A study of agitation, conflict and containment in association with change in ward physical environment

Abstract

Aims: To assess the impact of a changed ward environment upon levels of inpatient arousal and aggression on a National Health Service psychiatric intensive care unit.Method: A retrospective service evaluation comparing seclusion episodes, duration of close observation, recorded aggressive incidents and data from the Nursing Observed Illness Intensity Scale (NOIIS) on a psychiatric intensive care unit for two three-month periods either side of a move from an old, temporary building to a new, purpose-built ward. The ward environments were also objectively assessed and compared using the Environment Assessment Inventory (EAI).Results: A statistically significant reduction in episodes of seclusion, total seclusion hours and aggressive incidents, as well as a reduction in levels of agitation from the NOIIS data on the new ward compared to the old ward. The EAI scores showed important qualitative improvements on the new ward.Conclusions: This study supports the hypothesis that the physical environment of a psychiatric intensive care unit has a significant impact on levels of arousal and aggression. Established measures of ward environment should be applied to the development and improvement of psychiatric wards.

Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards

“…Only the 16 studies that were formally evaluated were rated for quality using the EPHPP tool. One intervention had a strong quality rating (Bowers et al ., ; James et al ., ) and two interventions had a moderate quality rating (Jenkins, Dye & Foy, ; Ray et al ., ). The remaining interventions were all rated as poor based on their study design (see appendix Table S3).…”

“…Eight out of the 13 interventions were specifically designed to address the constant observation practice. The aim of these studies were to improve the quality and safety of constant observation practice (Dennis, ; Reynolds et al ., ), reduce the unnecessary use of constant observation (Dodds & Bowles ; Kettles & Paterson, ; Moran, ; Ray et al ., ), replace constant observations with another practice (Carr, ; Dodds & Bowles ; Kettles & Paterson, ; Moran, ; Ray et al ., ), monitor frequency of constant observation following a change (Jenkins, Dye & Foy, ) or reduce the cost of constant observation (Triplett et al ., ). Larger interventions were also reviewed, providing that they included attempts to improve or reduce constant observation.…”

“…The remaining studies designed their interventions by reviewing existing clinical guidelines (Kettles & Paterson, ; Reynolds et al ., ) and using author's personal experience (Moran, ). One study monitored the constant observation practice after a planned change (Jenkins, Dye & Foy, ).…”

“…Interventions were delivered by training members of staff (Bisconer, ; Bowers et al ., ; Dennis, ; James et al ., ; Kettles & Paterson, ; Reynolds et al ., ), meeting clinical teams (Moran, ) and getting approval by senior clinical staff (Ray, Perkins & Meijer, ; Ray et al ., ). The remaining studies either did not describe how interventions were delivered (Bowers et al ., , ; Carr, ; Sullivan et al ., ; Triplett et al ., ) or described a change that was already taking place at the time of the study (Jenkins, Dye & Foy, ).…”

“…Seven out of the 13 evaluated interventions could be categorized into a single component (Bisconer, ; Bowers et al ., ; Bowers et al ., ; Dennis, ; Jenkins, Dye & Foy, ; Kettles & Paterson, ; Moran, ; Triplett et al ., ), and the remaining were complex interventions with two or more components (Bowers et al ., ; Carr, ; Dodds & Bowles ; James et al ., ; Ray, Perkins & Meijer, ; Ray et al ., ; Reynolds et al ., ; Sullivan et al ., ). The most common intervention component was changes to record keeping and assessment.…”