Influence of nursing staff characteristics on seclusion in acute mental health care—A prospective two-year follow-up study

Paul Doedens,Gerben Ter Riet,Jentien Vermeulen,Lindy-Lou Boyette,Corine Latour,Lieuwe De Haan

doi:10.1016/j.apnu.2021.07.003

Abstract

IntroductionSeclusion still occurs on mental health wards, despite absence of therapeutic efficacy and high risks of adverse patient effects. Literature on the effect of nursing teams, and the role of psychological characteristics in particular, on frequency of seclusion is scarce. AimTo explore the influence of demographic, professional or psychological, nursing team-level, and shift characteristics on the frequency of use of seclusion. MethodsProspective two-year follow-up study. ResultsWe found that the probability of seclusion was lower when nursing teams with at least 75% males were on duty, compared to female only teams, odds ratio (OR = 0.283; 95% CrI 0.046–0.811). We observed a trend indicating that teams scoring higher on the openness personality dimension secluded less, (OR = 0.636; 95% CrI 0.292–1.156). DiscussionHigher proportions of male nurses in teams on duty were associated with lower likelihood of seclusion. We found an indication that teams with a higher mean openness personality trait tended to seclude less. These findings, if causal, could serve as an incentive to reflect on staff mix if circumstances demand better prevention of seclusion.

Highlights

Seclusion still occurs on mental health wards, despite absence of therapeutic efficacy and high risks of adverse patient effects
This study aimed to explore the effects of nursing team characteris tics, shift characteristics on the use of seclusion on acute mental health wards, while controlling for patient characteristics
We conclude that more male nurses on shift seem to lower the probability of the decision to seclude patients and that there is some indication that the extent to which nursing teams have more open per sonality characteristics may influence the decision whether to seclude patients

Summary

Introduction

Seclusion still occurs on mental health wards, despite absence of therapeutic efficacy and high risks of adverse patient effects. We found an indication that teams with a higher mean openness personality trait tended to seclude less These findings, if causal, could serve as an incentive to reflect on staff mix if circumstances demand better prevention of seclusion. Coercive measures, such as seclusion and restraint, are still common practice on mental health wards in some countries, despite the absence of evidence for their therapeutic efficacy (Chieze, Hurst, Kaiser, & Sentissi, 2019; Sailas & Fenton, 2000). The type of coercive measure used on mental health wards (e.g. seclusion, physical restraint, involuntary medication) and frequency of use vary substantially be tween countries (Bak & Aggernaes, 2012; Raboch et al, 2010). The use of seclusion in the Netherlands declined from 11.8% in 2008 to 7.1% of patients admitted in 2013, likely because of a nation-wide seclusion reduction program (Noor thoorn et al, 2016)

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