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Baker J, Kendal S, Bojke C, Louch G, Halligan D, Shafiq S, Sturley C, Walker L, Brown M, Berzins K, Brierley-Jones L, O'Hara JK, Blackwell K, Wormald G, Canvin K, Vincent C. A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-182. [PMID: 38794956 DOI: 10.3310/udbq8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s) Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Limitations Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration This study is registered as ISRCTN14470430. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John Baker
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Sarah Kendal
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Daisy Halligan
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Saba Shafiq
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Lauren Walker
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Mark Brown
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Kathryn Berzins
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Jane K O'Hara
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Gemma Wormald
- Department of Health Sciences, University of York, York, UK
| | - Krysia Canvin
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Charles Vincent
- Social Spider CIC, The Mill (Community Centre), London, UK
- Thrive by Design, Leeds, UK
- University of Oxford Medical Sciences Division, Oxford, UK
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Rowsell KA, Akinbola A, Hancock M, Nyambayo T, Jackson Z, Hunt DF. Reducing use of seclusion on a male medium secure forensic ward. BMJ Open Qual 2024; 13:e002576. [PMID: 38365432 PMCID: PMC10875490 DOI: 10.1136/bmjoq-2023-002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients' feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice.Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration (outcome measure) and frequency (balancing measure) of the use of seclusion by 10% over 6 months. Following the analysis of our local data systems and feedback from both patients and staff, we identified the high levels of use of seclusion, and reluctance to terminate it. These included a lack of awareness of the effective and appropriate use of such a facility, a hesitancy to use de-escalation techniques and an over-reliance on multidisciplinary team and consultant decision making.We subsequently designed and implemented three tests of change which reviewed seclusion processes, enhanced de-escalation skills and improved decision making. Our tests of change were applied over a 6-month period. During this period, we surpassed our original target of a reduction of frequency and duration by 10% and achieved a 33% reduction overall. Patients reported feeling safer on the ward, and the team reported improvements in relationships with patients.Our project highlights the importance of relational security within the secure setting and provides a template for other wards wishing to reduce the frequency and duration of seclusions.
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Affiliation(s)
- Kathryn Amy Rowsell
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ayodele Akinbola
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mark Hancock
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Tsitsi Nyambayo
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Zoe Jackson
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - David Francis Hunt
- School of Psychology, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
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Beames L, Onwumere J. Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review. J Psychiatr Ment Health Nurs 2022; 29:220-239. [PMID: 33835622 DOI: 10.1111/jpm.12757] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive practices such as restraint (physically holding a person) or seclusion (containing a person in locked room) are frequently used in mental health care. How often and which specific practices are used is not consistent across different healthcare systems, hospitals or wards. Internationally, there is agreement on the need to monitor and reduce the use of coercive practices. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The reviewed evidence suggests a number of different factors affect a person's risk of experiencing coercive practices, while admitted to a mental health ward. However, there is currently not enough high-quality research evidence to say which factors are most important or how they work to influence the likelihood of a person experiencing coercive practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When carrying out risk assessments, mental health professionals must take into account that a number of different factors are important and explore these with the patient. Care plans aimed at minimizing the use of coercive practices, such as restraint, must be personalized and developed with the individual. ABSTRACT: Introduction Coercive practices, such as physical restraint and seclusion, are a common feature of all mental healthcare systems. However, there is considerable variation in their use, concern about their iatrogenic potential and agreement internationally on the need to monitor and reduce their use. Aims To examine the evidence concerning risk factors associated with use of coercive practices in adults admitted to inpatient psychiatric services. Method A systematic review, consistent with PRIMSA guidelines, of four databases (PsychINFO, Medline, CINHAL and Embase). Peer-reviewed, English language articles from database inception to February 2020 were included. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies. Results Twenty studies met inclusion criteria. Risk factors examined in the studies organized around four categories: patient socio-demographic; patient clinical; staff; and organizational factors. Overall, methodological quality of papers was deemed weak, and there was insufficient evidence to support any singular risk factor. Discussion The reviewed evidence suggests risk of coercive practice in inpatient mental health settings is multifactorial. Further research to standardize concept definitions and elucidate the mechanisms behind variance in use is required. Implications for Practice Assessment of patients at risk of coercive practice must take a multifactorial approach.
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Affiliation(s)
- Lewys Beames
- South London and Maudsley NHS Foundation Trust, London, Bethlem Royal Hospital, Beckenham, UK
| | - Juliana Onwumere
- South London and Maudsley NHS Foundation Trust, London, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
Mental health challenges are a leading health issue, and while nurses should be well positioned to provide care to this client population, nurses are not adequately prepared for this role during their education. This qualitative narrative inquiry explored nursing students' (N = 15) experiences within their mental health practicums. Analyzed through Foucault's concept of micropower, participants' narratives illustrate that students observed nurses holding power over patients, and enacted resistance to this power in a complex interplay of empowerment and disempowerment. Study findings speak to the need for systemic shifts in mental health practice and ongoing educator support of students in mental health practicums.
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Harrington A, Darke H, Ennis G, Sundram S. Evaluation of an alternative model for the management of clinical risk in an adult acute psychiatric inpatient unit. Int J Ment Health Nurs 2019; 28:1099-1109. [PMID: 31206989 DOI: 10.1111/inm.12621] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/24/2019] [Indexed: 11/24/2022]
Abstract
Despite their widespread use, typical visual observation practices are not evidence-based and adverse events - such as self-harm and absconding - still occur even under the most intense forms of observation. This study aimed to (i) develop and implement an engagement-focused systematized model of clinical risk management in an adult acute psychiatric inpatient unit; and (ii) prospectively evaluate its effect on rates of violence, self-harm, absconding, sexually inappropriate behaviour, and seclusion. A new model of engagement-focused clinical risk management was developed using a participatory action research framework and implemented in an adult acute psychiatric inpatient unit. Using a mirror-image design, rates of violence/aggression, self-harm, absconding, sexually inappropriate behaviour, and seclusion were compared before and after implementation, and staff satisfaction levels were measured. The clinical engagement-based model was introduced, and 1087 admissions before implementation (24 months) were compared with 965 admissions post-implementation (18 months). The new model was associated with significantly reduced rates of absconding (pre: 10.5/1000 occupied bed days, 95% CI [9.0, 12.1] compared with post: 6.5/1000 occupied bed days [5.2, 8.1], P < 0.001) and seclusion (pre: 43.7/1000 occupied bed days, 95% CI [40.6, 46.9] compared with post: 30.9/1000 occupied bed days [27.9, 34.1], P < 0.0001). Rates of aggression, deliberate self-harm, and sexually inappropriate behaviour were non-significantly decreased. Findings suggest that this engagement-focused model of clinical risk management in an adult psychiatric inpatient unit significantly reduced adverse patient events and was preferred by staff over current practice. Other psychiatric inpatient facilities may see a reduction in adverse events following the introduction of this well-tolerated risk management model.
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Affiliation(s)
| | - Hayley Darke
- Psychiatry Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Gary Ennis
- North Western Mental Health, Melbourne, Victoria, Australia.,Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, Rockhampton, Queensland, Australia.,School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Suresh Sundram
- North Western Mental Health, Melbourne, Victoria, Australia.,Psychiatry Monash Health, Monash University, Melbourne, Victoria, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.,Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.,Adult Psychiatry, Monash Health, Melbourne, Victoria, Australia
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Management of Violence and Aggression in Emergency Environment; a Narrative Review of 200 Related Articles. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e7. [PMID: 31172118 PMCID: PMC6548084 DOI: 10.22114/ajem.v0i0.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Context: The aim of this study is to reviewing various approaches for dealing with agitated patients in emergency department (ED) including of chemical and physical restraint methods. Evidence acquisition: This review was conducted by searching “Violence,” “Aggression,” and “workplace violence” keywords in these databases: PubMed, Scopus, EmBase, ScienceDirect, Cochrane Database, and Google Scholar. In addition to using keywords for finding the papers, the related article capability was used to find more papers. From the found papers, published papers from 2005 to 2018 were chosen to enter the paper pool for further review. Results: Ultimately, 200 papers were used in this paper to conduct a comprehensive review regarding violence management in ED. The results were categorized as prevention, verbal methods, pharmacological interventions and physical restraint. Conclusion: In this study various methods of chemical and physical restraint methods were reviewed so an emergency medicine physician be aware of various available choices in different clinical situations for agitated patients.
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The Use of Restraints in Civilian and Military Health Care Settings. ANNUAL REVIEW OF NURSING RESEARCH 2018; 36:7-25. [PMID: 30568012 DOI: 10.1891/0739-6686.36.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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8
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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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Price O, Baker J, Bee P, Grundy A, Scott A, Butler D, Cree L, Lovell K. Patient perspectives on barriers and enablers to the use and effectiveness of de-escalation techniques for the management of violence and aggression in mental health settings. J Adv Nurs 2017; 74:614-625. [PMID: 29082552 DOI: 10.1111/jan.13488] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
Abstract
AIM Investigate patient perspectives on barriers and enablers to the use and effectiveness of de-escalation techniques for aggression in mental health settings. BACKGROUND De-escalation techniques are the recommended first-line intervention for the management of aggression in mental health settings internationally, yet use of higher risk restrictive practices persists. This indicates de-escalation techniques are not used at optimum frequency and/or there are important factors limiting their use and effect. DESIGN Descriptive qualitative research using semi-structured interviews and Framework Analysis. METHODS Inpatient interviews (N = 26) exploring staff, patient and environmental factors influencing the use and effectiveness of staff de-escalation were conducted mid-2014. Three service user researchers led analysis. RESULTS Data were synthesized in three deductive themes relating to staff, patient and environmental influences on the use and effectiveness of de-escalation techniques. The dominant view was that restrictive practices, rather than de-escalation techniques, are used in response to escalating patient behaviour. Under-use of de-escalation techniques was attributed to: lack of staff reflection on culture and practice and a need to retain control/dominance over patients. Ward rules, patient factors and a lack of staff respect for patients diluted their effectiveness. Participants identified a systematic process of de-escalation, rule subversion, reduced social distance and staff authenticity as enablers of effective de-escalation. CONCLUSION This study investigated patient perspectives on staff, patient and environmental influences on the use and effectiveness of de-escalation techniques. Our framework of barriers and enablers provides indicators of organizational/behaviour change targets for interventions seeking to reduce violence and restrictive practices through enhanced de-escalation techniques.
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Affiliation(s)
- Owen Price
- Mental Health Nursing, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - John Baker
- Mental Health Nursing, University of Leeds, Leeds, UK
| | - Penny Bee
- Mental Health Services Research, University of Manchester, Manchester, UK
| | - Andrew Grundy
- Mental Health Services Research, University of Nottingham, Nottingham, UK
| | - Anne Scott
- Mental Health Services Research, University of Manchester, Manchester, UK
| | - Debbie Butler
- Mental Health Services Research, University of Nottingham, Nottingham, UK
| | - Lindsey Cree
- Mental Health Services Research, University of Manchester, Manchester, UK
| | - Karina Lovell
- Mental Health Nursing, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Jalil R, Huber JW, Sixsmith J, Dickens GL. Mental health nurses’ emotions, exposure to patient aggression, attitudes to and use of coercive measures: Cross sectional questionnaire survey. Int J Nurs Stud 2017; 75:130-138. [DOI: 10.1016/j.ijnurstu.2017.07.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/03/2017] [Accepted: 07/30/2017] [Indexed: 10/19/2022]
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Kurjenluoma K, Rantanen A, McCormack B, Slater P, Hahtela N, Suominen T. Workplace culture in psychiatric nursing described by nurses. Scand J Caring Sci 2017; 31:1048-1058. [PMID: 28439913 DOI: 10.1111/scs.12430] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/15/2016] [Indexed: 11/30/2022]
Abstract
AIM This study looks to describe the workplace culture from the viewpoints of stress, job satisfaction and practice environment. METHODS Data were collected from nurses (n = 109) using a web-based survey, The Person-Centred Nursing Index, from two purposefully selected hospital districts in Finland. Data were statistically analysed. RESULTS Nurses described their workplace culture in slightly positive terms. Nurses only occasionally experienced stress (mean = 2.56, SD = 0.55) and were fairly satisfied with their job (mean = 4.75, SD = 0.66) and their practice environment (mean = 4.42, SD = 0.81). Demographic variables such as the nurses' age, length of time in nursing, time at their present hospital, working shifts and their use of patient restriction were more frequently associated with their perceived workplace culture. CONCLUSION Older nurses and those with a longer work history in the nursing profession tended to be more satisfied with their workplace culture in psychiatric nursing. Young and/or newly graduated nurses felt more negatively on their workplace culture; this issue should be recognised and addressed with appropriate support and mentoring. Nurses who used restrictive measures were more often less satisfied with their workplace culture. Continuous efforts are needed to reduce the use of coercive measures, which challenge also the managers to support nursing practice to be more person-centred.
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Affiliation(s)
- K Kurjenluoma
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - A Rantanen
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - B McCormack
- School of Health Sciences, Queen Margaret University, Edinburgh, Scotland
| | - P Slater
- Ulster University, Belfast, Northern Ireland
| | - N Hahtela
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - T Suominen
- School of Health Sciences, University of Tampere, Tampere, Finland
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Slemon A, Jenkins E, Bungay V. Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nurs Inq 2017; 24. [PMID: 28421661 PMCID: PMC5655749 DOI: 10.1111/nin.12199] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 11/26/2022]
Abstract
The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self‐harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re‐centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re‐evaluating the risk management culture that gives rise to and legitimizes harmful practices.
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Affiliation(s)
- Allie Slemon
- School of Nursing, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia (UBC), Vancouver, British Columbia, Canada
| | - Vicky Bungay
- School of Nursing, University of British Columbia (UBC), Vancouver, British Columbia, Canada
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Coping with Violence in Mental Health Care Settings: Patient and Staff Member Perspectives on De-escalation Practices. Arch Psychiatr Nurs 2016; 30:499-507. [PMID: 27654228 DOI: 10.1016/j.apnu.2016.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/14/2016] [Accepted: 05/14/2016] [Indexed: 11/23/2022]
Abstract
This multiple case study explored de-escalation processes in threatening and violent situations based on patients and staff members perspectives. Our post hoc analysis indicated that de-escalation included responsive interactions influenced by the perspectives of both patients and staff members. We assembled their perspectives in a mental model consisting of three interdependent stages: (1) memories and hope, (2) safety and creativity and (3) reflective moments. The data indicated that both patients and staff strived for peaceful solutions and that a dynamic and sociological understanding of de-escalation can foster shared problem solving in violent and threatening situations.
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Berring LL, Hummelvoll JK, Pedersen L, Buus N. A Co-operative Inquiry Into Generating, Describing, and Transforming Knowledge About De-escalation Practices in Mental Health Settings. Issues Ment Health Nurs 2016; 37:451-63. [PMID: 27070499 DOI: 10.3109/01612840.2016.1154628] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff members as co-researchers and knowledge was generated in dynamic research cycles around an extended epistemology of knowing: experiential, presentational, propositional, and practical. Through this process, co-researchers became de-escalation learners, implementing de-escalation practices while transforming violence management. Neighbouring mental health communities' involvement strengthened the transformation process and assisted in validating the research results.
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Affiliation(s)
- Lene Lauge Berring
- a Psychiatric Research Unit, Region Zealand, Slagelse, Denmark; University of Southern Denmark , Department of Public Health , Odense , Denmark
| | | | - Liselotte Pedersen
- c Psychiatric Research Unit, Region Zealand, Slagelse, Denmark; University of Copenhagen , Department of Psychology , Copenhagen , Denmark
| | - Niels Buus
- d University of Sydney and St. Vincent Private Hospital Sydney, Faculty of Nursing , Sydney , Australia
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Bell A, Gallacher N. Succeeding in Sustained Reduction in the use of Restraint using the Improvement Model. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu211050.w4430. [PMID: 27335641 PMCID: PMC4915305 DOI: 10.1136/bmjquality.u211050.w4430] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/24/2016] [Indexed: 11/25/2022]
Abstract
As part of the Scottish Patient Safety Programme – Mental Health one of the main drivers was the reduction of harm to patients caused by restraint. The aim of this project was to reduce the number of restraints on our Acute Admissions ward. Through use the of the Improvement Model (PDSA), frontline staff were empowered to implement small tests of change at a grassroots level. This approach has led to frontline staff having ownership of driving the changes on a daily basis within the Clinical area. The use of a restraint data collection tool has been adapted and developed with frontline staff to ensure that the staff have ownership of data collected and is used to facilitate improvement. This data is used to inform the development of our Physical Interventions training. Most recently, following analysis, were able to introduce changes to promote the increased use of de-escalation and a shift from prone restraint to the safer seated restraint position. Patient involvement has been paramount with their inclusion in the debrief process. The information gleaned from the patients is used for staff and patient reflection. This has created a learning environment not only for staff but also patients and carers. Everyone involved is able to identify reasons and triggers and generate ideas to reduce the possibility of another restraint. The use of staff and patient safety climate surveys has ensured that we are constantly monitoring improvements in the feeling of safety amongst staff and patients. Our approach has resulted in a change in the culture of restraint resulting in a sustained reduction of 50% in restraint.
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Boumans CE, Egger JIM, Bouts RA, Hutschemaekers GJM. Seclusion and the importance of contextual factors: An innovation project revisited. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 41:1-11. [PMID: 25846558 DOI: 10.1016/j.ijlp.2015.03.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Variation in seclusion rates between psychiatric facilities cannot be adequately explained by patient characteristics alone and there is a growing awareness of the influence of 'cultural' and staff factors on the use of seclusion. In this study, staff variables as well as seclusion parameters were investigated during the implementation of an innovation project, against the background of an institutional program to reduce the use of coercive measures. The results demonstrate the impact of confidence within the team, staffing level and communication with the patient on nurses' decisions on seclusion. The importance of the organizational context is further illustrated by the negative effects of organizational instability on nurses' attitudes and decision making with respect to seclusion, and on seclusion rates. A reduction in the use of seclusion was achieved after the implementation of the innovation project; however, during a period of organizational turmoil, the work engagement scores of staff decreased and the use of seclusion increased. The results of this study show the vulnerability of innovations within the continuously changing organizational context of mental health care.
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Affiliation(s)
- Christien E Boumans
- Mental Health Institute Oost Brabant, Boekel, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
| | - Jos I M Egger
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Pompe Institute for Forensic Psychiatry, Pro Persona, Nijmegen, The Netherlands
| | - Richard A Bouts
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Giel J M Hutschemaekers
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Pro Persona Centre for Education and Science (ProCES), Wolfheze, The Netherlands
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De Vecchi N, Kenny A, Kidd S. Stakeholder views on a recovery-oriented psychiatric rehabilitation art therapy program in a rural Australian mental health service: a qualitative description. Int J Ment Health Syst 2015; 9:11. [PMID: 25834636 PMCID: PMC4381511 DOI: 10.1186/s13033-015-0005-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/19/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Recovery-oriented care is a guiding principle for mental health services in Australia, and internationally. Recovery-oriented psychiatric rehabilitation supports people experiencing mental illness to pursue a meaningful life. In Australia, people with unremitting mental illness and psychosocial disability are often detained for months or years in secure extended care facilities. Psychiatric services have struggled to provide rehabilitation options for residents of these facilities. Researchers have argued that art participation can support recovery in inpatient populations. This study addressed the research question: Is there a role for the creative arts in the delivery of recovery-oriented psychiatric rehabilitation for people with enduring mental illness and significant psychosocial disability detained in a secure extended care unit? METHODS The study had two major aims: to explore the experiences of consumers detained in a rural Australian secure extended care unit of an art therapy project, and to examine the views of nurse managers and an art therapist on recovery-oriented rehabilitation programs with regard to the art therapy project. A qualitative descriptive design guided the study, and a thematic network approach guided data analysis. Ethics approval was granted from the local ethics committee (AU/1/9E5D07). Data were collected from three stakeholders groups. Five consumers participated in a focus group; six managers and the art therapist from the project participated in individual interviews. RESULTS The findings indicate that consumer participants benefitted from art participation and wanted more access to rehabilitation-focussed programs. Consumer participants identified that art making provided a forum for sharing, self-expression, and relationships that built confidence, absent in the regular rehabilitation program. Nurse manager and the art therapist participants agreed that art participation was a recovery-oriented rehabilitation tool, however, systemic barriers thwarted its provision. CONCLUSIONS The transformation of mental health services towards a recovery orientation requires commitment from service leaders to provide evidence-based programs. Psychiatric rehabilitation programs based on local need should be included in public mental health services. This study supports the use of art-based rehabilitation programs for people detained in rural secure extended care facilities. Introducing these programs into clinical practice settings can improve the consumer experience and support organisational culture change towards a recovery orientation.
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Affiliation(s)
- Nadia De Vecchi
- />La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3552 Australia
| | - Amanda Kenny
- />La Trobe Rural Health School, La Trobe University, Bendigo, VIC 3552 Australia
| | - Susan Kidd
- />Psychiatric Services Professional Development Unit, Bendigo Health, Bendigo, VIC 3552 Australia
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Paterson B, Bennet L, Bradley P. Positive and Proactive Care: could new guidance lead to more problems? BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:939-941. [PMID: 25251176 DOI: 10.12968/bjon.2014.23.17.939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Delaney KR, Johnson ME. Metasynthesis of research on the role of psychiatric inpatient nurses: what is important to staff? J Am Psychiatr Nurses Assoc 2014; 20:125-37. [PMID: 24667372 DOI: 10.1177/1078390314527551] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Inpatient psychiatric nurses are a large workforce, but their work is poorly articulated and thus poorly understood outside of the professional inpatient community. OBJECTIVE To learn how inpatient psychiatric nurses depict their work, define important aspects of their role, and view the impact of the unit environment on their clinical practice. DESIGN Metasynthesis of research that has focused on the ideas and perceptions of inpatient psychiatric nurses around their role and practice on inpatient psychiatric units. RESULTS Three themes emerged from the analysis; the first was an umbrella for three important aspects of nursing work: the nurses' efforts to forge engagement with patients; their activities which maintained the safety of the unit and interventions nurses viewed as educating/empowering patients. The second theme captures the conditions that enabled nurses to do this work such as a cohesive nursing team and their sense of self-direction in their role. The final theme centers on difficulties nurses encountered in enacting their role which included multiple responsibilities for patient care and management of the milieu; intense work often with low visibility and scant support within the organization. CONCLUSIONS Nurses need to articulate their practice so they can assert for the staffing and resources needed to keep units safe and promote patients' well-being, strive toward quality, and promote the development of the specialty.
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Affiliation(s)
- Kathleen R Delaney
- Kathleen R. Delaney, PhD, PMH-NP, FAAN, Professor, Rush College of Nursing, Chicago, IL, USA
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