Underaged Patients' Opinions Toward Different Containment Measures: A Questionnaire Survey in <scp>F</scp>innish Adolescent Psychiatry

Hottinen, Anja; Välimäki, Maritta; Sailas, Eila; Putkonen, Hanna; Joffe, Grigori; Noda, Toshie; Lindberg, Nina

doi:10.1111/jcap.12006

Cited by 10 publications

(14 citation statements)

References 28 publications

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“…In line with several publications ( 29 , 30 , 54 ), Swiss patients, NOK, and HCP most clearly rejected the net bed. This measure is not applied in Switzerland and is likely, as in Finland, perceived as “inhumane and cruel” ( 28 ). Mechanical restraints and seclusion were rejected second- and third-most by all groups.…”

Section: Discussionmentioning

confidence: 99%

“…The Attitudes to Containment Measures Questionnaire (ACMQ) is a self-rating paper-and-pencil questionnaire that has been validated ( 38 ) and used in several publications from different countries, and thus from different cultures ( 24 , 25 , 28 , 30 , 39 , 48 – 55 ). One disadvantage of the ACMQ is that it also collects data on coercive measures that are uncommon or not used at all in Switzerland, such as the net bed.…”

Section: Methodsmentioning

confidence: 99%

“…Generally, a differentiation can be made between more and less invasive coercive measures. Measures, such as PRN ( pro re nata ) medication, observation, and time-out, are considered less invasive and are therefore preferable to the more invasive measures ( 28 – 30 ). However, particularly with violent patients, measures that more strongly limit personal freedom, including physical restraints, seclusion, and forced medication, may become inevitable ( 31 ).…”

Section: Introductionmentioning

confidence: 99%

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Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

et al. 2018

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Background: In clinical psychiatric practice, health care professionals (HCP) must decide in exceptional circumstances after the weighing of interests, which, if any, containment measures including coercion are to be used. Here, the risk for patients, staff, and third parties, in addition to therapeutic considerations, factor into the decision. Patients' preference and the inclusion of relatives in these decisions are important; therefore, an understanding of how patients and next of kin (NOK) experience different coercive measures is crucial for clinical decision making. The aim of this study is to compare how patients, HCP, and NOK assess commonly used coercive measures.Methods: A sample of 435 patients, 372 HCP, and 230 NOK completed the Attitudes to Containment Measures Questionnaire (ACMQ). This standardized self-rating questionnaire assessed the degree of acceptance or rejection of 11 coercive measures.Results: In general, HCPs rated the coercive measures as more acceptable than did NOK and patients. The largest discrepancy in the ratings was found in regard to the application of coercive intramuscular injection of medication (effect size: 1.0 HCP vs. patients). However, the ratings by NOK were significantly closer to the patients' ratings compared to patients and HCP. The only exception was the acceptance of treatment in a closed acute psychiatric ward, which was deemed significantly more acceptable by NOK than by patients. Also, patients who had experienced coercive measures themselves more strongly refused other measures.Conclusion: Patients most firmly rejected intramuscular injections, and the authors agree that these should only be used with reservation considering a high threshold. This knowledge about the discrepancy of the ratings should therefore be incorporated into professional training of HCP.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

et al. 2018

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“…Previous studies found varying attitudes towards containment measures in patients and HCP [15, 16]. Furthermore, it was shown that not only patients‘ characteristics or preferences but also the traditions and policies of the respective clinics influence the decision for or against specific containment measures [17].…”

Section: Introductionmentioning

confidence: 99%

Attitudinal variance among patients, next of kin and health care professionals towards the use of containment measures in three psychiatric hospitals in Switzerland

et al. 2019

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Background In psychiatric treatment containment measures are used to de-escalate high-risk situations. These measures can be characterized by their immanent amount of coercion. Previous research could show that the attitudes towards different containment measures vary throughout countries. The aim of this study was to compare the attitudes towards containment measures between three study sites in Switzerland which differ in their clinic traditions and policies and their actual usage of these measures. Methods We used the Attitude to Containment Measures Questionnaire (ACMQ) in three psychiatric hospitals in Switzerland (Zurich, Muensingen and Monthey) in patients, their next of kin (NOK) and health care professionals (HCP). Furthermore, we assessed the cultural specifics and rates of coercive measures for these three hospitals. Results We found substantial differences in the usage of and the attitudes towards some containment measures between the three study sites. The study site accounted for a variance of nearly zero in as needed medication to 15% in seclusion. The differences between study sites were bigger in the HCPs’ attitudes (up to 50% of the variance), compared to NOK and patients. In the latter the study site accounted for up to 6% of the variance. The usage/personal experience of containment measures in general was associated with higher agreement. Conclusions Although being situated in the same country, there are substantial differences in the rates of containment measures between the three study sites. We showed that the HCP’s attitudes are more associated with the clinic traditions and policies compared to patients’ and their NOKs’ attitudes. One can conclude that patients’ preferences depend less on clinic traditions and policies. Therefore, it is important to adapt treatment to the individual patients’ attitudes. Trial registration The study was reviewed and approved by the Cantonal Ethics Commission of Zurich, Switzerland (Ref.-No. EK: 2016–01526, decision on 28.09.2016) and the Cantonal Ethics Commission of Bern, Switzerland (Ref.-Nr. KEK-BE: 2015–00074). This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The permission for conduction of the study was granted by the medical directors at the three study sites. The authors informed the respondents (patients, NOK, HCP) of their rights in the study in an oral presentation and/or a cover letter. They assured the participants of the confidentiality and anonymity of the data, and the voluntariness of participation. Patients were given an information sheet with the possibility to consent in the conduction of the study. Return of the completed questionnaires from HCP and NOK was constituted as confirmation of their consent. No identifying factors were collected to ensure privacy. This article does not contai...

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“…In two of the studies, children were asked about their opinion on different practices to manage crises (Hottinen et al . ; Kazdin ). In these studies, the different interventions children had to rate or comment on were all coercive; no information was provided on what alternatives children might suggest.…”

Section: Introductionmentioning

confidence: 99%

Children's moral experiences of crisis management in a child mental health setting

Montreuil

Thibeault

McHarg

et al. 2018

Int J Mental Health Nurs

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The experiences of children related to conflict and crisis management in child mental health settings, especially those aged 12 and below, have been rarely studied. This study examined the moral experiences of children related to conflict and crisis management and the related use of restraint and seclusion in a child mental health setting. A 5-month focused ethnography using a participatory hermeneutic framework was conducted in a day hospital programme for children with severe disruptive disorders within a mental health institute. Children considered restraints and seclusion could help them feel safe in certain instances, for example if another child was being aggressive towards them or in exceptional cases to prevent self-injury. However, their own experiences of being restrained were predominantly negative, especially if not knowing the reason for their use, which they then found unfair. Some of the children emphasized the punitive nature of the use of restraints and seclusion, and most children disagreed with these practices when used as a punishment. Children's perspectives also highlighted the limits of the use of a uniform de-escalation approach by the staff to manage crises. Children considered discussing with the staff and developing a relationship with them as more helpful in case of a crisis then the use of a de-escalation approach or coercive strategies.

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Underaged Patients' Opinions Toward Different Containment Measures: A Questionnaire Survey in Finnish Adolescent Psychiatry

Cited by 10 publications

References 28 publications

Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

Attitudinal variance among patients, next of kin and health care professionals towards the use of containment measures in three psychiatric hospitals in Switzerland

Children's moral experiences of crisis management in a child mental health setting

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