Abstract: Background For patients, seclusion during psychiatric treatment is often a traumatic experience. To prevent such experiences, adjustments in the design of seclusion rooms have been recommended. Methods As there have been no empirical studies on the matter, we used a quasi-experimental design to compare the experiences in seclusion of two groups of patients: 26 who had been secluded in a room designed according to the principles of healing environment, a so called ‘Enriched Environment Seclusion room’ (EES), and 27 who had been secluded in a regular seclusion (RS) room. The enrichment included audio-visual facilities, a fixed toilet, a couch and a self-service system to adjust light, colour, blinds and temperature according to the patient’s preferences. Insight into their experiences was obtained using the Patient View-of-Seclusion Questionnaire, which comprises nine statements on seclusion, supplemented with open-ended questions. Results The responses regarding seclusion experiences between the two groups did not differ significantly (U = 280.00, p = .21, r = -.17). Although those who had been secluded in the specially designed room had greatly appreciated the opportunities for distraction, and those who had been secluded in a regular seclusion room expressed the need for more distracting activities during seclusion, both groups described seclusion as a dreadful experience. If seclusion cannot be avoided, patients recommend facilities for distraction (such as those provided in an enriched environment seclusion room) to be available. Conclusion Whatever the physical environment and facilities of a seclusion room, we may thus conclude that seclusion is a burdensome experience.
DOCUMENT
IntroductionSeclusion still occurs on mental health wards, despite absence of therapeutic efficacy and high risks of adverse patient effects. Literature on the effect of nursing teams, and the role of psychological characteristics in particular, on frequency of seclusion is scarce.AimTo explore the influence of demographic, professional or psychological, nursing team-level, and shift characteristics on the frequency of use of seclusion.MethodsProspective two-year follow-up study.ResultsWe found that the probability of seclusion was lower when nursing teams with at least 75% males were on duty, compared to female only teams, odds ratio (OR = 0.283; 95% CrI 0.046–0.811). We observed a trend indicating that teams scoring higher on the openness personality dimension secluded less, (OR = 0.636; 95% CrI 0.292–1.156).DiscussionHigher proportions of male nurses in teams on duty were associated with lower likelihood of seclusion. We found an indication that teams with a higher mean openness personality trait tended to seclude less. These findings, if causal, could serve as an incentive to reflect on staff mix if circumstances demand better prevention of seclusion.
MULTIFILE
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
