Psychiatric Inpatient Wards Research Articles

Five-year review of absconding in three acute psychiatric inpatient wards in Australia.

Absconding, where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. However, Australian data to drive nursing interventions remain sparse. The purpose of this retrospective study was to investigate absconding in three acute care wards from January 2006 to June 2010, in order to determine absconding rates, compare patients who did and did not abscond, and to examine incidents. The absconding rate was 17.22 incidents per 100 involuntary admissions (12.09% of patients), with no significant change over time. Being male, young, diagnosed with a schizophrenia or substance-use disorder, and having a longer hospital stay were predictive of absconding. Aboriginal and Torres Strait Islander patients had higher odds of absconding than Caucasian Australians. Over 25% of absconding patients did so multiple times. Patients absconded early in admission. More incidents occurred earlier in the year, during summer and autumn, and later in the week, and few incidents occurred early in the morning. Almost 60% of incidents lasted ≤24 hours. Formulation of prospective interventions considering population demographic factors and person-specific concerns are required for evidence-based nursing management of the risks of absconding and effective incident handling when they do occur.

Mindfulness-based training in residential settings: rationale, advantages and obstacles

SummaryThe past few decades have witnessed the synthesis of Buddhist mindfulness practice with the Western psychological paradigm, leading to the development of a variety of mindfulness-based interventions. These are delivered to various populations to treat a wide range of physical and psychological disorders, and several protocols have been implemented and evaluated, mostly, if not exclusively, in open or out-patient treatment settings. Little attention has been given to the definition of criteria, guidelines and protocols for the use of mindfulness in residential settings such as in-patient psychiatric wards, secure and forensic services, prisons, nursing homes and hospices. In this article, we discuss the rationale, advantages and obstacles to delivering mindfulness-based interventions in residential treatment settings, with specific reference to forensic settings. We also discuss the problem of developing robust outcome data and recommendations for future research.Learning Objectives•Understand the advantages and challenges of introducing mindfulness-based interventions in in-patient settings.•Understand how mindfulness-based interventions can be adapted to accommodate individual patient psychopathology.•Understand how mindfulness-based interventions can be adapted to specialist clinical settings such as forensic units.

'We have to be satisfied with the scraps': South African nurses' experiences of care on adult psychiatric intellectual disability inpatient wards.

Migrating nursing labour inadvertently reinforces South Africa's care drain, contributes to a global care crisis and forces us to reconsider migration motivation. This paper highlights issues that complicate psychiatric intellectual disability nursing care and identifies loci for change in an attempt to redress this care challenge. An exploratory descriptive-interpretivist method investigated nurses' experiences of psychiatric intellectual disability work. Sixteen free association narrative interviews were collected in 2013. Thematic analysis allowed findings to emerge from the data. Findings reflect a number of themes: 'relational interaction', 'care burden', 'system fatigue', 'infantilising dynamic of care' and 'resources for coping'. System fatigue contributes more to negative experiences of providing care than direct patient work, and nurses experience more relational reciprocity from patients than from institutional management. Organizations should meet nurses' needs for burnout prevention, afford them impact in implementing institutional controls, and engage in a non-exploitative and non-exclusionary way.

Implementation of a rapid HIV testing program in psychiatric inpatient wards

Aim According to New York State law, HIV testing must be offered to every patient aged 13-64. However, acute mental health hospitalizations can be difficult settings in which to conduct HIV screening. Because individuals with mental illness have higher rates of HIV infection, routine testing of stabilized patients in psychiatric inpatient wards could be beneficial. This study describes the implementation of a rapid HIV testing program in this nontraditional setting.

A Contact-Based Intervention for People Recently Discharged from Inpatient Psychiatric Care: A Pilot Study

People recently discharged from inpatient psychiatric care are at high risk of suicide and self-harm, with 6% of all suicides in England occurring in the 3 months after discharge. There is some evidence from a randomized trial carried out in the United States in the 1960s–70s that supportive letters sent by psychiatrists to high-risk patients in the period following hospital discharge resulted in a reduction in suicide. The aim of the current pilot study was to assess the feasibility of conducting a similar trial, but in a broader group of psychiatric discharges, in the context of present day UK clinical practice. The intervention was piloted on 3 psychiatric inpatient wards in southwest England. On 2 wards a series of 8 letters were sent to patients over the 12 months after discharge and 6 letters were sent from the third ward over a 6 month period. A total of 102 patients discharged from the wards received at least 1 letter, but only 45 (44.1%) received the full series of letters. The main reasons for drop-out were patient opt-out (n = 24) or readmission (n = 26). In the context of a policy of intensive follow-up post-discharge, qualitative interviews with service users showed that most already felt adequately supported and the intervention added little to this. Those interviewed felt that it was possible that the intervention might benefit people new to or with little follow-up from mental health services but that fewer letters should be mailed.

Impacts of Social Networking Sites on Patient Care in the Emergency Department

The use of Facebook is ubiquitous among both patients and physicians. Often Facebook intrudes into medical practice, thereby highlighting its potential to be either a positive or negative factor in a patient's medical care. Despite being a "hot topic" in the medical literature, very few real world examples exist of physicians actually using information obtained from Facebook to reach a diagnosis or otherwise affect patient care. We present a case involving a 13-year-old girl who posted photographs and captions on Facebook demonstrating suicidal ideation. The patient's parents were alerted to the girl's statements in her Facebook profile and brought her to the emergency department. The girl's statements and photographs, as reported by her parents, were used by an emergency physician to make a diagnosis of suicidal risk and to disposition of the patient to an inpatient psychiatric ward. We discuss the potential diagnostic utility of information posted on Facebook and briefly discuss the ethical questions surrounding this situation.

Reproductive health in women with serious mental illnesses

To determine what problems female psychiatric patients have in terms of reproductive health. The reproductive health problems faced by female psychiatric patients are matters that have been neglected in the areas of both psychiatry and women's health. This study aims to make a contribution from Turkey to the literature in this neglected field. The study is descriptive and was conducted with 292 female patients treated in an acute inpatient psychiatric ward. Data were collected through face-to-face interviews and a questionnaire based on the literature and prepared by the researchers which was designed to determine the kinds of reproductive health issues the patients were experiencing. It was found that compared with healthy women, the distinctive features of the participants in terms of sexuality were more negative; in particular, patients diagnosed with bipolar disorder were more likely to have been forced by their partners to have sex, they had suffered from rape or sexually transmitted diseases, the majority of those who had previous sexual experience had tried to use contraceptives but had been unable to continue using them, they were most likely to choose the method of withdrawal for contraception, their rates of pregnancy and abortion were high, they received less antenatal care, and they were more likely to have smoked during pregnancy. It was found that female patients with psychiatric disorders had more negative attributes with regard to marriage, sexuality, family planning, maternal characteristics and pregnancy, compared with a corresponding healthy population. The results of this study may be useful for nurses in the clinical field for calling an attention and raising an awareness of the reproductive health problems of women with psychiatric disorders, taking the necessary preventive measures, and developing damage-reducing strategies.

Evaluating the Built Environment in Inpatient Psychiatric Wards

Research on inpatient psychiatric care has paid little attention to the built environment of psychiatric wards. This study described the built environment in a sample of inpatient psychiatric wards in England and investigated relationships between staff satisfaction with the built environment of the ward and objective design features of the environment. Trained researchers completed a checklist of built-environment characteristics of 98 inpatient wards in England in 2007-2009. Interrater reliability was assessed and confirmed. Staff on these wards completed a three-item measure assessing the ward for overall design, fitness for purpose, and role in ensuring safety. Multilevel modeling was used to test relationships between built-environment features and staff satisfaction. A total of 1,540 staff responded. The wards encompassed a wide variety of service types and built-environment features. Staff satisfaction with the built environment was associated with noncorridor design and with the provision of personal bathrooms for patients. No association with observability of patients, exterior views, or other facilities was found. There was no difference between nurses and other groups in satisfaction with overall design, but nurses rated ward environment lower on ensuring safety (p=.036) and on fitness for purpose (p=.012). Objective measurement of the built environment in inpatient psychiatric settings is feasible and can be used to identify features that increase user satisfaction.

Staff happiness and work satisfaction in a tertiary psychiatric centre

Mental health professionals are at a high risk of burnout. Positive psychology outcomes of staff in acute in-patient psychiatric wards are poorly researched and unclear. To quantify the satisfaction with life and work-life satisfaction of mental health staff at a large university-affiliated tertiary psychiatric centre. We utilized the Satisfaction with Life Scale (SWLS) and the Work-Life Satisfaction Questionnaire (WLSQ). Two hundred and nine out of 450 staff members (46%) participated; mean age 48.2 + 9.9 years; 63% were male. On average the participants had been practising their speciality for 21.1 + 9.8 years (range: 2-48). The mean total SWLS scores differed significantly between professions (P < 0.05). The highest levels of happiness were reported by psychologists and social workers, followed by the administrative staff, the psychiatrists and finally the nursing staff. Staff scored the highest for work as a 'calling' followed by work as a 'career' and the lowest rating for work as a 'job'. The mean total WLSQ score differed between professions, (P < 0.01). The highest levels of work as a calling were reported by psychiatrists (mean 2.87 of possible 5.0), followed by psychologists and social workers, nursing staff and finally administrative staff. Satisfaction with life and work orientation do not correlate among mental health professionals. Although highly motivated and perceiving psychiatry as a 'calling' psychiatrists score low on levels of satisfaction with life. Improving staff happiness may contribute to increase in moral and counter burnout.

‘Safe enough in here?’: patients' expectations and experiences of feeling safe in an acute psychiatric inpatient ward

To understand the experience of being a patient on an acute psychiatric inpatient ward. Acute psychiatric inpatient care is an integral part of the mental health system. A key driver for admission to acute wards is risk. Previous research indicates that people do not always feel safe when in an acute ward. Understanding the patient experience of safety can influence nursing practice, as well as policy and service development. A qualitative approach was used. Patient experience was conceptualised as represented through narrative as data. Sociolinguistic theories linking narrative structure with meaning informed the development of the analytic framework. Thirteen patients with a variety of diagnoses were recruited from an acute ward. Unstructured interviews were carried out in participants' homes two and six weeks postdischarge. Holistic analysis of each individual's data set was undertaken. Themes running across these holistic analyses were then identified and developed. Participant narratives were focused around themes of help, safety and power. This study presents findings relating to the experience of safety. Participants expected to be safe from themselves and from others. Initially, they experienced a sense of safety from the outside world. Lack of knowledge of their fellow patients made them feel vulnerable. Participants expected the nurses to keep them safe, and felt safer when there were male nurses present. Participants talk about safety in terms of psychological and physical safety. A key issue was the perception of threat from other patients, highlighting the need to consider patient safety as more than physical safety. Nurses need to be sensitive to the possibility that patients feel unsafe in the absence of obvious threat. Institutional structures that challenge patients' sense of safety must be examined.

Hearing voices: re/presenting the findings of narrative research into patient experience as poems

The study aimed to understand the experience of being a patient on an acute psychiatric inpatient ward. A further aim was to open up spaces for the voices of participants to be heard. Contemporary government policy places patient experience at the centre of healthcare policy and service development. Despite this, those who occupy marginalized discourses struggle to be heard within the dominant discourse of health care. A qualitative approach was used, and narrative was conceptualized as representing experience. Sociolinguistic theories informed the development of the analytic framework treating meaning as contextual and arising from both content and structure of narratives. Concepts of representation, voice and authorship were problematized. Thirteen people who had been inpatients on an acute psychiatric inpatient ward participated. Narrative data were gathered using unstructured interviews. The data were analysed holistically using a method that attended to both the structure and content of the narrative. The product of these holistic narratives was the development of a poem representing each participant's experience. This paper focuses on the development of these poems as a method of decentring the authorial voice and opening up spaces for the voices of the participants to be heard.

Suicide Prevention as a Prerequisite for Recovery from Severe Mental Illness

For a significant number of people suffering from severe mental illness (SMI) prevention of suicide is a prerequisite for their recovery. This review summarises and interprets risk/protective factors for suicide in the context of schizophrenia and bipolar disorder, thereby enabling evidence-based suicide risk assessment and management. A history of self-harm greatly increases suicide risk among people with schizophrenia or bipolar disorder. Suicide prevention for patients with SMI necessitates constant vigilance by (mental) health and social care professionals in contact with them, particularly those with a history of self-harm, males, young people, those near illness onset, people with a family history of suicidal behaviour (especially suicide), victims of childhood abuse, those challenged by recent adverse life events (notably interpersonal conflict), people with aggressive/impulsive personality features, and those who have expressed hopelessness. Research suggests that suicide risk associated with SMI should be reduced by early intervention, restricting access to lethal means, improvement of treatment adherence, treating more patients with clozapine and lithium, assertive outreach, treating psychiatric comorbidity (depression, alcohol/drug misuse, etc.), 24-hour crisis care, timely (compulsory) hospitalization (sufficient bed provision imperative), improving psychiatric inpatient ward safety, lowering the risk of absconding from wards, appropriate use of electroconvulsive therapy, intensive follow-up postdischarge, and improving access to psychological/psychosocial interventions, notably cognitive behavioural therapy. The clinical interview is the optimum method of suicide risk assessment and locally developed risk assessment tools should not be used. Evidence-based suicide risk assessment/management within primary care and secondary mental health services warrants recurrent, mandatory training.

The day-to-day acute effect of wake therapy in patients with major depression using the HAM-D6 as primary outcome measure: results from a randomised controlled trial.

BackgroundThis paper reports day-to-day data for from a one-week intervention phase, part of a 9-weeks randomised parallel study with patient having major depression (data from weekly visits have been reported). Wake therapy (sleep deprivation) has an established antidepressant effect with onset of action within hours. Deterioration on the following night’s sleep is, however, common, and we used daily light therapy and sleep time stabilisation as a preventive measure. In particular, we evaluated the day-to-day acute effect of and tolerance to sleep deprivation and examined predictors of response.MethodsPatients were assessed at psychiatric inpatient wards. In the wake group (n = 36), patients did three wake therapies in combination with light therapy each morning together with sleep time stabilisation. In the exercise group (n = 38), patients did daily exercise. Hamilton subscale scores were primary outcome (not blinded), secondary outcome was self-assessment data from the Preskorn scale and sleep.ResultsPatients in the wake therapy group had an immediate, large, stable, and statistically significant better antidepressant effect than patients in the exercise group with response rates at day5 of 75.0%/25.1% and remission rates of 58.6%/6.0%, respectively. The response and remission rates were diminished at day8 with response rates of 41.9%/10.1% and remission rates of 19.4%/4.7%, respectively. Patients and ward personnel found the method applicable with few side effects. Positive diurnal variation (mood better in the evening) predicted a larger response to wake therapy. In the wake group napping on days after intervention predicted greater deterioration on day8. ConclusionsThe intervention induced an acute antidepressant response without relapse between wake nights but with a diminishing effect after intervention. Development is still needed to secure maintenance of response. Avoiding napping in the days after wake therapy is important.Trial RegistrationClinical trials.gov NCT00149110

Evaluation of somatic health care practices in psychiatric inpatient wards

Evaluation of somatic health care practices in psychiatric inpatient wards

Correlation Between Levels of Conflict and Containment on Acute Psychiatric Wards: The City-128 Study

OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high. This study investigated wards with the counterintuitive combination of low containment and high conflict or high containment and low conflict. METHODS The authors conducted a secondary analysis of cross-sectional data collected from 136 acute psychiatric wards across England in 2004-2005. The wards were categorized into four groups on the basis of median splits of containment and conflict rates: high conflict and high containment, high conflict and low containment, low conflict and low containment, and low conflict and high containment. Features significantly associated with these ward types were identified. RESULTS Among the variables significantly associated with the various typologies, some-for example, environmental quality-were changeable, and others-such as social deprivation of the area served-were fixed. High-conflict, low-containment wards had higher rates of male staff and lower-quality environments than other wards. Low-conflict, high-containment wards had higher numbers of beds. High-conflict, high-containment wards utilized more temporary staff as well as more unqualified staff. No overall differences were associated with low-conflict, low-containment wards. CONCLUSIONS Wards can make positive changes to achieve a low-containment, nonpunitive culture, even when rates of patient conflict are high.

The Prevalence of Mental Disorders among Serving Soldier Requiring Admission

Introduction: Numerous studies have been done to study the psychiatric conditions in army personnel but none have been done in Nepalese army personnel. The purpose of the present study was to determine the prevalence of common mental disorders among Nepalese Army Personnel who were admitted in psychiatric ward. Methods: Retrospectively 186 case records of Nepalese Army Personnel, who received treatment at the inpatient psychiatric ward over a period of one year (15th May 2010 to 15th May 2011) , were included in this study. Descriptive analysis of their demographic data and types of psychiatric disorders was done using SPSS v16. Results: Among the 186 patients who were admitted during the study period, 184 (98.92 %) were male. The most common age range was 21-30 years (70.43%). The prevalence of the first ten rank of mental disorders among Nepalese Army Personnel were Major Depression (25.27%), Alcohol dependence (22.58%), Schizophrenia (14.67%), Bipolar disorder (8.6%), Anxiety disorder(6.52%), Substance induced psychotic disorder(4.35%), Schizoaffective disorder(3.26%), Deliberate self harm (2.72%), Malingering(2.72%) and Poly substance dependence (2.72). Conclusions: The most common prevalence of mental disorders among inpatient of Nepalese Army Personnel in psychiatric department in the year 2010-11 were Major depressive disorder, Alcohol dependence and Schizophrenia.Medical Journal of Shree Birendra Hospital; July-December 2012/vol.11/Issue2/14-17 DOI: http://dx.doi.org/10.3126/mjsbh.v11i2.7902

The effects of motivational interviewing on patients with comorbid substance use admitted to a psychiatric emergency unit - a randomised controlled trial with two year follow-up

BackgroundThe prevalence of substance use in people acutely admitted to in-patient psychiatric wards is high and the patients` duration of stay is limited. Motivational interviewing is a method with evidence based effect in short interventions. The aims of the present study were to compare the effects of 2 sessions of motivational interviewing and treatment as usual (intervention group) with treatment as usual only (control group) on adult patients with comorbid substance use admitted to a psychiatric in-patient emergency unit.MethodsThis was an open randomised controlled trial including 135 patients where substance use influenced the admittance. After admission and assessments, the patients were allocated to the intervention group (n = 67) or the control group (n = 68). The primary outcome was self-reported days per month of substance use during the last 3 months at 3, 6, 12 and 24 months after inclusion. Data was analysed with a multilevel linear repeated measures regression model.ResultsBoth groups reduced substance use during the first 12 months with no substantial difference between the 2 groups. At 2 year follow-up, the control group had increased their substance use with 2.4 days (95% confidence interval (CI) –1.5 to 6.3), whereas the intervention group had reduced their monthly substance use with 4.9 days (95% CI 1.2 to 8.6) compared to baseline. The 2 year net difference was 7.3 days of substance use per month (95% CI 1.9 to 12.6, p < 0.01) in favour of the intervention group.ConclusionsThe present study suggests that 2 sessions of motivational interviewing to patients with comorbid substance use admitted to a psychiatric emergency unit reduce substance use frequency substantially at 2 year follow-up.Trial registrationClinicalTrials.gov Identifier: NCT00184223

Factors associated with hospitalization of adult psychiatric patients: cluster analysis

Factors associated with acute admission to inpatient psychiatric wards have been difficult to replicate, possibly reflecting methodological limitations of analyzing individual variables. The objective of this analysis was to identify factors associated with hospitalization at an inpatient psychiatric unit using cluster analytic methods. Demographic, admission and treatment data for all admissions to a single inpatient unit in 2010 were collected retrospectively. Cluster analysis was performed using Ward's method. The initial clustering identified a high suicidality/crisis group, which then gave two further subclusters, an internalizing one characterized by affective symptoms and an externalizing one characterized by intoxication at admission, and a population with poor medication compliance that included most cases of psychosis. These subclusters had different clinical and demographic characteristics, different rates of hospital readmission and different durations of stay. Cluster analysis may be a useful exploratory technique to assist in planning and developing services for adult patients needing admission to a psychiatric hospital.

1086 – Barriers to somatic health care in psychiatric inpatient wards

Cardiometabolic diseases are under-diagnosed and under-treated in psychiatric inpatients. A common solution is implementation of screening guidelines. However, we often forget to ask the essential question: Why were our patients underdiagnosed in the first place? To identify causes of under-diagnosing and under-treatment in the context of local clinical practices. All consecutive admissions (n=63) over 93 days were screened for hypertension, diabetes, dyslipidemias and abdominal obesity. Patients identified with both (a) undiagnosed and untreated disease and (b) admission on a separate occasion within the previous two years to the ward in question, were selected for a retrospective patient file review. These patients (n=32) had their medical records scrutinized for information on how each cardiometabolic measure was assessed at previous admission. Relevant examination were performed in 38% of cases and test results were abnormal for 54% of these. Abnormal test results were evaluated in 14% of cases and none of the evaluated results were acted upon. Rigorous examination and testing of patients is only of value if clinicians have the essential knowledge to interpret the results and feel responsibility to do so. These barriers must be broken down before implementing screening guidelines in routine clinical practice.

Exploring peoples' needs in a psychiatric ward: social community, design and the interior environment in a healthcare setting

This article examines ways to improve the functioning of an in-patient psychiatric ward. Included in the study is a review of psychology and design, an overview of the physical setting and existing services on the ward, as well as feedback from patients and staff regarding potential solutions on how to redesign the interior spaces so as to promote staff-patient community practices and to adhere to their needs. The findings suggest that the interior environments in psychiatric wards affect the functioning and well-being of those who reside or work in the setting and that input from patients and staff can add valuable information on how the spaces might be reconfigured.