Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders).

BACKGROUND: Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure hospitals to assess necessity and proportionality between imminent violence and restrictive practices including de-escalation, seclusion, restraint, forced medication and others. METHODS: In this retrospective observational cohort study, 28 patients on a 12 bed male admissions unit in a secure psychiatric hospital were assessed daily for six months. Data on adverse incidents were collected from case notes, incident registers and legal registers. Using the functional assessment sequence of antecedents, behaviours and consequences (A, B, C) we devised and applied a multivariate framework of structured professional assessment tools, common adverse incidents and preventive clinical interventions to develop a tool to analyse clinical practice. We validated by testing assumptions regarding the use of restrictive and intrusive practices in the prevention of violence in hospital. We aimed to provide a system for measuring contextual and individual factors contributing to adverse events and to assess whether the measured seriousness of threating and violent behaviours is proportionate to the degree of restrictive interventions used. General Estimating Equations tested preliminary models of contexts, decisions and pathways to interventions. RESULTS: A system for measuring adverse behaviours and restrictive, intrusive interventions for prevention had good internal consistency. Interventions were proportionate to seriousness of harmful behaviours. A 'Pareto' group of patients (5/28) were responsible for the majority (80%) of adverse events, outcomes and interventions. The seriousness of the precipitating events correlated with the degree of restrictions utilised to safely manage or treat such behaviours. CONCLUSION: Observational scales can be used for restrictive, intrusive or coercive practices in psychiatry even though these involve interrelated complex sequences of interactions. The DRILL tool has been validated to assess the necessity and demonstrate proportionality of restrictive practices. This tool will be of benefit to services when reviewing practices internally, for mandatory external reviewing bodies and for future clinical research paradigms.

Development of a leadership role in a secure environment.

UNLABELLED: The ever-changing demands of recruitment and retention, both nationally and at a local level, have resulted in many staff with little or no experience in managing a unit in a secure setting. This study aimed to elicit the views of a cross-section of unit-based staff and middle management, on their experiences of leadership and taking charge of a shift/unit. A qualitative descriptive design was adapted for this study. The data were collected using focus group interviews guided by semistructured interview schedules. Twenty-one subjects participated in three focus groups. The data were analyzed using Colaizzi's (1978) framework. Five themes emerged from the data analysis. These are: Perceived practical skills deficit, perceived difference in experience, training program, leadership skills, and teaching learning methods. IMPLICATIONS: The themes generated will provide a framework to develop a training program, which will prepare staff to take on a leadership role within a unit, if required.

U.S. consumer demand for restaurant calorie information: targeting demographic and behavioral segments in labeling initiatives.

PURPOSE: To identify different segments of U.S. consumers based on food choices, exercise patterns, and desire for restaurant calorie labeling. DESIGN: Using a stratified (by region) random sample of the U.S. population, trained interviewers collected data for this cross-sectional study through telephone surveys. SETTING: Center for Rural Studies U.S. national health survey. SUBJECTS: The final sample included 580 responses (22% response rate); data were weighted to be representative of age and gender characteristics of the U.S. population. MEASURES: Self-reported behaviors related to food choices, exercise patterns, desire for calorie information in restaurants, and sample demographics. ANALYSIS: Clusters were identified using Schwartz Bayesian criteria. Impacts of demographic characteristics on cluster membership were analyzed using bivariate tests of association and multinomial logit regression. RESULTS: Cluster analysis revealed three clusters based on respondents' food choices, activity levels, and desire for restaurant labeling. Two clusters, comprising three quarters of the sample, desired calorie labeling in restaurants. The remaining cluster opposed restaurant labeling. Demographic variables significantly predicting cluster membership included region of residence (p < .10), income (p < .05), gender (p < .01), and age (p < .10). CONCLUSIONS: Though limited by a low response and potential self-reporting bias in the phone survey, this study suggests that several groups are likely to benefit from restaurant calorie labeling. Specific demographic clusters could be targeted through labeling initiatives.

Uses of administrative data at the Social Security Administration.

The Social Security Administration (SSA) collects a wealth of data in its role as administrator of two large national entitlement programs. Linking SSA's administrative data with survey data yields a broader set of demographic and socioeconomic information and also improves the quality of the survey data. The agency uses these data to produce analyses and research on policy initiatives for its programs and on the earnings of the working and beneficiary populations. SSA studies how these programs and potential changes to them affect individuals, the economy, and program solvency, and develops models to project demographic and economic characteristics of the current working population into the future. The agency also produces public-use microdata files that are available to outside researchers, as well as a variety of research and statistical publications to inform policymakers and the public.

Prediction of violence and self-harm in mentally disordered offenders: a prospective study of the efficacy of HCR-20, PCL-R, and psychiatric symptomatology.

The efficacy of the Historical, Clinical, and Risk Management Scales (HCR-20; C. D. Webster, D. Eaves, K. S. Douglas, & A. Wintrup, 1995), Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991), Beck Hopelessness Scale (BHS; A. T. Beck, A. Weissman, D. Lester, & L. Trexler, 1974), and Brief Psychiatric Rating Scale (BPRS) to predict violence and self-harm in 34 institutionalized mentally disordered offenders was assessed. Both the HCR-20 and BPRS were strong predictors of violence whereas the PCL-R had moderate predictive ability. BHS was the only variable predictive of self-harm. Although risk assessment measures were successful at predicting in-patient violence, a clinical measure of mental state was at least as effective in these mentally disordered offenders.