Therapeutic engagement in acute psychiatric inpatient services

Pereira, Stephen; Woollaston, Kate

doi:10.1017/s1742646407001057

Cited by 12 publications

(9 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Findings from the present study lend support to existing research on observation that puts a relationship between staff and patients in which patients can find comfort in simple acts of compassionate care, at the heart of therapeutic exchanges in one‐to‐one observation (Cardell & Pitula, ; Cleary et al., ; Cutcliffe & Barker, ; Fletcher, ; Jones, Ward, Wellman, Hall, & Lowe, ; Pereira & Woollaston, ). Yet integration of staff and patient accounts has also yielded novel findings that contrast to existing definitions of engagement in previous literature, whereby patients were less likely than staff to describe the importance of what Bowles et al.…”

Section: Discussionsupporting

confidence: 83%

Staff and patient perspectives on therapeutic engagement during one‐to‐one observation

Insua-Summerhays

Hart

Plummer

et al. 2018

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

Accessible summary What is known on the subject? One‐to‐one observation uses continuous staff observation to safeguard patients judged likely to harm themselves or others. Policies increasingly mandate that staff engage therapeutically with patients during one‐to‐one observation. Yet not enough is known about factors facilitating or impeding such therapeutic engagement. What does this paper add to existing knowledge? This study enriches existing literature on one‐to‐one observation through integrating the perspectives of staff of different levels of qualification, and patients of different diagnostic and risk profiles. Whilst previous research has highlighted the occurrence of counter‐therapeutic staff‐patient interactions, integration of patient and staff perspectives in the current study has demonstrated that patient and staff often attribute the causes differently, with each apportioning blame to the other, leading both parties to feel misunderstood, and staff lack confidence to overcome these challenges. A novel finding was that rapport‐building via simple demonstrations of compassion and conversations about everyday things, was viewed as an essential prerequisite to encouraging patients to open up about their experiences of emotional distress, whilst implementation of techniques drawn from psychological interventions was viewed as less important than staff's core relational skills. What are the implications for practice? Therapeutic engagement during observation can enhance its risk management aims, providing thought is given to understanding and negotiating complex dynamics between staff and patients. Supervision for staff conducting observations should focus on building rapport in preference to emphasizing psychological intervention (e.g. DBT), and should enable staff to reflect on better understanding and managing their own emotions towards “hard‐to‐engage” patients. Abstract IntroductionPolicies increasingly focus on staff‐patient interactions during one‐to‐one psychiatric nursing observations as an opportunity for therapeutic engagement – yet if and how this is feasible is unknown. AimThis study aimed to integrate staff and patient perspectives to determine what factors facilitate or impede therapeutic engagement during one‐to‐one observation. MethodThematic analysis of qualitative interviews with 31 psychiatric inpatient staff at different levels of seniority and 28 inpatients spanning a range of diagnoses and risk profiles. ResultsNegative experiences of observation were characterized by a reciprocal dynamic where both patients and staff withdrew from interactions, having felt the other did not want to engage with them. Staff and patients agreed that these difficulties could be overcome when staff showed patients that they cared, gradually building trust through simple demonstrations of compassion and ‘normalizing’ conversation about everyday things. This approach helped patients to feel safe enough to open up about their distress, which in turn helped staff to better understand their expe...

show abstract

Section: Discussionsupporting

confidence: 83%

Staff and patient perspectives on therapeutic engagement during one‐to‐one observation

Insua-Summerhays

Hart

Plummer

et al. 2018

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

show abstract

“…Eight studies described interventions related to constant observations without conducting any formal evaluation (see appendix Table S1). Three of these studies implemented the intervention on psychiatric wards in the UK (Ashaye, Ikkos & Rigby, ; Dennis, ; Pereira & Woollaston, ), and two studies implemented interventions in the United States (Janofsky, ; Sullivan & Rivera, ). The remaining studies did not implement the intervention on an inpatient psychiatric ward or did not report whether the intervention had been implemented.…”

Section: Resultsmentioning

confidence: 99%

“…Studies were categorized based on the main intervention components (see Box 1) and whether the intervention made changes directly to constant observation or made systemic organizational changes on the ward. Out of the eight descriptive interventions, three could be categorized into a single component (Bharti et al ., ; Björkdahl et al ., ; Janofsky, ) and the remaining interventions were complex consisting of two or more components (Ashaye, Ikkos & Rigby, ; Dennis, ; Pereira & Woollaston, ; Russ, ; Sullivan & Rivera, ). The most commonly used intervention components were staff education and training, and changes to record keeping and assessment, and one intervention described the use of technology as an alternative tool to constant observation.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards

Reen

Bailey

Maughan

et al. 2020

Int J Mental Health Nurs

View full text Add to dashboard Cite

Constant observation is frequently conducted on inpatient psychiatric units to manage patients at risk of harming themselves or others. Despite its widespread use, there is little evidence of the efficacy of the practice or of its impact on patients and nursing staff. Unnecessary use of this practice can be restrictive and distressing for all involved and can cause considerable strain on healthcare resources. We sought to review interventions aiming to improve the quality and safety of constant observation or to reduce unnecessary use of this restrictive practice on adult inpatient psychiatric wards. A systematic search conducted in December 2018 using PubMed, PsycINFO, CINAHL, EMBASE and Google Scholar identified 24 studies with interventions related to constant observation. Only 16 studies evaluated a total of 13 interventions. The most common intervention components were changes to team, education and training for staff, changes to record keeping and assessment, and involving patients in care. A range of outcome measures were used to evaluate interventions. Over half of the interventions showed some positive impact on constant observation. One study recorded patient feedback. All interventions were targeted towards mental health nurses. Overall, there is no consensus on how best to improve the safety and quality of constant observations or reduce its unnecessary use. Studies vary widely in design, intervention and outcome measures. Existing research does however suggest that teamwork interventions can improve the patient experience of constant observation and safely reduce their degree and frequency. Priorities for future research on constant observations are highlighted.

show abstract

“…Although the practice description provided by Best (1996) is very useful, it is based predominantly on one person's experience and provides only anecdotal information. Other literature also supports the importance of occupational therapy or meaningful activities in the context of PICUs or HDUs (Ash, Suetan, Nair & Halpin, 2015;Gwinner & Ward, 2014;Pereira & Woollaston, 2007;Salzmann-Erikson, L€ utz en, Ivarsson & Eriksson, 2011;Sullivan et al, 2004), but there is very little specific information about the types of activities that are helpful or specific approaches that should be taken by occupational therapists in these settings. This lack of specificity is consistent with findings from Crowhurst and Bowers (2002) who reported that there was a lack of specific intervention guidelines for treatment approaches in PICUs.…”

Section: Evidence For Occupational Therapy In Picus and Hdusmentioning

confidence: 99%

“…This lack of specificity is consistent with findings from Crowhurst and Bowers () who reported that there was a lack of specific intervention guidelines for treatment approaches in PICUs. In general, the benefits of meaningful activities in the context of PICUs and HDUs have been described as: (i) improving the consumer experience, (ii) promoting more supportive relationships between staff and consumers, (iii) providing daily structure, (iv) minimising aggression related to boredom and (v) assisting services to become more recovery oriented, shifting from a culture of ‘control’ to a culture of care (Ash et al .; Gwinner & Ward; Pereira & Woollaston; Salzmann‐Erikson et al .; Sullivan et al .).…”

Section: Introductionmentioning

confidence: 99%

Exploring consumer functioning in High Dependency Units and Psychiatric Intensive Care Units: Implications for mental health occupational therapy

et al. 2016

View full text Add to dashboard Cite

This study provides the first description of functional abilities of consumers admitted to an HDU and PICU. Results were used to develop an initial conceptualisation of 'stages' of regaining functional abilities and a set of initial guidelines to support targeted occupational therapy interventions. This study will contribute to a better understanding of the functional abilities of individuals admitted to HDUs and PICUs and will support the development of optimal occupational therapy interventions in these settings.

show abstract

Therapeutic engagement in acute psychiatric inpatient services

Cited by 12 publications

References 10 publications

Staff and patient perspectives on therapeutic engagement during one‐to‐one observation

Staff and patient perspectives on therapeutic engagement during one‐to‐one observation

Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards

Exploring consumer functioning in High Dependency Units and Psychiatric Intensive Care Units: Implications for mental health occupational therapy

Contact Info

Product

Resources

About