An investigation into nurses' perceptions of secluding patients on closed psychiatric wards

Muir‐Cochrane, Eimear

doi:10.1111/j.1365-2648.1996.tb00019.x

Cited by 50 publications

(67 citation statements)

References 23 publications

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“…The nurses provided a compelling account of the polarized differences in philosophy of care amongst the nurses, exemplified in the differences between therapeutic philosophy and a philosophy of 'zero tolerance' and forced early intervention using security staff. The findings in this study are consistent with the literature on ethical problems experienced by mental health nurses in acute facilities, that is, the conflict between ethical behaviour and adherence to the dominant culture (Duffy 1995;Fisher 1995;Muir-Cochrane 1996).…”

Section: Discussionsupporting

confidence: 93%

“…The literature documents the overzealous use of seclusion in acute mental health nursing (Gijbels 1995;Sullivan 1998a). The patients in this study identified the need for therapeutic interventions to prevent seclusion and the value of such intervention is well documented in the literature (Muir-Cochrane & Harrison 1996;Muir-Cochrane 1996).…”

Section: Discussionmentioning

confidence: 98%

“…Many studies have suggested that an organizational ideology that emphasizes control and restraint, which is the case in many closed wards (Muir-Cochrane & Harrison 1996;Muir-Cochrane 1996) or hospital rules, and practices that disregard patients' autonomy, will undermine the therapeutic value of care and create ethical dilemmas for nurses (Lutzen 1990;MuirCochrane & Holmes 2001;Sullivan 1998b).…”

Section: Ethical Decision-making Processesmentioning

confidence: 98%

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Mental health nursing practice in acute psychiatric close‐observation areas

O’Brien

Cole

2004

Int J Mental Health Nurs

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The provision of evidence-based therapeutic nursing care in close-observation units or psychiatric intensive care units, has been identified as a problem internationally. These areas of nursing practice have been the subject of considerable discussion particularly in relation to the management of aggression, violence, involuntary treatment, and seclusion. This study used a participatory action research framework to identify qualitative and quantitative measures of activity in the area. Quantitative data collected included rates of critical incidents, the use of prn medication, and the use of seclusion. These data were used as base-line data and were predicted as a measure of change. Qualitative data, collected by interview and focus groups, were used to reveal the experience of patients, relatives, and nurses in a close-observation area. Analysis of this data revealed three main themes: design and environment, lack of activity and structured time, and nursing care. The importance of this study is in demonstrating the multiple problems that exist in the provision of care in close-observation areas and the corresponding need for fundamental changes.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 98%

Section: Ethical Decision-making Processesmentioning

confidence: 98%

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Mental health nursing practice in acute psychiatric close‐observation areas

O’Brien

Cole

2004

Int J Mental Health Nurs

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“…Contemporary understandings of the humanitarian, ethical, and legal issues associated with the use of containment methods attempt to balance the need for staff to protect the therapeutic milieu of the ward; a utilitarian ethic of the greatest good for the greatest number; and the rights of the individual, who is acutely disturbed, to the least restrictive environment (Muir-Cochrane, 1996).…”

mentioning

confidence: 99%

Patients Subject to High Levels of Coercion: Staff's Understanding

Bowers

Wright

Stewart

2014

Issues in Mental Health Nursing

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Measures to keep staff and patients safe (containment) frequently involve coercion. A small proportion of patients is subject to a large proportion of containment use. To reduce the use of containment, we need a better understanding of the circumstances in which it is used and the understandings of patients and staff. Two sweeps were made of all the wards, spread over four hospital sites, in one large London mental health organization to identify patients who had been subject to high levels of containment in the previous two weeks. Data were then extracted from their case notes about their past history, current problem behaviours, and how they were understood by the patients involved and the staff. Nurses and consultant psychiatrists were interviewed to supplement the information from the case records. Twenty-six heterogeneous patients were identified, with many ages, genders, diagnoses, and psychiatric specialities represented. The main problem behaviours giving rise to containment use were violence and self-harm. The roots of the problem behaviours were to be found in severe psychiatric symptoms, cognitive difficulties, personality traits, and the implementation of the internal structure of the ward by staff. Staff's range and depth of understandings was limited and did not include functional analysis, defence mechanisms, specific cognitive assessment, and other potential frameworks. There is a need for more in-depth assessment and understanding of patients' problems, which may lead to additional ways to reduce containment use.

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“…In addition, after making their complaints, patients may be afraid of impaired quality of care, or of retribution 19. Moreover, attitudes towards the complaint process may be pessimistic because of unbalanced power structures between staff and patients 20 21. In Finland, mental health patients’ complaints rarely lead to consequences 22.…”

mentioning

confidence: 99%

Patient complaints in Finland 2000–2004: a retrospective register study

et al. 2008

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Today, monitoring of patient complaints in healthcare services is being used as a tool for quality assurance systems and in the future development of services. This nationwide register study describes the number of all complaints processed, number of complaints between different state provinces, healthcare services and healthcare professionals, and outcomes of complaints in Finland during the period 2000-2004. All complaints processed at the State Provincial Offices and the National Authority for Medicolegal Affairs were analysed by statistical methods. Complaints about mental healthcare were explored in greater detail. The analysis showed that the number of patient complaints increased considerably during the study period. There were changes in the number of complaints between study years in different provinces. Out of different healthcare services, an especially marked increase was seen in private healthcare. Nearly all complaints were lodged against physicians, and over half of the complaints were made because of medical error. In mental health care, patients more often complained about unsatisfactory certificates and statements and the use of compulsory hospital care. An analysis of the outcomes revealed that in mental health care complaints more seldom led to consequences. The results need to be utilised when planning interventions for advanced supervision, prevention of adverse events and patient safety in healthcare, and especially in mental health care. From the patients' perspective, it is important to create a culture where most problem situations are handled where the treatment was provided, thus avoiding a complex complaints process.

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An investigation into nurses' perceptions of secluding patients on closed psychiatric wards

Cited by 50 publications

References 23 publications

Mental health nursing practice in acute psychiatric close‐observation areas

Mental health nursing practice in acute psychiatric close‐observation areas

Patients Subject to High Levels of Coercion: Staff's Understanding

Patient complaints in Finland 2000–2004: a retrospective register study

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