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Berring LL, Georgaca E. A Call for Transformation: Moving Away from Coercive Measures in Mental Health Care. Healthcare (Basel) 2023; 11:2315. [PMID: 37628513 PMCID: PMC10454462 DOI: 10.3390/healthcare11162315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Coercion is common practice in mental health care [...].
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Asikainen J, Vehviläinen-Julkunen K, Repo-Tiihonen E, Louheranta O. Patients' Perceptions of Safety and Debriefing in Forensic Mental Health Care in Finland. JOURNAL OF FORENSIC NURSING 2023; 19:187-196. [PMID: 37590941 DOI: 10.1097/jfn.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
BACKGROUND Safety is of paramount importance to patients and staff in forensic mental health hospitals. Previous research has focused on organizational and nurses' perceptions of safety and violence in psychiatric wards. However, little is known about how patients view their safety. This study aimed to describe how patient debriefing can improve safety. METHODS Qualitative research using thematic analysis was used. Data were collected by semistructured interviews and debriefing forms. Inpatient interviews ( n = 45) were conducted between June and July 2018, with debriefing forms ( n = 376) collected retrospectively. RESULTS Forensic inpatient responses were divided into two main categories: psychological and physical security. Psychological safety included care culture and patient-related themes. Responses on care culture highlighted weaknesses in nurse-patient communication, whereas patient-related themes related to respondents' descriptions of the challenges posed by mental illness. Physical safety related to both the environment and patient-related themes, with various restrictions and environmental distractions seen by respondents as negatively affecting patient safety. CONCLUSIONS Patients who participated in the study felt that care culture, especially communication with nurses, most significantly impacted their safety. Forensic hospitals should consider patients' perceptions of their care while systematically gathering information through debriefing, as these practices can contribute to the development of a safer care environment. The next step will be clarifying how changes in nursing practices and the care environment can be used to prevent violence in psychiatric wards.
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Affiliation(s)
- Jaana Asikainen
- Author Affiliations: Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | | | - Eila Repo-Tiihonen
- Author Affiliations: Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Olavi Louheranta
- Author Affiliations: Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
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Downe S, Nowland R, Clegg A, Akooji N, Harris C, Farrier A, Gondo LT, Finlayson K, Thomson G, Kingdon C, Mehrtash H, McCrimmon R, Tunçalp Ö. Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001594. [PMID: 37093790 PMCID: PMC10124898 DOI: 10.1371/journal.pgph.0001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for 'othered' groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against 'othered' groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.
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Affiliation(s)
- Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebecca Nowland
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Naseerah Akooji
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Cath Harris
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Alan Farrier
- Healthy and Sustainable Settings Unit, University of Central Lancashire, Preston, United Kingdom
| | | | - Kenny Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Carol Kingdon
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rebekah McCrimmon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate the effects of post‐incident debriefing after coercive measures for people with schizophrenia or schizophrenia‐type psychosis.
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Wilson K, Foye U, Thomas E, Chadwick M, Dodhia S, Allen-Lynn J, Allen-Lynn J, Brennan G, Simpson A. Exploring the use of body-worn cameras in acute mental health wards: A qualitative interview study with mental health patients and staff. Int J Nurs Stud 2023; 140:104456. [PMID: 36821953 DOI: 10.1016/j.ijnurstu.2023.104456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/30/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Body-worn cameras are increasingly being used as a violence prevention tool in inpatient mental health wards. However, there is a dearth of research on their use in these settings, particularly when it comes to patient perspectives. OBJECTIVE This study aimed to explore the perspectives of patients, mental health staff, and senior management on body-worn cameras to identify the possible impacts of this technology in inpatient mental health settings. DESIGN This was an exploratory qualitative study. SETTING We undertook interviews online and in-person on a number of acute inpatient wards across five mental health hospitals in England. Participants were recruited in-person, online via social media, and through professional networks. PARTICIPANTS This study recruited 24 patients from acute wards, 25 staff from acute wards, six Mental Health Nursing Directors, and nine community-based patients. METHODS Semi-structured interviews were conducted online and in-person. Interviews were analysed using reflexive thematic analysis. Ethical approval was granted by the Health Research Authority. RESULTS The subjective nature of how violence and aggression is defined shapes how staff and patients view the prospect of using body-worn cameras. Both staff and patients cited issues resulting from an underlying culture of mistrust in inpatient settings that leave staff and patients feeling unsafe. Body worn cameras may intensify power dynamics and undermine therapeutic relationships. Participants felt that engaging existing interventions and addressing systemic causes of violence and aggression should take priority over introducing body-worn cameras. CONCLUSIONS There is no indication that staff or patients believe body-worn cameras will deter violence and aggression on inpatient mental health wards. They may serve as a tool for safeguarding and staff training, but there are still unexplored ethical concerns about their use and a lack of evidence to support use of this technology to deter violence in NHS mental health settings. TWEETABLE ABSTRACT Mental health patients & staff have complex perspectives on controversial body-worn camera technology @thekeiranwilson @unafoye @maddych4dwick @gbrennancafc @cityalan.
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Affiliation(s)
- Keiran Wilson
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/thekeiranwilson
| | - Una Foye
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/unafoye
| | - Ellen Thomas
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Madeleine Chadwick
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/maddych4dwick
| | - Sahil Dodhia
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jenny Allen-Lynn
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Jude Allen-Lynn
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Geoff Brennan
- Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom. https://twitter.com/gbrennancafc
| | - Alan Simpson
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom; Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
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Wormdahl I, Hatling T, Husum TL, Kjus SHH, Rugkåsa J, Brodersen D, Christensen SD, Nyborg PS, Skolseng TB, Ødegård EI, Andersen AM, Gundersen E, Rise MB. The ReCoN intervention: a co-created comprehensive intervention for primary mental health care aiming to prevent involuntary admissions. BMC Health Serv Res 2022; 22:931. [PMID: 35854270 PMCID: PMC9296016 DOI: 10.1186/s12913-022-08302-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 07/05/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Reducing involuntary psychiatric admissions is a global concern. In Norway, the rate of involuntary admissions was 199 per 100,000 people 16 years and older in 2020. Individuals' paths towards involuntary psychiatric admissions usually unfold when they live in the community and referrals to such admissions are often initiated by primary health care professionals. Interventions at the primary health care level can therefore have the potential to prevent such admissions. Interventions developed specifically for this care level are, however, lacking. To enhance the quality and development of services in a way that meets stakeholders' needs and facilitates implementation to practice, involving both persons with lived experience and service providers in developing such interventions is requested. AIM To develop a comprehensive intervention for primary mental health care aiming to prevent involuntary admissions of adults. METHODS This study had an action research approach with a participatory research design. Dialogue conferences with multiple stakeholders in five Norwegian municipalities, inductive thematic analysis of data material from the conferences, and a series of feedback meetings were conducted. RESULTS The co-creation process resulted in the development of the ReCoN (Reducing Coercion in Norway) intervention. This is a comprehensive intervention that includes six strategy areas: [1] Management, [2] Involving Persons with Lived Experience and Family Carers, [3] Competence Development, [4] Collaboration across Primary and Specialist Care Levels, [5] Collaboration within the Primary Care Level, and [6] Tailoring Individual Services. Each strategy area has two to four action areas with specified measures that constitute the practical actions or tasks that are believed to collectively impact the need for involuntary admissions. CONCLUSIONS The ReCoN intervention has the potential for application to both national and international mental health services. The co-creation process with the full range of stakeholders ensures face validity, acceptability, and relevance. The effectiveness of the ReCoN intervention is currently being tested in a cluster randomised controlled trial. Given positive effects, the ReCoN intervention may impact individuals with a severe mental illness at risk of involuntary admissions, as more people may experience empowerment and autonomy instead of coercion in their recovery process.
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Affiliation(s)
- Irene Wormdahl
- grid.458589.d Norwegian Resource Centre for Community Mental Health, NTNU Social Research, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Hatling
- grid.458589.d Norwegian Resource Centre for Community Mental Health, NTNU Social Research, Trondheim, Norway
| | - Tonje Lossius Husum
- grid.5510.10000 0004 1936 8921Centre for Medical Ethics, Institute for Health & Society, University of Oslo, Oslo, Norway ,grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Solveig Helene Høymork Kjus
- grid.458589.d Norwegian Resource Centre for Community Mental Health, NTNU Social Research, Trondheim, Norway
| | - Jorun Rugkåsa
- grid.411279.80000 0000 9637 455XHealth Service Research Unit, Akershus University Hospital, Lørenskog, Norway ,grid.463530.70000 0004 7417 509XCentre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Dorte Brodersen
- Department of Health Care, Ullensaker Municipality, Ullensaker, Norway
| | | | - Petter Sundt Nyborg
- Department of Mental Health and Addiction, Elverum Municipality, Elverum, Norway
| | | | - Eva Irene Ødegård
- Department of Mental Health and Addiction, Grimstad Municipality, Grimstad, Norway
| | | | | | - Marit B. Rise
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Hammervold UE, Norvoll R, Sagvaag H. Post-incident reviews after restraints-Potential and pitfalls. Patients' experiences and considerations. J Psychiatr Ment Health Nurs 2022; 29:472-483. [PMID: 34060178 DOI: 10.1111/jpm.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Restraint has negative psychological, physical and relational consequences for mental health patients and care providers. Several countries have implemented seclusion and restraint (S/R) reduction programmes in which post-incident reviews (PIRs) including patients and care providers are one of several strategies. Existing knowledge indicates that PIRs have the potential to contribute to S/R prevention, but knowledge of the patients' perspectives on PIRs is scarce. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides in-depth knowledge about patients' experiences of being participants in PIRs after restraint events. Patients experience PIRs to result in being strengthened and developing new coping strategies. The paper reveals pitfalls when planning and conducting PIRs that make patients experience PIRs as meaningless, feel objectified or long for living communication and closeness. The patients' mental state, the quality of the relationships and the services' care philosophies, influence patients' experiences of PIRs as supporting their personal recovery processes or as continuation of coercive contexts. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Patients' vulnerability during the PIRs must be acknowledged. Trusted persons or advocacy must support the patient in the PIR and thus reduce the power-dependence imbalance. The PIR must be conducted in a supportive, non-punishing atmosphere. Patients must influence planning for the PIR concerning time point and participants and themes to be discussed. The PIR forms should be extended to support the patients' empowerment and well-being. ABSTRACT: Introduction Post-incident reviews (PIRs), including patients, nurses and other care providers, following incidents of restraints are recommended in mental health services. Few studies have examined patients' experiences and considerations concerning PIRs. Aim The study aims to explore patients' perspectives on PIRs in relation to how they experience participation in PIRs and further view PIRs' potential for care improvement and restraint prevention. Method We conducted a qualitative study based on individual interviews. Eight current and previous inpatients from two Norwegian mental health services were interviewed. Results The patients experienced PIRs as variations on a continuum from being strengthened, developing new coping strategies and processing the restraint event to at the other end of the continuum; PIRs as meaningless, feeling objectified and longing for living communication and closeness. Discussion PIRs' beneficial potential is extended in the study. The findings highlight however that personal and institutional conditions influence whether patients experience PIRs as an arena for recovery promotion or PIRs as continuation of coercive contexts. Implications for practice We recommend patients' active participation in planning the PIR. PIRs should be conducted in a supportive atmosphere, including trusted persons, emphasizing and acknowledging a dialogical approach.
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Affiliation(s)
- Unn Elisabeth Hammervold
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Hildegunn Sagvaag
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Waddell AE, Gratzer D. Patient Safety and Mental Health-A Growing Quality Gap in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:246-249. [PMID: 34378413 PMCID: PMC9099078 DOI: 10.1177/07067437211036596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient safety research in mental health has focused mainly on suicide and violence risk at the expense of other domains of safety. In Canada, we lack a national strategy or research agenda for this important area. This piece calls on psychiatrists to consider the scope of missed opportunities in patient safety in current practice and presents how to begin to consider the safety of our patients in a systematic manner.
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Affiliation(s)
- Andrea E Waddell
- General Adult Psychiatry & Health Systems, 7978CAMH, Toronto, Ontario.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
| | - David Gratzer
- General Adult Psychiatry & Health Systems, 7978CAMH, Toronto, Ontario.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario
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Hollins L, Seagrave L, Stubbs B. What are the most common restraint techniques taught by expert practitioners? J Psychiatr Ment Health Nurs 2022; 29:274-286. [PMID: 33851476 DOI: 10.1111/jpm.12761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/11/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Physical restraint is used across the NHS in Mental Health, Learning disability and other specialist settings. Physical restraint should be used as a last resort, with least amount of force for the minimum amount of time. There is no national set of skills from which trainers or practitioners choose what might be appropriate for them and the population they care for. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A national online survey gathered insights from representatives of public and private training services in relation to 20 selected techniques and their perceived risks. The most frequently taught techniques are identified and evident trends were seen among respondents according to their perceived suitability for different population groups. The need to be able to compare and contrast techniques is discussed, and the utility of developing an evaluative framework is outlined. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In England the restraint training is now being regulated. This survey reveals the variation in the techniques used across groups or settings. The ability to compare techniques and make informed decisions around which techniques to commission, specify or use, could support the aims of the RRN Training Standards (RRN, 2020a) and Towards Safer Services (RRN, 2020b) and in so doing support the goals of safer, less restrictive person-centred practice. Individuals are encouraged to reflect on their practice and think critically about what is a good restraint technique. ABSTRACT: Introduction Despite widespread use of restraint techniques, it is unclear what techniques are taught. Aim To identify the types of techniques commonly taught. Method A national online survey was developed through iteration and stakeholder involvement. Ethical approval was obtained and it was disseminated through the Positive and Safe network, and the Restraint Reduction Network Community of Practice where expert practitioners answered questions relating to 20 randomly selected used physical 'Holds'. Results One hundred seventy-two people completed the survey. The most commonly taught techniques were a Guiding Posture (71%), a Guiding Hold (44%), a Two-Handed Forearm Hold (36%), a Finger, Thumb & Wrist Hold (27%) and a Cupped/Capped Fist Hold (26%). The Guiding Posture (71%), and Guiding Hold were used most commonly across populations. Despite the potential to induce pain, the Finger, Thumb and Wrist Hold was deemed suitable for Adult populations, but not Older Adults, Young Persons and Children. Wrap-Type Holds were seen as unsuitable for all populations. Discussion There is currently high variation in which techniques are taught across different settings. An evaluation framework could be beneficial. IMPLICATIONS FOR PRACTICE: An evaluation framework could aid training commissioners, providers and practitioner reflect on what constitutes a good restraint technique.
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Affiliation(s)
- Lee Hollins
- Strathclyde University, Glasgow, UK.,BILD ACT, Birmingham, UK
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Lefèvre-Utile J, Montreuil M, Perron A, Reyre A, Carnevale F. Acknowledging caregivers' vulnerability in the managment of challenging behaviours to reduce control measures in psychiatry. Nurs Ethics 2022; 29:758-779. [PMID: 35172661 DOI: 10.1177/09697330211015275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of challenging behaviours in inpatient with intellectual disability and/or autism spectrum disorders can lead to an escalation of control measures. In these complex situations where patients have an intellectual disability/autism spectrum disorder accompanied by a psychiatric comorbidity, the experiences of caregivers related to the crisis management have rarely been studied. PURPOSE This study examined the moral experiences of caregivers related to challenging behaviours' management and alternatives to control measures. RESEARCH DESIGN Using Charles Taylor's hermeneutic framework, a 2-month focused ethnography with a participatory approach was used. PARTICIPANTS AND RESEARCH CONTEXT Sixteen caregivers were interviewed in a Canadian mental health setting for adults with intellectual disability/autism spectrum disorder and psychiatric comorbidity. ETHICAL CONSIDERATIONS The research was conducted in compliance with the Declaration of Helsinki and local Research Ethics Board approval. Written informed consent was collected systematically from participants. FINDINGS By accounting for caregivers' moral experiences, this study sheds light on a neglected dimension of the care relationship: the vulnerability of the caregiver. We highlight the main barriers and facilitators to alternatives to control measures. First, a caregiver's vulnerability was characterised by the overall impact of challenging behaviours and the moral distress associated with the use of control measures and exclusion mechanisms of intellectual disability/autism spectrum disorder patients. Second, a strong ambiguity between care and control measures and a lack of inclusive approaches were identified as the two main barriers to challenging behaviour management. Third, the involvement, both professional and personal, of caregivers was deemed necessary to implement alternatives to control measures. DISCUSSION A conflict of values opposes two conceptions of autonomy: a rational autonomy, which is counterproductive to the reduction of control measures, versus a relational autonomy based on shared vulnerability. CONCLUSION The recognition of caregiver's vulnerability is a benchmark to create alternative approaches, which defuse the logic of control and promote an ethics of care within which caregivers' self-concern can be understood as fostering mutual respect.
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Wullschleger A, Vandamme A, Mielau J, Stoll L, Heinz A, Bermpohl F, Bechdolf A, Stelzig M, Hardt O, Hauth I, Holthoff-Detto V, Mahler L, Montag C. Effect of standardized post-coercion review on subjective coercion: Results of a randomized-controlled trial. Eur Psychiatry 2021; 64:e78. [PMID: 34872630 PMCID: PMC8715283 DOI: 10.1192/j.eurpsy.2021.2256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Post-coercion review has been increasingly regarded as a useful intervention in
psychiatric inpatient setting. However, little is known about its effect on perceived
coercion. Methods A multicenter, two-armed, randomized controlled trial was conducted, aiming at
analyzing the effect of post-coercion review on perceived coercion. People with severe
mental disorders, who experienced at least one coercive measure during inpatient
treatment, were randomized using Zelen’s design to an intervention group receiving
standardized post-coercion review, or a control group treated as usual. The MacArthur
admission experience scale (AES) and the coercion ladder (CL) were used to assess
perceived coercion during inpatient treatment. The coercion experience scale (CES)
measured experienced coercion during the coercive intervention. Analyses of covariance
were performed to determine group differences. Results Of 422 randomized participants, n = 109 consented to participate in
the trial. A restricted intention-to-treat analysis of all individuals who consented
revealed no significant effect of the intervention on perceived coercion. A significant
interaction effect between the factors gender and intervention on the AES scores was
found. Sensitivity analysis revealed significant effects of the intervention on both AES
and CL scores and an interaction effect between intervention and gender, indicating a
higher efficacy in women. No effect of the intervention on CES scores was found. Conclusions Standardized post-coercion review sessions did not alleviate the subjective perception
of coercion in the total sample. However, post hoc analysis revealed a significant
effect of the intervention in women. Results indicate the need to further address
gender-specific issues related to coercion.
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Affiliation(s)
- A Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - A Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - J Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - L Stoll
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Hospital Am Urban and Vivantes Hospital im Friedrichshain/Charité Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - M Stelzig
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Wenckebach Clinic, Berlin, Germany
| | - O Hardt
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinic Neukölln, Berlin, Germany
| | - I Hauth
- Department of Psychiatry, Psychotherapy and Psychosomatics, St. Joseph Hospital Berlin-Weissensee, Berlin, Germany
| | - V Holthoff-Detto
- Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Kliniken Berlin, Berlin, Germany.,Medical Faculty, University of Technology, Dresden, Germany
| | - L Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - C Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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12
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Gideon Asuquo E, Tighe SM, Bradshaw C. Interventions to reduce work-related musculoskeletal disorders among healthcare staff in nursing homes; An integrative literature review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2021. [DOI: 10.1016/j.ijnsa.2021.100033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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Abstract
Background Psychological safety—speaking up about ideas and concerns, free from interpersonal risk—are essential to the high-risk environment, such as healthcare settings. Psychologically safe working is particularly important in mental health where recovery-oriented approaches rely on collaborative efforts of interprofessional teams to make complex decisions. Much research focuses on antecedents and outcomes associated with psychological safety, but little focus on the practical steps for how to increase psychological safety across and at different levels of a healthcare organisation. Aims We explore how a mental health organisation creates an organisation-wide plan for building the foundations of mental health and how to enhance psychological safety. Methods This review encompasses strategies across psychological safety and organisational culture change to increase psychological safety at an individual, team and organisational level. Summary We set out a comprehensive overview of the types of strategies and interventions for increasing the ethos of psychological safety and setting the foundations for delivering an organisation-wide programme on this topic. We also provide a list of key targeted areas in mental health that would maximally benefit from increasing psychological safety—both in clinical and non-clinical settings. Conclusions Psychological safety is a crucial determinant of safe and effective patient care in mental health services. This paper provides the key steps and considerations, creating a large-scale programme in psychological safety with a focus on mental health and drawing from the current literature, providing concrete steps for how our current understanding of psychological safety into practice.
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14
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Barbui C, Purgato M, Abdulmalik J, Caldas-de-Almeida JM, Eaton J, Gureje O, Hanlon C, Nosè M, Ostuzzi G, Saraceno B, Saxena S, Tedeschi F, Thornicroft G. Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence. Br J Psychiatry 2021; 218:185-195. [PMID: 32847633 DOI: 10.1192/bjp.2020.144] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services. AIMS To evaluate the strength and credibility of evidence on the efficacy of interventions to reduce coercive treatment in mental health services. Protocol registration: https://doi.org/10.17605/OSF.IO/S76T3. METHOD Systematic literature searches were conducted in MEDLINE, Cochrane Central, PsycINFO, CINAHL, Campbell Collaboration, and Epistemonikos from January 2010 to January 2020 for meta-analyses of randomised studies. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was classified using quantitative umbrella review criteria, and credibility of evidence was assessed using the GRADE approach. RESULTS A total of 23 primary studies (19 conducted in European countries and 4 in the USA) enrolling 8554 participants were included. The evidence on the efficacy of staff training to reduce use of restraint was supported by the most robust evidence (relative risk RR = 0.74, 95% CI 0.62-0.87; suggestive association, GRADE: moderate), followed by evidence on the efficacy of shared decision-making interventions to reduce involuntary admissions of adults with severe mental illness (RR = 0.75, 95% CI 0.60-0.92; weak association, GRADE: moderate) and by the evidence on integrated care interventions (RR = 0.66, 95% CI 0.46-0.95; weak association, GRADE: low). By contrast, community treatment orders and adherence therapy had no effect on involuntary admission rates. CONCLUSIONS Different levels of evidence indicate the benefit of staff training, shared decision-making interventions and integrated care interventions to reduce coercive treatment in mental health services. These different levels of evidence should be considered in the development of policy, clinical and implementation initiatives to reduce coercive practices in mental healthcare, and should lead to further studies in both high- and low-income countries to improve the strength and credibility of the evidence base.
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Affiliation(s)
- Corrado Barbui
- Professor of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Marianna Purgato
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Jibril Abdulmalik
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - José Miguel Caldas-de-Almeida
- Professor of Psychiatry, Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Portugal
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK; and CBM Global, Laudenbach, Germany
| | - Oye Gureje
- Professor of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, UK; and WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University; and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | - Michela Nosè
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Giovanni Ostuzzi
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Benedetto Saraceno
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Portugal
| | - Shekhar Saxena
- Professor of the Practice of Global Mental Health, Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Federico Tedeschi
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Graham Thornicroft
- Professor of Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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15
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Krieger E, Fischer R, Moritz S, Nagel M. [Post-seclusion/post-restraint debriefing with patients-overview and current situation]. DER NERVENARZT 2021; 92:44-49. [PMID: 32725493 DOI: 10.1007/s00115-020-00969-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research on measures to prevent or reduce the use of coercive measures is steadily gaining momentum in research. Post-seclusion/post-restraint debriefings with the affected patients are recommended in treatment guidelines but the effectiveness as an intervention has so far only scarcely been studied. AIMS AND METHODS This article briefly outlines the existing literature on post-seclusion/post-restraint debriefings, the legal basis in Germany, recommendations by various treatment guidelines as well as the existing evidence of the effectiveness. Furthermore, challenges pertaining to the implementation of debriefings are discussed. RESULTS Various treatment guidelines recommend post-seclusion/post-restraint debriefings with patients and the individual Mental Health Laws (PsychKG) of the German federal states provide more or less specific guidance on how to implement the intervention. So far, hardly any scientific studies on the effectiveness of post-seclusion/post-restraint debriefings exist but they are already carried out in a variety of complex treatment concepts. Various parameters, e.g. who participates and when the debriefing is conducted, also vary across implementations. Initial pilot studies have shown indications for positive effects in terms of reducing coercive measures through the implementation of post-seclusion/post-restraint debriefings; however, structured debriefings are not yet part of routine practice. CONCLUSION Structured post-seclusion/post-restraint debriefings with patients constitute a possible intervention to reduce coercive measures, but as of now there is little scientific evidence for the efficacy. Incorporating them into complex therapeutic treatment concepts for ward programs appears to be meaningful.
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Affiliation(s)
- Eva Krieger
- Klinik für Psychiatrie und Psychotherapie, Asklepios Klinik Nord - Wandsbek, Jüthornstraße 71, 22043, Hamburg, Deutschland. .,Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland.
| | - Rabea Fischer
- Klinik für Psychiatrie und Psychotherapie, Asklepios Klinik Nord - Wandsbek, Jüthornstraße 71, 22043, Hamburg, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland
| | - Steffen Moritz
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland
| | - Matthias Nagel
- Klinik für Psychiatrie und Psychotherapie, Asklepios Klinik Nord - Wandsbek, Jüthornstraße 71, 22043, Hamburg, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
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16
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Goodman H, Papastavrou Brooks C, Price O, Barley EA. Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: a qualitative study. Int J Ment Health Syst 2020; 14:59. [PMID: 32774452 PMCID: PMC7397665 DOI: 10.1186/s13033-020-00392-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023] Open
Abstract
Background Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours. Methods Semi-structured individual interviews (n = 12) and focus groups (n = 3) were conducted with eight patients, four carers and 25 staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training.
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Affiliation(s)
- Helena Goodman
- Kate Granger Building, University of Surrey, Guildford, GU2 7YH UK
| | | | - Owen Price
- Jean McFarlane Building, University of Manchester, Manchester, M13 9PY UK
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17
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Hammervold UE, Norvoll R, Vevatne K, Sagvaag H. Post-incident reviews-a gift to the Ward or just another procedure? Care providers' experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study. BMC Health Serv Res 2020; 20:499. [PMID: 32493391 PMCID: PMC7268524 DOI: 10.1186/s12913-020-05370-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context. Methods Within a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process. Results Care providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions. Conclusion Human care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.
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Affiliation(s)
- Unn Elisabeth Hammervold
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Kari Vevatne
- Department of care and ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hildegunn Sagvaag
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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