Location of Power within Psychiatry: A Fifty-Year Journey as Represented in Film.

Over the last half of the twentieth century, many advances in the field of psychiatry and mental health have occurred and continue today. Among these developments are the increasing recognition of patient rights and the expanding role of psychiatric nurses. This paper presents a view of how these changes have been reflected in film over a period of fifty years in both documentary and Hollywood movies. Discussion of advances in psychiatry, as identified in the selected films, is presented against the background of social change that was occurring in the United States and Western Europe during this period.

Acceptability and use of coercive methods across differing service configurations with and without seclusion and/or psychiatric intensive care units.

AIMS: The aim of this study was to compare across different service configurations the acceptability of containment methods to acute ward staff and the speed of initiation of manual restraint. BACKGROUND: One of the primary remits of acute inpatient psychiatric care is the reduction in risks. Where risks are higher than normal, patients can be transferred to a psychiatric intensive care unit or placed in seclusion. The abolition or reduction in these two containment methods in some hospitals may trigger compensatory increases in other forms of containment which have potential risks. How staff members manage risk without access to these facilities has not been systematically studied. DESIGN: The study applied a cross-sectional design. METHODS: Data were collected from 207 staff at eight hospital sites in England between 2013 - 2014. Participants completed two measures; the first assessing the acceptability of different forms of containment for disturbed behaviour and the second assessing decision-making in relation to the need for manual restraint of an aggressive patient. RESULTS: In service configurations with access to seclusion, staff rated seclusion as more acceptable and reported greater use of it. Psychiatric intensive care unit acceptability and use were not associated with its provision. Where there was no access to seclusion, staff were slower to initiate restraint. There was no relationship between acceptability of manual restraint and its initiation. CONCLUSION: Tolerance of higher risk before initiating restraint was evident in wards without seclusion units. Ease of access to psychiatric intensive care units makes little difference to restraint thresholds or judgements of containment acceptability.

Need for Specialized Support Services for Nurse Victims of Physical Assault by Psychiatric Patients.

Assault of nurses in the psychiatric setting is an ongoing global concern. In a prior study by these authors, many nurses reported concern about the lack of supportive interventions offered to nurses after the assault event. These nurses reported ongoing psychosocial and emotional disturbance consistent with symptoms of post-traumatic stress disorder. A follow-up study was done to investigate the perceived need of assaulted nurses for specialized support groups to assist them in dealing with the experience. A quantitative, cross sectional survey descriptive research design was done to assess assaulted nurses' perceived need for specialized support groups. The survey also gathered data relating to the reporting of the assault. A qualitative narrative section was added to gather data that might have been missed in the quantitative segment. The sample consisted of 57 previously assaulted nurses currently working at multiple acute care sites. Study findings showed that if specialized support groups were available, 57% of the nurses might be interested in attending these, and 41% would be interested in attending these. These nurses also reported multiple signs and symptoms of post-traumatic stress disorder. Considering the serious negative impact of assault on nurses and their desire for follow-up support, there is a need for the availability of supportive services.

A Conceptual Model for Nurses' Decision-making with the Aggressive Psychiatric Patient.

Violence in the acute care psychiatric setting is an ongoing serious problem. Maintenance of a safe therapeutic environment is a paramount responsibility of nurses practicing in this area. Ethical and legal standards demand that the nurse intervenes in aggressive situations in a manner that employs the least intrusive and restrictive measures necessary to provide safety. Therefore, accurate and effective decision-making in aggressive situations, which can escalate rapidly, is of great importance. This paper discusses a theoretical model for decision-making in selecting interventions with aggressive psychiatric patients. This model may provide a basis for the development of training and education programs for effective decision-making in this area.

Differences in male and female nurses' responses to physical assault by psychiatric patients: a supplemental finding of a mixed-methods study.

In one segment of a multifactor study conducted in 2011 at five psychiatric sites in three counties of Long Island, New York, 110 nurses were interviewed about their experiences with physical assault by psychiatric patients. Marked differences were identified between the male and female nurse participants who were assaulted. Women expressed feelings of inadequacy and questioned their competence. They felt blamed by administration and sometimes even colleagues. In addition, many did not report the incident for fear of reprisal. Women believed that violence was to be expected, and they considered it part of the job. On the other hand, men did not question their competency. They blamed external factors, such as poor staffing or unsafe design of the unit, or they stated that the patient was inadequately medicated and impossible to control. The male nurses did not feel blamed for the incident. All but one male nurse formally reported the incidents. They believed that violence in psychiatry is to be expected but should not be considered part of the job. These findings may be explained by Weiner's Attribution Theory.

Construction of an instrument to evaluate nurses' decision making in relation to the use of restraint in acute care psychiatry.

Use of physical restraint in acute care psychiatry has been, and continues to be, a controversial issue. For this reason, a study was conducted in 1996 that examined nurses' decision making related to the use of physical restraint with aggressive psychiatric patients. An instrument, the Moylan Assessment of Progressive Aggression Tool (MAPAT), was developed for this purpose. Information relating to this instrument has not been previously published. It is currently in use in an ongoing research study by the author. A description of the process of the development of the MAPAT is provided here, along with the validity and reliability of the instrument, and implications for potential use in research, training, and education.

Physical restraint in acute care psychiatry: a humanistic and realistic nursing approach.

Despite the many advances in psychiatry, violence in acute care settings continues and may be increasing. This is particularly problematic, considering the desire of mental health professionals to attain the goal of a restraint-free environment. Respecting the inherent worth, dignity, and autonomy of the patient is necessary if a therapeutic outcome is to be achieved; however, protecting the safety of the patient, other patients, and the caregivers is of no less importance, yet this responsibility also carries with it legal and ethical implications. Balancing these two responsibilities can be realized even in a situation where supportive therapeutic interventions have been ineffective in de-escalation of an aggressive patient. When used with a compassionate, humanistic approach, restraint can achieve a therapeutic outcome for the patient while protecting the safety of others.