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

Reen, Gurpreet; Bailey, Jill; Maughan, Daniel; Vincent, Charles

doi:10.1111/inm.12696

Cited by 11 publications

(13 citation statements)

References 71 publications

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“…Fourthly, there was bias in the literature towards examining only a small number of the various types of CP, specifically, seclusion and physical or mechanical restraint. Thus, there remains a gap in the literature regarding a large array of other CP including some of the most prevalent CP such as enhanced or constant observations, where one or more nurses observes a patient constantly (Reen et al, 2020). This is critical as often these less tangible practices have a substantial impact on both patients and staff.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review

Beames

Onwumere

2021

Psychiatric Ment Health Nurs

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What is known on the subject?• Coercive practices such as restraint (physically holding a person) or seclusion (containing a person in locked room) are frequently used in mental health care.• How often and which specific practices are used is not consistent across different healthcare systems, hospitals or wards.• Internationally, there is agreement on the need to monitor and reduce the use of coercive practices. What this paper adds to existing knowledge?• The reviewed evidence suggests a number of different factors affect a person's risk of experiencing coercive practices, while admitted to a mental health ward.• However, there is currently not enough high-quality research evidence to say which factors are most important or how they work to influence the likelihood of a person experiencing coercive practice. What are the implications for practice?• When carrying out risk assessments, mental health professionals must take into account that a number of different factors are important and explore these with the patient.• Care plans aimed at minimizing the use of coercive practices, such as restraint, must be personalized and developed with the individual.

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review

Beames

Onwumere

2021

Psychiatric Ment Health Nurs

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“…Previous interventions that have made environmental changes to adolescent inpatient settings have either focused on long-term systemic changes with staff training as a main component [ 51 , 52 ] or have made immediate changes on the ward alongside introducing psychosocial therapies [ 43 , 44 ]. This includes a recent study which introduced leisure activities for patients on the inpatient ward similar to those introduced in the present study, but in conjunction with an extensive DBT programme [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

“…Another intervention, consisting of ten best practices for staff to communicate with inpatients, also showed a significant reduction in self-harming behaviours [ 50 ]. However, these and other similar interventions have been conducted on adult inpatient settings [ 49 – 51 ] and have not always been replicated [ 52 ]. A much larger intervention conducted over 5 years on an adolescent psychiatric unit significantly reduced self-harm by training staff to improve communication with adolescents on the ward and by improving responses to maladaptive patient behaviours [ 53 ].…”

Section: Introductionmentioning

confidence: 99%

Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis

Reen

Bailey

McGuigan

et al. 2020

Eur Child Adolesc Psychiatry

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Existing interventions to reduce self-harm in adolescents admitted to psychiatric wards are usually focused on individual psychological treatments. However, the immediate ward environment in which treatment takes place is an important factor in the success of the treatment and can also influence the likelihood of self-harming behaviours. The aim of the current study was to evaluate changes made to a psychiatric ward environment on incidence of self-harm in adolescents. A quasi-experimental interrupted time series study was conducted on one child and adolescent psychiatric ward. An intervention was developed alongside staff and patients to address the high incidence of self-harm on weekday evenings on the ward. The intervention components involved adding a regular twilight shift (3-11 pm) for nursing staff and introducing a structured evening activity programme on the ward. A segmented regression analysis of an interrupted time series found that the rate of self-harm per 100 bed days was already declining at baseline and continued to decline post-intervention, but the rate of decline was not significant (p = 0.415). However, the proportion of patients self-harming was increasing at baseline and significantly reduced post-intervention (p = 0.001), and this reduction was significantly larger in the evenings (p = 0.004) compared to other times of day (p = 0.09). A tailored intervention targeting the psychiatric ward environment helped to reduce the proportion of adolescents self-harming on the ward. An interrupted time series analysis should be considered for future interventions making changes to health systems over time.

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“…Observation is, however, potentially distressing and personally invasive for patients, burdensome and time-consuming for staff and can still result in death by suicide for the patient. 29 , 30 …”

Section: Self-harm On Wardsmentioning

confidence: 99%

“… 42 , 43 These wider causes and influences can also be addressed in social and organisational interventions such as adjusting staff rotas to cover high-risk periods and providing additional interests and social activities. 29 Such interventions, in the context of an in-patient environment, have the advantages of a relatively immediate impact, providing a more positive atmosphere for both patients and staff and potentially reducing the need for observation, restraint and seclusion.…”

Section: Reducing Self-harm On Psychiatric Wardsmentioning

confidence: 99%

Interventions to reduce self-harm on in-patient wards: systematic review

et al. 2021

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Background Incidents of self-harm are common on psychiatric wards. There are a wide variety of therapeutic, social and environmental interventions that have shown some promise in reducing self-harm in in-patient settings, but there is no consensus on the most appropriate means of reducing and managing self-harm during in-patient admissions. Aims To review interventions used to reduce self-harm and suicide attempts on adolescent and adult psychiatric in-patient wards. Method A systematic literature search was conducted between 14 March 2019 and 25 January 2021 using PsycINFO and Medline (PROSPERO ID: CRD42019129046). A total of 23 papers were identified for full review. Results Interventions fell into two categories, therapeutic interventions given to individual patients and organisational interventions aimed at improving patient–staff communication and the overall ward milieu. Dialectical behaviour therapy was the most frequently implemented and effective therapeutic intervention, with seven of eight studies showing some benefit. Three of the six ward-based interventions reduced self-harm. Two studies that used a combined therapeutic and ward-based approach significantly reduced self-harm on the wards. The quality of the studies was highly variable, and some interventions were poorly described. There was no indication of harmful impact of any of the approaches reported in this review. Conclusions A number of approaches show some promise in reducing self-harm, but the evidence is not strong enough to recommend any particular approach. Current evidence remains weak overall but provides a foundation for a more robust programme of research aimed at providing a more substantial evidence base for this neglected problem on wards.

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

Cited by 11 publications

References 71 publications

Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review

Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review

Environmental changes to reduce self-harm on an adolescent inpatient psychiatric ward: an interrupted time series analysis

Interventions to reduce self-harm on in-patient wards: systematic review

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