Acute Mental Health Care Settings Research Articles

Uncovering Complexities in Reducing Aggression, Conflict and Restrictive Practices in Acute Mental Healthcare Settings: An Overview of Reviews.

Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high-level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re-extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy-based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand-alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff-related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity-informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups.

The evaluation of IMR in crisis resolution home treatment, a mixed methods study protocol

IntroductionIn the past years, recovery has become a central concept in psychiatric treatment (Sowers et al. Acad Psychiatry 2016; 40 461-467). However, in acute mental health care the concept of recovery is lacking attention (Rabenschlag et al. Psychiatry Q 2014; 85 225-239; Jaeger et al. Nord J Psychiatry 2015; 69 188-195; Luigi et al. Can. Med. Educ. J. 2010; 11 62-73). In 2021 a short version of Illness Management and Recovery (IMR) was implemented at the Psychiatric Emergency Service Amsterdam-Amstelland (SPAA). IMR is an evidence based group intervention for patients with severe mental illness, based on cognitive-behavioral, psychoeducational and motivational components. The aim of IMR is to support participants to manage their mental illness (Mueser et al. Schizophr Bull 2006; 32 32-43). To our knowledge this the first time that IMR is implemented within an acute mental health care setting Therefore the effects of IMR program on recovery in the acute phase of psychiatric illness are unknown.ObjectivesInsight in effects of IMR in acute mental health care.MethodsWe will carry out a mixed method study. In phase 1 the intervention will be carried out. 25 patients who are admitted to acute mental health care and diagnosed with a severe mental illness (SMI) will take part in the shortened version of IMR. Effects will be measured by the client version of the IMR-scale (Salyers et al. Community Ment. Health J. 2007; 43 459-480).Phase 2 includes qualitative interviews with a subsample from phase 1 (using maximum variety in diagnosis and demographic characteristics) to gain insight in the mechanisms and impact of the program.ResultsThe proposed study will investigate the effects of an adjusted evidenced-based treatment within a population of people who receive treatment in a Psychiatric Emergency Service. The original intervention is shortened in time and topics, to match the needs of people in the acute phase of psychiatric illness. The question that arises is if an existing treatment can be translated to a different group of patients.ConclusionsThe proposed project has some important limitations that we feel deserve mentioning. It is questionable if a person can profit from a recovery program during a phase of acute crisis. Also, can we expect the same effects if the new program is a shortened version of the original evidence based intervention?Disclosure of InterestNone Declared

Remote consultations in the era of COVID-19 pandemic: Preliminary experience in a regional Australian public acute mental health care setting.

In the wake of the recent pandemic of Corona Virus Disease 2019 (COVID-19), with confirmed cases having crossed 750,000, health systems across the world are getting overwhelmed; making it strenuous to maintain essential health services. Several changes were implemented in our acute mental health care service using a collaborative approach to maintain a balance between preventive measures to ‘flatten the curve’ and to provide care to those who were in need. Mode of service delivery was changed predominantly to tele-medicine, amongst others. It was found to be a workable model, albeit further follow up will be required to better understand its viability and feasibility to withstand the COVID-19 cataclysm.

Educating undergraduate general nursing students to conduct Mental State Assessments using high fidelity video simulations that develops learning in the affective domain

Nursing students require a range of clinical skills to contribute as part of the mental health care team, we would argue that one of the quintessential skills is the ability to complete and accurately record a Mental State Assessment (MSA). Teaching students how to complete a MSA using high fidelity video simulations (HVFS) prepares them for the reality of clinical practice including cognitive skill development and emotional readiness for clinical practicum in acute mental health care settings. In this study, three HVF simulations were created to facilitate students learning, based on well documented evidence supporting the use of video content as a learning media. However our focus is not only on cognitive skill development in conducting mental state assessments, but in distinguishing the approach to learning in the affective domain. Using this method, students learn to confront and manage their own feelings, beliefs and attitudes and in turn regulate their emotional responses in clinical situations. Pre and post workshop evaluations completed by students for the past three years has resulted in consistently high levels of confidence in ability to conduct a MSA after the workshop. The paired t test was used to calculate the difference between pre and post workshop confidence scores, revealing the two-tailed p value of less than .0001 which is considered to be extremely statistically significant. Therefore, it can be concluded that students completing the 3-day workshop had a significant increase in confidence and competence in performing MSA’s.

A Co-operative Inquiry Into Generating, Describing, and Transforming Knowledge About De-escalation Practices in Mental Health Settings

De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff members as co-researchers and knowledge was generated in dynamic research cycles around an extended epistemology of knowing: experiential, presentational, propositional, and practical. Through this process, co-researchers became de-escalation learners, implementing de-escalation practices while transforming violence management. Neighbouring mental health communities’ involvement strengthened the transformation process and assisted in validating the research results.

The experiences of mental health professionals and patients in the use of pro re nata medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence

A previous version of this article has been retracted. See: Morkunas B, Porritt K, Stephenson M. RETRACTED: The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence. JBI Database System Rev Implement Rep 2014; 12(7):164-172. doi:10.11124/jbisrir-2014-1669 REVIEW QUESTION / OBJECTIVE The objective of this review is to synthesize the best available qualitative evidence on the experiences of mental health professionals and patients with the use of pro re nata medication in acute mental health care settings. More specifically, the review question is: what do mental health professionals experience when they administer or prescribe PRN medications and what do patients who receive these pro re nata medications experience? INCLUSION CRITERIA Types of participants This review will consider studies that include mental health professionals working in an acute adult mental health care setting who prescribe and administer pro re nata medications as well as adults admitted to an acute adult mental health care setting. Phenomena of interest This review will consider studies that investigate mental health professionals’ and patients’ experiences in the use of PRN medication. Context The context for the review is acute adult inpatient mental health care settings. These settings are usually within public health systems or private mental health settings. Types of studies This review will consider English language studies only that focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research.

The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence

The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: a systematic review protocol of qualitative evidence

Transforming the Culture of Caring

Direct care staff struggle with the decision of when to physically intervene with patients. There is a widely held belief that they are expected to place themselves in danger of harm to prevent patients from hurting themselves or others. In this acute mental health care setting, an educational program was developed, using principles of adult and transformational learning, to dispel the idea that getting hurt is part of the job. The Staying Safe program strongly discourages staff from physically intervening alone and promotes staff getting enough help and having a plan. Staff are encouraged to interact with patients in helpful ways and to respond to patient requests in ways that do not increase frustration or evoke anger. There has been a positive response to the training program, evidenced by changes in the way staff think about their jobs and a reduction in the number of assaults and injuries to staff.

Service users’ experiences of ‘as needed’ psychotropic medications in acute mental healthcare settings

This paper reports a study which aimed to explore service users' views and experiences of the processes associated with the prescription and administration of 'as needed' (p.r.n.) psychotropic medications in acute mental health settings. Few studies have explored the use of 'as needed' medication in acute mental healthcare settings. Such medication is frequently requested by service users, but the literature is unclear about the reasons for these requests or service users' experiences of this treatment. A convenience sample of 22 inpatients participated in face-to-face semi-structured interviews exploring their treatment experiences of 'as needed' psychotropic medication in acute mental health settings in a large city in the United Kingdom in 2005. Thematic content analysis was carried out. Interviewees highlighted the value of 'as needed' medications. However, the process associated with their use was perceived as confusing and stigmatizing. Service users had limited understanding of and felt unsupported in attempts to use alternatives approaches. Additionally, the decision-making and information-giving processes were unclear to them, which raises issues of power and control in acute mental health settings. Nurses should take account of the issues of power and control when administering 'as needed' medication. The provision of adequate treatment information should be a priority to enable informed choices to be made about this form of medication.

Physical restraint of patients in acute mental health care settings: patient, staff, and environmental factors associated with the use of a horizontal restraint position

Physical restraint of potentially violent patients can take place on the floor in prone or supine positions (horizontal restraint) or, less intrusively, in standing or sitting positions (vertical restraint). The decision to use horizontal restraint may be made unnecessarily if the level of risk in an interaction is overestimated and/or the capacity to otherwise control the situation is underestimated by staff. A model of the decision-making process in this situation based on the concept of cognitive appraisal of imminent threat is proposed here. The aim of the study reported here was to test this model by examining the patient, staff, and environmental factors associated with the use of horizontal (as opposed to vertical) restraint. Logistic regression analysis of secondary data on the first-recorded episode of restraint of 261 patients occurring over a three-year period (1999 – 2001) in an acute care psychiatric trust in the UK was conducted, followed by a ROC analysis of the discriminative ability of the derived model to predict horizontal restraint. It was found that patients admitted under Section 2 of the Mental Health Act, those committing self-harm, and those with unclear thoughts and increased vocal volume prior to the incident were more likely to be restrained horizontally. Older people, those with perceived rational causation such as bad news and personal gain, and those with no obvious warning signs were less likely to be restrained horizontally. The AUC of the model was .76 (95% CI .70 – .82), indicating acceptable discriminative ability. It is concluded that certain patient characteristics and certain staff appraisals of pre-incident behaviour are associated with an increased risk of horizontal restraint.

Researchers’ experience of co‐operative inquiry in acute mental health care

The aim of this article is to reflect upon our experiences of using co-operative inquiry in an acute mental health care setting, with a focus on the methodology used in a 4-year intervention programme developed in Norway between 1999 and 2003. Action research plays a crucial role in assisting nurses to integrate theory and research with nursing practice. The central characteristic of this approach is the grounding of research in practice in collaboration with clinical practitioners. The research was a co-operative inquiry based on a hermeneutic-phenomenological approach. The research methods used were ethnographic, including participant observation and face-to-face interviews, questionnaires, focus group interviews, and our process notes. The different methods used in the co-operative inquiry design of the Project Teaching Ward (PTW) had both benefits and drawbacks. In particular, the focus group method proved useful due to its ability to stimulate participants' research interest, and thus motivating them to be actively involved in the development of knowledge. The particular knowledge development process used has been described as a local knowledge dialogue. This dialogue must incorporate critical subjectivity on the part of participants in order to ensure that the research has a reflective resistance, which is decisive for its validity and quality. The findings also highlight the importance of the different roles of project leader in lengthy action research collaboration. The PTW has illustrated that co-operative inquiry was well suited for developing knowledge relevant to practice, thus contributing to bridging the gap between practice and theory. In order for this to happen, the research collaboration should be characterized by patience, realism and engagement.

Cognitive behaviour therapy within acute mental health care: A critical appraisal

This paper examines the evidence for the use of cognitive behavioural therapy (CBT) within acute mental health-care settings. Through the provision of a literature review the authors critique the research into the effectiveness of CBT when delivered within acute mental health-care settings, to clients who are acutely psychotic. The review concludes with recommendations for future research to expand the current evidence base.

Nursing attitudes towards acute mental health care: development of a measurement tool

This paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units. The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported. A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire. Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant 'Attitudes Towards Acute Mental Health Scale' (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0.72. The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care.