An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals

Abstract

IMPORTANCEInvesting in health care staffs' education can change the scope of action and improve care. The effectiveness of staff education remains inconclusive. OBJECTIVE To examine whether an evidence-based educational intervention for nurses decreases the use of seclusion rooms in psychiatric hospitals compared with usual practice. DESIGN, SETTING, AND PARTICIPANTS In this pragmatic, 2-arm parallel, stratified cluster randomized clinical trial, 28 wards in 15 psychiatric hospitals in Finland were screened for eligibility and randomly allocated (1:1). Nurses joined on either intervention (n = 13) or usual practice (n = 15)

Protocols to reduce seclusion in inpatient mental health units

“…Sixteen studies, including two RCTs (Bowers, 2014; Bowers et al., 2015; Välimäki et al., 2017, 2022), two concurrent comparisons (Boumans et al., 2014; Noorthoorn et al., 2008) and 12 pre‐post studies (Blair & Moulton‐Adelman, 2015; Dickens et al., 2020; Hellerstein et al., 2007; Khadivi et al., 2004; Lewis et al., 2009; McDonagh et al., 2019; Pollard et al., 2007; Richmond et al., 1996; Stoll et al., 2022; Taxis, 2002; Whitecross et al., 2020; Zuehlke et al., 2016), evaluated comprehensive/mixed approach interventions. Comprehensive interventions were described as multicomponent and included a variety of intervention functions aimed at targeting multiple levels (e.g., hospital, staff, patients) and determinants (e.g., knowledge, capability, motivation, procedures of care [and self‐care]) to prevent aggressive behaviours and subsequent use of coercive measures.…”

“…Six reports (American Psychiatric Nurses Association; Ashcraft et al., 2012; Clement J. Zablocki VA Medical Center, 2012; Iwamasa & Czekanski, 2018a, 2018b; VA Northern California Health Care System, 2019; Wale et al., 2011) without empirical data and 14 comparative studies (Blair & Moulton‐Adelman, 2015; Boumans et al., 2014; Hellerstein et al., 2007; Khadivi et al., 2004; Lewis et al., 2009; McDonagh et al., 2019; Noorthoorn et al., 2008; Pollard et al., 2007; Richmond et al., 1996; Stoll et al., 2022; Taxis, 2002; Välimäki et al., 2022; Whitecross et al., 2020; Zuehlke et al., 2016) described comprehensive/mixed protocols using multiple intervention functions targeting both staff and patients. Most protocols included intervention functions of education and training , but the content varied between interventions.…”

“…Based on evidence from one RCT (Välimäki et al., 2017, 2022), two concurrent comparison studies (Boumans et al., 2014; Noorthoorn et al., 2008) and 11 pre‐post studies (Blair & Moulton‐Adelman, 2015; Hellerstein et al., 2007; Khadivi et al., 2004; Lewis et al., 2009; McDonagh et al., 2019; Pollard et al., 2007; Richmond et al., 1996; Stoll et al., 2022; Taxis, 2002; Whitecross et al., 2020; Zuehlke et al., 2016), episodes of seclusion, duration of seclusion, duration of restraint, episodes of composite measures of coercion, and duration of composite measures of coercion may be reduced by comprehensive/mixed interventions. There is no evidence of differences for episodes of restraints and forced medication use.…”

Recovery‐oriented mental health principles in psychiatric hospitals: How service users, family members and staff perceive the realization of practices

“…For privacy reasons in our small participant groups, no background information of the participants was collected. The characteristics of the study wards are described in more detail in articles by Lantta et al (2021) and Välimäki et al (2022). Participants were notified about the possibility to leave the interview at any time without any explanation or consequences.…”

“…The study wards in the VIOLIN project were randomly allocated into intervention and control wards. (Välimäki et al, 2022). The characteristics of the wards are described in more detail in an article by Lantta et al (2021).…”