scholarly journals Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care

2021 ◽  
Author(s):  
Charlotta Perers ◽  
Beata Bäckström ◽  
Björn Axel Johansson ◽  
Olof Rask
Keyword(s):  
Dialectical Behavior Therapy ◽  
Care Pathway ◽  
Psychiatric Inpatient ◽  
Child And Adolescent ◽  
Autism Spectrum ◽  
Successful Implementation ◽  
Negative Consequences ◽  
Coercive Measures ◽  
Trauma Informed ◽  
Inpatient Units

AbstractRestraints and seclusions are restrictive interventions used in psychiatric inpatient units when there is an imminent risk of harm to the patient or others. Coercive measures are controversial and can lead to negative consequences, including negative emotions, re-traumatization, injuries, or death. The article summarizes the last 10 years of literature regarding methods and strategies used for reducing seclusions and restraints in child and adolescent psychiatric inpatient units, and reports on their outcomes. The literature was reviewed by searching PubMed and PsycInfo for English-language articles published between May 2010 and May 2020. Eighteen articles were found that described methods or strategies aimed at reducing restraint or seclusion utilization in child and adolescent psychiatric inpatient units. The following interventions were evaluated: Trauma-Informed Care (TIC), Six Core Strategies, Child and Family Centered Care (CFCC), Collaborative & Proactive Solutions (CPS), Strength-Based Care, Modified Positive Behavioral Interventions and Supports (M-PBIS), Behavioral Modification Program (BMP), Autism Spectrum Disorder Care Pathway (ASD-CP), Dialectical Behavior Therapy (DBT), sensory rooms, Mindfulness-Based Stress Reduction Training (MBSR) of staff, and Milieu Nurse-Client Shift Assignments. Most of the interventions reduced the use of seclusions and/or restraints. Two child-centered and trauma-informed initiatives eliminated the use of mechanical restraints. This review shows that the use of coercive measures can be reduced and should be prioritized. Successful implementation requires ongoing commitment on all levels of an organization and a willingness to learn. To facilitate comparisons, future models should evaluate different standardized parameters.

scholarly journals Variables Associated with the Use of Coercive Measures on Psychiatric Patients in Spanish Penitentiary Centers

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
E. Girela ◽  
A. López ◽  
L. Ortega ◽  
J. De-Juan ◽  
F. Ruiz ◽  
...  
Keyword(s):  
Mentally Ill ◽  
Psychiatric Patients ◽  
Psychiatric Inpatient ◽  
Psychiatric Hospitals ◽  
Coercive Measure ◽  
Coercive Measures ◽  
External Assessment ◽  
Mechanical Restraint ◽  
The Family ◽  
Inpatient Units

We have studied the use of coercive medical measures (forced medication, isolation, and mechanical restraint) in mentally ill inmates within two secure psychiatric hospitals (SPH) and three regular prisons (RP) in Spain. Variables related to adopted coercive measures were analyzed, such as type of measure, causes of indication, opinion of patient inmate, opinion of medical staff, and more frequent morbidity. A total of 209 patients (108 from SPH and 101 from RP) were studied. Isolation (41.35%) was the most frequent coercive measure, followed by mechanical restraint (33.17%) and forced medication (25.48%). The type of center has some influence; specifically in RP there is less risk of isolation and restraint than in SPH. Not having had any previous imprisonment reduces isolation and restraint risk while increases the risk of forced medication, as well as previous admissions to psychiatric inpatient units does. Finally, the fact of having lived with a partner before imprisonment reduces the risk of forced medication and communication with the family decreases the risk of isolation. Patients subjected to a coercive measure exhibited a pronounced psychopathology and most of them had been subjected to such measures on previous occasions. The mere fact of external assessment of compliance with human rights slows down the incidence of coercive measures.

Health Professionals’ Experiences of Providing Trauma-Informed Care in Acute Psychiatric Inpatient Settings: A Scoping Review

2020 ◽  
pp. 152483802090306
Author(s):  
Carol O’Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Scoping Review ◽  
Health Professionals ◽  
English Language ◽  
Psychiatric Inpatient ◽  
Gender Based Violence ◽  
Trauma Informed Care ◽  
Inpatient Settings ◽  
Trauma Informed ◽  
Gender Based ◽  
Inpatient Units

Background: Trauma-informed care is increasingly recognized as the ideal model of care for acute psychiatric inpatient units; however, it continues to be a challenge to implement. The aims of this review are (1) to synthesize the research exploring health professionals’ experiences of providing trauma-informed care in acute psychiatric inpatient settings and (2) to examine these experiences through a gender lens, particularly relating to gender-based violence. This research will provide additional insights to facilitate implementation of trauma-informed care in acute psychiatric inpatient care. Method: A comprehensive scoping review methodology was adopted. English-language, peer-reviewed articles published between January 1998 and March 2018 were identified from seven databases. Inclusion criteria included a qualitative or mixed-method study design. Results: Eight full-text articles were found. This review highlights the importance for health professionals to have a reflective environment and a multilayered level of collaboration to adopt trauma-informed care. However, negative attitudes toward female consumers and inconsistent implementation strategies continue to hold back implementation of trauma-informed care in acute psychiatric inpatient units. Overall, limited consideration for gendered issues and gender-based violence in the implementation of trauma-informed care in acute psychiatric inpatient settings was found. Conclusion and Implications: There is a lack of research on health professionals’ experiences of providing trauma-informed care in acute psychiatric inpatient units, with even less research considerating gender-based violence. We argue that more research is needed to gain a better understanding of the experience of health professionals from acute psychiatric inpatient settings to inform future implementation of trauma-informed care.

6.3 EXAMINING THE TIME TREND OF AGGRESSION ON CHILD AND ADOLESCENT PSYCHIATRIC INPATIENT UNITS

2016 ◽  
Vol 55 (10) ◽  
pp. S205
Author(s):  
Drew H. Barzman ◽  
Daniel Lin ◽  
Ashaki Warren ◽  
Douglas Mossman ◽  
Michael T. Sorter
Keyword(s):  
Time Trend ◽  
Psychiatric Inpatient ◽  
Child And Adolescent ◽  
Inpatient Units

Smoking Bans in Psychiatric Inpatient Settings? A Review of the Research

2005 ◽  
Vol 39 (10) ◽  
pp. 866-885 ◽  
Author(s):  
Sharon Lawn ◽  
Rene Pols
Keyword(s):  
Administrative Support ◽  
Psychiatric Inpatient ◽  
Medical Advice ◽  
Successful Implementation ◽  
International Studies ◽  
Smoking Bans ◽  
Electronic Search ◽  
Inpatient Settings ◽  
Discharge Against Medical Advice ◽  
Inpatient Units

Objective: This paper reviews the findings from 26 international studies that report on the effectiveness of smoking bans in inpatient psychiatric settings. The main aim is to identify which processes contribute to successful implementation of smoking bans and which processes create problems for implementation in these settings. Method: After performing an electronic search of the literature, the studies were compared for methods used, subjects involved, type of setting, type of ban, measures and processes used and overall results. Total bans were distinguished from partial bans. All known studies of smoking bans in psychiatric inpatient units from 1988 to the present were included. Results: Staff generally anticipated more smoking-related problems than actually occurred. There was no increase in aggression, use of seclusion, discharge against medical advice or increased use of as-needed medication following the ban. Consistency, coordination and full administrative support for the ban were seen as essential to success, with problems occurring where this was not the case. Nicotine replacement therapy was widely used by patients as part of coping with bans. However, many patients continued to smoke post-admission indicating that bans were not necessarily effective in assisting people to quit in the longer term. Conclusions: The introduction of smoking bans in psychiatric inpatient settings is possible but would need to be a clearly and carefully planned process involving all parties affected by the bans. Imposing bans in inpatient settings is seen as only part of a much larger strategy needed to overcome the high rates of smoking among mental health populations.

scholarly journals Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units.

2019 ◽  
Author(s):  
Carol O'Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Professional Training ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Structured Interviews ◽  
Trauma Informed ◽  
Inpatient Units

Abstract Background Survivors of sexual violence commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units.Methods This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis.Results Three main themes were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing. Discussion Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences.Conclusions Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perception and promote trauma-informed and gender-sensitive care across all disciplines, genders, and levels of experience.

scholarly journals Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units.

2019 ◽  
Author(s):  
Carol O'Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Professional Training ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Structured Interviews ◽  
Trauma Informed ◽  
Inpatient Units

Abstract Background: Survivors of sexual violence, who are predominantly women, commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units. Methods: This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis. Results: Three main typologies were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing. Discussion: Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences. Conclusions: Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perceptions and promote trauma-informed and gender-sensitive care across all disciplines, genders and levels of experience.

scholarly journals Health professionals’ experiences of providing care for women survivors of sexual violence in psychiatric inpatient units

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carol O’Dwyer ◽  
Laura Tarzia ◽  
Sabin Fernbacher ◽  
Kelsey Hegarty
Keyword(s):  
Mental Health ◽  
Sexual Violence ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Professional Training ◽  
Psychiatric Inpatient ◽  
Public Mental Health ◽  
Structured Interviews ◽  
Trauma Informed ◽  
Inpatient Units

Abstract Background Survivors of sexual violence, who are predominantly women, commonly access mental health services. Psychiatric inpatient units in Australia are predominately mixed gender and may further retraumatise these women. Sexual violence is under-recognised by mental health professionals and there is a lack of adequate policy or direction for mental health service services. To date, only a small amount of research has focused on health professionals’ experiences of providing trauma-informed care to women in psychiatric settings, with most studies focused on specific practices or interventions. Qualitative data is particularly lacking on this topic. This is a critical gap in the knowledge given that health professionals are key to detecting and addressing victimisation. The aim of this study was to gain an in-depth understanding of healthcare professionals’ experiences and perceptions in providing care to women who are survivors of sexual violence in psychiatric inpatient units. Methods This qualitative study utilised semi-structured interviews with 40 health professionals recruited from four psychiatric inpatient units within a large Australian public mental health organisation. Data were examined using thematic analysis. Results Three main typologies were developed to describe participants’ experiences of the care provided to women; 1) Dismissing and denying; 2) Acknowledging but unprepared; 3) Empathising but despairing. Discussion Gender, professional training, adherence to the biomedical model, and level of experience influenced health professionals’ experiences. Conclusions Health professionals in this study held varying attitudes towards female consumers and responses to sexual violence. Our findings suggest the need to address individual staff perception and promote trauma-informed and gender-sensitive care across all disciplines, genders, and levels of experience.

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