Don't Label Me: A Qualitative Study of Patients’ Perceptions and Experiences of Sedation During Behavioral Emergencies in the Emergency Department

Yap, Celene Y.L.; Knott, Jonathan; Kong, David C M; Gerdtz, Marie; Stewart, Kay; Taylor, David

doi:10.1111/acem.13218

Cited by 15 publications

(27 citation statements)

References 25 publications

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“…That so many participants in our study chose to disclose their drug use may be indicative of positive engagement between participants and those providing care. This assertion is consistent with previous qualitative work undertaken in the BAU regarding patients' perceptions of care postsedation for behavioural disturbance in which participants consistently described a relationship of trust between themselves and ED clinicians (Yap et al, 2017).…”

Section: Discussionsupporting

confidence: 89%

“…The clinical complexity of care for this group can be due to the acute concurrent physical and behavioural effects of intoxication and the long‐term use of the substances (McKetin et al, 2018). There are significant challenges for staff and patient safety due to the high rates of violence and aggression observed among those affected by these substances in both pre‐hospital (Jones et al, 2019, 2019) and ED settings (Jones et al, 2019, 2019; Sibanda et al, 2019; Yap et al, 2017). Long‐term use of amphetamine‐type stimulants is associated with increased risk of cardiovascular disease, namely heart failure and stroke (Sliman et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Amphetamine‐type stimulant use among patients admitted to the emergency department behavioural assessment unit: Screening and referral outcomes

Gerdtz

Yap

Daniel

et al. 2020

Int J Mental Health Nurs

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Amphetamine-type stimulant use, including methamphetamine, amphetamine, and 3,4-methylenedioxymethamphetamine, is associated with a range of behavioural symptoms. Screening for amphetamine-type stimulant use among people presenting to the emergency department with behavioural disturbance and referral to treatment has not been evaluated. The objective of this study was to determine the prevalence of amphetamine-type stimulant use among patients admitted to a behavioural assessment unit and report referral outcomes. A prospective observational design was used. Individuals who tested positive or self-reported amphetamine-type stimulant use were referred to the alcohol and other drug clinician. We measured the prevalence of amphetamine-type stimulant use in saliva and by self-report along with rates of referral. The setting was a behavioural assessment unit located within an Australian emergency department. Admitted adults were enrolled from July to December 2017. Those who tested positive or selfreported amphetamine-type stimulant use were provided with harm reduction advice and offered referral. Four hundred and seventy-two tests were performed. Fifteen were excluded due to invalid results or redundant enrolment. Of the 457 individuals, 59% were male, with a mean age of 35 years (SD 13). Fifty-three (11.6%, 95% CI: 8.9-15.0) tested positive for amphetamine-type stimulants. Of those with a negative test, 44 (9.6%, 95%

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Amphetamine‐type stimulant use among patients admitted to the emergency department behavioural assessment unit: Screening and referral outcomes

Gerdtz

Yap

Daniel

et al. 2020

Int J Mental Health Nurs

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“…The earliest papers reporting patient perspectives were published in 1996, exploring perspectives of forcibly medicated patients after discharge, and retrospective attitudes of patients to involuntary intramuscular medications . The four most recent papers also investigated patient and healthworker perspectives about coercion involving CR …”

Section: Resultsmentioning

confidence: 99%

International research into 22 years of use of chemical restraint: An evidence overview

Muir‐Cochrane

Oster

Grimmer

2019

Evaluation Clinical Practice

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Background: Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non-consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others.Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice.Aims: To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995.Methods: This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures.Results: This review identified 311 relevant primary studies (21 RCTs; 46 noncontrolled experimental or prospective observational studies; 77 cross-sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross-country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). Discussion:A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non-consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non-chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research.

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“…Some consumers and nurses could not build rapport due to physical conflicts with each other. Consumers reported shouting at, abusing and threatening nurses and blaming staff for using coercive practices (Goulet & Larue 2018; Tingleff et al 2019; Yap et al 2017). Others shared feelings of unresolved anger towards staff and perceived them as bad people disliking and hating them (Ezeobele et al 2014; Wilson et al 2017).…”

Section: Methodsmentioning

confidence: 99%

“…Some consumers mentioned having pain in mechanical restraint points, sleep problems and mental health issues such as feeling of splitting from reality and memory loss during seclusion and restraint events (Ezeobele et al 2014; Hamid & Daulima 2018; Jacob et al 2017; Lanthén et al 2015; Yap et al 2017). Both consumers and nurses experienced psychological pain.…”

Section: Methodsmentioning

confidence: 99%

Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review

Hawsawi

Power

Zugai

et al. 2020

Int J Mental Health Nurs

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Seclusion and restraint are coercive practices associated with physical and psychological harm. International bodies have called for an end to these practices. However, these practices continue to be used. Elimination programmes have had some success in reducing the rates of these practices. Understanding coercive practices through the perspectives of involved individuals may facilitate a complete cessation of seclusion and restraint from the practice. Therefore, this qualitative review explored how nurses and consumers experienced seclusion and restraint events in mental health care. Five databases were searched. The search strategy resulted in the inclusion of fourteen qualitative papers. A thematic analysis was used to synthesize the findings. Six themes emerged under three main categories; shared experiences: disruption in care, disruption in the therapeutic relationship and shared negative impacts; nurses' experiences: Absence of less coercive alternatives; and consumers' experiences: overpowered, humiliated and punished. Considering these experiences during planning for seclusion and restraint prevention might facilitate more effective implementation of seclusion and restraint elimination programmes. Our findings suggested that consumers should receive recovery-oriented, trauma-informed and consumer-centred care; while nurses should be better supported through personal, professional and organizational developmental strategies. Further research should focus on investigating shared interventions among consumers and nurses and exploring carers' experiences with coercive practices.

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Don't Label Me: A Qualitative Study of Patients’ Perceptions and Experiences of Sedation During Behavioral Emergencies in the Emergency Department

Cited by 15 publications

References 25 publications

Amphetamine‐type stimulant use among patients admitted to the emergency department behavioural assessment unit: Screening and referral outcomes

Amphetamine‐type stimulant use among patients admitted to the emergency department behavioural assessment unit: Screening and referral outcomes

International research into 22 years of use of chemical restraint: An evidence overview

Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review

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