Nursing staff composition and its influence on seclusion in an adult forensic mental health inpatient setting: The truth about numbers

Barr, Lesley; Heslop, Karen; Wynaden, Dianne; Albrecht, Matthew A.

doi:10.1016/j.apnu.2022.09.011

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…Such an approach might be easier to achieve with master‐level education in mental health nursing and could be helpful when striving to reduce the use of coercive measures. In line with Barr et al (2022), we argue that senior RNs with master‐level education in mental health nursing, as leaders of care, can convey feelings of safety and confidence when dealing with challenging situations. Furthermore, the presence of such RNs can guide the team to engage and perform early nursing interventions that could mean reduced use of coercive measures in FPIC.…”

Section: Discussionsupporting

confidence: 84%

Struggling with unnecessary suffering—Registered nurses' experiences of delayed decisions on treatment without consent in forensic psychiatric inpatient care

Antonsson,

Dahliavy,

Mouline

et al. 2023

Int J Mental Health Nurs

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Chemical restraints are used in forensic psychiatric inpatient care, however with caution as it can feel like an assault against patients' integrity. When waiting for decisions on treatment without consent, nursing staff are expected to care for patients with severe mental ill‐health without the use of medical treatment, often with a feeling of already having tried all other available means. Knowledge about how registered nurses experience such situations is sparse but could contribute to the development of both teamwork and nursing approaches that could mean reduced suffering for patients. The aim of this study was to describe registered nurses' experiences of delayed decisions on treatment without consent in forensic psychiatric inpatient care. Eleven semi‐structured interviews were conducted with registered nurses working in forensic psychiatric units in Sweden. Data were analysed through qualitative content analysis. The result showed that experiences of treatment without consent were about striving to protect patients from harm, striving for collaboration during difficult circumstances and striving to do good. This was interpreted as a struggle with unnecessary suffering. For registered nurses to be able to handle such challenging situations and relieve suffering for patients, experience and master‐level education in mental health nursing are highlighted. Another aspect that is highlighted is the importance of having consultants familiar with the circumstances at the unit. A method for joint reflection is suggested, to promote an open‐minded work culture with a well‐functioning decision‐making process and ensure that both consultants and nursing staff have support.

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Section: Discussionsupporting

confidence: 84%

Struggling with unnecessary suffering—Registered nurses' experiences of delayed decisions on treatment without consent in forensic psychiatric inpatient care

Antonsson,

Dahliavy,

Mouline

et al. 2023

Int J Mental Health Nurs

View full text Add to dashboard Cite

show abstract

“…While the association is plausible, other mechanisms due to patient acuity/characteristics cannot be discounted. A further study considered the number of staf working overtime per shift in relation to seclusion incidents in a forensic setting, but no data on staf total worked hours per shift were available [31]. Another study focused on compliance with vital sign observation protocols.…”

Section: Introductionmentioning

confidence: 99%

Nursing 12-Hour Shifts and Patient Incidents in Mental Health and Community Hospitals: A Longitudinal Study Using Routinely Collected Data

Dall’Ora,

Ejebu,

Jones

et al. 2023

Journal of Nursing Management

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Shifts of 12 hours or longer are common in nursing services within general hospital wards. Concerns have been raised about their safety, but previous research has mostly used staff-reported measures of quality and safety and has occurred in general hospital settings only. This study aims to measure the association between the use of 12+ hour shifts in nursing staff (including registered nurses, healthcare support workers or nursing assistants, and nursing associates) and the rate of patient incidents in mental health and community hospitals. This is a longitudinal study using routinely collected data from two mental health and community NHS trusts in the South of England. We accessed rosters of nursing staff and patient incident data from April 2018 to March 2021. We extracted 1,018,971 shifts and excluded those not worked by nursing staff, with a final sample of 898,143 shifts. We extracted 53,078 incidents. We only included incidents that involved patients and that occurred in wards. Our final sample consisted of 38,373 patient incidents. We linked all patient incidents and nurses’ worked shifts at the ward-day level. Depending on the distribution of incident rates, we used either negative binomial mixed-effects models or Poisson mixed-effect models to investigate the association between the proportion of 12+ hour shifts and all patient incidents, violence against staff, falls, self-injury, disruptive behaviour, and medication management incidents at the ward-day level. We found a relationship between 12+ hour shifts and the incident rate. Compared to days in wards with no long shifts, increasing the proportion of long shifts was initially associated with a small increase in the overall rate of incidents, but the rate increased sharply as the proportion of long shifts was above 70%. Rates of self-injury increased more steadily as the proportion of long shifts increased. The mandatory implementation of long shifts should be discouraged.

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What influences the use of seclusion? A cross-sectional study of forensic mental health nurses in a UK high secure hospital

Tulloch,

Walker,

Ion

2024

JFP

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Purpose Incidents of violence and aggression are a regular occurrence within adult forensic mental health inpatient settings and often lead to the use of restrictive practices such as seclusion. Such events are frequently attributed to the complexity of the patients. Research commonly focuses on patient’s characteristics and their association with seclusion use. Less attention has been centred on forensic mental health nurses’ attitudes to seclusion and the association of nursing staff characteristics. Design/methodology/approach A cross-sectional survey was undertaken using a standardised questionnaire, “Survey of Nurses’ Attitudes to Seclusion”. Responses were received from n = 147 nurses at a high secure forensic mental health hospital in the UK. Findings Key findings indicate that most participants believed seclusion should remain part of clinical practice. A correlation was identified between forensic mental health nurses’ attitudes to seclusion use and their characteristics: gender, age range, educational level and experience. Practical implications This paper presents novel information on seclusion reduction opportunities through modifiable workforce factors such as gender-sensitive rostering and staff training and development. Furthermore, recruitment and retention strategies should be prioritised so forensic mental health is perceived as an attractive career and a safe workplace. Originality/value The paucity of research in this area has prompted calls for further research to explore nursing staff characteristics and seclusion use. This is particularly important now due to the current global difficulty in the recruitment and retention of mental health nurses.

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Nursing staff composition and its influence on seclusion in an adult forensic mental health inpatient setting: The truth about numbers

Cited by 3 publications

References 38 publications

Struggling with unnecessary suffering—Registered nurses' experiences of delayed decisions on treatment without consent in forensic psychiatric inpatient care

Struggling with unnecessary suffering—Registered nurses' experiences of delayed decisions on treatment without consent in forensic psychiatric inpatient care

Nursing 12-Hour Shifts and Patient Incidents in Mental Health and Community Hospitals: A Longitudinal Study Using Routinely Collected Data

What influences the use of seclusion? A cross-sectional study of forensic mental health nurses in a UK high secure hospital

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