Do improved structural surroundings reduce restrictive practices in psychiatry?

Harpøth, A.J.; Kennedy, Harry G; Terkildsen, Morten Deleuran; Nørremark, Bettina; Carlsen, Anders Helles; Sørensen, Lambert K.

doi:10.1186/s13033-022-00562-7

Cited by 3 publications

(1 citation statement)

References 42 publications

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“…In forensic mental health, seclusion may be seen as a necessary intervention to ensure the safety of the individual patient, other patients in the ward and the forensic mental health staff (Harpøth et al., 2022; Kennedy et al., 2020). Patients in forensic mental health wards are often admitted for extended periods (Uhrskov Sørensen et al., 2020), making their social life and care and treatment regime highly dependent on strong patient–staff relations.…”

Section: Discussionmentioning

confidence: 99%

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

Shetty,

Burke,

Timmons

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Nurses‘ observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient‐staff relations. What the paper adds to existing knowledge? We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses‘ presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. What are the implications for practice? The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients‘ unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient‘s preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two‐way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient‘s presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co‐produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients‘ privacy. AbstractIntroductionA lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study.AimThe aim of the study was to explore patients’ experience of different methods of observation used while the patient was in seclusion.MethodA retrospective phenomenological approach, using semi‐structured interviews, ten patients’ experiences of being observed in the seclusion room was investigated. Colaizzi’s descriptive phenomenological method was followed to analyse the data.ResultsCommunicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion.DiscussionThe mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation.Implications for PracticeDifferent observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.

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Section: Discussionmentioning

confidence: 99%

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

Shetty,

Burke,

Timmons

et al. 2023

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

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Space for youth mental health—coercive measure use before and after architectural innovation at a department of child and adolescent psychiatry

Czernin,

Bründlmayer,

Baumgartner

et al. 2023

Child Adoles Ment Health

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BackgroundInfluence of architectural features in child and adolescent psychiatric wards on coercive measure use has not been investigated so far. We aimed to assess the effect of altering the physical environment of an adolescent psychiatric inpatient unit on the proportion and frequency of adolescents experiencing mechanical coercive measures.MethodIn a naturalistic observational design, coercive measures were compared before and after an architectural intervention facilitated by rebuilding a child and adolescent psychiatric department in October 2020. Age, gender, length of stay, main psychiatric diagnosis and indices of coercion in n = 782 admissions to inpatient child and adolescent psychiatry from April 2019 to April 2022 were extracted. Group comparisons were performed using chi‐squared tests for categorical and Mann–Whitney U‐tests for numerical variables.ResultsAfter structural modernization which included amplifying space and with the newly introduced availability of seclusion rooms, significantly fewer patients were affected by mechanical restraint (8.1% vs. 13.7%, p = .013). Rate of seclusion increased to 5.0% (vs. 0%, p < .001). Rate of seclusion and/or restraint decreased from 13.7% to 11.8% (p = .425). The median cumulative duration of all coercive measures per affected case decreased significantly (2.8 vs. 5.4 h, p = .005), as well as its proportion to length of stay (0.8% vs. 2.8%, p = .006).ConclusionsModernisation and restructuring of buildings hosting psychiatric departments can contribute to a reduction of coercive measures in child and adolescent psychiatric units.

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The impact of psychiatric facility design on reducing aggressive behaviours in an adult population: a narrative literature review

Grynevych,

Hew,

Olver

2024

Australas Psychiatry

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Objectives This review examines the literature to determine whether physical design features of psychiatric facilities can help reduce aggressive behaviours in an adult patient population. Methods Using PRISMA’s methodology, we conducted a narrative review of peer-reviewed primary studies on the physical design features and aggressive behaviours in psychiatric facilities. The Joanna Briggs Institute’s (JBI) critical appraisal tool was used to assess the quality of included studies. Results A total of eight studies were identified. The findings revealed underlying themes in physical design efforts to reduce the incidences of aggressive behaviours, which included changes in structural design (e.g. single rooms; visiting/living/recreational areas; views of outdoors/nature; and uncrowded spaces) and changes in interior design (e.g. art and home-like/comforting environment). There were varying measures of patient aggression. Conclusions There was mixed evidence that superficial or structural design changes to psychiatric wards reduced patient aggression. Some studies found reduced aggression; others found no changes, while one study found increased aggression following the implementation of physical design changes. The methodological limitations of the available studies made it difficult to draw causative links and further research on the topic is needed.

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Do improved structural surroundings reduce restrictive practices in psychiatry?

Cited by 3 publications

References 42 publications

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

Space for youth mental health—coercive measure use before and after architectural innovation at a department of child and adolescent psychiatry

The impact of psychiatric facility design on reducing aggressive behaviours in an adult population: a narrative literature review

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