Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-15T21:13:33.182Z Has data issue: false hasContentIssue false
  • English
  • Français

A study of agitation, conflict and containment in association with change in ward physical environment

Published online by Cambridge University Press:  16 May 2014

Oliver Jenkins ,
Stephen Dye Open the ORCID record for Stephen Dye [Opens in a new window]  and
Chris Foy
Oliver Jenkins*
Affiliation:
ST5, General Adult Psychiatry, Ipswich, Norfolk and Suffolk NHS Foundation Trust, UK
Stephen Dye
Affiliation:
Consultant, Inpatient Adult Psychiatry, Ipswich, Norfolk and Suffolk NHS Foundation Trust, UK
Chris Foy
Affiliation:
Medical Statistician, Gloucestershire NHS Foundation Trust, UK
*
Correspondence to: Dr Oliver Jenkins, Lark Ward, Woodlands Hospital, Ipswich IP4 5PD. Email: oliver.jenkins@nsft.nhs.uk
Get access

Abstract

Aims

To assess the impact of a changed ward environment upon levels of inpatient arousal and aggression on a National Health Service psychiatric intensive care unit.

Method

A retrospective service evaluation comparing seclusion episodes, duration of close observation, recorded aggressive incidents and data from the Nursing Observed Illness Intensity Scale (NOIIS) on a psychiatric intensive care unit for two three-month periods either side of a move from an old, temporary building to a new, purpose-built ward. The ward environments were also objectively assessed and compared using the Environment Assessment Inventory (EAI).

Results

A statistically significant reduction in episodes of seclusion, total seclusion hours and aggressive incidents, as well as a reduction in levels of agitation from the NOIIS data on the new ward compared to the old ward. The EAI scores showed important qualitative improvements on the new ward.

Conclusions

This study supports the hypothesis that the physical environment of a psychiatric intensive care unit has a significant impact on levels of arousal and aggression. Established measures of ward environment should be applied to the development and improvement of psychiatric wards.

Keywords

PICUenvironmentdisturbanceseclusion
Type
Original Research Articles
Information
Journal of Psychiatric Intensive Care , Volume 11 , Issue 1 , April 2015 , pp. 27 - 35
Copyright
Copyright © NAPICU 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blomhoff, S., Seim, S., Friis, S. (1990) Can prediction of violence among psychiatric inpatients be improved? Hospital & Community Psychiatry. 41: 771–775.Google Scholar
Bowers, L., Gournay, K., Duffy, D. (2000) Suicide and self-harm in inpatient psychiatric units: a national survey of observation policies. Journal of Advanced Nursing. 32(2): 437–444.Google Scholar
Bowers, L., Whittington, R., Nolan, P., Parkin, D., Curtis, S., Bhui, K., Hackney, D., Allan, A., Simpson, A., Flood, C. (2006) The City 128 Study of Observation and Outcomes on Acute Psychiatric Wards: Report to the NHS SDO Programme. London: City University, 235 pp.Google Scholar
Bowers, L., Stewart, D., Papadopoulos, C., Dack, C., Ross, J., Khanom, H. (2011a) Inpatient Violence and Aggression: A literature review. Report from the Conflict and Containment Reduction Research Programme. London: Institute of Psychiatry, 196 pp.Google Scholar
Bowers, L., Brennan, G., Ransom, S., Winship, G., Theodoridou, C. (2011b) The Nursing Observed Illness Intensity Scale (NOIIS). Journal of Psychiatric & Mental Health Nursing. 18(1): 28–34.Google Scholar
Currier, G.W. (2003) The controversy over ‘chemical restraint’ in acute psychiatry. Journal of Psychiatric Practice. 9(1): 59–70.CrossRefGoogle Scholar
Pereira, S., Clinton, C. (2002) Mental Health Policy Implementation Guide: National minimum standards for general adult services in psychiatric intensive care units (PICU) and low secure environments. Department of Health, 64 pp. http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4010439 Google Scholar
Department of Health (1999) Safety, Privacy and Dignity in Mental Health Units: Guidance on mixed sex accommodation for mental health services. London: Department of Health, 29 pp.Google Scholar
Dix, R., Pereira, S., Chaudhry, K., Dale, C., Halliwell, J. (2005) A PICU/LSU environment assessment inventory. Journal of Psychiatric Intensive Care. 1(2): 65–69.Google Scholar
Feeney, L., Kavanagh, A., Kelly, B.D., Mooney, M. (2007) Moving to a purpose built acute psychiatric unit on a general hospital site – does the new environment produce change for the better? Irish Medical Journal. 100(3): 391–393.Google Scholar
Fottrell, E. (1980) A study of violent behaviour among patients in psychiatric hospitals. British Journal of Psychiatry. 136: 216–221.Google Scholar
Frueh, B.C., Knapp, R.G., Cusack, K.J., Grubaugh, A.L., Sauvageot, J.A., Cousins, V.C., Yim, E., Robins, C.S., Monnier, J., Hiers, T.G. (2005) Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services. 56(9): 1123–1133.CrossRefGoogle ScholarPubMed
Hodgkinson, P.E., McIvor, L., Phillips, M. (1985) Patient assaults on staff in a psychiatric hospital: a two-year retrospective study. Medicine, Science & the Law. 25: 288–294.Google Scholar
Karlin, B.E., Zeiss, R.A. (2006) Environment and therapeutic issues in psychiatric hospital design: toward best practices. Psychiatric Services. 57(10): 1376–1378.Google Scholar
Moos, R.H. (1974) Evaluating Treatment Environments: A social ecological approach. New York: Wiley.Google Scholar
Ng, B., Kumar, S., Ranclaud, M., Robinson, E. (2001) Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatric Services. 52(4): 521–525.CrossRefGoogle Scholar
Nijman, H.L., Rector, G. (1999) Crowding and aggression on inpatient psychiatric wards. Psychiatric Services. 50(6): 830–831.Google Scholar
Olver, J., Love, M., Daniel, J., Norman, T., Nicholls, D. (2009) The impact of a changed environment on arousal levels of patients in a secure extended rehabilitation facility. Australasian Psychiatry. 17: 207–211.Google Scholar
Palmstierna, T., Wistedt, B. (1995) Changes in the pattern of aggressive behaviour among inpatients with changed ward organization. Acta Psychiatrica Scandinavica. 91(1): 32–35.CrossRefGoogle ScholarPubMed
Royal College of Psychiatrists (2007) Healthcare Commission National Audit of Violence 2006-7: Final report – working age adult services. London: Royal College of Psychiatrists’ Centre for Quality Improvement, 188 pp.Google Scholar
Sailas, E.E.S., Fenton, M. (2000) Seclusion and restraint for people with serious mental illnesses. Cochrane Database of Systematic Reviews. CD001163. doi:10.1002/14651858.CD001163 Google Scholar
Ulrich, R.S., Bogren, L., Lundin, S. (2012) Toward an evidence-based design theory for reducing aggression in psychiatric facilities. Paper presented to the conference: ARCH12: Architecture, Research, Care, Health. Gothenburg: Chalmers University.Google Scholar
Van Der Schaaf, P.S., Dusseldorp, E., Keuning, F.M., Janssen, W.A., Noothoorn, E.O. (2013) Impact of the physical environment of psychiatric wards on the use of seclusion. British Journal of Psychiatry. 202: 142–149.CrossRefGoogle ScholarPubMed
Virtanen, M., Vahtera, J., Batty, G.D., Tuisku, K., Pentti, J., Oksanen, T., Salo, P., Ahola, K., Kivima, M. (2011) Overcrowding in psychiatric wards and physical assaults on staff: data linked longitudinal study. British Journal of Psychiatry. 198: 149–155.Google Scholar
Supplementary material: File

Jenkins Supplementary Material

Appendix

Download Jenkins Supplementary Material(File)
File 139.8 KB