Systematic Investigation of Initiatives to Reduce Seclusion and Restraint in a State Psychiatric Hospital

Borckardt, Jeffrey J.; Madan, Alok; Grubaugh, Anouk L.; Danielson, Carla Kmett; Pelic, Christopher; Hardesty, Susan; Hanson, Rochelle F.; Herbert, Joan; Cooney, Harriet; Benson, Anna; Frueh, B. Christopher

doi:10.1176/ps.62.5.pss6205_0477

Cited by 95 publications

(113 citation statements)

References 34 publications

Supporting

Mentioning

109

Contrasting

Unclassified

Order By: Relevance

“…A recent study reported on a staged implementation of four strategies to reduce the use of seclusion and restraint (Borckardt et al . ). Therapeutic environmental changes was the only strategy found to be significantly correlated with the observed reductions in seclusion and restraint use, thought to be in part due to providing a constant reminder about the need to change practice.…”

Section: Discussionmentioning

confidence: 97%

Measuring the impacts of seclusion on psychiatry inpatients and the effectiveness of a pilot single‐session post‐seclusion counselling intervention

Whitecross¹,

Seeary²,

Lee

2013

Int J Mental Health Nurs

View full text Add to dashboard Cite

Despite the accumulation of evidence demonstrating patients' accounts of trauma associated with seclusion, the use of evidence-based post-seclusion debriefing is not apparent in the published work. This study aimed to identify the impacts seclusion has on an individual using the Impact of Events - Revised (IES-R), a standardized and widely used measure of trauma symptoms, and measure the effectiveness of a post-seclusion counselling intervention in mitigating the experience of seclusion-related trauma and reducing time spent in seclusion. The study design involved a comparison of the seclusion-related trauma and time in seclusion that was experienced by consenting patients managed on the two inpatient wards of Alfred Psychiatry. To investigate the efficacy of post-seclusion counselling to reduce event-related trauma as well as the use of seclusion, a brief single-session intervention was piloted comparing outcomes for patients treated on a ward implementing semistructured post-seclusion counselling and patients treated on a ward continuing with post-seclusion support as usual. A total of 31 patients consented to participate, with approximately 47% reporting trauma symptoms consistent with 'probable post-traumatic stress disorder' (IES-R total score, >33), although there was no difference in trauma experience between groups. Significantly fewer hours were spent in seclusion for patients treated on the ward piloting the post-seclusion counselling intervention. Findings, therefore, highlight not only the potential for significant trauma stemming from a seclusion event, but also the capacity for the implementation of such interventions as post-seclusion counselling to raise awareness of the need to minimize time spent in seclusion for patients.

show abstract

Section: Discussionmentioning

confidence: 97%

Measuring the impacts of seclusion on psychiatry inpatients and the effectiveness of a pilot single‐session post‐seclusion counselling intervention

Whitecross¹,

Seeary²,

Lee

2013

Int J Mental Health Nurs

View full text Add to dashboard Cite

show abstract

“…; Borckardt et al . ; Donat ; Donat ; Taxis ). The contrasting findings of our study compared with previous studies might be explained by the fact that, although the involvement of patients in the development of an individualized treatment plan is essential, the methodical work approach comprises more.…”

Section: Discussionmentioning

confidence: 99%

“…In Borckardt et al . 's () study, the involvement of patients in treatment planning was not found to be associated with a reduction in seclusion and restraint. The discrepancy between the axiomatic inclusion of the methodical work approach in the education of Dutch health‐care professionals, and the lack of evidence demonstrating the benefits for patient care, were an incentive for the present study.…”

Section: Introductionmentioning

confidence: 88%

See 1 more Smart Citation

Reduction in the use of seclusion by the methodical work approach

Boumans

Egger

Souren

et al. 2013

Int J Mental Health Nurs

View full text Add to dashboard Cite

Patient care in a psychiatric setting can benefit from a more systematic, transparent, and goal-driven way of working. The methodical work approach, with its cyclic five phases, provides such an approach: (i) translation of problems into goals; (ii) search for means to realize the goals; (iii) formulation of an individualized plan; (iv) implementation of the plan; and (v) evaluation and readjustment. We examined the effect of the methodical work approach on the use of seclusion at a ward for the intensive treatment of inpatients with psychoses and substance-use disorders. The team of this ward implemented the methodical work approach. Special attention was paid to the involvement of the patient and his/her family in the treatment process and to the role of the coordinating nurse. Compared to control wards within the same hospital, at the ward where the methodical work approach was implemented, a more pronounced reduction was achieved in the number of incidents and in the total hours of seclusion. Implementation of the methodical work approach can contribute to a reduction in the use of seclusion.

show abstract

“…Forster and colleagues 26 focused their training on increasing awareness of factors that lead to agitation and violence, teaching less restrictive interventions, and the teaching of safe reactions to patient violence. Borckardt and colleagues 27 implemented an engagement model that includes trauma-informed care training, changes in rules and language, patient involvement in treatment planning, and changes to the physical characteristics of the therapeutic environment. Project BETA believes that the culture that promotes the use of restraint and seclusion can be changed.…”

Section: Use Of Physical Restraintmentioning

confidence: 99%

Use and Avoidance of Seclusion and Restraint: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Seclusion and Restraint Workgroup

Knox¹,

Holloman²

2012

WestJEM

189

131

View full text Add to dashboard Cite

Issues surrounding reduction and/or elimination of episodes of seclusion and restraint for patients with behavioral problems in crisis clinics, emergency departments, inpatient psychiatric units, and specialized psychiatric emergency services continue to be an area of concern and debate among mental health clinicians. An important underlying principle of Project BETA (Best practices in Evaluation and Treatment of Agitation) is noncoercive de-escalation as the intervention of choice in the management of acute agitation and threatening behavior. In this article, the authors discuss several aspects of seclusion and restraint, including review of the Centers for Medicare and Medicaid Services guidelines regulating their use in medical behavioral settings, negative consequences of this intervention to patients and staff, and a review of quality improvement and risk management strategies that have been effective in decreasing their use in various treatment settings. An algorithm designed to help the clinician determine when seclusion or restraint is most appropriate is introduced. The authors conclude that the specialized psychiatric emergency services and emergency departments, because of their treatment primarily of acute patients, may not be able to entirely eliminate the use of seclusion and restraint events, but these programs can adopt strategies to reduce the utilization rate of these interventions.

show abstract

Systematic Investigation of Initiatives to Reduce Seclusion and Restraint in a State Psychiatric Hospital

Abstract: These data suggest that substantial reductions in use of seclusion and restraint are possible in inpatient psychiatric settings and that changes to the physical characteristics of the therapeutic environment may have a significant effect on use of seclusion and restraint.

Cited by 95 publications

References 34 publications

Measuring the impacts of seclusion on psychiatry inpatients and the effectiveness of a pilot single‐session post‐seclusion counselling intervention

Measuring the impacts of seclusion on psychiatry inpatients and the effectiveness of a pilot single‐session post‐seclusion counselling intervention

Reduction in the use of seclusion by the methodical work approach

Use and Avoidance of Seclusion and Restraint: Consensus Statement of the American Association for Emergency Psychiatry Project BETA Seclusion and Restraint Workgroup

Contact Info

Product

Resources

About