Presented is an analysis of the need for, and the problems involved in, achieving coordination of health services at the local level. These problems arise from the separate authorities that fund and administer the facilities, from the endeavor to provide comprehensive care, and the need to cut across various established but artificial lines among professional and other groups involved in health.
<p><strong>Background: </strong>Incidents of aggression are increasing in healthcare. Students are at higher risk of being on the receiving end of client aggression due to their lack of experience. Students also do not feel prepared to manage these situations.</p><p><strong>Methods: </strong>Students of health professions in the School of Primary and Allied Health Care will be eligible and contacted within lectures/via the learning management system Moodle. A randomised controlled trial (RCT) will be conducted to evaluate a suite of online aggression management modules for health professions students prior to entering their clinical years of study. If students are able to undertake face to face simulations they will be assessed by academic staff members using the English modified de-escalating aggressive behaviour scale (EMDABS). Mock clients will assess the students using the consultation and relational empathy (CARE) measure. Students will complete a self-assessment using the confidence with coping with patient aggression instrument and a knowledge questionnaire.</p><p><strong>Conlusions: </strong>This RCT will provide novel information on the effectiveness of delivering a suite of online aggression management modules to health professions students. There are three separate modules each of approximately 30 minutes duration such that the attention of students is maintained. The three modules are: 1. Recognising and preventing aggression-the basics, 2. Responding to aggression-the basics, 3. Aggression in healthcare-the basics (Case study).</p><p><strong>Trial registration number: </strong>This trial has been registered with the Australian and New Zealand clinical trials registry (ANZCTR) ACTRN12621000382875.</p>
The 2021 release of the report from the Royal Commission into Victoria's Mental Health System suggested 65 recommendations to improve a mental healthcare system that was described as “broken”. Several of these recommendations relate to the use of restrictive interventions, such as restraint (both physical and mechanical) and seclusion. These interventions continue to be used in Victorian inpatient mental health facilities today, often in response to aggression and violence towards staff, visitors, family and other consumers. Several health services have committed to the substantial reduction or elimination of the use of restrictive interventions. In this perspective paper, we argue that significant investment is required to achieve this goal. Pressure on mental health nursing staff to cease using restrictive interventions without viable alternatives to de‐escalation, restrictions in the built environment, workforce constraints and a lack of education provided early in nursing careers need to be addressed before we can achieve the elimination of restrictive interventions. We recommend that substantial investment in mental health inpatient units, the mental health nursing workforce, and a systemic shift in the role of the mental health nurse are required to attain sustained reduction and potential elimination of restrictive interventions.
The principles of least restrictive care and recovery‐focused practice are promoted as contemporary practice in the care of individuals with mental ill health, underpinning legislation concerning mental health and illness in many jurisdictions worldwide. Inpatient mental health units with locked doors are incompatible with this style of care and throwback to a time where care for mental illness was primarily custodial. The aim of this scoping review is to determine whether evidence exists for locking mental health unit doors, whether this practice is compatible with recovery‐focused care and to determine whether door locking has changed since a review conducted by Van Der Merwe et al. (Journal of Psychiatric and Mental Health Nursing, 16, 2009, 293) found that door locking was not the preferred practice in the management of acute mental health units. We used Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8, 2005, 19) framework for scoping reviews, with our initial search locating 1377 studies, with screening narrowing final papers for inclusion to 20. Methodologies for papers included 12 using quantitative methodology, 5 qualitative and 3 that used mixed methods designs. Poor evidence was found for door locking to mitigate risks such as absconding, aggression or illicit substance importation. Furthermore, locked doors had a detrimental impact on the therapeutic relationship, nurse job satisfaction and intention to leave the profession. This scoping review indicates that research is urgently needed to address a mental healthcare culture where door locking is an entrenched practice. Studies of alternative approaches to risk management are required to ensure inpatient mental health units are truly least‐restrictive, therapeutic environments.
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