Seasonal variation of hospital violence, seclusion and restraint in a forensic psychiatric hospital

Kuivalainen, Satu; Vehviläinen‐Julkunen, Katri; Louheranta, Olavi; Putkonen, Anu; Repo-Tiihonen, Eila; Tiihonen, Jari

doi:10.1016/j.ijlp.2017.05.004

Cited by 13 publications

(15 citation statements)

References 31 publications

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“…Researchers typically have focused on the impact of individual meteorological elements or biometeorological indicators on various types of mental disorders or their seasonal variations [2,16,30,45]. Few researchers studying diseases of the nervous system have investigated the cumulative effect of elements over a given area (pressure systems with directions of specific air masses and the presence of weather fronts).…”

Section: Discussionmentioning

confidence: 99%

“…More psychiatric visits occurred in Spain by patients with psychiatric histories and more inwardly and outwardly violent behavior, and who required greater use of restraints during hot temperatures, but no differences in the number of psychiatric emergencies or new admissions in psychiatry emergency departments were found [29]. In Finland, the least aggressive behavior was found among patients in winter [30].…”

Section: Introductionmentioning

confidence: 99%

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Weather and Aggressive Behavior among Patients in Psychiatric Hospitals—An Exploratory Study

Lickiewicz

Piotrowicz

Hughes

et al. 2020

IJERPH

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Background: The number of meteoropaths, or people negatively affected by weather conditions, is rising dramatically. Meteoropathy is developing rapidly due to ever poorer adaptations of people to changes in weather conditions. Strong weather stimuli may not only exacerbate symptoms in people with diseases of the cardiovascular and respiratory systems but may also induce aggressive behavior. Researchers have shown that patients suffering from mental illnesses are most vulnerable to changes in the weather and postulate a connection between the seasons and aggressive behavior. Methods: The goal of the study was to analyze the relationship between coercive measures and weather factors. The researchers identified what meteorological conditions prevailed on days with an increased number of incidents of aggressive behavior leading to the use of physical coercion towards patients in a psychiatric hospital in Poland. In order to determine the impact of weather conditions on the frequency at which physical coercion measures were used, the hospital’s “coercion sheets” from 1 January 2015 to 31 March 2017 were analyzed. The data were correlated with meteorological data. In order to determine the relationship between the occurrence of specific weather conditions and the number of coercive interventions (N), researchers utilized Spearman’s rank correlation analysis together with two-dimensional scatter diagrams (dependency models), multiple regression, stepwise regression, frequencies, and conditional probability (%). Results: Lower barometric pressure and foehn wind increased aggressive behavior in patients that led to coercive measures. For temperature (positive correlation) and humidity (negative correlation), there was a poor but statistically significant correlation. Conclusions: Monitoring weather conditions might be useful in predicting and preventing aggression by patients who are susceptible to weather changes

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Weather and Aggressive Behavior among Patients in Psychiatric Hospitals—An Exploratory Study

Lickiewicz

Piotrowicz

Hughes

et al. 2020

IJERPH

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“…Self-harm presents a serious challenge to providers of inpatient mental health services. Its occurrence precedes a sizeable proportion of the use of coercive techniques in these settings (Kuivalainen et al 2017;. There is little evidence that those techniques are effective in reducing self-harm and they may actually be counterproductive.…”

Section: Discussionmentioning

confidence: 99%

Coercive containment measures for the management of self‐cutting versus general disturbed behaviour: Differences in use and attitudes among mental health nursing staff

Dickens

Hosie

2022

Int J Mental Health Nurs

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Self-harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self-harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self-cutting management compared with for disturbed behaviours in general using a cross-sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self-cutting management. Respondents disapproved of using each coercive measure for self-cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self-cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self-cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self-harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative.

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“…Both patients and staff verbalize feelings of distress, fear, anger, anxiety, and frustration (Kinner et al 2017;Wilson et al 2017). In fact, many direct and indirect physical injuries, such as lung disease, lacerations, asphyxiation, and even sudden death, have been reported (Di Lorenzo et al 2014;Kuivalainen et al 2017). In addition, the use of mechanical restraint compromises the therapeutic relationship and the establishment of trust between nurses and patients experiencing these restrictive practices (McKeown et al 2020).…”

Section: Introductionmentioning

confidence: 99%

“…Nurses use verbal de-escalation to help patients manage violent behaviour and redirect them to calm down without confrontation or provocation (Berring et al 2016) and favour a better relationship between the staff and the patient, together with a solidification of the therapeutic alliance (Fern andez-Costa et al 2020;Mavandadi et al 2016). Numerous studies have demonstrated the benefits of managing violent situations or agitated patients by means of verbal de-escalation techniques (Berring et al 2016;Cusack et al 2016;Fern andez-Costa et al 2020;Garriga et al 2016;Hallett & Dickens 2015, 2017Jury et al 2019;Kuivalainen et al 2017;Lavelle et al 2016;Mavandadi et al 2016;McKeown et al 2019;Price et al 2015Price et al , 2018Richmond et al 2012). In addition to the reduced intervention time, other authors have described the following benefits: (i) avoiding violence and preventing harm without having to resort to mechanical restraint or isolation (Fern andez-Costa et al 2020;Jury et al 2019), (ii) verbal de-escalation helps nurses develop better relationships with their patients (Garriga et al 2016), increasing self-esteem, and job satisfaction (Cowin et al 2004;De Berardis et al 2020;Price et al 2018), (iii) verbal de-escalation is less time-consuming than the process of mechanical restraint and involuntary medication (Richmond et al 2012).…”

Section: Introductionmentioning

confidence: 99%

Relationship between nurses' use of verbal de‐escalation and mechanical restraint in acute inpatient mental health care: a retrospective study

Pérez‐Toribio

Poyato

Lluch‐Canut

et al. 2021

Int J Mental Health Nurs

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Although the use of verbal de-escalation in nursing has been shown to be an effective tool for controlling agitation and avoiding mechanical restraint, there is scarce evidence supporting the use of de-escalation by nurses and factors related to the patients who ultimately receive mechanical restraint. This retrospective study sought to examine the relationship between the use of verbal de-escalation by nurses and the clinical profile of patients who had received mechanical restraint at an acute mental health unit. This study analysed the records of patients who had received mechanical restraint between the years 2012 and 2019. A bivariate analysis was initially performed, followed by multiple logistic regression analysis. A total of 493 episodes of restraint were recorded. Of these, in almost 40% of cases, no prior use of verbal de-escalation was noted. The factors associated with the use of verbal de-escalation by nurses were patients with a history of restraint episodes and patients who previously had been administered medication. Furthermore, episodes of mechanical restraint that occurred later during the admission were also associated with the use of de-escalation. These findings confirm the relevance of early nurse interventions. Consequently, it is important to establish an adequate therapeutic relationship from

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Seasonal variation of hospital violence, seclusion and restraint in a forensic psychiatric hospital

Cited by 13 publications

References 31 publications

Weather and Aggressive Behavior among Patients in Psychiatric Hospitals—An Exploratory Study

Weather and Aggressive Behavior among Patients in Psychiatric Hospitals—An Exploratory Study

Coercive containment measures for the management of self‐cutting versus general disturbed behaviour: Differences in use and attitudes among mental health nursing staff

Relationship between nurses' use of verbal de‐escalation and mechanical restraint in acute inpatient mental health care: a retrospective study

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