Seclusion and restraint are regularly used to manage patient aggression events in psychiatric inpatient care, despite occupational safety concerns. There is currently a lack of information on how nurses perceive the use of patient seclusion and restraint as a risk for occupational safety. The aim of this study is to describe the risks for occupational hazards in patient seclusion and mechanical restraint practices as well as ideas for improvement identified by nurses. A qualitative descriptive design was adopted, using focus groups comprising nurses (N = 32) working in psychiatric inpatient care. The data were analysed using inductive content analysis, and the results were reported using the consolidated criteria for reporting qualitative studies (COREQ). Four themes of risk for occupational hazards were identified: patient‐induced, staff‐induced, organization‐induced, and environment‐induced risks. One significant finding was that nurses described that their actions can strongly contribute to occupational hazards during seclusion and mechanical restraint practices. The nurses gave various ideas for how occupational safety could be improved during seclusion and mechanical restraint events, ideas involving staff, the organization, and environmental enhancements.

Accessible Summary What is known on the subject? Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. What the paper adds to existing knowledge? This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. Implications for practice? Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm Abstract IntroductionSeclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. AimTo identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. MethodA descriptive design with non‐participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. ResultsSafety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. DiscussionThis is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for PracticeBeing better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.

Patient aggressive behaviour remains a significant public health concern worldwide. The use of restraint and seclusion remains a last resort but not an uncommon practice in clinical psychiatry in the management of aggressive events. There seems to be a paucity of evidenced‐based research examining the policy framework guiding the use of restraint and seclusion in Asia contexts. The purpose of this study was to conduct an analysis on the guidelines in psychiatric hospitals in Hong Kong, and to explore the extent to which these guidelines were aligned with the international clinical guidelines for the prevention and management of patient aggression in psychiatry. A descriptive document analysis was used to analyse the guidelines from four psychiatric hospitals in Hong Kong in comparison with the NICE (National Institute of Health and Care Excellence UK) guidelines. Data were collected from December 2017 to June 2018. A total of 91 written documents were retrieved. Preventing violence and aggression has the highest level of agreement (31%,) while the use of restrictive interventions has the lowest level of agreement (12%). The sub‐recommendation with most in line with the NICE guidelines were restrictive interventions, de‐escalation, and improving service users’ experiences. However, for example, staff training, working with police, and reduced use of restrictive interventions seemed to have no agreement with the NICE guidelines. Variation exists between the Asian (Hong Kong) local policy framework/guidelines and the European (UK) national policy framework. There are also large discrepancies in the written guidelines on patient aggressive behaviour when comparing local policy frameworks, cluster‐based documents, and departmental practices.

The need for psychiatric patients and their family members to have access to quality user‐friendly services has been studied for decades, yet few improvements have been made in treatment services. This study aims to explain how patients and family members have experienced facilitators of improvements, and their thoughts about barriers in the implementation of changes. An explanatory qualitative design was adopted. Data were collected using semi‐structured interviews with eight focus groups made up of a total of 35 participants from mental health associations in Finland. The Theoretical Domains Framework guided the deductive data analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was followed in the study. Participants in patient and family member associations had similar experiences and thoughts about facilitators of improvements in psychiatric services and barriers in the implementation of changes. For example, both participant groups experienced that promoting more positive roles of professionals could facilitate improvements in psychiatric care. On the other hand, a lack of theoretical competence and interpersonal skills of professionals could hinder change. We conclude that many of the facilitators that patients and families suggested could be addressed by enhancing collaboration and communication, having a more person‐centred approach, focusing on recovery throughout the course of care, and acknowledging staff’s well‐being at work. Second, the barriers to implementing changes centre around the limited knowledge and skills of staff, and a paternalistic system that focuses on managing risk and administering treatment.

Background: Patient falls are a major adverse event in psychiatric inpatient care. Purpose: To model the risk for patient falls in seclusion rooms in psychiatric inpatient care. Methods: Sociotechnical probabilistic risk assessment (ST-PRA) was used to model the risk for falls. Data sources were the research team, literature review, and exploration groups of psychiatric nurses. Data were analyzed with fault tree analysis. Results: The risk for a patient fall in a seclusion room was 1.8%. Critical paths included diagnosis of a psychiatric disorder, the mechanism of falls, failure to assess and prevent falls, and psychological or physical reason. The most significant individual risk factor for falls was diagnosis of schizophrenia. Conclusions: Falls that occur in seclusion events are associated with physical and psychological risk factors. Therefore, risk assessment methods and fall prevention interventions considering patient behavioral disturbance and physiological risk factors in seclusion are warranted.

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Accessible Summary What is known on the subject? Communication between nurses and patients is essential in mental health nursing. Lack of communication during seclusion causes dissatisfaction among patients. Coercive practices can cause psychological discomfort for patients and staff members. Research related to nurses' perceptions of nurse–patient communication during seclusion events is scant. In Finland, the use of coercive practices has been high despite efforts to reduce the need for coercive practices through the National Mental Health Policy since 2009. Nurse–patient communication is referred to in the Safewards model as one issue of delivering high‐quality care. What this paper adds to existing knowledge? Nurses aim to achieve high‐quality communication while treating patients in seclusion. Nurses aim to communicate in a way that is more patient‐centred. Various issues affect the quality of communication, such as nurses' professional behaviour and patients' state of health. What are the implications for practice? Improved communication between nurses and patients will support therapeutic relationships and could lead to a better quality of care. Nurses' enhanced communication may promote the use of noncoercive practices more frequently in psychiatric settings. Improving nurses' communication skills may help support the dignity and autonomy of secluded patients, resulting in patient experiences that are more positive in relation to care offered in seclusion. Nurses should be offered opportunities to take part in further training after education to enhance communication skills for demanding care situations. Further research that incorporates the perspectives of patients and those with lived experience of mental health problems is needed. Components of evidence‐based Safewards practices, such as using respectful and individual communication (Soft Words), could be relevant when developing nurse–patient communication in seclusion events. Abstract Introduction Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse–patient communication is highlighted. However, research related to nurses' perceptions of nurse–patient communication during seclusion is scant. Aim The aim of this study was to describe nurses' perceptions of nurse–patient communication during patient seclusion and the ways nurse–patient communication can be improved. Method A qualitative study design using focus group interviews was adopted. Thirty‐two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. Results Nurses aimed to communicate in a patient‐centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. Discussion Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communica...

IntroductionIn the literature, service users and informal caregivers have been critical towards psychiatric inpatient care. However, little is known about their fears related to hospital care.ObjectivesWe describe service users’ and informal caregivers’ experiences of fear in psychiatric hospital settings.MethodsThe data were collected from seven mental health associations located in six Finnish cities. Focus group interviews (f=8) were conducted (2015–2016) with service users (n=20) and informal caregivers (n=15), and were guided to focus on violence and challenging situations in psychiatric care. In a secondary analysis, experiences of fear were extracted from the transcriptions and analyzed using inductive content analysis.ResultsBoth groups’ experiences of fear focused on themes related to staff, treatment and fellow patients. Additionally, service users had experiences of fear related to the hospital environment. Fears related to staff involved intimidating personnel using force or acting in threatening ways. Participants also described staff seemingly being afraid of patients and care givers. Three types of fears related to treatment were described: fear of not being admitted to hospital even if needed, fear of being admitted to hospital, and fear of coercive methods used in care. Fear of fellow patients involved being afraid of aggressive, unpredictable behaviors, which could cause, e.g., a lack of sleep at night for service users. Fears related to the environment itself were also discussed.ConclusionsBeing hospitalized can be a difficult experience for service users and informal caregivers. These results can help psychiatric healthcare staff acknowledge areas in care that may potentially cause feelings of fear.DisclosureNo significant relationships.