Effectiveness of CRSCE-Based De-escalation Training on Reducing Physical Restraint in Psychiatric Hospitals: A Cluster Randomized Controlled Trial.

Background: The use of physical restraint (PR) causes clinical and ethical issues; great efforts are being made to reduce the use of PR in psychiatric hospitals globally. Aim: This study aimed to examine the effectiveness of CRSCE-based de-escalation training on reducing PR in psychiatric hospitals. Method: The proposed study adopted cluster randomized controlled trial design. Twelve wards of a psychiatric hospital were randomly allocated to experimental group (n = 6) and control group (n = 6). Wards of control group were assigned to routine training regarding PR; wards of experimental group underwent the same routine training while additionally received CRSCE-based de-escalation training. Before and after CRSCE-based de-escalation training, the frequency of and the duration of PR, and the numbers and level of unexpected events caused by PR, were recorded. Results: After CRSCE-based de-escalation training, the frequency (inpatients and patients admitted within 24 h) of and the duration of PR of experimental group, showed a descending trend and were significantly lower than those of control group (P < 0.01); compared to control group, the numbers of unexpected events (level II and level III) and injury caused by PR of experimental group had been markedly reduced (P < 0.05). Conclusions: CRSCE-based de-escalation training would be useful to reduce the use of PR and the unexpected event caused by PR in psychiatric hospitals. The modules of CRSCE-based de-escalation training can be adopted for future intervention minimizing clinical use of PR. Clinical Trial Registration: This study was registered at Chinese Clinical Trial Registry (Registration Number: ChiCTR1900022211).

The Emerging Role of Police in Facilitating Psychiatric Evaluation Since the 2013 Implementation of the First Chinese Mental Health Law.

In 2013, China's first Mental Health Law (MHL) took effect, with the goal of better protecting patients' rights. Under the law the police, with appropriate training, rather than family members, employers or medical staff sent from a hospital, are the ones who bring persons in behavioral crises to medical facilities for psychiatric assessment for possible involuntary hospitalization. We examined the proportion and distinctive characteristics of persons brought to psychiatric emergency services (PES) by the police since the implementation of MHL. We used medical records to document demographic and clinical characteristics of all persons evaluated at the PES of the Guangzhou Psychiatric Hospital, the largest psychiatric hospital in China's fourth largest city, from April 2017 to August 2017. Bivariate and multivariate statistical analyses were performed to identify characteristics of patients brought to the PES by the police. Among 1515 PES visits, 166 (11.0%) were brought by the police as compared to virtually none in the years before the law took effect. Compared to non-police referrals, police referrals were associated with male gender, age greater than 30, more documented violent behavior, greater likelihood of having been restrained, and higher rates of hospital admission after assessment. Assessed risk of suicidality and diagnoses of substance use disorder were not significantly associated with police referral. A modest but increased and noteworthy proportion of patients evaluated at the PES after implementations of China's MHL were brought by the police, especially those with violent behavior requiring restraint and hospitalization resulting from mental illness.

Evaluating the effectiveness of a CRSCE-based de-escalation training program among psychiatric nurses: a study protocol for a cluster randomized controlled trial.

BACKGROUND: The high incidence of workplace violence (WPV) in clinical mental health settings has caused a series of negative impacts on nurses, which has subsequently increased public concern. De-escalation (DE) is recommended as a training program which aims at providing nurses with skills and strategies to more effectively respond and manage WPV. Very few studies have examined the effectiveness of DE training, with current studies possessing various limitations due to their design and small sample sizes. By using a cluster randomized controlled design, the proposed study aims to evaluate the effectiveness of a CRCSE-based DE training programs among psychiatric nurses. METHOD: A cluster randomized controlled trial, with a 6-month follow-up period after the end of the intervention, will be conducted among psychiatric hospitals in Guangdong, China. The randomization unit is each involved psychiatric hospital. Participants in the control group will be assigned to routine WPV management training, participants of the intervention group will undergo the same training while additionally receiving DE training. The DE training will include the following five modules: communication, response, solution, care, and environment (CRSCE). Primary outcomes are objective clinical indicators, which will be extracted from the information systems of the enrolled hospitals. These include the incidence of WPV, injuries caused by WPV, and the use of coercion (physical restraint and seclusion) by nurses. Secondary outcomes, aims at evaluating the effects of DE training on nurses, include the capacity of DE, DE confidence, level of job burnout, and professional quality of life. Data will be collected at baseline (T0), at 3 months (T1, intervention completed), and at 6 months after intervention (T2, follow-up). DISCUSSION: This study will offer trial-based evidence of the efficacy of a DE training program targeted at WPV among psychiatric nurses. DE training is expected to reduce both the total incidence and negative impacts of WPV, with additional improvements in psychiatric nurses' coping skills. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1900022211 . Prospectively registered on 30 March 2019.

Ethical consideration on use of seclusion in mental health services.

Seclusion was widely used in mental health service, which had caused various negative effects on patients and nurses. In China, the clinical use of seclusion was gradually increasing, which had led to ethical dilemma and had gained public concern. This article aimed to synthesize the ethical issue according to the principle of autonomy, justice, beneficence, and non-maleficence. Given that nursing workforce was limited and work burden among psychiatric nurses was heavy, seclusion was one of coercive interventions managing aggressive behavior. In relation to cope with ethical dilemma, it was proposed to improve therapeutic environment, and to apply de-escalation technique. Additionally, reducing clinical use and adverse effects of seclusion was also important, this goal would be achieved by building appropriate patient-nurse relationship, increasing staff engagement, and promoting guideline of seclusion.

Physical restraint in mental health nursing: A concept analysis.

OBJECTIVE: Physical restraint is frequently used in medical services, such as in mental health settings, intensive care units and nursing homes, but its nature varies in different institutions. By reviewing related literature, this study aims to clarify the concept of physical restraint in mental health nursing. METHOD: Three databases (PubMed, PsycINFO and CINAHL) were retrieved, and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing. RESULTS: Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement. It should be the last option used by qualified personnel. Antecedents of physical restraint are improper behavior (violence and disturbance) of patients, medical assessment prior to implementation and legislation governing clinical usage. Consequences of physical restraint are alleviation of conflict, physical injury, mental trauma and invisible impact on the institution. DISCUSSION: This study defined the characteristics of physical restraint in mental health nursing. The proposed concept analysis provided theoretical foundation for future studies.

Perceived Burden and Quality of Life in Chinese Caregivers of People With Serious Mental Illness: A Comparison Cross-Sectional Survey.

PURPOSE: The aim of this study was to investigate perceived caregiver burden and quality of life (QOL) among Chinese family caregivers for people with serious mental illness (SMI). DESIGN AND METHODS: This is a cross-sectional study design. Participants were recruited and independently interviewed using the Chinese version of the World Health Organization Quality of Life-Brief Form, Hospital Anxiety and Depression Scale, Social Support Rating Scale, and Family Burden Interview Schedule as outcome measures. FINDINGS: In this study, 363 family caregivers were recruited. This study found that caregivers in Guangzhou perceived significantly higher levels of burden than did family caregivers in Hong Kong (all p values <.001). Weekly hours of contact with patients; subjective support; and subdomains of physical, psychological, and environmental QOL were significant predictors of perceived overall caregiver burden. Education levels, depressive symptoms, objective support, and objective caregiver burden significantly predicted caregivers' QOL. PRACTICE IMPLICATIONS: Study findings suggest there is a need for developing and implementing effective intervention strategies to reduce caregiver burden and improve caregivers' QOL. Health policy makers should provide relevant resources, such as financial assistance with care for family caregivers, as it is important that the health policy fully recognizes the role of family caregivers as a healthcare resource in caring for people with SMI.

Generic and disease-specific quality of life and its predictors among Chinese inpatients with schizophrenia.

This study aims to describe generic and disease-specific quality of life (QOL) and its predictors among Chinese inpatients with schizophrenia. A total of 209 subjects participated in this study: 121 men and 88 women. Their ages ranged from 18 to 64, with a mean age of 33.85 (S.D.=10.84). The total scores of generic and disease-specific QOL were statistically significant, correlated with patients׳ total symptom severity scores and social support scores (all P values less than 0.01). Multiple regression analysis revealed that monthly household income and subjective social support were statistically significant predictors of generic and disease-specific QOL. Duration of hospitalization, support use degree, negative and general psychopathology symptoms were additional significant predictors of disease-specific QOL. This study suggests the importance of improving subjective social support in order to promote generic and disease-specific QOL. Controlling negative and general psychopathology symptoms and improving support use degree could additionally enhance the disease-specific QOL in patients with schizophrenia.