questionnaire developed for this study. The findings indicate a low degree of support for use of PCMs among participants who were older, female, more qualified psychiatric nurses, with longer duration of employment, and those who have not participated in coercive intervention in the past year. The majority of the sample reported a low willingness to reduce the use of PCMs, and a lack of institutional support after participating in a coercive event. High hospital occupancy and insufficient staffing were perceived as contributing factors to coercive incidents. Therefore, availability of trained and experienced staff, elimination of organizational barriers, along with creating and maintaining a safe clinical environment should be a priority. Alternative non-coercive interventions should further be taught and used for managing aggressive and violent behaviour in the psychiatric clinical settings.
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Affiliation(s)
- Ilya Galbert
- Department of Nursing, Recanati School of Community Health Professions, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Abed N Azab
- Department of Nursing, Recanati School of Community Health Professions, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel.,Department of Clinical Biochemistry and Pharmacology, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Zeev Kaplan
- Beer-Sheva Mental Health Center, Beer-Sheva, Israel.,Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
| | - Lika Nusbaum
- Department of Nursing, Recanati School of Community Health Professions, Ben-Gurion University of the Negev Faculty of Health Sciences, Beer-Sheva, Israel
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49
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Faden J, Musselman M, Citrome L. Sublingual dexmedetomidine: repurposing an anesthetic as an anti-agitation agent. Expert Rev Neurother 2023; 23:97-106. [PMID: 36707066 DOI: 10.1080/14737175.2023.2174430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Especially when acutely ill, individuals with schizophrenia and bipolar disorder can present with agitated behavior. The initial approach to agitation management are non-pharmacologic strategies such as verbal de-escalation techniques; however, pharmacologic interventions may be needed. Dexmedetomidine is a selective alpha-2 adrenergic receptor agonist, and a sublingual formulation has been approved in the US for the treatment of agitation associated with schizophrenia and bipolar disorder in adults. AREAS COVERED The authors review the published literature on sublingual dexmedetomidine using the US National Library of Medicine's PubMed.gov resource. Pharmacodynamics, pharmacokinetics, and efficacy and tolerability findings are summarized. The authors also provide a discussion to its potential place in the treatment armamentarium. EXPERT OPINION Sublingual dexmedetomidine is an effective and well-tolerated pharmacologic option for the treatment of agitation associated with schizophrenia and bipolar disorder. The sublingual method of administration allows for a rapid onset of action with treatment effects beginning as early as 20 minutes after administration. Adverse effects include somnolence, hypotension, oral paresthesia, hypoesthesia, and dry mouth. Further study will be needed to evaluate sublingual dexmedetomidine in real-world patients receiving concomitant psychotropic medications.
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Affiliation(s)
- Justin Faden
- Department of Psychiatry and Behavioral Sciences, Temple University School of Medicine, Philadelphia, PA, United States
| | - Meghan Musselman
- Department of Psychiatry and Behavioral Sciences, Temple University School of Medicine, Philadelphia, PA, United States
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, New York, NY, United States
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50
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Bachmann L, Vatne S, Mundal IP. Safeguarding patients while implementing mechanical restraints: A qualitative study of nurses and ward staff's perceptions and assessment. J Clin Nurs 2023; 32:438-451. [PMID: 35178794 PMCID: PMC10078747 DOI: 10.1111/jocn.16249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To explore nurses' and ward staff's perceptions and assessments of patient care while implementing mechanical restraints. BACKGROUND To prevent the risks associated with the use of restraints in psychiatry and ensure safe mental health care, it is necessary to know more about how the nursing staff experiences, comprehends and intervenes in managing patients subjected to coercive measures. DESIGN This study employed a qualitative descriptive design, in accordance with the COREQ guidelines. METHODS Semi-structured interviews were conducted with 18 nurses and ward staff aged between 22 and 45 years old, who had experience implementing mechanical restraints. Data were digitally audio-recorded and transcribed verbatim. Inductive thematic analysis was conducted using NVivo 12. RESULTS The participants believed that mechanical restraints should be used as a last resort and that safeguarding patients during implementation is important; however, their assessments of the patients' physical and mental conditions varied. A clear difference emerged in how management qualified professionals handled situations prior to and during the implementation of mechanical coercive measures. CONCLUSIONS The findings emphasise the need to focus on the assessment of patients prior to and during restraint, ensure the quality of safe implementation in a risk-of-harm situation, prioritise competence in education, and practice, and improve management. RELEVANCE TO CLINICAL PRACTICE The findings highlight the importance of assessing the physical and mental condition of patients while implementing restraints, as well as aiding the management, nurses and ward staff in tailoring safety procedures.
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Affiliation(s)
- Liv Bachmann
- Department of Health and Social Sciences, Molde University College, Molde, Norway
| | - Solfrid Vatne
- Department of Health and Social Sciences, Molde University College, Molde, Norway
| | - Ingunn Pernille Mundal
- Department of Health and Social Sciences, Molde University College, Molde, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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