Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T16:28:25.308Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of the effect of a structured intervention for the management of behavioural disturbance on the level of seclusion in an acute psychiatric inpatient ward

Published online by Cambridge University Press:  04 May 2010

Tom Trauer ,
Bridget Hamilton ,
Chris Rogers  and
David Castle
Tom Trauer*
Affiliation:
St. Vincent’s Hospital Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia Department of Psychiatry, University of Melbourne, Australia School of Psychology and Psychiatry, Monash University, Australia
Bridget Hamilton
Affiliation:
St. Vincent’s Hospital Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
Chris Rogers
Affiliation:
St. Vincent’s Hospital Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia
David Castle
Affiliation:
St. Vincent’s Hospital Mental Health Service, St. Vincent’s Hospital, Melbourne, Australia Department of Psychiatry, University of Melbourne, Australia
*
Correspondence to: Professor Tom Trauer, St. Vincent’s Hospital Mental Health Service, St. Vincent’s Hospital, Melbourne, PO Box 2900, Fitzroy, Victoria 3065, Australia. Tel: +61 3 9288 3295; E-mail: Tom.Trauer@med.monash.edu.au
Get access

Abstract

Background: Seclusion in psychiatric inpatient settings is contentious, and services attempt to minimize its use. Many studies compare seclusion rates before and after the introduction of an intervention, but few control for the effect of external factors such as legislative constraints and patient characteristics.

Aims: To evaluate the effect of a programme designed to manage acute arousal.

Method: Seclusion rates in a six-month period incorporating a programme to manage acute arousal were compared with the previous six months. The intervention focused on formal assessment of arousal levels and an escalating set of actions by nursing staff.

Results: Seclusion rates in the two periods were comparable, both before and after controlling for patient characteristics. Duration of seclusion events appeared to be heavily influenced by local legislative constraints.

Conclusions: A programme designed to reduce seclusion showed no difference from baseline after taking various factors into account. This may have been at least partly because most seclusion events occurred early in an admission. Many patients arrive on the unit already requiring seclusion, and any impact of a ward programme on them is limited. Since seclusion is a comparatively uncommon event, and attributable to a minority of patients, appropriate analytic methods are required.

Keywords

Seclusioninpatient psychiatrybehavioural disturbance
Type
Original Article
Information
Journal of Psychiatric Intensive Care , Volume 6 , Issue 2 , December 2010 , pp. 91 - 100
Copyright
Copyright © NAPICU 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Atkins, M.S. and Ricciuti, A. (1993) The disproportionate use of seclusion in a children's psychiatric state hospital. Residential Treatment for Children & Youth. 10: 23–33.Google Scholar
Binder, R.L. (1979) The use of seclusion on an inpatient crisis intervention unit. Hospital and Community Psychiatry. 30: 266–269.Google Scholar
Bowers, L., Brennan, G., Flood, C., Lipang, M. and Oladapo, P. (2006) Preliminary outcomes of a trial to reduce conflict and containment on acute psychiatric wards: City Nurses. Journal of Psychiatric and Mental Health Nursing. 13: 165–172.CrossRefGoogle ScholarPubMed
Busch, A.B. and Shore, M.F. (2000) Seclusion and restraint: A review of recent literature. Harvard Review of Psychiatry. 8: 261–270.Google Scholar
Castle, D., Daniel, J., Knott, J., Fielding, J., Goh, J. and Singh, B. (2005) Development of clinical guidelines for the pharmacological management of behavioural disturbance and aggression in people with psychosis. Australasian Psychiatry. 13: 247–252.CrossRefGoogle ScholarPubMed
Castle, D.J. and Alderton, D. (2003) Management of acute arousal in psychosis. In: Castle, D.J., Copolov, D.L., Wykes, T. (eds). Pharmacological and Psychosocial Treatment in Schizophrenia. London: Martin Dunitz, pp. 89–102.Google Scholar
D'Orio, B.M., Purselle, D., Stevens, D. and Garlow, S.J. (2004) Reduction of episodes of seclusion and restraint in a psychiatric emergency service. Psychiatric Services. 55: 581–583.Google Scholar
De Lacy, L.C. (2006) The influence of nursing staff numbers and skill mix on seclusion and restraint use in public psychiatric hospitals. Dissertation Abstracts International: Section B: The Sciences and Engineering. 66(11-B): 5899.Google Scholar
Donat, D.C. (2002) Impact of improved staffing on seclusion/restraint reliance in a public psychiatric hospital. Psychiatric Rehabilitation Journal. 25: 413–416.Google Scholar
Donat, D.C. (2003) An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. Psychiatric Services. 54: 1119–1123.Google Scholar
Dye, S., Brown, S. and Chhina, N. (2009) Seclusion and restraint usage in seven English psychiatric intensive care units (PICUs). Journal of Psychiatric Intensive Care. 5: 69–79.Google Scholar
El-Badri, S.M. and Mellsop, G. (2002) A study of the use of seclusion in an acute psychiatric service. Australian and New Zealand Journal of Psychiatry. 36: 399–403.Google Scholar
Fisher, W.A. (2003) Elements of successful restraint and seclusion reduction programs and their application in a large, urban, state psychiatric hospital. Journal of Psychiatric Practice. 9: 7–15.CrossRefGoogle Scholar
Fitzgerald, R.G. and Long, I. (1973) Seclusion in the treatment and management of severely disturbed manic and depressed patients. Perspectives in Psychiatric Care. 11: 59–64.Google Scholar
Gaskin, C.J., Elsom, S.J. and Happell, B. (2007) Interventions for reducing seclusions in psychiatric facilities: A review of the literature. British Journal of Psychiatry. 191: 298–303.Google Scholar
Goren, S., Singh, N.N. and Best, A.M. (1993) The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital. Journal of Child and Family Studies. 2: 61–73.Google Scholar
Greene, R.W., Ablon, J. and Martin, A. (2006) Use of collaborative problem solving to reduce seclusion and restraint in child and adolescent inpatient units. Psychiatric Services. 57: 610–612.CrossRefGoogle ScholarPubMed
Kalogjera, I.J., Bedi, A., Watson, W.N. and Meyer, A.D. (1989) Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients. Hospital and Community Psychiatry. 40: 280–285.Google Scholar
Mattson, M.R. and Sacks, M.H. (1978) Seclusion: Uses and complications. American Journal of Psychiatry. 135: 1210–1213.Google Scholar
Muralidharan, S. and Fenton, M. (2006) Containment strategies for people with serious mental illness. Cochrane Database of Systematic Reviews. 3: CD002084. DOI: 10.1002/14651858.CD002084.pub2.Google Scholar
National Centre for Classification in Health (2002) ICD-10-AM Mental Health Manual. Sydney, Faculty of Health Sciences, The University of Sydney.Google Scholar
Oldham, J.M., Russakoff, L. and Prusnofsky, L. (1983) Seclusion: Patterns and milieu. Journal of Nervous and Mental Disease. 171: 645–650.CrossRefGoogle ScholarPubMed
Olsen, D.P. (1998) Ethical considerations of video monitoring psychiatric patients in seclusion and restraint. Archives of Psychiatric Nursing. 12: 90–94.Google Scholar
Plutchik, R., Karasu, B.T., Conte, H.R. and Siegel, B. (1973) The seclusion room: Its role in psychiatric practice. Proceedings of the Annual Convention of the American Psychological Association 1973, 459–460.Google Scholar
Regan, K., Curtin, C. and Vorderer, L. (2006) Paradigm shifts in impatient psychiatric care in children: Approaching child- and family-centered care. Journal of Child and Adolescent Psychiatric Nursing. 19: 29–40.Google Scholar
Schreiner, G.M., Crafton, C.G. and Sevin, J.A. (2004) Decreasing the use of mechanical restraints and locked seclusion. Administration and Policy in Mental Health. 31: 449–463.Google Scholar
Schwab, P.J. and Lahmeyer, C.B. (1979) The uses of seclusion on a general hospital psychiatric unit. Journal of Clinical Psychiatry. 40: 228–231.Google Scholar
Smith, G.M., Davis, R.H., Bixler, E.O., Lin, H.-M., Altenor, A., Altenor, R.J., Hardentstine, B.D. and Kopchick, G.A. (2005) Pennsylvania State Hospital system’s seclusion and restraint reduction program. Psychiatric Services. 56: 1115–1122.Google Scholar
Sourander, A., Ellila, H., Valimaki, M. and Piha, J. (2002) Use of holding, restraints, seclusion and time-out in child and adolescent psychiatric in-patient treatment. European Child & Adolescent Psychiatry. 11: 162–167.CrossRefGoogle ScholarPubMed
Stolker, J.J., Hugenholtz, G.W., Heerdink, E.R., Nijman, H.L., Leufkens, H.G. and Nolen, W.A. (2005) Seclusion and the use of antipsychotics in hospitalized psychiatric patients. Psychology, Crime & Law. 11: 489–495.Google Scholar
Swett, C. (1994) Inpatient seclusion: Description and causes. Bulletin of the American Academy of Psychiatry & the Law. 22: 421–430.Google Scholar
Thompson, P. (1986) The use of seclusion in psychiatric hospitals in the Newcastle area. British Journal of Psychiatry. 149: 471–474.Google Scholar
Tunde-Ayinmode, M. and Little, J. (2004) Use of seclusion in a psychiatric acute inpatient unit. Australasian Psychiatry. 12: 347–351.Google Scholar
Victorian Government (1986). Mental Health Act. Melbourne: Victorian Government Printing Office. http://www.legislation.vic.gov.au/Google Scholar
Way, B.B. and Banks, S.M. (1990) Use of seclusion and restraint in public psychiatric hospitals: Patient characteristics and facility effects. Hospital and Community Psychiatry. 41: 75–81.Google Scholar
Wing, J.K., Beevor, A.S., Curtis, R.H., Park, S.B.G., Hadden, S. and Burns, A. (1998) Health of the Nation Outcome Scales (HoNOS). Research and Development. British Journal of Psychiatry. 172: 11–18.Google Scholar