ABSTRACT
OBJECTIVES: Reducing seclusion and restraint use is a prominent focus of efforts to improve patient safety in inpatient psychiatry. This study examined the poorly understood relationship between seclusion and restraint rates and organizational climate and clinician morale in inpatient psychiatric units. METHODS: Facility-level data on hours of seclusion and physical restraint use in 111 U.S. Department of Veterans Affairs (VA) hospitals in 2014 to 2016 were obtained from the Centers for Medicare & Medicaid Services. Responses to an annual census survey were identified for 6646 VA inpatient psychiatry clinicians for the same period. We examined bivariate correlations and used a Poisson model to regress hours of seclusion and restraint use on morale and climate measures and calculated incident rate ratios (IRRs). RESULTS: The average physical restraint hours per 1000 patient hours was 0.33 (SD, 1.27; median, 0.05). The average seclusion hours was 0.31 (SD, 0.84; median, 0.00). Physical restraint use was positively associated with burnout (IRR, 1.76; P = 0.04) and negatively associated with engagement (IRR, 0.22; P = 0.01), psychological safety (IRR, 0.48; P < 0.01), and relational climate (IRR, 0.69; P = 0.04). Seclusion was positively associated with relational climate (IRR, 1.69; P = 0.03) and psychological safety (IRR, 2.12; P = 0.03). Seclusion use was also nonsignificantly associated with lower burnout and higher engagement. CONCLUSIONS: We found significant associations between organizational climate, clinician morale, and use of physical restraints and seclusion in VA inpatient psychiatric units. Health care organization leadership may want to consider implementing a broader range of initiatives that focus on improving organizational climate and clinician morale as one way to improve patient safety.
Subject(s)
Inpatients , Restraint, Physical , Aged , Humans , Medicare , Morale , Patient Isolation , United StatesSubject(s)
Anxiety , Depression , Exposure to Violence/psychology , Psychotherapy/methods , Refugees/psychology , Selective Serotonin Reuptake Inhibitors/administration & dosage , Stress Disorders, Post-Traumatic , Syncope , Adult , Anxiety/diagnosis , Anxiety/therapy , Depression/diagnosis , Depression/psychology , Female , Humans , Medically Unexplained Symptoms , Pain/etiology , Pain/psychology , Psychotherapeutic Processes , Refugee Camps , Resilience, Psychological , Self-Management/methods , Social Support , Stress Disorders, Post-Traumatic/complications , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/psychology , Syncope/etiology , Syncope/psychology , SyriaABSTRACT
BACKGROUND: The anatomy course offers important opportunities to develop professionalism at an early stage in medical education. It is an academically significant course that also engenders stress in some students. METHODS: Over a three-year period, 115 of 297 students completed creative projects. Thirty-four project completers and 47 non-completers consented to participate in the study. Projects were analyzed for professionalism themes using grounded theory. A subset of project completers and non-completers were interviewed to determine their views about the stress of anatomy and medical school, as well as the value of the creative projects. We also compared test performance of project completers and non-completers. RESULTS: Projects completed early in the course often expressed ambivalence about anatomy, whereas later projects showed more gratitude and sense of awe. Project completers tended to report greater stress than noncompleters, but stated that doing projects reduced stress and caused them to develop a richer appreciation for anatomy and medicine. Project completers performed significantly lower than non-completers on the first written exam (pre-project). Differences between groups on individual exams after both the first and second creative project were nonsignificant. CONCLUSION: For some students, creative projects may offer a useful way of reflecting on various aspects of professionalism while helping them to manage stress.
