Abstract:Aim: To more fully understand the experiences of seclusion in a learning disability service for women. Background: This paper reports on one of the analytical themes, seclusion, from an ethnographic study exploring the lives of learning disabled women on locked wards. Method: Participant observation was used on three locked wards for women in a learning disability secure (forensic) unit in the United Kingdom. Themes from the analysis of field-notes were used to construct an interview schedule. Sixteen detained… Show more
“…Fish (2018) found that incidents of aggression or self‐harm can work to keep a person longer in a unit. Importantly, a staff member here describes how good relationships can work to reduce incidents of aggression, therefore bringing about stability: Iona: My attitude towards her was very upbeat and very OK.…”
Section: Resultsmentioning
confidence: 99%
“…Drawing on our previous research, and that by Head et al, it is clear that relationships are an important factor in the well‐being of residents including their ability to move through the services and be discharged successfully into the community (Fish, 2017; Fish & Duperouzel, 2008; Fish & Morgan, 2019; Head et al, 2018). However, there are multiple challenges to the building of relationships, related to the requirement for maintaining boundaries and professionalism on behalf of staff, and self‐sufficiency on behalf of residents (Fish, 2016, 2018; Parkes & Freshwater, 2012).…”
Accessible summary
We talked to people who lived in a secure unit and their staff. We asked them about good relationships with each other. The majority of the people said that good relationships with staff can help people move back to the community and be “in a good space”.
Staff said that good relationships can stop people feeling angry. They said that they like to help people and have trust. It is important to have a good staff team who know the person well.
Residents said staff help them and listen to them when they are upset. They said they like it when staff spend time with them doing activities.
Based on what residents told us, we think it is important that services work on helping people to have good relationships. This is because these relationships were very important in helping people to move more quickly back into the community.
Please see an easier to read version here: https://wp.me/pcRSAn‐3V
Abstract
Background
Despite repeated policy initiatives, an enduring number of people with learning disabilities remain resident in secure settings (also referred to as locked wards). The spatial and emotional distance from family and friends means that relationships with staff become central to people's lives, and are critical for a successful transition to making their home in the community.
Methods
This article uses a synthesis of evidence from two qualitative studies. We re‐analysed data from fieldnotes and interview transcripts with people with learning disabilities resident in secure settings and with staff who worked with them. The purpose of the original studies was service improvement however, relationships —particularly with between staff and residents— emerged as a significant theme in both studies. Therefore, the data were revisited to explore these relationships in more depth.
Findings
The analysis identified that positive relationships with staff were critical in enabling residents to be “in a good space”—something they and staff viewed as a crucial factor for moving on. The analysis identified four main themes: (i) the characteristics of positive relationships, (ii) the challenges for positive relationships, (iii) how positive relationships can be encouraged and (iv) how positive relationships support people to move on.
Conclusion
We conclude that flattening the hierarchy between staff and residents is key when supporting people with learning disabilities to move on. We stress the importance of the “soft skills” in enabling people to transition back to their community. There is a pressing need for research with people who have made the transition from hospital to generate retrospective narratives about what elements of these relationships are most significant in supporting a successful transition.
“…Fish (2018) found that incidents of aggression or self‐harm can work to keep a person longer in a unit. Importantly, a staff member here describes how good relationships can work to reduce incidents of aggression, therefore bringing about stability: Iona: My attitude towards her was very upbeat and very OK.…”
Section: Resultsmentioning
confidence: 99%
“…Drawing on our previous research, and that by Head et al, it is clear that relationships are an important factor in the well‐being of residents including their ability to move through the services and be discharged successfully into the community (Fish, 2017; Fish & Duperouzel, 2008; Fish & Morgan, 2019; Head et al, 2018). However, there are multiple challenges to the building of relationships, related to the requirement for maintaining boundaries and professionalism on behalf of staff, and self‐sufficiency on behalf of residents (Fish, 2016, 2018; Parkes & Freshwater, 2012).…”
Accessible summary
We talked to people who lived in a secure unit and their staff. We asked them about good relationships with each other. The majority of the people said that good relationships with staff can help people move back to the community and be “in a good space”.
Staff said that good relationships can stop people feeling angry. They said that they like to help people and have trust. It is important to have a good staff team who know the person well.
Residents said staff help them and listen to them when they are upset. They said they like it when staff spend time with them doing activities.
Based on what residents told us, we think it is important that services work on helping people to have good relationships. This is because these relationships were very important in helping people to move more quickly back into the community.
Please see an easier to read version here: https://wp.me/pcRSAn‐3V
Abstract
Background
Despite repeated policy initiatives, an enduring number of people with learning disabilities remain resident in secure settings (also referred to as locked wards). The spatial and emotional distance from family and friends means that relationships with staff become central to people's lives, and are critical for a successful transition to making their home in the community.
Methods
This article uses a synthesis of evidence from two qualitative studies. We re‐analysed data from fieldnotes and interview transcripts with people with learning disabilities resident in secure settings and with staff who worked with them. The purpose of the original studies was service improvement however, relationships —particularly with between staff and residents— emerged as a significant theme in both studies. Therefore, the data were revisited to explore these relationships in more depth.
Findings
The analysis identified that positive relationships with staff were critical in enabling residents to be “in a good space”—something they and staff viewed as a crucial factor for moving on. The analysis identified four main themes: (i) the characteristics of positive relationships, (ii) the challenges for positive relationships, (iii) how positive relationships can be encouraged and (iv) how positive relationships support people to move on.
Conclusion
We conclude that flattening the hierarchy between staff and residents is key when supporting people with learning disabilities to move on. We stress the importance of the “soft skills” in enabling people to transition back to their community. There is a pressing need for research with people who have made the transition from hospital to generate retrospective narratives about what elements of these relationships are most significant in supporting a successful transition.
“…Studies explored staff,148–157 patient147 158–165 and mixed groups’166–173 views and experiences of seclusion and restraint. Nine studies focused on the processes surrounding seclusion and restraint 136 137 174–180.…”
ObjectivesPatients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.DesignSystematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to ‘mental health’, ‘patient safety’, ‘inpatient setting’ and ‘research’. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.ResultsOf the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.ConclusionsPatient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.PROSPERO registration numberCRD42016034057.
“…Østvik et al (2018) pick this theme up in the new issue, exploring how friendships between disabled children using augmentative and alternative communication and non-disabled children can be facilitated or inhibited in mainstream primary school settings. The problems of institutional segregation to lack of opportunities for privacy (Fish, 2018), or lack of social participation and exclusion from the surrounding community (Søndenaa et al, 2018) is also present in the new issue.…”
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