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Belayneh Z, Chavulak J, Lee DCA, Petrakis M, Haines TP. Prevalence and variability of restrictive care practice use (physical restraint, seclusion and chemical restraint) in adult mental health inpatient settings: A systematic review and meta-analysis. J Clin Nurs 2024; 33:1256-1281. [PMID: 38304928 DOI: 10.1111/jocn.17041] [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: 04/24/2023] [Revised: 11/15/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised. AIMS This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates. METHODS Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates. RESULTS A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions. CONCLUSION There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations. RELEVANCE TO CLINICAL PRACTICE Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities. PATIENT/PUBLIC CONTRIBUTION This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study. PROTOCOL REGISTRATION The protocol for this review has been registered to PROSPERO: CRD42022335167.
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Affiliation(s)
- Zelalem Belayneh
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- Department of Psychiatry, College of Health, and Medical Sciences, Dilla University, Dila, Ethiopia
| | - Jacinta Chavulak
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
| | - Den-Ching A Lee
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University, Frankston, Victoria, Australia
| | - Melissa Petrakis
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- St Vincent's Hospital Mental Health Service, Melbourne, Victoria, Australia
| | - Terry P Haines
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Monash University, Frankston, Victoria, Australia
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Wolfe C, McCoin N. Management of the Agitated Patient. Emerg Med Clin North Am 2024; 42:13-29. [PMID: 37977745 DOI: 10.1016/j.emc.2023.06.010] [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: 11/19/2023]
Abstract
The acutely agitated patient should be managed in a step-wise fashion, beginning with non-coercive de-escalation strategies and moving on to pharmacologic interventions and physical restraints as necessary. Face-to-face examination, monitoring, and documentation by the physician are essential. The emergency physician should be familiar with multiple pharmaceutical options, tailored to the individual patient. Use of ketamine, benzodiazepines and antipsychotics should be considered. Patient autonomy, safety, and medical well-being are paramount.
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Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, Tristar Skyline Medical Center, 3443 Dickerson Pike, Suite 230, Nashville, TN 37207, USA.
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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3
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Lawrence RE, Krumheuer A, Loh R, Stanley B, Simpson SA. Persons Who Engage in Self-Harm While in the Emergency Department: A Case-Control Analysis. J Nerv Ment Dis 2022; 210:736-740. [PMID: 36179373 PMCID: PMC9525888 DOI: 10.1097/nmd.0000000000001528] [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] [Indexed: 11/26/2022]
Abstract
ABSTRACT Some patients engage in self-harm behaviors while in the emergency department. Risk factors for self-harm have been described for inpatient and outpatient/community settings, but not among emergency department patients. Authors conducted case-control, retrospective reviews of medical records and incident reports for emergency department patients in two academic medical centers. Variables were analyzed using conditional logistic regression. There were 113 individuals who engaged in self-harm while in the emergency department and 226 individuals who did not. Four variables were significant in the final model: a history of nonsuicidal self-harm (odds ratio [OR], 4.28; 95% confidence interval [CI], 1.95-9.41), opioid use in the prior 2 weeks (OR, 2.89; CI, 1.19-7.02), current manic episode (OR, 3.59; CI, 1.33-9.70), and a history of seizures (OR, 4.19; CI, 1.16-15.14). Risk of self-harm while in the emergency department may be mitigated with interventions that support adaptive coping skills, promptly address pain and withdrawal symptoms, and treat mania.
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Affiliation(s)
- Ryan E Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Aaron Krumheuer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ryan Loh
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
| | - Barbara Stanley
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health and Hospital Authority, Denver, Colorado
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Coralic Z, Rader ES, Vinson DR, Wilson MP. Haloperidol Versus Ziprasidone With Concomitant Medications and Other Predictors of Physical Restraint Duration in the Emergency Department. J Emerg Med 2022; 62:636-647. [PMID: 35361510 DOI: 10.1016/j.jemermed.2021.12.018] [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: 05/27/2021] [Revised: 11/09/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with severe agitation are frequently encountered in the emergency department (ED). At times, these patients are physically restrained and given calming medications; however, little is known about the effects of medications and other predictors on restraint duration. OBJECTIVE Our aim was to compare restraint duration when haloperidol or ziprasidone was used as the primary antipsychotic with or without concomitant medications, and to identify predictors of restraint duration. METHODS We performed a review of a retrospective cohort of physically restrained ED patients between January 1, 2013 and November 30, 2017. An unadjusted analysis and adjusted linear regression model were used to evaluate the effect of antipsychotic choice on restraint duration, controlling for sex, age, race, homelessness, arrival in restraints, re-restraint during visit, concomitant medications (i.e., benzodiazepines or anticholinergics), additional medications given during restraint, time of day, and patient disposition. RESULTS In 386 patients (319 haloperidol, 67 ziprasidone), the average restraint duration was 2.4 h (95% confidence interval [CI] 2.2 to 2.6 h). There were no differences in physical restraint times between ziprasidone and haloperidol groups in the unadjusted (mean difference 0.12 h; 95% CI -0.42 to 0.66 h) or adjusted analyses (-12.7%; 95% CI -33.9% to 8.6%). Haloperidol given with diphenhydramine alone was associated with decreased restraint duration (-30.8%; 95% CI -50.6% to -11.1%) The largest association with restraint duration was administration of additional sedating medications during restraint, prolonging restraint by 62% (95% CI 27.1% to 96.9%). In addition, compared with White patients, Black patients spent significantly more time restrained (mean difference 33.9%; 95% CI 9.0% to 58.9%). CONCLUSIONS Restraint duration of agitated ED patients was similar when haloperidol or ziprasidone was used as the primary antipsychotic. However, race and additional medications given during restraint were significantly associated with restraint duration.
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Affiliation(s)
- Zlatan Coralic
- Department of Pharmacy, University of California San Francisco, San Francisco, California; Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | | | - David R Vinson
- Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, California; Division of Research, Kaiser Permanente, Oakland, California
| | - Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Celofiga A, Kores Plesnicar B, Koprivsek J, Moskon M, Benkovic D, Gregoric Kumperscak H. Effectiveness of De-Escalation in Reducing Aggression and Coercion in Acute Psychiatric Units. A Cluster Randomized Study. Front Psychiatry 2022; 13:856153. [PMID: 35463507 PMCID: PMC9021532 DOI: 10.3389/fpsyt.2022.856153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Most guidelines for the management of aggressive behavior in acute psychiatric patients describe the use of de-escalation as the first-choice method, but the evidence for its effectiveness is inconsistent. The aim of the study was to assess the effect of verbal and non-verbal de-escalation on the incidence and severity of aggression and the use of physical restraints in acute psychiatric wards. METHODS A multi-center cluster randomized study was conducted in the acute wards of all psychiatric hospitals in Slovenia. The research was carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. The intervention was implemented after the baseline period and included training in verbal and non-verbal de-escalation techniques for the staff teams on experimental wards. RESULTS In the baseline study period, there were no significant differences in the incidence of aggressive behavior and physical restraints between the experimental and control groups. The incidence rates of aggressive events, severe aggressive events, and physical restraints per 100 treatment days decreased significantly after the intervention. Compared to the control group, the incidence rate of aggressive events was 73% lower in the experimental group (IRR = 0.268, 95% CI [0.221; 0.342]), while the rate of severe events was 86% lower (IRR = 0.142, 95% CI [0.107; 0.189]). During the intervention period, the incidence rate of physical restraints due to aggression in the experimental group decreased to 30% of the rate in the control group (IRR = 0.304, 95% CI [0.238; 0.386]). No reduction in the incidence of restraint used for reasons unrelated to aggression was observed. After the intervention, a statistically significant decrease in the severity of aggressive incidents (p < 0.001) was observed, while the average duration of restraint episodes did not decrease. CONCLUSION De-escalation training is effective in reducing the incidence and severity of aggression and the use of physical restraints in acute psychiatric units. CLINICAL TRIAL REGISTRATION [www.ClinicalTrials.gov], identifier [NCT05166278].
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Affiliation(s)
- Andreja Celofiga
- Department of Psychiatry, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Blanka Kores Plesnicar
- University Psychiatric Clinic Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jure Koprivsek
- Department of Psychiatry, University Medical Centre Maribor, Maribor, Slovenia
| | - Miha Moskon
- Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| | - Dominik Benkovic
- Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
| | - Hojka Gregoric Kumperscak
- Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Child and Adolescent Psychiatry Unit, University Medical Centre Maribor, Maribor, Slovenia
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Gao YN, Oberhardt M, Vawdrey D, Lawrence RE, Dixon LB, Luo SX. Medication Use and Physical Assaults in the Psychiatric Emergency Department. J Clin Psychiatry 2021; 83:21m13970. [PMID: 34905665 PMCID: PMC8682673 DOI: 10.4088/jcp.21m13970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective: To evaluate the relationship between medications used to treat acute agitation (antipsychotics, mood stabilizers, and benzodiazepines) and subsequent assault incidence in the psychiatric emergency department. Methods: Medication orders and assault incident reports were obtained from electronic health records for 17,056 visits to an urban psychiatric emergency department from 2014 to 2019. Assault risk was modeled longitudinally using Poisson mixed-effects regression. Results: Assaults were reported during 0.5% of visits. Intramuscular (IM) medications were ordered in 23.3% of visits overall and predominantly were ordered within the first 4 hours of a visit. IM medication orders were correlated with assault (incident rate ratio [IRR] = 24.2; 95% CI, 5.33-110.0), often because IM medications were ordered immediately subsequent to reported assaults. Interacted with time, IM medications were not significantly associated with reduction in subsequent assaults (IRR = 0.700; 95% CI, 0.467-1.04). Neither benzodiazepines nor mood stabilizers were associated with subsequent changes to the risk of reported assault. By contrast, antipsychotic medications were associated with decreased assault risk across time (IRR = 0.583; 95% CI, 0.360-0.942). Conclusions: Although assault prevention is not the sole reason for ordering IM medications, IM medication order rates are high relative to overall assault incident risk. Of the 3 major categories of medications ordered commonly in the psychiatric emergency setting, only antipsychotic medications were associated with measurable decreases in subsequent assault risk. As antipsychotic medication can have a significant side effect burden, careful weighing of the risks and benefits of medications is encouraged.
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Affiliation(s)
- Y. Nina Gao
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY
| | - Matthew Oberhardt
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY
| | - David Vawdrey
- Geisinger Steele Institute for Health Innovation, Danville, PA
| | - Ryan E. Lawrence
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY
| | - Lisa B. Dixon
- Division of Behavioral Health Services and Policy Research, Department of Psychiatry, New York State Psychiatric Institute, New York, NY
| | - Sean X. Luo
- Columbia University Division on Substance Use Disorders, and Research Scientist, New York State Psychiatric Institute, New York, NY
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7
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Mann K, Gröschel S, Singer S, Breitmaier J, Claus S, Fani M, Rambach S, Salize HJ, Lieb K. Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics. BMC Psychiatry 2021; 21:419. [PMID: 34419009 PMCID: PMC8380405 DOI: 10.1186/s12888-021-03410-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. METHODS Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1-3.0 for patients < 65 years; OR 8.0, CI 3.1-20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7-3.9). CONCLUSIONS The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.
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Affiliation(s)
- Klaus Mann
- Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Sonja Gröschel
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,grid.410607.4Department of Neurology, University Medical Center, Mainz, Germany
| | - Susanne Singer
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Jörg Breitmaier
- Department of Psychiatry and Psychotherapy, Krankenhaus Zum Guten Hirten, Ludwigshafen, Germany
| | - Sylvia Claus
- Department of Psychiatry, Psychosomatics und Psychotherapy, Pfalzklinikum, Klingenmünster, Germany
| | - Markus Fani
- Department of Geriatric Psychiatry, Psychosomatics und Psychotherapy, Pfalzklinikum, Klingenmünster, Germany
| | - Stephan Rambach
- Clinic for Psychiatry and Psychotherapy, Municipal Hospital, Pirmasens, Germany
| | - Hans-Joachim Salize
- grid.413757.30000 0004 0477 2235Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
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[Mental health and human rights: The experience of professionals in training with the use of mechanical restraints in Madrid, Spain]. Salud Colect 2021; 17:e3045. [PMID: 33822542 DOI: 10.18294/sc.2021.3045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022] Open
Abstract
Mechanical restraint is a coercive procedure in psychiatry, which despite being permitted in Spain, raises significant ethical conflicts. Several studies argue that non-clinical factors - such as professionals' experiences and contextual influences - may play a more important role than clinical factors (diagnosis or symptoms) in determining how these measures are employed. The aim of this study is to understand how the experiences of mental health professionals in training relate to the use of mechanical restraints in Madrid's mental health network. Qualitative phenomenological research was conducted through focus groups in 2017. Interviews were transcribed for discussion and thematic analysis with Atlas.ti. Descriptive results suggest that these measures generate emotional distress and conflict with their role as caregivers. Our findings shed light on different factors related to their experiences and contexts that are important in understanding the use of mechanical restraint, as well as the contradictions of care in clinical practice.
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Collazos F, Malagón A, Falgas-Bague I, Qureshi A, Gines JM, Ramos MDM, McPeck S, Hussain I, Wang Y, Alegría M. Treating immigrant patients in psychiatric emergency rooms. Transcult Psychiatry 2021; 58:126-139. [PMID: 32281520 PMCID: PMC7554163 DOI: 10.1177/1363461520916697] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We examine whether patient variables (geographic origin, gender, Spanish language proficiency) and subjective clinician aspects in emergency department psychiatric encounters (diagnostic certainty, clinician's comfort level with patient) are associated with diagnosis and the use of coercive measures. Using a descriptive cross-sectional design, we recorded 467 visits (400 foreign-born and 67 native-born patients) in hospital psychiatry emergency rooms (ERs) in Barcelona between 2007 and 2015. We first assessed the association of patient variables and subjective clinician aspects of psychiatric encounters with service use outcomes and with mental illness diagnosis. Fitted logistic models predicted the likelihood of service use outcomes and estimated the propensity of receiving each diagnosis. The null model evaluated the role of patient's geographical origin, while the full model evaluated the additional roles of patient's gender and language, the clinician's assessment of the influence of culture in diagnosis, and clinician comfort with two outcomes: patient's diagnosis and use of coercive measures in the ER. Women were less likely to receive coercive measures or intramuscular medications compared to men. Significant ethnic/racial and gender differences were found in receiving certain diagnoses. Additionally, a patient's lower Spanish proficiency was correlated with a higher probability of receiving a psychosis diagnosis. The clinician's level of diagnostic certainty was also positively correlated with increasing clinician-reported comfort with patient. Overall, ethnic factors and the subjective aspects of psychiatric encounters were found to influence diagnosis and the use of coercive measures. Cultural competency programs and interpreter services within psychiatric ER settings should thus be required.
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Affiliation(s)
- Francisco Collazos
- Hospital Universitari Vall d’Hebron, Service of Psychiatry. Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain
- Department of Psychiatry and Forensic Medicine. Universitat Autonoma de Barcelona. Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
| | - Angeles Malagón
- Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Irene Falgas-Bague
- Department of Psychiatry and Forensic Medicine. Universitat Autonoma de Barcelona. Plaça Cívica, s/n, 08193 Bellaterra, Barcelona, Spain
- Department of Medicine. Massachusetts General Hospital. Disparities Research Unit. 50 Staniford St., Boston, MA, USA, 02114
| | - Adil Qureshi
- Hospital Universitari Vall d’Hebron, Service of Psychiatry. Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - Jose Maria Gines
- Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain
| | - Maria del Mar Ramos
- Hospital Universitari Vall d’Hebron, Service of Psychiatry. Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - Samantha McPeck
- Department of Medicine. Massachusetts General Hospital. Disparities Research Unit. 50 Staniford St., Boston, MA, USA, 02114
| | - Isra Hussain
- Department of Medicine. Massachusetts General Hospital. Disparities Research Unit. 50 Staniford St., Boston, MA, USA, 02114
| | - Ye Wang
- Department of Medicine. Massachusetts General Hospital. Disparities Research Unit. 50 Staniford St., Boston, MA, USA, 02114
| | - Margarita Alegría
- Department of Medicine. Massachusetts General Hospital. Disparities Research Unit. 50 Staniford St., Boston, MA, USA, 02114
- Department of Psychology, Harvard Medical School, William James Hall, 33 Kirkland St., Cambridge, Massachusetts, USA 02138
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Yurtbasi MK, Melvin G, Pavlou C, Gordon M. Nurse and patient factors: Predicting seclusion in adolescent psychiatric units. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:112-119. [PMID: 33393691 DOI: 10.1111/jcap.12306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
PROBLEM Seclusion is considered a necessity when alternatives have failed. There is a consensus that seclusion has no therapeutic benefit, which justifies efforts to reduce the practice. This study aimed to identify nurse and patient variables that are predictive of seclusion on a large adolescent inpatient unit. METHODS Nested case controls were used to compare 72 afternoon shifts on which seclusion occurred to 216 afternoon shifts on which no seclusion occurred, between 2010 and 2013, at an Adolescent Psychiatric Inpatient Unit. FINDINGS Increased seclusion was predicted by a lower nurse to patient ratio, more male nurses on shift, fewer female nurses on shift, the presence of agency/temporary nurses on shift, greater combined years of mental health experience, and lower total HoNOSCA behavior subscale score. Unique predictors that increased risk of seclusion included greater number of male nurses and the presence of agency/temporary nurses, while a greater number of female nurses decreased risk of seclusion. CONCLUSIONS Nurses play a unique role in seclusion outcomes that are separate to patient-factors and act as both protective and risk factors for seclusion. Changes can be made to staffing to reduce seclusion and future research should investigate why these nurse-factors contribute to seclusion.
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Affiliation(s)
- Miriam K Yurtbasi
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Glenn Melvin
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
| | - Christine Pavlou
- Psychiatric Services at Monash Health, Early in Life Mental Health Service, Monash Children's Hospital, Clayton, Australia
| | - Michael Gordon
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences, Monash University, Clayton, Australia.,Psychiatric Services at Monash Health, Early in Life Mental Health Service, Monash Children's Hospital, Clayton, Australia
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Abstract
The appropriate treatment of mentally unwell, aggressive patients has challenged psychiatry for centuries. Seclusion is practiced worldwide, but concerns remain regarding its appropriateness and lack of alternatives. Patients generally report seclusion as a negative experience, though there is a paucity of literature exploring this in detail. This investigation was a service evaluation appraising inpatients' perspective of processes occurring before (information, communication), during (review, care), and after (debrief, reflection) seclusion in a psychiatric intensive care unit (PICU). In this phenomenological study, qualitative data were gathered using a questionnaire in a structured interview. All patients had been nursed in seclusion during admission to a male PICU at South London and the Maudsley NHS Foundation Trust. Ten patients were interviewed over 4 months. The central theme was perceived lack of communication in the patient-professional relationship, which manifested itself as (i) violence against patients, (ii) lack of psychological support, and (iii) the need for alternatives. Such feedback from patients queries whether national guidelines are appropriate and/or being adhered to. Healthcare practitioners have a responsibility to challenge accepted practice to continually improve the standard of patient-centred care. Utilising patient perspectives can be a powerful driver of change towards more humane treatment of vulnerable patients.
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Affiliation(s)
- Silvia Allikmets
- Department of Life Sciences & Medicine, GKT School of Medical Education, King's College London, London, United Kingdom
| | - Caryl Marshall
- Southwark High Support Rehabilitation, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Community Forensic LD/ASD, Oxleas NHS Foundation Trust, South London Partnership, London, United Kingdom
| | - Omar Murad
- Psychiatric Intensive Care, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kamal Gupta
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
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12
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13
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Shirzad F, Hadi F, Mortazavi SS, Biglari M, Sari HN, Mohammadi Z, Atoofi MK, Shariat SV. First line in psychiatric emergency: pre-hospital emergency protocol for mental disorders in Iran. BMC Emerg Med 2020; 20:19. [PMID: 32178629 PMCID: PMC7074981 DOI: 10.1186/s12873-020-00313-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/26/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This article is a report of designing a rapid and effective guide for paramedics who take care of patients in a pre-hospital setting to answer developing demands. METHODS The relevant literature was reviewed, and the topics were extracted. Then, the extracted items were discussed in an expert panel. Finally, items were discussed in a meeting including emergency technicians and emergency technical assistants to identify implementation problems. RESULTS Important topics for managing psychiatric patients were categorized at three levels: 1) Patient safety and security issues, 2) Patient status assessment and diagnosis, and 3) Patient management (medical, behavioral management, and referral to a treatment center). DISCUSSION This protocol can be a solution to improve emergency technician training. Such summarized protocols can be used for rapid review immediately before exposing a patient with an acute psychiatric condition. Due to specific cultural and different access to medicines in Iran, some issues are different.
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Affiliation(s)
- Fatemeh Shirzad
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadi
- Mental Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Salehe Mortazavi
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Biglari
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hassan Noori Sari
- Deputy of Technical and Operations of the Emergency Organization, Tehran, Iran
| | | | | | - Seyed Vahid Shariat
- Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Tehran, Iran
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14
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Rossa-Roccor V, Schmid P, Steinert T. Victimization of People With Severe Mental Illness Outside and Within the Mental Health Care System: Results on Prevalence and Risk Factors From a Multicenter Study. Front Psychiatry 2020; 11:563860. [PMID: 33033483 PMCID: PMC7509533 DOI: 10.3389/fpsyt.2020.563860] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/20/2020] [Indexed: 12/03/2022] Open
Abstract
We performed a cross-sectional study using a self-reporting survey to assess lifetime violent and non-violent victimization in people with severe mental illness experienced both inside (i.e., any service providing mental health care such as psychiatric hospitals, psychosocial rehabilitative programs, or outpatient care) and outside (i.e., in the personal life of the participants) of the mental health care system. We recruited 170 participants from 20 community mental health facilities. We built logistic regression models to assess potential risk factors for victimization inside the mental health care system. Outside of the mental health care system, the most commonly reported events were theft (n=93, 54.7%), physical violence without use of a weapon (n=87, 51.2%), and sexual harassment (n=82, 50.6%). Within the mental health care system, most commonly reported incidents were theft (n=68, 40.0%), sexual assault (n=18, 10.6%), and physical violence (n=47, 27.7%) by other patients or staff. Significant risk factors for specific victimization events inside the mental health care system were psychotic disorder, victimization in childhood and youth, female gender, number of hospitalizations, and duration of illness. Findings call for increased attention to victimization of people with severe mental illness, especially within the mental health care system as such victimization events may severely impact patients' trajectories.
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Affiliation(s)
- Verena Rossa-Roccor
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Peter Schmid
- Department of Psychiatry and Psychotherapy I Weissenau, Ulm University, Ravensburg, Germany
| | - Tilman Steinert
- Department of Psychiatry and Psychotherapy I Weissenau, Ulm University, Ravensburg, Germany
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15
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Danielsen AA, Fenger MHJ, Østergaard SD, Nielbo KL, Mors O. Predicting mechanical restraint of psychiatric inpatients by applying machine learning on electronic health data. Acta Psychiatr Scand 2019; 140:147-157. [PMID: 31209866 DOI: 10.1111/acps.13061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Mechanical restraint (MR) is used to prevent patients from harming themselves or others during inpatient treatment. The objective of this study was to investigate whether incident MR occurring in the first 3 days following admission could be predicted based on analysis of electronic health data available after the first hour of admission. METHODS The dataset consisted of clinical notes from electronic health records from the Central Denmark Region and data from the Danish Health Registers from patients admitted to a psychiatric department in the period from 2011 to 2015. Supervised machine learning algorithms were trained on a randomly selected subset of the data and validated using an independent test dataset. RESULTS A total of 5050 patients with 8869 admissions were included in the study. One hundred patients were mechanically restrained in the period between one hour and 3 days after the admission. A Random Forest algorithm predicted MR with an area under the curve of 0.87 (95% CI 0.79-0.93). At 94% specificity, the sensitivity was 56%. Among the ten strongest predictors, nine were derived from the clinical notes. CONCLUSIONS These findings open for the development of an early warning system that may guide interventions to reduce the use of MR.
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Affiliation(s)
- A A Danielsen
- Psychosis Research Unit, Department for Psychosis, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M H J Fenger
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - S D Østergaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - K L Nielbo
- Department of History, University of Southern Denmark, Odense, Denmark
| | - O Mors
- Psychosis Research Unit, Department for Psychosis, Aarhus University Hospital - Psychiatry, Aarhus, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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16
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Cui N, Long M, Zhou S, Zhang T, He C, Gan X. Knowledge, Attitudes, and Practices of Chinese Critical Care Nurses Regarding Physical Restraint. J Contin Educ Nurs 2019; 50:121-126. [PMID: 30835322 DOI: 10.3928/00220124-20190218-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND This multicenter cross-sectional study sought to determine the knowledge, attitudes, and practices regarding the use of physical restraints by Chinese nurses in intensive care units (ICUs) of tertiary hospitals. METHOD A scale technique was used to measure the knowledge, attitudes, and practices of 383 RNs from eight tertiary hospitals in Chongqing, China. RESULTS A total of 383 valid questionnaires were returned, for a response rate of 89.49%. Approximately 8.1% of the nurses were male, 67.1% had a bachelor's degree or above, and 55.09% were ICU specialists. The average age was 28.62 years (SD = 4.56). The mean scores were 74.33 of 111 (SD = 9.552), 24.41 of 40 (SD = 4.872), and 65.66 of 130 (SD = 20.880) regarding knowledge, attitudes, and nursing practices, respectively. For the attitude scale, the scores of nurses who were certified ICU specialists and had extensive working experience were higher than those with less experience; the difference was statistically significant (p < .05). CONCLUSION Results indicated that nurses employed in the ICUs of tertiary hospitals in Chongqing, China, have relatively insufficient knowledge, comparatively incorrect attitudes, and unreasonable means of practicing physical restraint. Continuing education should focus strongly on the relationship between physical restraint and unplanned extubation, and guidelines on physical restraint urgently need to be developed. [J Contin Educ Nurs. 2019;50(3):121-126.].
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17
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Nielsen LD, Bech P, Hounsgaard L, Gildberg FA. Construct validity of the Mechanical Restraint - Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument. Nord J Psychiatry 2019; 73:331-339. [PMID: 31264926 DOI: 10.1080/08039488.2019.1634757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: A new short-term risk assessment instrument, the Mechanical Restraint - Confounders, Risk, Alliance Score (MR - CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists' etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient's readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR - CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR - CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR - CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient's readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR - CRAS among clinicians at closed forensic mental health inpatient units. MR - CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.
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Affiliation(s)
- Lea Deichmann Nielsen
- a Department of Psychiatry , Middelfart , Denmark.,b Nursing Education, University College South , Esbjerg , Denmark.,c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
| | - Per Bech
- e Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen , Hilleroed , Denmark
| | - Lise Hounsgaard
- c Open, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark , Odense , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark.,f Institute of Nursing and Health Science, University of Greenland , Nuuk , Greenland.,g University College Lillebaelt , Vejle , Denmark
| | - Frederik Alkier Gildberg
- a Department of Psychiatry , Middelfart , Denmark.,d Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark , Odense , Denmark
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18
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Jury A, Lai J, Tuason C, Koning A, Smith M, Boyd L, Swanson C, Fergusson D, Gruar A. People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores. Int J Ment Health Nurs 2019; 28:199-208. [PMID: 30010239 DOI: 10.1111/inm.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/27/2022]
Abstract
The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.
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Affiliation(s)
- Angela Jury
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | | | | | | | - Mark Smith
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | - Lois Boyd
- Te Pou o te Whakaaro Nui, Auckland, New Zealand
| | | | - David Fergusson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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19
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Baldaçara L, Ismael F, Leite V, Pereira LA, Dos Santos RM, Gomes Júnior VDP, Calfat ELB, Diaz AP, Périco CAM, Porto DM, Zacharias CE, Cordeiro Q, da Silva AG, Tung TC. Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach. ACTA ACUST UNITED AC 2018; 41:153-167. [PMID: 30540028 PMCID: PMC6781680 DOI: 10.1590/1516-4446-2018-0163] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/03/2018] [Indexed: 12/18/2022]
Abstract
Objective: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient’s appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree. Conclusion: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint. Systematic review registry number: CRD42017054440.
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Affiliation(s)
- Leonardo Baldaçara
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Universidade Federal do Tocantins (UFT), Palmas, TO, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil
| | - Flávia Ismael
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Coordenadoria de Saúde Mental, São Caetano do Sul, SP, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Universidade de São Caetano do Sul, São Caetano do Sul, SP, Brazil
| | - Verônica Leite
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria de Estado de Saúde do Tocantins, Palmas, TO, Brazil.,Secretaria de Saúde do Município de Palmas, Palmas, TO, Brazil
| | - Lucas A Pereira
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Tecnologia e Ciências (FTC), Salvador, BA.,Universidade Salvador (UNIFACS), Salvador, BA, Brazil.,Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, BA, Brazil
| | - Roberto M Dos Santos
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Hospital Universitário Lauro Wanderley, Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil.,Pronto Atendimento de Saúde Mental, João Pessoa, PB, Brazil
| | - Vicente de P Gomes Júnior
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Associação Psiquiátrica do Piauí (APPI), Teresina, PI, Brazil
| | - Elie L B Calfat
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Centro de Atenção Integrada à Saúde Mental, Franco da Rocha, SP, Brazil
| | - Alexandre P Diaz
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC, Brazil
| | - Cintia A M Périco
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina do ABC, Santo André, SP, Brazil.,Coordenadoria de Saúde Mental, São Bernardo do Campo, SP, Brazil
| | - Deisy M Porto
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria de Santa Catarina, São José, SC, Brazil.,Coordenação Estadual de Saúde Mental, Florianópolis, SC, Brazil
| | - Carlos E Zacharias
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Secretaria de Estado da Saúde de São Paulo, São Paulo, SP, Brazil.,Secretaria de Saúde do Município de Sorocaba, Sorocaba, SP, Brazil
| | - Quirino Cordeiro
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.,Coordenação-Geral de Saúde Mental, Álcool e Outras Drogas, Ministério da Saúde, Brazil
| | - Antônio Geraldo da Silva
- Asociación Psiquiátrica de América Latina (APAL).,ABP, Rio de Janeiro, RJ, Brazil.,Faculdade de Medicina, Universidade do Porto/Conselho Federal de Medicina (CFM), Porto, Portugal
| | - Teng C Tung
- Comissão de Emergências Psiquiátricas, Associação Brasileira de Psiquiatria (ABP), Rio de Janeiro, RJ, Brazil.,Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
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20
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Terrell C, Brar K, Nuss S, El-Mallakh RS. Resource Utilization with the Use of Seclusion and Restraint in a Dedicated Emergency Psychiatric Service. South Med J 2018; 111:703-705. [PMID: 30392009 DOI: 10.14423/smj.0000000000000885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES There is a dearth of data regarding the use of emergency interventions in dedicated emergency psychiatric service settings, and reliable data are needed. This article describes the frequency and duration of the use of seclusion and restraint for imminent or existing agitation, aggression, or violence in a dedicated emergency psychiatric service located within an academic university hospital and staffed by sufficient numbers of trained personnel. METHODS We performed a retrospective chart review of 6 months' visits to a dedicated emergency psychiatric service. RESULTS Men outnumbered women with a 1.6 ratio of visits. Of 2843 subjects, 425 (14.6%) received emergent medication for anxiety (n = 90), substance withdrawal (n = 28), or agitation (n = 290). Physical interventions were used in 3.4%; 96 (3.3%) were secluded, and 9 (0.3%) were restrained. The average duration of seclusion was (mean ± standard deviation) 58.7 ± 37.4 minutes and for restraint 63.2 ± 23.4 minutes. Each episode of seclusion or restraint required approximately 3 hours of staff time. CONCLUSIONS The use of an intervention such as seclusion in >3% and restraint in 0.3% of patients represents the use of seclusion and restraint in a dedicated psychiatric emergency service with personnel trained to minimize the use of seclusion and restraint.
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Affiliation(s)
- Christina Terrell
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Kanwar Brar
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Sharon Nuss
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Rif S El-Mallakh
- From the Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
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21
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Wong AH, Taylor RA, Ray JM, Bernstein SL. Physical Restraint Use in Adult Patients Presenting to a General Emergency Department. Ann Emerg Med 2018; 73:183-192. [PMID: 30119940 DOI: 10.1016/j.annemergmed.2018.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE The prevalence of agitation among emergency department (ED) patients is increasing. Physical restraints are routinely used to prevent self-harm and to protect staff, but are associated with serious safety risks. To date, characterization of physical restraint use in the emergency setting has been limited. We thus aim to describe restraint patterns in the general ED to guide future investigation in the management of behavioral disorders. METHODS We conducted a cross-sectional study of adult patients presenting to 5 adult EDs within a large regional health system for 2013 to 2015, and with a physical restraint order during their visit. We undertook descriptive analyses and cluster analysis to determine unique meaningful groups within our sample. RESULTS In 956,153 total ED visits, 4,661 patients (0.5%) had associated restraint orders, representing 3,739 unique patients. The median age was 47 years (interquartile range 32 to 59 years), 66.7% of patients were men, 61.9% had a psychiatric history, and 91.1% arrived by ambulance. For chief complaints, 33.7% were alcohol or drug use, 45.4% medical, 12.3% psychiatric, and 8.5% trauma. Cluster analysis identified 2 distinct cohorts. A younger, predominantly male population presented with alcohol or drug use, whereas an older group arrived with medical complaints. CONCLUSION Our data found strong association of alcohol or drug use with physical restraints and identified a unique elderly population with behavioral disturbances in the ED. Further characterization of causal links and safer practices to manage agitation for these vulnerable populations are needed.
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Affiliation(s)
- Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Jessica M Ray
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Yale School of Public Health, New Haven, CT
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22
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Abstract
The objective is to describe the characteristics of mechanically restrained patients in the emergency department (ED) of a university hospital and to evaluate the quality of restraint documentation that was filled out according to the dedicated protocol with respect to the law on restraint. All adult patients (≥16 years) who were admitted to the ED from January 2009 to December 2010 and were mechanically restrained were included. We assessed medical and demographic characteristics, the completeness of the dedicated protocol, and the concomitant use of chemical sedation. 72,844 patients were admitted to the ED. Of these, 593 (0.81%) were mechanically restrained. Two types of patients were restrained: young patients under the influence of psychoactive substances who were usually discharged home, and confused older patients who were hospitalized. 186 dedicated protocols were missing (31.4%). From the 407 filled-out protocols, only 119 (29.2%) were complete. Of the mechanically restrained patients, 215 (36.2%) received additional chemical sedation. Even though restraint is strictly regulated by law, many protocols justifying the privation of liberty were not filled out. This emphasizes the need for strict respect of the dedicated protocol and the use of guidelines and training sessions for nursing and medical staff that address specific procedures for the two categories of patients needing to be restrained.
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Affiliation(s)
- Nicolas Beysard
- Emergency Department, Lausanne University Hospital, Rue Du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Bertrand Yersin
- Emergency Department, Lausanne University Hospital, Rue Du Bugnon 46, 1011, Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital, Rue Du Bugnon 46, 1011, Lausanne, Switzerland
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23
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Vedana KGG, da Silva DM, Ventura CAA, Giacon BCC, Zanetti ACG, Miasso AI, Borges TL. Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff. Arch Psychiatr Nurs 2018; 32:367-372. [PMID: 29784216 DOI: 10.1016/j.apnu.2017.11.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/02/2017] [Accepted: 11/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical restraint in psychiatric units is a common practice but extremely controversial and poorly evaluated by methodologically appropriate investigations. The cultural issues and professionals' perceptions and attitudes are substantial contributors to the frequency of restraint that tend to be elevated. Aim In this qualitative study, we aimed to understand the experiences and perceptions of nursing staff regarding physical restraint in psychiatric units. METHOD Through theoretical sampling, 29 nurses from two Brazilian psychiatric units participated in the study. Data were collected from 2014 to 2016 from individual interviews and analyzed through thematic analysis, employing theoretical presuppositions of symbolic interactionism. RESULTS Physical restraint was considered unpleasant, challenging, risky, and associated with dilemmas and conflicts. The nursing staff was often exposed to the risks and injuries related to restraint. Professionals sought strategies to reduce restraint-related damages, but still considered it necessary due to the lack of effective options to control aggressive behavior. CONCLUSIONS This study provides additional perspectives about physical restraint and reveals the need for safer, humanized and appropriate methods for the care of aggressive patients that consider the real needs and rights of these patients.
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24
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Geoffrion S, Goncalves J, Giguère CÉ, Guay S. Impact of a Program for the Management of Aggressive Behaviors on Seclusion and Restraint Use in Two High-Risk Units of a Mental Health Institute. Psychiatr Q 2018; 89:95-102. [PMID: 28500477 DOI: 10.1007/s11126-017-9519-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The Omega Program for the Management of Aggressive Behaviors aims to reduce patients' dangerous behaviors, towards themselves or others, and to reduce the use of seclusion and restraint (S/R). A previous study in a Mental Health Institute (Montreal, Canada) showed that implementing this program allowed employees of the intensive care and emergency units to gain confidence in coping with patients' aggressions and to reduce their psychological distress. The present study, conducted in the same high-risk units, assesses the effect of the program on S/R use. We hypothesize that the incidence and duration of S/R should diminish significantly following the implementation of the program in both units. This naturalistic, prospective study covered archival data between April 2010 and July 2014. Pre-training data (April 2010-December 2011) were compared to data during training (January 2012-October 2012) and to post-training data (November 2012-July 2014) for both units. In the intensive care unit, we confirmed an increase of both mean daily number and duration of S/R by admissions in pre-training, followed by a decrease during the training and post-training. In the emergency unit, a decreasing trend is seen during the entire period thus suggesting that the decrease in S/R may be independent of the training. These findings suggest that Omega is a promising intervention program to use in an intensive care unit. However, a more global approach, including institutional changes in culture and attitude, can be important factors to develop to increase the positive outcomes.
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Affiliation(s)
- Steve Geoffrion
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada.,University of Montreal, Pavillon Lionel-Groulx, 3150 Jean-Brillant, Montreal, Quebec, H3T 1N8, Canada
| | - Jane Goncalves
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada
| | - Charles-Édouard Giguère
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada
| | - Stéphane Guay
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, Quebec, H1N 3V2, Canada. .,University of Montreal, Pavillon Lionel-Groulx, 3150 Jean-Brillant, Montreal, Quebec, H3T 1N8, Canada.
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Nielsen LD, Gildberg FA, Bech P, Lange Dalgaard J, Munksgaard G, Hounsgaard L. Forensic mental health clinician's experiences with and assessment of alliance regarding the patient's readiness to be released from mechanical restraint. Int J Ment Health Nurs 2018; 27:116-125. [PMID: 27982496 DOI: 10.1111/inm.12300] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 12/17/2022]
Abstract
One of the main reasons for prolonged duration of mechanical restraint is patient behaviour in relation to the clinician-patient alliance. This article reports on the forensic mental health clinicians experiences of the clinician-patient alliance during mechanical restraint, and their assessment of parameters of alliance regarding the patient's readiness to be released from restraint. We used a qualitative, descriptive approach and conducted focus group interviews with nurses, nurse assistants and social and healthcare assistants. The results show that a pre-established personal clinician-patient alliance formed the basis for entering into, and weighing the quality of, the alliance during mechanical restraint. In consideration of the patient's psychiatric condition, the clinicians observed and assessed two quality parameters for the alliance: 'the patient's insight into or understanding of present situation' (e.g. the reasons for mechanical restraint and the behaviour required of the patient to discontinue restraint) and 'the patient's ability to have good and stable contact and cooperation with and across clinicians. These assessments were included, as a total picture of the quality of the alliance with the patient', in the overall team assessment of the patient's readiness to be released from mechanical restraint. The results contribute to inform the development of a short-term risk assessment instrument, with the aim of reducing the duration of mechanical restraint.
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Affiliation(s)
- Lea Deichmann Nielsen
- Department of Psychiatry, Psychiatric Hospital, Middelfart, Denmark.,University College South, Esbjerg, Denmark.,OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Frederik Alkier Gildberg
- Department of Psychiatry, Psychiatric Hospital, Middelfart, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Per Bech
- Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, København, Denmark
| | | | - Gitte Munksgaard
- Department of Psychiatry, Psychiatric Hospital, Middelfart, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lise Hounsgaard
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Center for Psychiatric Nursing and Health research, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland.,University College of Lillebaelt, Vejle, Denmark
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Kuronen M, Kautiainen H, Karppi P, Hartikainen S, Koponen H. Physical restraints and associations with neuropsychiatric symptoms and personal characteristics in residential care: a cross-sectional study. Int J Geriatr Psychiatry 2017; 32:1418-1424. [PMID: 27910133 DOI: 10.1002/gps.4629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physical restraints are widely used in residential care. The objective was to investigate restraint use and its associations with neuropsychiatric symptoms and personal characteristics in residential care. METHODS Data were collected in the South Savo Hospital District from 66 of 68 public or private institutions providing long-term residential care. Nurses assessed the use of physical restraints and neuropsychiatric symptoms (NPS) included in the symptom list of the Neuropsychiatric Inventory (NPI). Drug use was obtained from medical records, and activities of daily living (ADL) were assessed by the nurses according to the Barthel Index. RESULTS The total number of persons in residential care was 1386. Any restraint was used for 721 patients (52%) in the preceding 24 h. Bedrails were the most common restraints. In the multivariate analysis, psychotic symptoms (OR 1.94, 95% CI 1.14-3.31) and use of benzodiazepines (OR 1.69, 95% CI 1.18-2.41) were positively associated with restraint use, whereas antipsychotic (OR 0.62, 95% CI 0.44-0.87) and antidepressant drug use (OR 0.64, 95% CI 0.45-0.90) and higher ADL score (OR 0.9, 95% CI 0.92-0.93) were negatively associated. Concomitant use of at least two restraints was associated with high prevalence of hyperactivity NPS symptoms. CONCLUSIONS More than half of the residents were exposed to some physical restraint, most frequently bedrails, within the last 24 h. Psychotic symptoms and benzodiazepine use increased while good ADL and antipsychotic or antidepressant use decreased the risk of restraint use. Bedridden persons were the most frequently restrained which may pose an ethical problem. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Marja Kuronen
- South Savo Hospital District, Mikkeli Central Hospital, Mikkeli, Finland
| | - Hannu Kautiainen
- Primary Care, University of Helsinki and Helsinki University Hospital, Finland.,Unit of Primary Health Care, Kuopio University Hospital, Mikkeli, Finland
| | - Pertti Karppi
- South Savo Hospital District, Mikkeli Central Hospital, Mikkeli, Finland
| | - Sirpa Hartikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland.,Kuopio Research Centre of Geriatric Care, HUS, Finland
| | - Hannu Koponen
- Psychiatry, University of Helsinki and Helsinki University Hospital, Finland
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Abstract
The study aims to identify independent predictors of physical restraint in acute psychiatric patients and to determine the predictive power of a risk assessment model centered on psychopathological dimensions. We included 1552 patients admitted to a psychiatric intensive care unit over a 5-year period. Patients were rated on the Brief Psychiatric Rating Scale (BPRS-E) at admission. Principal axis factoring (PAF) with varimax rotation was performed on BPRS-E items to identify psychopathological factors. Multiple logistic regression analysis was performed. PAF pointed six factors: positive symptoms, negative symptoms, resistance, activation, negative affect, and disorganization. Male sex, younger age, proposal for compulsory admission, severity of symptoms, resistance, activation, and disorganization were identified as independent predictors. Negative symptoms and negative affect were instead protective factors. The BPRS-E factors, when added to other sociodemographic and clinical variables, significantly increased the predictive power of the model. Our findings suggest that a systematic evaluation of the psychopathological dimensions can be usefully included in the early risk assessment of restraint.
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Jegede OO, Ahmed SF, Olupona T, Akerele E. Restraints utilization in a psychiatric emergency room. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2017. [DOI: 10.1080/00207411.2017.1295781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Oluwole O. Jegede
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Saad F. Ahmed
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Tolu Olupona
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Evaristo Akerele
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
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Simpson SA, Pasic J. The Peregrinating Psychiatric Patient in the Emergency Department. West J Emerg Med 2016; 17:600-6. [PMID: 27625725 PMCID: PMC5017845 DOI: 10.5811/westjem.2016.6.30179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/24/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022] Open
Abstract
Many emergency department (ED) psychiatric patients present after traveling. Although such travel, or peregrination, has long been associated with factitious disorder, other diagnoses are more common among travelers, including psychotic disorders, personality disorders, and substance abuse. Travelers’ intense psychopathology, disrupted social networks, lack of collateral informants, and unawareness of local resources complicate treatment. These patients can consume disproportionate time and resources from emergency providers. We review the literature on the emergency psychiatric treatment of peregrinating patients and use case examples to illustrate common presentations and treatment strategies. Difficulties in studying this population and suggestions for future research are discussed.
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Affiliation(s)
- Scott A Simpson
- University of Colorado, Denver, School of Medicine, Department of Psychiatry, Aurora, Colorado; Denver Health Medical Center, Department of Psychiatry, Denver, Colorado
| | - Jagoda Pasic
- University of Washington School of Medicine, Department of Psychiatry, Seattle, Washington
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Abstract
Acute agitation psychiatric emergencies as frequently occur in psychiatric as well as in non-psychiatric settings, such as general hospitals, specialized clinics, emergency services and private practices. Psychiatric emergencies can be life-threatening and necessitate immediate treatment. This article presents the core symptomatology, differential diagnoses and treatment options of acute agitation emergencies. Case control studies and reliable data regarding prevalence and treatment of acute agitation in psychiatric and general hospitals or private practices are sparse. Existing evidence suggests that optimization of diagnosis and therapy of psychiatric emergencies, such as acute agitation is warranted. Treatment of acute agitation, psychological distress and other psychiatric emergencies are highly demanding regarding psychiatric expertise and concerning the personality and behavior of the therapist. The basis of therapy comprises the ability to form a stable and trustworthy relationship with the patient as well as to patiently calm down agitated patients. Unambiguous and rapid decision-making that takes effective pharmacological treatment options into account usually leads to swift amelioration of the acute symptomatology.
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Affiliation(s)
- P Mavrogiorgou
- Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, LWL-Universitätsklinikum der Ruhr-Universität Bochum, Alexandrinenstr. 1, 44791, Bochum, Deutschland
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Hall A, McKenna B, Dearie V, Maguire T, Charleston R, Furness T. Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: a pilot study. BMC Nurs 2016; 15:21. [PMID: 27013926 PMCID: PMC4806472 DOI: 10.1186/s12912-016-0141-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/16/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Practicing with trauma informed care (TIC) can strengthen nurses' knowledge about the association of past trauma and the impact of trauma on the patient's current mental illness. An aim of TIC is to avoid potentially re-traumatising a patient during their episode of care. A TIC education package can provide nurses with content that describes the interplay of neurological, biological, psychological, and social effects of trauma that may reduce the likelihood of re-traumatisation. Although mental health nurses can be TIC leads in multidisciplinary environments, the translation of TIC into clinical practice by nurses working in emergency departments (EDs) is unknown. However, before ED nurses can begin to practice TIC, they must first be provided with meaningful and specific education about TIC. Therefore, the aims of this study were to; (1) evaluate the effectiveness of TIC education for ED nursing staff and (2) describe subsequent clinical practice that was trauma informed. METHODS This project was conducted as exploratory research with a mixed methods design. Quantitative data were collected with an 18-item pre-education and post-education questionnaire. Qualitative data were collected with two one-off focus groups conducted at least three-months after the TIC education. Two EDs were involved in the study. RESULTS A total of 34 ED nurses participated in the TIC education and 14 ED nurses participated in the focus groups. There was meaningful change (p < 0.01, r ≥ 0.35) in 9 of the 18-items after TIC education. Two themes, each with two sub-themes, were evident in the data. The themes were based on the perceived effectiveness of TIC education and the subsequent changes in clinical practice in the period after TIC education. CONCLUSION Emergency department nurses became more informed of the interplay of trauma on an individual's mental health. However, providing care with a TIC framework in an ED setting was a considerable challenge primarily due to time constraints relative to the day-to-day ED environment and rapid turnover of patients with potentially multiple and complex presentations. Despite this, nurses understood the effect of TIC to reduce the likelihood of re-traumatisation and expressed a desire to use a TIC framework.
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Affiliation(s)
- Andrea Hall
- Emergency Department, The Royal Melbourne Hospital, Melbourne Health, Parkville, Australia
| | - Brian McKenna
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Vikki Dearie
- Western Victorian Mental Health Learning & Development Cluster, Melbourne Health, Parkville, Australia
| | - Tessa Maguire
- Forensicare, Fairfield, Australia ; Centre for Forensic Behavioural Science, Swinburne University, Clifton Hill, Australia
| | - Rosemary Charleston
- Western Victorian Mental Health Learning & Development Cluster, Melbourne Health, Parkville, Australia
| | - Trentham Furness
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Fitzroy, Australia ; NorthWestern Mental Health, The Royal Melbourne Hospital, Parkville, Australia
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Braga IP, Souza JCD, Leite MB, Fonseca V, Silva EMD, Volpe FM. Contenção física no hospital psiquiátrico: estudo transversal das práticas e fatores de risco. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivos Descrever a utilização da contenção física em um hospital psiquiátrico público e analisar os fatores de risco associados com seu uso, no contexto da implantação de um protocolo clínico. Métodos Em um hospital psiquiátrico público de Belo Horizonte-MG, os formulários de registro e monitoramento de contenção física (2011-2012) foram analisados e comparados com os registros das demais internações englobadas no mesmo período. Neste estudo transversal, além das análises descritivas das características clínicas e demográficas dos pacientes contidos, das técnicas utilizadas e das complicações reportadas, os fatores de risco associados com o uso da contenção foram analisados por meio de regressão logística múltipla. Resultados A contenção foi utilizada em 13,4% das internações, sendo mais comum em pacientes jovens, do sexo masculino, portadores de psicoses não orgânicas, apresentando agitação/agressividade. A técnica foi geralmente de quatro pontos, durando entre 61-240 minutos. Os únicos fatores de risco significativos para o uso da contenção incluíram a idade (OR = 0,98; p = 0,008) e o tempo de permanência (OR = 1,01; p < 0,001). Conclusões A contenção física foi utilizada usualmente na abordagem aguda do paciente agitado/agressivo inabordável verbalmente, no contexto de um transtorno psicótico. O registro dos dados vitais e dos efeitos adversos foram os itens menos aderentes aos protocolos vigentes.
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Affiliation(s)
- Isabela Pinto Braga
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | - Jaqueline Conceição de Souza
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | - Milena Bellei Leite
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação de Amparo à Pesquisa do Estado de Minas Gerais, Brasil
| | | | | | - Fernando Madalena Volpe
- Fundação Hospitalar do Estado de Minas Gerais, Brasil; Fundação Hospitalar do Estado de Minas Gerais, Brasil
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Green-Hennessy S, Hennessy KD. Predictors of Seclusion or Restraint Use Within Residential Treatment Centers for Children and Adolescents. Psychiatr Q 2015; 86:545-54. [PMID: 25733324 DOI: 10.1007/s11126-015-9352-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study identified predictors of seclusion or restraint use among licensed and/or accredited residential treatment centers (RTCs) for children and youth in the United States responding to a federally-sponsored survey of mental health services. 693 licensed and/or accredited child and adolescent RTCs responded to questions about the demographic and admission status of clients served on an identified date, services offered, size, ownership, funding, and their use of seclusion or restraint practices within the preceding 12 months. Logistic regression was used to determine factors predicting facility use of seclusion or restraint. A large majority of licensed and/or accredited child and adolescent RTCs (82 %) reported using seclusion or restraint in the prior year. Contrary to prior research, individual patient characteristics (percent of males, minorities, and involuntary admissions) did not predict the use of coercive techniques. Instead facility and funding variables accounted for approximately 27 % of the variance in the use of seclusion or restraint. Larger, privately-owned RTC's funded primarily through public monies and which offered medication and programming for SED youth were more likely to endorse having used seclusion or restraint in the previous year. Despite visible policy and advocacy efforts to reduce seclusion and restraint use over the past decade, a majority of licensed and/or accredited RTCs for children and adolescents report using such practices. Findings emphasize the importance of examining facility-level variables in predicting their use, and highlight the disconnect between nationally espoused goals and current practices regarding coercive techniques in child and adolescent RTCs.
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Affiliation(s)
| | - Kevin D Hennessy
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1 Choke Cherry Road, Rockville, MD, 20857, USA
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Abstract
Objective. To examine psychiatric patients' experience of mechanical restraints and to describe the care the patients received. Background. All around the world, threats and violence perpetrated by patients in psychiatric emergency inpatient units are quite common and are a prevalent factor concerning the application of mechanical restraints, although psychiatric patients' experiences of mechanical restraints are still moderately unknown. Method. A qualitative design with an inductive approach were used, based on interviews with patients who once been in restraints. Results. This study resulted in an overbridging theme: Physical Presence, Instruction and Composed Behaviour Can Reduce Discontent and Trauma, including five categories. These findings implicated the following: information must be given in a calm and sensitive way, staff must be physically present during the whole procedure, and debriefing after the incident must be conducted. Conclusions. When mechanical restraints were unavoidable, the presence of committed staff during mechanical restraint was important, demonstrating the significance of training acute psychiatric nurses correctly so that their presence is meaningful. Nurses in acute psychiatric settings should be required to be genuinely committed, aware of their actions, and fully present in coercive situations where patients are vulnerable.
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Shiina A, Iyo M, Hirata T, Igarashi Y. Audit study of the new hospitalization for assessment scheme for forensic mental health in Japan. World J Psychiatry 2015; 5:234-242. [PMID: 26110125 PMCID: PMC4473495 DOI: 10.5498/wjp.v5.i2.234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/06/2015] [Accepted: 04/02/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To clarify the components of hospitalization for assessment (HfA) and the management changes from the beginning of the scheme to the present.
METHODS: This study is composed of two surveys. In 2013 survey, we created two paper questionnaires (facility and case questionnaires) for psychiatrists working in psychiatric hospitals accepting HfA patients. Questionnaires were sent to 205 hospitals that were identified as accepting the HfA cases, and responses were requested via mail. The facility questionnaire was designed to clarify the following specifications and characteristics of each facility: the facility organizer (public sector or private hospital), and the number of beds, psychiatrists, psychiatric nurses, occupational therapists, psychiatric social workers, psychotherapists, public health nurses, and patients treated through HfA during the survey period. The case questionnaire was then used to collect data of the patients under HfA based on the Medical Treatment and Supervision (MTS) Act who were discharged between July 1, 2012 and June 30, 2013. Gathered information included: legal information of each case, demographic data, past history of the offenders, issued offense and the relationship to the victim, information regarding past psychiatric testimonies, psychiatric diagnoses, contents of the treatment during HfA, information regarding seclusion and restraint during the HfA, the verdict of the District Court panel, and so forth. Next, we compared those results with relevant data obtained in 2007. The 2007 survey comprised data of HfA patients from July 15, 2005 (the date the MTS Act was enforced) to January 15, 2007.
RESULTS: We obtained 171 cases, approximately a half of whole contemporary cases of HfA, from 134 facilities, of which 46 were national, prefectural, or semi-official hospitals, and 88 were private hospitals, in 2013 survey. The majority of subjects were male, schizophrenic, and experienced previous psychiatric treatment. The most frequent type of the offense was injury, followed by arson. Most of the subjects were medicated, and a few cases took psychotropic injection during the HfA. The frequency of injection was decreased in 2013 (χ2 = 7.54, df = 1, P = 0.006) than in 2007. Psychiatric testimony was more likely to be conducted in 2013 (χ2 = 8.56, df = 1, P = 0.004). The examiner psychiatrist was more likely to belong to the HfA facility to which the patient was hospitalized (χ2 = 5.32, df = 1, P = 0.02). Hospitalization orders were more frequently selected in 2013 (χ2 = 19.76, df = 3, P < 0.001), although the characteristics of the subjects had not changed.
CONCLUSION: Although the management of HfA has improved in recent years, structural problems remain.
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Garrido Viñado E, Lizano-Díez I, Roset Arissó PN, Villagrán Moreno JM, Mur de Viu Bernad C. El coste económico de los procedimientos de contención mecánica de origen psiquiátrico en España. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.psiq.2015.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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