Seclusion as a necessary vs. an appropriate intervention: a vignette study among mental health nurses.

In a vignette study, mental health nurses were asked to score vignettes on necessity and appropriateness using a Likert scale. Sixty-nine clinical nurses from four mental health institutes scored 64 vignettes on necessity (there is no alternative) and appropriateness (seclusion supports patients' treatment) of seclusion simultaneously. Data analysis focused on the differences between both scores, and included general linear model analysis, t-test statistics and Kendall's tau. The t-test resulted in a significantly higher score on necessity than on appropriateness. Differences between both scores could be explained for 32% by a combination of nurse characteristics and vignette variables. Necessity and appropriateness were found to be strongly associated with each other, showing that underpinning patterns were largely the same. This research enhances the understanding of underlying factors that influence the decision of nurses to use seclusion. This is essential for the development of interventions aimed at the reduction of seclusion use in mental health practice.

Professionals' attitudes after a seclusion reduction program: anything changed?

Changing professionals' attitudes toward seclusion is seen as an important condition to reduce its use. The purpose of this study was to determine whether professionals from a mental health institute in the Netherlands changed in their attitudes toward seclusion after implementation of a multifaceted seclusion reduction program. Professionals working on four acute admission wards filled in the Professional Attitudes Toward Seclusion Questionnaire (PATS-Q) before and after a seclusion reduction program. Changes were analyzed by comparing mean scores on the PATS-Q. After the program, professionals scored significantly higher on 'ethics' and 'more care'. As expected, no change occurred on 'reasons' for the use of seclusion. In addition, no significant changes were found on 'confidence', 'better care' and 'other care'. Significant changes in professional attitudes concerning the ethics of using seclusion and involving issues of more care were observed after a seclusion reduction program. Mental health professionals moved in the direction of 'transformers', indicating an increased criticism of the practice of seclusion and increased willingness to change their own use of seclusion.

Nurses' decision on seclusion: patient characteristics, contextual factors and reflexivity in teams.

While many characteristics of patients, professionals and facilities with relevance to seclusion rates have been investigated, their relative importance is unclear. Virtually no attention has been paid to team processes and reflexivity in relation to decision making on seclusion. The aim of this paper is to estimate the effects of these factors on nurse decision making on seclusion. Sixty Dutch psychiatric nurses of four closed wards reported team reflexivity and their tendency to seclude a theoretical patient. Approachability (whether there was a good or hardly any possibility to communicate with the patient), staffing level and confidence within the team had the greatest impact on the decision to seclude. Intra class correlation was 0.30. There was a large interaction effect of reflexivity with team 4, and team reflexivity was highly correlated with team tendency to avoid seclusion. In nurses' decision on seclusion, the effects of 'pure' patient characteristics are small as compared with the effects of interpersonal and contextual factors, and nurses vary widely in their judgement. Team reflexivity is related to the tendency to prevent seclusion.

[E-mental health interventions for family caregivers of older adults: a review]. / E-mental health interventies voor mantelzorgers van ouderen: een overzicht.

PURPOSE: To present a systematic overview of the different e-mental health interventions for caregivers of older adults. METHODS: Systematic literature research of implemented and evaluated e-mental interventions for caregivers of older adults. RESULTS: Thirteen e-mental health interventions are included: six telephone, one camera and six internet interventions. In general, research on user friendliness and client satisfaction shows positive results. The effectiveness of three e-mental health interventions have been studied. The family-based structural in-home intervention with the computer telephone integrated system shows a decrease in depressive symptoms after six and eighteen month. The telephone linked computer system did not show positive mental health effects for the total group of family caregivers. After online lessons, caregivers were more capable to organize respite care and to manage disruptive and challenging behaviours of the care recipient. Their ability to solve their own problems increased and their subjective burden decreased. A cost analysis of an internet intervention shows a reduction in costs in comparison to regular care. CONCLUSION: E-mental health interventions for caregivers of older adults are encouraging, although research in this field is still in its infancy. Research on the effectiveness and cost-effectiveness of these type of interventions is needed. In addition, the opportunities of internet interventions could be used more extensively.