Existing interventions to reduce self-harm in adolescents admitted to psychiatric wards are usually focused on individual psychological treatments. However, the immediate ward environment in which treatment takes place is an important factor in the success of the treatment and can also influence the likelihood of self-harming behaviours. The aim of the current study was to evaluate changes made to a psychiatric ward environment on incidence of self-harm in adolescents. A quasi-experimental interrupted time series study was conducted on one child and adolescent psychiatric ward. An intervention was developed alongside staff and patients to address the high incidence of self-harm on weekday evenings on the ward. The intervention components involved adding a regular twilight shift (3-11 pm) for nursing staff and introducing a structured evening activity programme on the ward. A segmented regression analysis of an interrupted time series found that the rate of self-harm per 100 bed days was already declining at baseline and continued to decline post-intervention, but the rate of decline was not significant (p = 0.415). However, the proportion of patients self-harming was increasing at baseline and significantly reduced post-intervention (p = 0.001), and this reduction was significantly larger in the evenings (p = 0.004) compared to other times of day (p = 0.09). A tailored intervention targeting the psychiatric ward environment helped to reduce the proportion of adolescents self-harming on the ward. An interrupted time series analysis should be considered for future interventions making changes to health systems over time.
Mental health nurses use forcible touch during physical restraint. Little research considers nurses’ experiences and the meanings they give to forcible touch. This study investigated nurses’ lived experiences of forcibly touching service users during physical restraint. A qualitative approach informed by phenomenology guided the study. The COREQ checklist ensured explicit and detailed reporting of the study. Fourteen nurses participated in semi‐structured interviews analysed using a phenomenological process. The participants’ experienced their touch during restraint as a problematic aspect of practice. They expressed preferences for holding different parts of the service user’s body, described their proximity to the service user’s body, and their experience of intimacy. The meanings of touch included forced, gentle, protective, and compassionate touches. Three themes revealed the complexity of this previously unproblematized area of nursing practice identified through their narratives. These were ‘needing to justify’, ‘inconsistent knowing’, and ‘compassionate whilst careworn’. Physical restraint training requires reconceptualization towards touch to help nurses connect with the meanings of their bodily contact with service users, and the potential influence upon care. Articulation of these touch meanings will help to develop a nursing discourse on this neglected area of nursing practice. Training courses orientate primarily towards techniques, whilst nurses’ conversations about touch are unclear. Training courses and practice fora can enhance understanding of the nursing contribution to physical restraint by addressing the nature of nurses’ bodywork. This discourse will help to reveal the complexity of this touch intervention, identify areas of good practice, and areas for practice development.
AimsTo describe the nature and causes of patient safety incidents relating to care at home for children with enteral feeding devices.MethodsWe analysed incident data relating to paediatric nasogastric, gastrostomy or jejunostomy feeding at home from England and Wales’ National Reporting and Learning System between August 2012 and July 2017. Manual screening by two authors identified 274 incidents which met the inclusion criteria. Each report was descriptively analysed to identify the problems in the delivery of care, the contributory factors and the patient outcome.ResultsThe most common problems in care related to equipment and devices (n=98, 28%), procedures and treatments (n=86, 24%), information, training and support needs of families (n=54, 15%), feeds (n=52, 15%) and discharge from hospital (n=31, 9%). There was a clearly stated harm to the child in 52 incidents (19%). Contributory factors included staff/service availability, communication between services and the circumstances of the family carer.ConclusionsThere are increasing numbers of children who require specialist medical care at home, yet little is known about safety in this context. This study identifies a range of safety concerns relating to enteral feeding which need further investigation and action. Priorities for improvement are handovers between hospital and community services, the training of family carers, the provision and expertise of services in the community, and the availability and reliability of equipment. Incident reports capture a tiny subset of the total number of adverse events occurring, meaning the scale of problems will be greater than the numbers suggest.
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