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Husum TL, Siqveland J, Ruud T, Lickiewicz J. Systematic literature review of the use of Staff Attitudes to Coercion Scale (SACS). Front Psychiatry 2023; 14:1063276. [PMID: 36824675 PMCID: PMC9941667 DOI: 10.3389/fpsyt.2023.1063276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVE Staff's attitudes to the use of coercion may influence the number of coercive interventions employed and staff willingness to engage in professional development projects aimed at reducing the use of coercion itself. The Staff Attitude to Coercion Scale (SACS) was developed to assess the attitudes of mental healthcare staff to the use of coercion in 2008 and has been employed subsequently. This global study systematically reviews and summarizes the use of the scale in research. METHODS Seven databases were searched for studies using SACS in articles published in peer reviewed journals and gray literature. In addition, researchers who have asked for permission to use the scale since its development in 2008 were contacted and asked for their possible results. Extracting of data from the papers were performed in pairs of the authors. RESULTS Of the 82 identified publications, 26 papers with 5,838 respondents were selected for review. A review of the research questions used in the studies showed that the SACS questionnaire was mostly used in studies of interventions aimed at reducing coercion and further explain variation in the use of coercion. CONCLUSION SACS is, to our best of knowledge, the only questionnaire measuring staff's attitudes to the use of coercive interventions in mental health services. Its widespread use indicates that the questionnaire is perceived as feasible and useful as well as demonstrating the need for such a tool. However, further research is needed as the relationship between staff attitudes to coercion and the actual use of coercion remains unclear and needs to be further investigated. Staff attitudes to coercion may be a prerequisite for leaders and staff in mental healthcare to engage in service development and quality improvement projects.
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Affiliation(s)
- Tonje Lossius Husum
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.,Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Kraków, Poland
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Özgönül ML, Bademli K. Ethical problems experienced by family caregivers of patient with schizophrenia: A hermeneutic phenomenological study. Perspect Psychiatr Care 2022; 58:2127-2136. [PMID: 35102567 DOI: 10.1111/ppc.13039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study was to provide information on the ethical problems faced by family caregivers of patients with schizophrenia. METHOD This study was conducted using a hermeneutical approach to phenomenology. Data were obtained by means of an individual interview process using a semi-structured interview guide. RESULTS The results of this study revealed the following themes and sub-themes: higgledy-piggledy, walking on a thorny path, decision-making, subtheme, back of the mirror, victim, and dark well. PRACTICE IMPLICATIONS Expressed concerns have shown that caregivers not only face difficult challenges in the management of complicated and complicated illnesses, but also face ethical issues inherent in the role of caregivers and must take ethical decisions.
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Affiliation(s)
- Mustafa Levent Özgönül
- Department of Medical History and Ethics, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Kerime Bademli
- Psychiatric Nursing Department, Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Kuppili PP, Vengadavaradan A, Bharadwaj B. A Cross-Sectional Study to Assess the Frequency of Restraint, and Knowledge and Attitudes of the Caregivers of Patients Toward Restraint in a General Hospital Psychiatry Setting from South India. Indian J Psychol Med 2022; 44:359-365. [PMID: 35949638 PMCID: PMC9301748 DOI: 10.1177/02537176211061304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is limited Indian data on the epidemiology of hospital-based restraint practices and the knowledge and attitude of caregivers toward restraint. Therefore, this study aimed to report the frequency and pattern of restraints in a general hospital psychiatry setting and assess the knowledge and attitude about restraint practices among caregivers of patients. METHODS We calculated the frequency of restraints (physical and chemical) over one year. The knowledge and attitude toward restraint were assessed in 75 caregivers each of patients from inpatient and outpatient settings, using a questionnaire designed by the authors and pretested in a pilot study. RESULTS The frequency of any form of restraint was 19%. The frequency of chemical and physical restraints was 19% and 0.5%, respectively. Less than 20% of caregivers in both groups reported that restraint was either stigmatizing (5.33% inpatient caregivers vs. 12% outpatient caregivers), cruel (8% inpatient caregivers vs. 15.33% outpatient caregivers), or a measure of punishment (9% inpatient caregivers vs. 16% outpatient caregivers). No significant difference was found between knowledge and attitude about restraint between caregivers of outpatients and inpatients, except for a significantly greater number of caregivers of outpatients reporting that the restraint practices in the hospital were similar to those adopted by faith healers or religious/spiritual centers. CONCLUSION The frequency of either physical or chemical restraint was less compared to the existing international and Indian data. In addition, most caregivers of patients of both outpatients and inpatients did not report a negative attitude toward restraints.
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Affiliation(s)
| | - Ashvini Vengadavaradan
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvanthri Nagar, Puducherry, India
| | - Balaji Bharadwaj
- Dept. of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvanthri Nagar, Puducherry, India
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Ayhan D, Mercan N, Doğan R, Yüksel Ç. The aggressive patient experiences of healthcare professionals exposed to physical violence in a psychiatric clinic: A phenomenological study. Perspect Psychiatr Care 2022; 58:501-508. [PMID: 34270096 DOI: 10.1111/ppc.12918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study investigated the experiences of healthcare professionals, exposed to physical violence, related to aggressive patients at a psychiatry service. DESIGN AND METHODS The qualitative study sample consisted of a total of 21 healthcare professionals. The data were collected through in-depth interviews. An inductive qualitative content analysis was used to analyze the data. FINDINGS Three themes, the effects of warning signs of violence, clinical management of violence, and effects of violence, and 13 sub-themes were determined. PRACTICE IMPLICATIONS The effects of physical violence on healthcare professionals can be seen and will contribute to planning in this regard.
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Affiliation(s)
- Didem Ayhan
- Department of Nursing, Faculty of Health Sciences, Bandirma Onyedi Eylul University, Balıkesir, Turkey
| | - Neşe Mercan
- Department of Child Development, Faculty of Health Sciences, Bilecik Seyh Edebali University, Bilecik, Turkey
| | - Reyhan Doğan
- Department of Hematology, Gulhane Training and Research hospital, Ankara, Turkey
| | - Çiğdem Yüksel
- Department of Mental Health and Psychiatric Nursing, Gulhane Faculty of Nursing, University of Health Sciences, Ankara, Turkey
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A Visual Dashboard to Monitor Restraint Use in Hospitalized Psychiatry Patients. Jt Comm J Qual Patient Saf 2021; 47:282-287. [PMID: 33648859 DOI: 10.1016/j.jcjq.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Restraint events are tracked using a duration rate as part of a national psychiatry quality reporting program and tracked annually. Visual dashboards can help track metrics in near real time but are not routinely used in psychiatric settings. METHODS This observational study sought to characterize restraint events by extracting electronic medical record data on restraint episodes between January 1, 2017, and December 31, 2019, in five inpatient units in one academic medical center. The data were also used to build a visual dashboard and calculate restraint metrics (duration and frequency) across locations and time. RESULTS A total of 540 distinct restraint events occurred during the study period. Highest restraint episode counts occurred during evening shift (54.8%), compared to daytime (37.2%) and nighttime (8.0%) shifts. Highest episode duration rates occurred in an adult unit (61.3% of total hours spent in restraints across all units), while highest episode counts occurred in the adolescent unit (48.3% of all restraint episodes). A visual dashboard with two views (summary and detailed) was created. The summary view integrates patient volume data (total patient hours per month) with total duration and number of episodes per month. The detailed view displays event frequency by hour of day, nursing shift, weekday, and patient length of stay at the time of restraint. CONCLUSIONS Visual dashboards can provide timely and efficient access to granular data elements and metrics related to restraint events, beyond the reporting requirement of a national quality program. Visual dashboards can reveal variations in restraint use and yield important opportunities for clinical quality improvement.
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Hawsawi T, Power T, Zugai J, Jackson D. Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review. Int J Ment Health Nurs 2020; 29:831-845. [PMID: 32198811 DOI: 10.1111/inm.12716] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/28/2022]
Abstract
Seclusion and restraint are coercive practices associated with physical and psychological harm. International bodies have called for an end to these practices. However, these practices continue to be used. Elimination programmes have had some success in reducing the rates of these practices. Understanding coercive practices through the perspectives of involved individuals may facilitate a complete cessation of seclusion and restraint from the practice. Therefore, this qualitative review explored how nurses and consumers experienced seclusion and restraint events in mental health care. Five databases were searched. The search strategy resulted in the inclusion of fourteen qualitative papers. A thematic analysis was used to synthesize the findings. Six themes emerged under three main categories; shared experiences: disruption in care, disruption in the therapeutic relationship and shared negative impacts; nurses' experiences: Absence of less coercive alternatives; and consumers' experiences: overpowered, humiliated and punished. Considering these experiences during planning for seclusion and restraint prevention might facilitate more effective implementation of seclusion and restraint elimination programmes. Our findings suggested that consumers should receive recovery-oriented, trauma-informed and consumer-centred care; while nurses should be better supported through personal, professional and organizational developmental strategies. Further research should focus on investigating shared interventions among consumers and nurses and exploring carers' experiences with coercive practices.
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Affiliation(s)
- Tahani Hawsawi
- Faculty of Nursing, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Joel Zugai
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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Efkemann SA, Scholten M, Bottlender R, Juckel G, Gather J. A German Version of the Staff Attitude to Coercion Scale. Development and Empirical Validation. Front Psychiatry 2020; 11:573240. [PMID: 33536947 PMCID: PMC7847975 DOI: 10.3389/fpsyt.2020.573240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Individual staff factors, such as personality traits and attitudes, are increasingly seen as an important factor in the reduction of coercion in mental health services. At the same time, only a few validated instruments exist to measure those factors and examine their influence on the use of coercion. Aim: The present study aimed to develop and validate a German version of the Staff Attitude to Coercion Scale (SACS). Methods: The original English version of the SACS published was translated into German. Subsequently, it was empirically validated on a sample of N = 209 mental health professionals by conducting an exploratory factor analysis. Results: The three-factor structure in the original version of the SACS, consisting of critical, pragmatic and positive attitudes toward the use of coercion, could not be replicated. Instead, the German version revealed one factor ranging from rejecting to approving the use of coercion. Conclusion: The SACS is one of the first instruments created to assess staff attitudes toward coercion in a validated way. The version of the instrument developed in this study allows for a validated assessment of those attitudes in German. Our results highlight the ethical importance of using validated measurements in studies on the role of staff factors in the reduction of coercion.
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Affiliation(s)
- Simone A Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Ronald Bottlender
- Klinik für Psychiatrie und Psychotherapie, Klinikum Lüdenscheid, Märkische Klinken, Lüdenscheid, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Abstract
Restraint and seclusion are measures to restrict the movement of a person. The predominant reason cited for the use of restraint in mental health settings is the safety of the staff and the patient in times of aggression and to control problem behaviors. However, there have been significant issues in terms of ethics, rights of the patient, and the harmful effects of restraint. Recently, there has been a move in Western countries to decrease its use by incorporating alternative methods and approaches. In India, the Mental Healthcare Act of 2017 advocates the use of least restrictive measures and alternatives to restraint in providing care and treatment for person with mental illness. In this context, approach to restraints is all the more relevant. This article looks to overview the types of restraints, complications of restraints, and the alternatives to restraint in diverse settings.
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Affiliation(s)
| | - Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Mahesh Gowda
- Department of Psychiatry, Spandana Health Care, Bengaluru, Karnataka, India
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Abstract
India enacted the Mental Healthcare Act, 2017 (MHCA 2017) on April 7, 2017 to align and harmonize with United Nations Convention on Persons with Disabilities and the principles of prioritizing human rights protection. While MHCA 2017 is oriented toward the rights of the patients, the rights of the family members and professionals delivering treatment, care, and support to persons with severe mental disorder (SMD) often suffer. MHCA 2017 mandates discharge planning in consultation with the patients for admitted patients and makes the service providers responsible for ensuring continuity of care in the community. The concerns surrounding the chances of relapse and recurrence when a person with a SMD stops medications continue to remain largely unaddressed. The rights-based MHCA 2017 makes it difficult for the prevailing practices of surreptitious treatment by the family/caregiver and proxy consultations on behalf of the patients. This will, in turn, lead to increased chances of relapse, risk of violence, homelessness, stigma, and suicide in persons with SMDs in the community, largely due to noncompliance to treatment. This will also result in increased caregiver burden and burnouts and may also cause disruptions in the family and the community. To strike a balance over the current MHCA 2017, there is a need to amend or bring-forth a new law rooted in the principles of community treatment order.
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Affiliation(s)
- Guru S Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Arun Enara
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Mahesh Gowda
- Department of Psychiatry, Spandana Health Care, Bengaluru, Karnataka, India
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