Patients’ Experiences of Restrictive Interventions in Australia: Findings From the 2010 Australian Survey of Psychosis

Brady, Nicole S.; Spittal, Matthew J; Brophy, Lisa; Harvey, Carol

doi:10.1176/appi.ps.201600300

Cited by 13 publications

(9 citation statements)

References 15 publications

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“…This is supported in several previous studies where patients perceived seclusion to be a distinctly negative experience [32–35]. Some recent studies suggest that patients can experience seclusion ambiguously—both beneficial and not—as having access to shelter or as being sent to prison [63, 64].…”

Section: Discussionsupporting

confidence: 70%

Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals

Haugom

Ruud

Hynnekleiv

2019

BMC Health Serv Res

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BackgroundSeclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion.MethodsThis study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis.ResultsThe main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff’s sincere desire to provide good treatment and the patients’ behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice.ConclusionEthical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.

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Section: Discussionsupporting

confidence: 70%

Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals

Haugom

Ruud

Hynnekleiv

2019

BMC Health Serv Res

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“…Most studies (n=42) reported on restraint and seclusion techniques. The pooled prevalence for coercive interventions was 47.8% (95% CI 0.38 to 0.57) with high heterogeneity (I 2 100.0%) in 12 studies136–147 (online supplementary file 6).…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

Patient safety in inpatient mental health settings: a systematic review

et al. 2019

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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.

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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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Patients’ Experiences of Restrictive Interventions in Australia: Findings From the 2010 Australian Survey of Psychosis

Abstract: People with psychosis who experienced a greater number of restrictive interventions were less likely to find restrictions justified or beneficial. The cumulative effect of increased numbers of restrictions may also lead to worsening perceptions of benefit.

Cited by 13 publications

References 15 publications

Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals

Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals

Patient safety in inpatient mental health settings: a systematic review

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

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