BACKGROUND Seclusion is an intervention widely used in Dutch mental health care. The intervention can be effective in acute situations to avert (further) aggression or self-harm. However, seclusion is also a controversial intervention that may not have any positive effect with regard to symptom improvement. In general patients report negative effects after being secluded e.g. anxiety and having had a traumatic experience.The main reason for seclusion is not manageable aggressive behaviour of a patient. Earlier studies reported several risk factors that may contribute to seclusion, regarding patients’ characteristics, but also with regard to staff characteristics, working protocols and unit characteristics. Because of unequivocally results there is the need for a longitudinal prospective study to examine staff- and unit determinants in association with seclusion.AIMS The objective of this study is to determine which nursing staff and unit characteristics are associated with seclusion following aggression in hospitalized adult psychiatric patients. We hope to create a predictive model to estimate the risk of seclusion on an acute psychiatric ward.METHODS We will conduct a prospective observational study on a closed psychiatric ward of an academic hospital. Patients are aged 18 – 65 years and are admitted when their psychiatric condition leads to an immediate threat to the patient themselves or their surroundings.All nurses on the ward are all qualified nurses and registered in the Dutch registration of healthcare professionals. They are trained every six months in techniques of verbal de-escalation and safe physical restraint. For both nurses and the patients baseline characteristics are monitored. Every shift (day, evening, night) data are gathered on the patients, nurses and unit. Data are retrieved from the electronic patient chart, including information of the Brøset Violence Checklist. Furthermore, the exchange of information among nurses is measured using the Grid instrument. Data will be analysed using multilevel regression analysis. Data will be collected for a period of 2 years, which started January 2013.RESULTS The primary endpoint in our study is the incidence of seclusion. As a secondary endpoint, the duration of the seclusion is measured. These endpoints are measured using the Argus registration system and will be linked to predictors of seclusion, with special focus on the nursing staff- and unit determinants.
LINK
In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes. Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.
Background: Traumatic brain injury (TBI) is in the developed countries the most common cause of death and disability in childhood. Aim: The purpose of this study is to estimate the incidence of TBI for children and young people in an urbanised region of the Netherlands and to describe relevant characteristics of this group. Methods: Patients, aged 1 month - 24 years who presented with traumatic brain injury at the Erasmus University Hospital (including the Sophia Children's Hospital) in 2007 and 2008 were included in a retrospective study. Data were collected by means of diagnosis codes and search terms for TBI in patient records. The incidence of TBI in the different referral areas of the hospital for standard, specialised and intensive patient care was estimated. Results: 472 patients met the inclusion criteria. The severity of the Injury was classified as mild in 342 patients, moderate in 50 patients and severe in 80 patients. The total incidence of traumatic brain injury in the referral area of the Erasmus University Hospital was estimated at 113.9 young people per 100.000. The incidence for mild traumatic brain injury was estimated at 104.4 young people, for moderate 6.1 and for severe 3.4 young people per 100.000. Conclusion: The ratio for mild, moderate and severe traumatic brain injury in children and young people was 33.7e1.8e1.In the mild TBI group almost 17% of the patients reported sequelae. The finding that 42% of them had a normal brain CT scan at admission underwrites the necessity of careful follow up of children and young people with mild TBI.
