Staff Attitudes Towards Seclusion and Restraint in Forensic Settings

Laiho, Tero; Hottinen, Anja; Lindberg, Nina; Sailas, Eila

doi:10.1007/978-3-319-26748-7_12

Cited by 5 publications

(5 citation statements)

References 40 publications

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“…The report identified that staff feedback showed some resentment that patient safety was prioritized ahead of workplace safety for staff. This finding has been reflected in other studies in Australia (Muir‐Cochrane et al 2018) and internationally (De Benedictis et al 2011; Laiho et al 2016).…”

Section: Introductionsupporting

confidence: 71%

Implementing a Psychiatric Behaviours of Concern emergency team in an acute inpatient psychiatry unit: Staff perspectives

Digby

Bushell

Bucknall

2020

Int J Mental Health Nurs

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Behaviours of concern including aggression are widespread in mental health inpatient settings. Restrictive interventions such as restraint and seclusion can cause additional trauma to already traumatized patients. To decrease use of these interventions in an acute psychiatric unit in Melbourne, Australia, a Psychiatric Behaviours of Concern (Psy-BOC) response team was introduced. In a Psy-BOC call, senior medical, nursing, and allied health staff respond to escalating behavioural situations to work with the primary treating team to implement clinical interventions of least restrictive practice. Here, we present qualitative findings reporting staff response to Psy-BOC. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Twenty-four staff participated in five focus groups. Four themes were identified: Identifying behavioural deterioration, responding to behaviours of concern, staff reactions, and barriers. Although staff were skilled in recognizing and de-escalating behaviours of concern, patients were secluded when heightened risk was perceived. The adoption of Psy-BOC was met with some resistance to the cultural change required to adopt this new model. Increased awareness, early identification of behaviours of concern, and pressure from management resulted in reductions in restrictive interventions. Management of patients with drug-induced psychosis without restraint presented specific difficulties. The ward setting was challenging, offering no break-out spaces for patients, and few comfortable areas. Some staff appreciated the advice and expertise of the Psy-Boc team, others felt disempowered and undermined. Improving leadership, staff education, support and collaboration, and including frontline staff in refining the process could enhance the Psy-BOC response and increase safety for all.

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Section: Introductionsupporting

confidence: 71%

Implementing a Psychiatric Behaviours of Concern emergency team in an acute inpatient psychiatry unit: Staff perspectives

Digby

Bushell

Bucknall

2020

Int J Mental Health Nurs

View full text Add to dashboard Cite

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“…On interactional levels, it can be argued that staff are afraid of the patients (Laiho et al . ), and studies have shown that forensic patients experience only moments of good care (Hörberg et al . ).…”

Section: Discussionmentioning

confidence: 99%

“…This would suggest that the patients in the current study displayed ‘overt protest reactions’ because of the nature of the custodial care in the forensic setting (Hörberg & Dahlberg ; Laiho et al . ; Rose et al . ).…”

Section: Discussionmentioning

confidence: 99%

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Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

Tingleff

Hounsgaard

Bradley³

et al. 2018

Int J Mental Health Nurs

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To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence‐based patient care, we need more knowledge about patients’ subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients’ perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: ‘overt protest reactions’, ‘silent protest reactions’, ‘illness‐related behaviour’, and ‘genuinely calm’, which together characterize patients’ perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: ‘pattern of protest’ and ‘pattern of illness’. Further research is needed to illuminate the associations between patients’ perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.

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“…In recent years, the reduction of coercive measures in forensic mental healthcare, especially concerning the use of seclusion, has received increasing attention (Laiho et al, 2016 ). Seclusion is known to have a negative impact on patients, care professionals and care institutions (Goulet et al, 2017 ; Haw et al, 2011 ; Keski-Valkama et al, 2010 ).…”

Section: Introductionmentioning

confidence: 99%

The Forensic High and Intensive Care Monitor: Measurement Properties of a Model Fidelity Scale for Contact-Based Care in Forensic Psychiatry

Gerritsen

Widdershoven

Melle

et al. 2022

Adm Policy Ment Health

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Forensic High and Intensive Care (FHIC) has recently been developed as a new care model in Dutch forensic psychiatry. FHIC aims to provide contact-based care. To support Dutch forensic care institutions in the implementation of the model, a model fidelity scale was developed called the FHIC monitor. The aim of this study was to assess the inter-rater reliability, content validity, and construct validity of the FHIC monitor. A multi-methods design was used, combining qualitative and quantitative research. To collect data, audits and focus group meetings were organized to score care at individual wards with the monitor and get feedback from auditors and audit receiving teams about the quality of the monitor. In total, fifteen forensic mental healthcare institutions participated. The instrument showed acceptable inter-rater reliability and content validity, and a significant difference between expected high and low scoring institutions, supporting construct validity. The instrument can be used as a valid instrument to measure the level of implementation of the FHIC model on forensic psychiatric wards in the Netherlands.

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Staff Attitudes Towards Seclusion and Restraint in Forensic Settings

Cited by 5 publications

References 40 publications

Implementing a Psychiatric Behaviours of Concern emergency team in an acute inpatient psychiatry unit: Staff perspectives

Implementing a Psychiatric Behaviours of Concern emergency team in an acute inpatient psychiatry unit: Staff perspectives

Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

The Forensic High and Intensive Care Monitor: Measurement Properties of a Model Fidelity Scale for Contact-Based Care in Forensic Psychiatry

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