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Factors influencing seclusion rates in an adult psychiatric intensive care unit

Published online by Cambridge University Press:  01 December 2007

Jane E O'Malley ,
Christopher Frampton ,
Anne-Marie Wijnveld  and
Richard J Porter
Jane E O'Malley
Affiliation:
Senior Lecturer
Christopher Frampton
Affiliation:
Associate Professor
Anne-Marie Wijnveld
Affiliation:
Nurse Practice Consultant
Richard J Porter*
Affiliation:
Associate Professor, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
*
Correspondence to: Associate Professor Richard Porter, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, PO Box, 4345, Christchurch, New Zealand. Tel: ++63 3 3720400; Fax: ++64 3 3720407; Email: richard.porter@chmeds.ac.nz
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Abstract:

Seclusion of psychiatric inpatients is used as a last resort in managing disturbed behaviour. Research on factors contributing to its use is limited. The aim of this study was to examine the effect of a change in unit size and other variables, such as time of day and nursing workload, on the rates of use of seclusion in an intensive care inpatient psychiatric unit. Rates of seclusion were examined in randomly selected nursing shifts across three time periods; one before and two after a change in the size of the unit. Effects on seclusion rates of size, shift and four nursing workforce variables were explored using multivariate analysis. Unit size, shift and nurse hours together explained 23% of the variance in seclusion use. Of particular significance was the change from a 20 bed unit to two separate 10 bed units. The findings have implications for the organisation of inpatient psychiatric units. Smaller units may allow better management of disturbed behaviour.

Keywords

Seclusionpsychiatric inpatientskill mixgenderunit size
Type
Original Paper
Information
Journal of Psychiatric Intensive Care , Volume 3 , Issue 2 , July 2007 , pp. 93 - 100
Copyright
Copyright © NAPICU 2007

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References

Bowers, L., Allan, T., Simpson, A., Nijman, H. and Warren, J. (2007) Adverse incidents, patient flow and nursing workforce variables on acute psychiatric wards: The Tompkins Acute Ward Study. International Journal of Social Psychiatry. 53: 75–84.CrossRefGoogle ScholarPubMed
Bowers, L., Jarrett, M., Clark, N., Kiyimba, F. and McFarlane, L. (2000) Determinants of absconding by patients on acute psychiatric wards. Journal of Advanced Nursing. 32: 644–649.CrossRefGoogle ScholarPubMed
Bowers, L., van der Werf, B., Vokkolainen, A., Muir-Cochrane, E., Allan, T. and Alexander, J. (2007) International variation in containment measures for disturbed psychiatric inpatients: A comparative questionnaire survey. International Journal of Nursing Studies. 44: 357–364.CrossRefGoogle ScholarPubMed
Convertino, K., Pinto, R.P. and Fiester, A.R. (1980) Use of inpatient seclusion at a community mental health center. Hospital and Community Psychiatry. 31(12): 848–850.Google Scholar
D'Orio, B.M., Purselle, D., Stevens, D. and Garlow, S.J. (2004) Reduction of episodes of seclusion and restraint in a psychiatric emergency service. Psychiatric Services. 55(5): 581–583.CrossRefGoogle Scholar
Donat, D.C. (2002) Impact of improved staffing on seclusion/restraint reliance in a public psychiatric hospital. Psychiatric Rehabilitation Journal. 25(4): 413–416.CrossRefGoogle Scholar
Donat, D.C. (2003) An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. Psychiatric Services. 54(8): 1119–1123.CrossRefGoogle Scholar
Donovan, A., Plant, R., Peller, A., Siegel, L. and Martin, A. (2003) Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths. Psychiatric Services. 54(7):987–993.CrossRefGoogle ScholarPubMed
Duxbury, J. (2002) An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: a pluralistic design. Journal of Psychiatric and Mental Health Nursing. 9(3): 325–337.CrossRefGoogle ScholarPubMed
El-Badri, S.M. and Mellsop, G. (2002) A study of the use of seclusion in an acute psychiatric service. Australian and New Zealand Journal of Psychiatry. 36(3): 399–403.CrossRefGoogle Scholar
Freuh, B.C., Knapp, R.G., Cusack, K.J., Grubaugh, A.L., Sauvageot, J.A., Cousins, V.C., et al. (2005) Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services. 56(9): 1123–1133.CrossRefGoogle Scholar
Hafner, R.J., Lammersma, J., Ferris, R. and Cameron, M. (1989) The use of seclusion: A comparison of two psychiatric intensive care units. Australian and New Zealand Journal of Psychiatry. 23(2): 235–239.CrossRefGoogle ScholarPubMed
Haller, E., McNiel, D.E. and Binder, R.L. (1996) Impact of a smoking ban on a locked psychiatric unit. Journal of Clinical Psychiatry. 57(8): 329–332.Google ScholarPubMed
Kaltiala-Heino, R., Tuohimaki, C., Korkeila, J. and Lehtinen, V. (2003) Reasons for using seclusion and restraint in psychiatric inpatient care. International Journal of Law and Psychiatry. 26(2): 139–149.CrossRefGoogle ScholarPubMed
Khadivi, A.N., Patel, R.C., Atkinson, A.R. and Levine, J.M. (2004) Association between seclusion and restraint and patient-related violence. Psychiatric Services. 55(11): 1311–1312.CrossRefGoogle ScholarPubMed
Kirkpatrick, H. (1989) A descriptive study of seclusion: The unit environment, patient behavior and nursing interventions. Archives of Psychiatric Nursing. 3(1): 3–9.Google Scholar
Mason, T. (1994) Seclusion: An international comparison. Medicine, Science and the Law. 34(10): 54–60.CrossRefGoogle ScholarPubMed
Morrison, P. (1990) A multidimensional scalogram analysis of the use of seclusion in acute psychiatric settings. Journal of Advanced Nursing. 15: 59–66.CrossRefGoogle ScholarPubMed
Morrison, P. and Lehane, M. (1995) Staffing levels and seclusion use. Journal of Advanced Nursing. 22(6): 1193–1202.CrossRefGoogle ScholarPubMed
National Mental Health Information Center (2002) Chapter 6: Sixteen-state study on mental health performance measures. www.mentalhealth.samhsa.gov/publications/allpubs/SMA04-3938/Chapter06.aspGoogle Scholar
O'Brien, L. and Cole, R. (2004) Mental health nursing practice in acute psychiatric close-observation areas. International Journal of Mental Health Nursing. 13(2): 89–99.CrossRefGoogle ScholarPubMed
Robins, C.S., Sauvageot, J.A., Cusack, K.J., Suffoletta-Maierle, S. and Frueh, B.C. (2005) Consumers’ perceptions of negative experiences and “sanctuary harm” in psychiatric settings. Psychiatric Services. 56(9): 1134–1138.CrossRefGoogle Scholar
Royal College of Psychiatrists (1998) Not just bricks and mortar: Report of the Royal College of Psychiatrists Working Party on the size, staffing, structure, sitting, and security of new acute adult psychiatric in-patient units (No. Council Report CR62). London: Royal College of Psychiatrists.Google Scholar
Salib, E., Ahmed, A.G. and Cope, M. (1998) Practice of seclusion: A five-year retrospective review in north Cheshire. Medicine, Science and the Law. 38(4): 321–327.CrossRefGoogle ScholarPubMed
Smith, G.M., Davis, R.H., Bixler, E.O., Lin, H.M., Altenor, A., Altenor, R.J., et al. (2005) Pennsylvania State Hospital system's seclusion and restraint reduction program. Psychiatric Services. 56(9): 1115–1122.CrossRefGoogle ScholarPubMed
Tunde-Ayinmode, M. and Little, J. (2004) Use of seclusion in a psychiatric acute inpatient unit. Australasian Psychiatry. 12(4): 347–351.CrossRefGoogle Scholar
Visalli, H. and McNasser, G. (2000) Reducing seclusion and restraint: Meeting the organizational challenge. Journal of Nursing Care Quality. 14(4): 35–44.CrossRefGoogle ScholarPubMed
Vittengl, J.R. (2002) Temporal regularities in physical control at a state psychiatric hospital. Archives of Psychiatric Nursing. 16(2): 80–85.CrossRefGoogle Scholar