Factors influencing seclusion rates in an adult psychiatric intensive care unit

Abstract

Seclusion of psychiatric inpatients is used as a last resort in managing disturbed behaviour. Research on factors contributing to its use is limited. The aim of this study was to examine the effect of a change in unit size and other variables, such as time of day and nursing workload, on the rates of use of seclusion in an intensive care inpatient psychiatric unit. Rates of seclusion were examined in randomly selected nursing shifts across three time periods; one before and two after a change in the size of the unit. Effects on seclusion rates of size, shift and four nursing workforce variables were explored using multivariate analysis. Unit size, shift and nurse hours together explained 23% of the variance in seclusion use. Of particular significance was the change from a 20 bed unit to two separate 10 bed units. The findings have implications for the organisation of inpatient psychiatric units. Smaller units may allow better management of disturbed behaviour.

Nurses' decision on seclusion: patient characteristics, contextual factors and reflexivity in teams

“…We did not find any relation of nurse characteristics like gender, age, years of experience with and frequency of participation in seclusion with the tendency to seclude, which is in accordance with some publications (Nijman et al 1994, O'Malley et al 2007) but at odds with some other (Wynaden et al 2002, Whittington et al 2009). The findings of Mann-Poll et al (2011) that rater characteristics explained 32% of the judgement on necessity to seclude were not reproduced in the current study, which can be partly explained by differences in the study design and population: three of the rater characteristics of Mann-Poll (education, type of care and institute) were no part of the design of the current study, in which all participants were nurses of more or less comparable teams of the same hospital.…”

“…We did not find any relation of nurse characteristics like gender, age, years of experience with and frequency of participation in seclusion with the tendency to seclude, which is in accordance with some publications (Nijman et al . 1994, O'Malley et al . 2007) but at odds with some other (Wynaden et al .…”

Six years of national mental health seclusion data: the Australian experience

“…However substantial variation among individual services remains and is likely to reflect factors including the consumer and case-mix, 12 clinical practice, leadership, staff views and culture. 13–15 This variation has been seen in other recently published studies of individual Australian mental health services. 16–21 High seclusion rates have been reported in child and adolescent services in Australia, the United States and Europe, 17,18,22 and largely attributed to individual child and family characteristics.…”

Nurse and patient factors: Predicting seclusion in adolescent psychiatric units

“…While nurse‐factors have been associated with increased and decreased risk of seclusion, the sparse research shows equivocal findings and is primarily done in adult psychiatric populations. These include greater variability in mental health experience between nurses predicting less seclusion, but also nurse‐experience showing no relationship to seclusion outcomes (Doedens et al, 2017; Janssen et al, 2007; O'Malley et al, 2008). A greater number of male nurses predict more seclusions (Bowers et al, 2010; Morrison & Lehane, 1995) but less seclusions in other studies (Janssen et al, 2007; O'Malley et al, 2008).…”