Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services

Abstract

BackgroundPeople admitted to psychiatric hospitals with a diagnosis of schizophrenia may display behavioural problems. These may require management approaches such as use of coercive practices, which impact the well-being of staff members, visiting families and friends, peers, as well as patients themselves. Studies have proposed that not only patients’ conditions, but also treatment environment and ward culture may affect patients’ behaviour. Seclusion and restraint could possibly be prevented with staff education about user-centred, more humane approaches. Staff education could also increase collaboration between patients, family members and staff, which may further positively affect treatment culture and lower the need for using coercive treatment methods.MethodsThis is a single-blind, two-arm cluster randomised controlled trial involving 28 psychiatric hospital wards across Finland. Units will be randomised to receive either a staff educational programme delivered by the team of researchers, or standard care. The primary outcome is the incidence of use of patient seclusion rooms, assessed from the local/national health registers. Secondary outcomes include use of other coercive methods (limb restraint, forced injection, and physical restraint), service use, treatment satisfaction, general functioning among patients, and team climate and employee turn-over (nursing staff).DiscussionThe study, designed in close collaboration with staff members, patients and their relatives, will provide evidence for a co-operative and user-centred educational intervention aiming to decrease the prevalence of coercive methods and service use in the units, increase the functional status of patients and improve team climate in the units. We have identified no similar trials.Trial registrationClinicalTrials.gov NCT02724748. Registered on 25th of April 2016.

Correlates of psychiatric staff's attitude toward coercion and their sociodemographic characteristics

“…In brief, coercive measures are now widely recognized as a last resort measure when all other alternatives do not yield the intended outcomes with negative consequences for the psychiatric patients and staff involved 5,8 . Nevertheless, these interventions continue to be used frequently in psychiatric settings internationally 23 . In Jordan, the same scenario is reported, where despite the presence of policies and procedures to regulate and control the utilization of coercive measures in psychiatric settings, the World Health Organization and Ministry of Health 11 reported the high rates of coercive measures usage in Jordanian psychiatric healthcare facilities.…”

Psychiatric staff attitudes toward coercive measures: An experimental design

“…Lesser usage of coercive measures results in greater protection of the patient's dignity and safety. Thus, the control measures undertaken by psychiatric nurses in regard to patients’ aggressive behaviors should meet ethical and legal standards, be the least restrictive possible, and preserve human and patient rights …”

“…2,3 Despite the devastating negative impacts of coercive measures such as restraint and seclusion, they are considered to be among the most highly controversial measures still used in psychiatric settings. 4 The controversy arises because of the necessity of controlling patient aggressive behaviors to maintain the safety of the patient, other patients and the staff members. Lesser usage of coercive measures results in greater protection of the patient's dignity and safety.…”

“…Thus, the control measures undertaken by psychiatric nurses in regard to patients' aggressive behaviors should meet ethical and legal standards, be the least restrictive possible, and preserve human and patient rights. 4 To change the routine use of coercive measures among psychiatric nurses, attitudes toward its usage should be ascertained. 5 According to Mann-Poll and colleagues, a "deep change" refers to a change that goes beyond surface structures to alter nursing staff attitudes and is necessary for a sustainable change in actual practice.…”

A Nursing Perspective on Seclusion in Australia’s Mental Health System

“…In the situation where seclusion is clinically necessary to prevent harm and is permitted under legislation, healthcare providers need to follow the procedure of safe application of seclusion which is regulated by state and territory legislation and mandatory policy [21][22][23]. Additionally, this essay has discussed the relevant practice of chemical restraint which can be an alternative approach to seclusion in some cases and might have a better outcome when used with cautions.…”