Seclusion and restraint are regularly used to manage patient aggression events in psychiatric inpatient care, despite occupational safety concerns. There is currently a lack of information on how nurses perceive the use of patient seclusion and restraint as a risk for occupational safety. The aim of this study is to describe the risks for occupational hazards in patient seclusion and mechanical restraint practices as well as ideas for improvement identified by nurses. A qualitative descriptive design was adopted, using focus groups comprising nurses (N = 32) working in psychiatric inpatient care. The data were analysed using inductive content analysis, and the results were reported using the consolidated criteria for reporting qualitative studies (COREQ). Four themes of risk for occupational hazards were identified: patient‐induced, staff‐induced, organization‐induced, and environment‐induced risks. One significant finding was that nurses described that their actions can strongly contribute to occupational hazards during seclusion and mechanical restraint practices. The nurses gave various ideas for how occupational safety could be improved during seclusion and mechanical restraint events, ideas involving staff, the organization, and environmental enhancements.

Accessible Summary What is known on the subject? Coercive measures such as seclusion are used to maintain the safety of patients and others in psychiatric care. The use of coercive measures can lead to harm among patients and staff. What the paper adds to existing knowledge? This study is the first of its kind to rely on video observation to expose safety hazards in seclusion events that have not been reported previously in the literature. The actions that both patients and staff take during seclusion events can result in various safety hazards. Implications for practice? Constant monitoring of patients during seclusion is important for identifying safety hazards and intervening to prevent harm. Nursing staff who use seclusion need to be aware of how their actions can contribute to safety hazards and how they can minimize their potential for harm Abstract IntroductionSeclusion is used to maintain safety in psychiatric care. There is still a lack of knowledge on potential safety hazards related to seclusion practices. AimTo identify safety hazards that might jeopardize the safety of patients and staff in seclusion events in psychiatric hospital care. MethodA descriptive design with non‐participant video observation was used. The data consisted of 36 video recordings, analysed with inductive thematic analysis. ResultsSafety hazards were related to patient and staff actions. Patient actions included aggressive behaviour, precarious movements, escaping, falling, contamination and preventing visibility. Staff actions included leaving hazardous items in a seclusion room, unsafe administration of medication, unsecured use of restraints and precarious movements and postures. DiscussionThis is the first observational study to identify safety hazards in seclusion, which may jeopardize the safety of patients and staff. These hazards were related to the actions of patients and staff. Implications for PracticeBeing better aware of possible safety hazards could help prevent adverse events during patient seclusion events. It is therefore necessary that nursing staff are aware of how their actions might impact their safety and the safety of the patients. Video observation is a useful method for identifying safety hazards. However, its use requires effort to safeguard the privacy and confidentiality of those included in the videos.

Accessible Summary What is known on the subject? Communication between nurses and patients is essential in mental health nursing. Lack of communication during seclusion causes dissatisfaction among patients. Coercive practices can cause psychological discomfort for patients and staff members. Research related to nurses' perceptions of nurse–patient communication during seclusion events is scant. In Finland, the use of coercive practices has been high despite efforts to reduce the need for coercive practices through the National Mental Health Policy since 2009. Nurse–patient communication is referred to in the Safewards model as one issue of delivering high‐quality care. What this paper adds to existing knowledge? Nurses aim to achieve high‐quality communication while treating patients in seclusion. Nurses aim to communicate in a way that is more patient‐centred. Various issues affect the quality of communication, such as nurses' professional behaviour and patients' state of health. What are the implications for practice? Improved communication between nurses and patients will support therapeutic relationships and could lead to a better quality of care. Nurses' enhanced communication may promote the use of noncoercive practices more frequently in psychiatric settings. Improving nurses' communication skills may help support the dignity and autonomy of secluded patients, resulting in patient experiences that are more positive in relation to care offered in seclusion. Nurses should be offered opportunities to take part in further training after education to enhance communication skills for demanding care situations. Further research that incorporates the perspectives of patients and those with lived experience of mental health problems is needed. Components of evidence‐based Safewards practices, such as using respectful and individual communication (Soft Words), could be relevant when developing nurse–patient communication in seclusion events. Abstract Introduction Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse–patient communication is highlighted. However, research related to nurses' perceptions of nurse–patient communication during seclusion is scant. Aim The aim of this study was to describe nurses' perceptions of nurse–patient communication during patient seclusion and the ways nurse–patient communication can be improved. Method A qualitative study design using focus group interviews was adopted. Thirty‐two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. Results Nurses aimed to communicate in a patient‐centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. Discussion Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communica...

Patient aggressive behaviour remains a significant public health concern worldwide. The use of restraint and seclusion remains a last resort but not an uncommon practice in clinical psychiatry in the management of aggressive events. There seems to be a paucity of evidenced‐based research examining the policy framework guiding the use of restraint and seclusion in Asia contexts. The purpose of this study was to conduct an analysis on the guidelines in psychiatric hospitals in Hong Kong, and to explore the extent to which these guidelines were aligned with the international clinical guidelines for the prevention and management of patient aggression in psychiatry. A descriptive document analysis was used to analyse the guidelines from four psychiatric hospitals in Hong Kong in comparison with the NICE (National Institute of Health and Care Excellence UK) guidelines. Data were collected from December 2017 to June 2018. A total of 91 written documents were retrieved. Preventing violence and aggression has the highest level of agreement (31%,) while the use of restrictive interventions has the lowest level of agreement (12%). The sub‐recommendation with most in line with the NICE guidelines were restrictive interventions, de‐escalation, and improving service users’ experiences. However, for example, staff training, working with police, and reduced use of restrictive interventions seemed to have no agreement with the NICE guidelines. Variation exists between the Asian (Hong Kong) local policy framework/guidelines and the European (UK) national policy framework. There are also large discrepancies in the written guidelines on patient aggressive behaviour when comparing local policy frameworks, cluster‐based documents, and departmental practices.

IntroductionDespite the abundance of existing literature on evidence-based nursing practice, knowledge regarding evidence-based leadership, that is, leadership supported by an evidence-based approach, is lacking. Our aim is to conduct a mixed-methods systematic review with qualitative and quantitative studies to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurses and nurse leaders and their performance as well as on organisational and clinical outcomes.Methods and analysisWe will search the following databases with no year limit or language restrictions: CINAHL (EBSCO), Cochrane Library, Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science. In addition, the databases for prospectively registered trials and other systematic reviews will be screened. We will include articles using any type of research design as long as the study includes a component of an evidence-based leadership approach. Three reviewers will independently screen all titles, abstracts and full-text articles and two reviewers will extract the data according to the appropriate checklists. The quality of each study will be appraised using specific appraisal tool fitting in study design used in each study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) grid, PRISMA Protocols, Synthesis Without Meta-analysis and ENTREQ will guide the study process and reporting. Outcomes related to individual or group performance of nurses or nurse managers regarding leadership skills (e.g., communication skills), organisational outcomes (e.g., work environment, costs) and clinical outcomes (e.g., patient quality of life, treatment satisfaction) will be extracted and synthesised.Ethics and disseminationThis systematic review will not include empirical data, and therefore, ethics approval will not be sought. The results of the review will be disseminated in a peer-reviewed scientific journal and in a conference presentation.PROSPERO registration numberCRD42021259624.