Patients In Psychiatric Wards Research Articles

Restraints Practices on Patients of the Psychiatric Wards in a Selected Hospital, Mangalore

Abstract Background Restraints are one of the common procedures performed in various medical settings, especially intensive care units, and psychiatric wards. There are various forms of restraints, including chemical, physical, and mixed restraints. The primary reasons for using restraints are to prevent injury to the patient and others, and to reduce violent behavior in psychotic patients. Objectives The aim of this article was to identify the types of restraints used for psychiatric patients and current restraint practices for patients in psychiatric wards of selected mental health facilities. Methods This was a descriptive cross-sectional study conducted among 100 psychiatric patients selected using purposive sampling techniques. An observational checklist was used to assess restraint practice in patients who met study criteria. Results The majority of patients (44%) received chemical restraints, some (28%) received physical restraints, but a minority (28%) used mixed restraints. In terms of practice, most patients (91%) received reasonably safe restraint care. An association was found between practice of restraints and restraints type with a p-value (0.001) less than 0.05 at a significance level of 0.05. Conclusions The development of mandatory practice protocols is critical for better nursing care.

Nurses' Perspectives on Smoking Policies, Safety and Cessation Support in Psychiatric Wards: A Cross-Sectional Survey.

A high prevalence of smoking and low rates of smoking cessation interventions can be observed in psychiatric wards. A questionnaire-based, cross-sectional study was performed in five hospitals among 107 psychiatric ward nurses. The aim was to investigate nurses’ views on patients’ smoking practices and their influence on the safety of both the patients and medical personnel. In addition, we asked about the availability of smoking cessation support. Most of the respondents noticed the negative impacts of smoking on patients and medical personnel. Nearly a third of our respondents (29.0%) recalled smoking-related accidents in their facilities. In 45.2% of these accidents, a patient set someone else on fire. Around one fifth of nurses had rather permissive attitudes towards tobacco use in hospital wards. Significant associations were identified between respondents’ smoking status and their opinions on amending smoking policies and on unsupervised smoking. Regarding professional help available to smoking patients, 88.8% of participants reported that interventions to address smoking were available in their wards. Psychiatric hospitalisation can be an opportunity to offer tobacco treatment to patients with mental health conditions. To make use of this opportunity, smoke-free policies need to be put in place and hospital personnel, particularly nurses, should be trained and equipped with the knowledge and skills needed to assist in the smoking care of psychiatric ward patients.

Co-produced Positive Psychotherapy for Acute Psychiatric Ward Patients and Staff: an Evaluation of Feasibility and Acceptability

Aim: To investigate feasibility and acceptability of positive psychotherapy for acute psychiatric ward patients and staff, when delivered by non-psychology clinical staff, and co-produced with staff with lived experience. Method: Group or individual strengths-based positive psychotherapy was led by an activity coordinator and co-facilitated by a peer support worker with lived experience of mental health problems. It was delivered for acute ward patients and staff. Feasibility was measured by completion of session components and percentage of participants able to identify a strength, plan a strength-based activity, and activity completion. Acceptability was measured by comparing pre- and post-session mood, and with helpfulness ratings and narrative feedback. Results: Participants (n = 22) included 12 patients and 10 staff members. Participants were mainly female and of white or mixed ethnicity. Most patients had a psychotic disorder. Staff were nurses and healthcare assistants. The most identified strengths were self-regulation, social intelligence and perseverance. Typical activities included activity-scheduling, sleep hygiene, walking, gardening and cooking. High completion rates for components and activities indicated feasibility. Lack of adverse effect on mood, high helpfulness ratings, and positive feedback indicated acceptability. Conclusion: This evaluation indicates that non-psychology staff can deliver psychological interventions, that interventions can be co-produced with staff with lived experience, and that patient and staff participants can collaborate on these interventions. This shows how psychological interventions on acute wards can be inclusive, positively impact on ward culture, and be more widely delivered to support patients and staff.

The reliability of symptom assessment by telepsychiatry compared with face to face psychiatric interviews

IntroductionWith the start of the COVID-19 pandemic, the various social distancing policies imposed have mandated psychiatrists to consider the option of using telepsychiatry as an alternative to face-to-face interview in Hong Kong. Limitations over sample size, methodology and information technology were found in previous studies and the reliability of symptoms assessment remained a concern. AimTo evaluate the reliability of assessment of psychiatric symptoms by telepsychiatry comparing with face-to-face psychiatric interview. MethodThis study recruited a sample of adult psychiatric patients in psychiatric wards in Queen Mary Hospital. Semi-structural interviews with the use of standardized psychiatric assessment scales were carried out in telepsychiatry and face-to-face interview respectively by two clinicians and the reliability of psychiatric symptoms elicited were assessed. Results90 patients completed the assessments The inter-method reliability in Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Columbia Suicide Severity Rating Scale and Brief Psychiatric Rating Scale showed good agreement when compared with face-to-face interview. ConclusionSymptoms assessment by telepsychiatry is comparable to assessment conducted by face-to-face interview.

Isolated Psychiatric Ward Patients in Southern Israel with Severe Mental Illnesses Describe Their Sexual Needs: A Qualitative Study

Intimacy and sexuality are fundamental issues in human nature, but have been neglected in the rehabilitation of mental health patients, particularly those admitted into psychiatric wards. Patients’ sexuality is excluded from the discourse; yet it exists in the daily lives of the patients. The study examines the sexual needs and challenges of people with severe mental illnesses admitted to an isolated psychiatric ward. 13 men were interviewed in a semi-structured interview regarding their sexuality and the challenges they meet when experiencing and expressing their sexuality as patients in an isolated ward. A thematic analysis was conducted. Two principal themes were identified: 1. Challenges in realizing sexuality within the isolated ward. This theme included sub themes: performing sexual acts and exposure to sexuality within the ward; medications' side effects; dialogue with the staff; sexuality in the ward presented as crossing limits; and absence of a space to fulfill sexuality. 2. Suggestions for improvements in the hospital, stemming from the patients' experiences and ideas, such as starting an open dialogue with the staff, supplying patients with measures for protected sex, and more. The findings highlight the lack of healthy expression of sexuality inside the wards, despite its importance for improving patients’ well-being during their rehabilitation. Medical staff and policymakers should be aware of the sexual aspects of hospitalization in a psychiatric ward. The study also indicates the need for national policy that will address patients' sexual needs, including clear instructions that consider the uniqueness of the target population.

The Frequency and Factors Related to Aggressive Behavior in Psychiatric Patients Controlled by a Variety of Restraint Methods

Background: Aggressive behavior of patients in psychiatric wards is one of the main challenges faced by healthcare workers. Despite the abundance of research on the frequency of aggressive behavior, not enough attention has been paid to its severity. Furthermore, limited studies have evaluated the restraint methods used to manage aggressive behaviors. Objectives: The current descriptive study aimed to compare the relationship between demographic characteristics, diagnosis of psychiatric illness, medical illness, and hospitalization characteristics with features of aggressive behavior in patients experiencing different types of restraint during hospitalization. Methods: We evaluated subjects admitted to the adult psychiatric wards of Imam Hossein and Taleghani hospitals in Tehran, Iran, in 2018. The patients were controlled by various restraint methods during hospitalization. All the patients were evaluated for the severity of aggression, which was determined utilizing the Persian version of the Modified Overt Aggression Scale (MOAS). All the data along with demographic and clinical characteristics obtained from medical records were analyzed using the Mann-Whitney and Kruskal-Wallis nonparametric test (P-value = 0.05) and Spearman correlation coefficient to describe the factors affecting the aggressive behavior of patients. Results: In this study, the prevalence of aggressive behavior was 11.7%. Among the demographic variables, gender (P-value = 0.003), education level (P-value = 0.05), and the history of aggressive behavior (P-value = 0.001) were significantly associated with the MOAS. Furthermore, as the hospitalization duration increased, the frequency of aggressive behavior decreased, and its severity intensified. Moreover, there was a significant relationship between aggression severity with admission type (P-value = 0.00), concurrent medical illness (P-value = 0.026), and substance abuse (P-value = 0.025). Conclusions: Variables affecting aggressive behavior, such as male gender, involuntary admission, and a history of aggression, might aid in the early detection of patients who may exhibit more severe aggressive behavior.

Frequency of Psychiatric Readmission Causes and Associated Risk Factors

Introduction: Readmission after discharge is recognized as one of the major indicators of the quality of care provided in hospitals. Recurrent hospitalization is common among patients in psychiatric wards and is caused by a myriad of factors. The present study aimed to identify the causes of readmission and associated risk factors in patients with a history of recurrent hospitalization in 22 Bahman Psychiatric Hospital in Qazvin, Iran. Methods: This retrospective cross-sectional study was performed by the census method in Psychiatric Hospital in Qazvin, Iran, on all the patients who were admitted at least three times from 2015 to 2019. The following data were extracted from patient profiles using certain checklists: age, gender, educational level, residential location, occupation, marital status, clinical diagnosis, number of hospitalizations, duration of disease, intervals between admissions, substance abuse, regular outpatient visits, and regular use of medications. Data were analyzed in SPSS software (version 22). A P < 0.05 was considered statistically significant. Results: The current study was conducted on 182 patients with a history of readmission who were selected by the census method. The majority of subjects (n = 131) were male, and their mean age score was reported as 39.96 ± 10.41 years. Furthermore, the most frequent clinical diagnosis based on which the patients were admitted included bipolar I disorder (manic phase) (29.7%) and schizophrenia (22.2%), respectively. The number of hospitalizations was significantly correlated with education level (0.013), marital status (0.012), residential location (0.049), intervals between admissions (0.009), follow-up pattern (<0.001), and treatment pattern (<0.001). Conclusion: As evidenced by the results of the present study, clinical diagnosis, education level, marital status, residential location, intervals between admissions, treatment patterns, and follow-up patterns of patients were effective in the frequency of recurrent hospitalization in patients with mental disorders.

Nurses’ Recognition for Care for Patients in Psychiatric Wards

Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide and it has been a widespread concern. Japan had some problems in psychiatric wards such as long hospital stay. The purpose of this study investigated recognition of nurses in psychiatric wards for future care. We conducted questionnaire research for psychiatric nurses and they described recognition of nursing in free de-scription. Qualitative analysis was performed on description. Results showed that six categories were chosen like “Increase of stress and fatigue caused of infection control,” “Negative effects to body and mind of patients,” “Effects to nursing care in psychiatric nursing,” “Differences of attitude toward infection control in the hospital,” “Cognition for social movement related to Coronavirus,” and “New recognition by Coronavirus infection and future.” These results suggest the following, 1) some kind of supports will be needed for nurses’ stress for infection control, 2) supports or interventions for palliate of patients stress like limitation of prolonged quarantine, limit of visiting or home stay overnight, 3) integrated leaderships to cognition and behavior for infection control in a hospital.

The Relationship Between Health Literacy and Satisfaction of Patients in Psychiatric Wards of Service Providers in Hospitals of Isfahan University of Medical Sciences, Iran

The Relationship Between Health Literacy and Satisfaction of Patients in Psychiatric Wards of Service Providers in Hospitals of Isfahan University of Medical Sciences, Iran

Effectiveness of a training on the recognition of subtle facial emotions in health and social workers.

This study analyzed the effectiveness of a training course on the recognition of subtle facial emotions in health and social workers, especially those who work in contact with difficult and aggressive patients in psychiatric wards and emergency departments. A total of 177 health and social workers were involved in the training course (138 females and 39 men, mean age was 53.3 years). The training was implemented in three different editions of the course (a three day course each) on the prevention and management of violence and the learning achieved has been evaluated in each edition. During the second and third day of training, 14 photographs from the Ekman SETT Test, representing the seven universal emotions (anger, fear, sadness, disgust, contempt, surprise, happiness), were administered to all participants. Participants selected the emotion demonstrated in each photograph on a response sheet. Differences in the answers between these two days were tested. The participants in the three editions showed a statistically significant improvement in the subtle facial emotion expressions recognition ability. Female health and social workers recognized significantly better facial emotion expressions than their colleagues (difference in the two days for the emotions= 0,205; p=0.006). Considering the professional qualifications, physicians have shown less ability in recognizing facial expression of anger, compared to nurses and other health and social workers (difference in the scores for anger of the third and the second day= 0.213; p=0.024). The study showed that the ability to recognize subtle facial expressions of emotions can be trained. The skills acquired during the training can be used to enhance communication with patients, especially with difficult and aggressive ones and their family members in emergency and psychiatric settings. The course on prevention and management of violence should possibly include training on the recognition of subtle facial emotions.

Detection of Impending Aggressive Outbursts in Patients with Psychiatric Disorders: Violence Clues from Dogs

Aggression in psychiatric wards is a continuing matter of concern for both patients and medical staff. Here we have tested the hypothesis that the frequency of such incidents can be reduced with a new strategy of using trained alert dogs that warn of impending violent outbursts. Dogs were positioned among patients in psychiatric wards. Analyses show that the dogs warned of impending aggressive outbursts, responding to signals from a specific patient out of a group of unfamiliar psychotic patients. Their alerts were not a response to stress as canine cortisol levels were not significantly changed. Visual glance was the preferred method used by young dogs to respond to patient. Until a similar electronic technology is developed, trained alert dogs can help caregivers to protect both the patient and those around them from injuries that may otherwise result from aggressive outbursts in psychiatric patients.

Assessment of Nurses’ Knowledge about Restraint and Seclusion used for Aggressive Patients in Psychiatric Wards

Violence and aggression in mental health settings occur most frequently in psychiatric inpatient, and most acute hospital assaults take place in emergency departments. A descriptive correlation study used the assessment approach to assess the levels of nurses’ knowledge regarding restraint and seclusion at the psychiatric teaching hospitals in Baghdad City. A non-probability (purposive sample) study. The sample consisted of (41) nurse ((20) male and (21) female) were selected from the psychiatric teaching hospitals (AL-Rashad Psychiatric Teaching and Ibn-Rushed Psychiatric Teaching) in Baghdad City, during the period of 1st November 2017 to 16th June 2018. The data was collected by questionnaire which consisted of two parts, first part consists socio demographic data, Second part is about restraint and seclusion which consist of (50) items scale of knowledge about restraint and seclusion. In the present study, data were analyzed through the use of statistical package for social sciences (SPSS), version 21. The finding of the study indicated that Most of the nurses who participated in the study have preparative school graduates, and they have an extremely low level of knowledge more than others. And there is a non-significant relationship between demographic characteristics and domains of knowledge for the sample.

Factors for inhibition of early discharge from the psychiatric emergency ward for elderly patients

BackgroundAs society is aging, the number of elderly patients with psychiatric disorder, such as dementia, is increasing. The hospitalization period of elderly patients in psychiatric wards tends to be prolonged. In this study, we have determined the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients in Japan.MethodsThe information was collected from patients admitted to our hospital’s emergency ward for elderly patients with psychiatric disorders between May 2015 and April 2016. We compared various factors between the early discharge group and the non-early discharge group. In addition, we used a multiple logistic regression model to clarify the risk factors for non-early discharge.ResultsOf the 208 elderly patients, body mass index (BMI) and serum albumin level were significantly lower in the non-early discharge group. In addition, we also showed that higher serum C-reactive protein (CRP) (> 0.5 mg/dL) and use of seclusion or physical restraint significantly inhibited the early discharge of patients. The results of multiple logistic analysis showed that the BMI ≤ 17.5 kg/m2 (OR, 2.41 [95% confidence interval (CI) 1.06–5.46]), serum albumin level ≤ 30 g/L (OR, 3.78 [95% CI 1.28–11.16]), and use of seclusion or physical restraint (OR 3.78 [95% CI 1.53–9.37]) are particularly important explanatory factors.ConclusionsHypoalbuminemia, low BMI, and the use of seclusion or physical restraint were identified as the factors that inhibit early discharge from the psychiatric emergency ward for elderly patients. These factors reflect malnutrition and extremely serious psychiatric symptoms.

Survey of the Occurrence of Sarcopenia and Malnutrition among Psychiatric Ward Patients Who Were Prescribed Physiotherapy and Their Relationships with Activities of Daily Living

Survey of the Occurrence of Sarcopenia and Malnutrition among Psychiatric Ward Patients Who Were Prescribed Physiotherapy and Their Relationships with Activities of Daily Living

Perceived stress among nurses of psychiatric ward patients with and without suicidal behavior

Background and Objectives: The present research was conducted to obtain a perceived stress pattern among nurses attending the psychiatric patients with suicidal and non-suicidal behavior in the different hospitals and clinics of the twin- cities (Islamabad and Rawalpindi) of Pakistan. The main objective of the study was to have an idea about the environment of nursing in psychiatric wards in Pakistani culture.Participants and Method: The sample (N= 36) comprised of the nurses of psychiatric ward attending the one patient for 12 hours (n=16) with and (n=20) without suicidal behavior working into night and day shifts respectively. All the participants gave responses on the perceived stress scale. Participants were approached during their duty hours and were given perceived stress scale 10- items along with demographic information sheet and the consent form. Between group-design was used in the present study.Results and Conclusion: The results indicated that verification of both hypotheses, i.e. the nurses of patients with suicidal behavior had more perceived stress (M= 42 ±3.5) than the nurses of patients without suicidal behavior (M= 19.11 ± 5.7) and also the old nurses had a greater level of perceived stress than the younger nurses according to the same statistics. The t- test, t (28.5) = 14.9 p< 0.05 was significant on 95% confidence interval with variance not equal. Limitations and suggestions for future were also discussed. Both the hypotheses were supported by the analysis- results and by the previous literature.

Connecting with suicidal patients in psychiatric wards: Therapist challenges

ABSTRACTIn this qualitative interview study, the authors investigated how therapists experience and view treatment and care for suicidal patients in psychiatric wards. The focus is on aspects that may contribute toward shaping and possibly constraining therapists’ connections with suicidal individuals. They conducted semistructured interviews of 4 psychiatrists and 4 psychologists and analyzed the data by means of thematic analysis. The findings suggest that high emphasis on diagnostics and standardized suicide risk assessments, limited direct care of suicidal patients, and fragmented mental health services may challenge therapists’ connections with suicidal patients.

Dissociative Experiences in Psychiatric Inpatients

Dissociative disorders are conditions that involve disruptions of memory, awareness, identity, or perception. Data collected in diverse geographic locations underline the consistency in clinical symptoms of dissociative disorders. In this cross-sectional descriptive study, prevalence of dissociative experiences has been screened in hospitalized patients in psychiatric wards of Shiraz University of Medical Sciences in Iran. One hundred and sixty patients in two hospitals entered the study. Our tool to screen the prevalence of dissociative experiences was Dissociative Experience Scale (DES). Linear regression analysis shows that gender and age are predictors of high DES scores to some extent while psychiatric disorders are not good predictors. Age, gender and psychiatric disorders are poor predictors (almost 7%) of high DES scores in this study (R square=0.69). In this study, patients with Borderline Personality Disorder had higher dissociative experiences based on DES score (Mean: 56.44), followed by Schizophrenic patients (Mean: 28.22) and patients with Bipolar Personality Disorder (Mean: 25.18). This study showed that we might be able to create a new category in psychological disorders based on dissociative experiences. As age, gender and psychological disorders were poor predictors of dissociative experiences, stronger predictors such as positive childhood psychological traumas could be responsible for dissociative disorders.

Stressful Life Events in Onset of First Episode of Acute and Transient Psychotic Disorder

Background: Acute and transient psychotic disorder (ATPD) characterized by acute onset of polymorphic psychotic symptomatology and rapid resolution. The aim of this study was to identify the role of stressful life events among patients with ATPD. Methods: The study included 50 patients attending psychiatric OPD and admitted patients in psychiatric wards, at a tertiary care center of Rajasthan, India who were clinically screened for acute and transient psychotic disorder. The patients, suggestive of suffering from ATPD, were thoroughly evaluated for the diagnosis by using ICD-10 criteria for the ATPD and the diagnosis confirmed by a consultant psychiatrist. All the participants were subjected to presumptive stressful life event scale (PSLE) for assessing the role of stressful life events among patients with ATPD. Results: Out of fifty patients, 58% were female and 42% were male. 82% patients were experienced stressful life events before the onset of first episode of acute and transient psychotic disorder. Female experience more stress in areas like death or illness of a family member, marriage or engagement, violence. Whereas male were experienced more stress in areas like marital and family conflicts, financial or occupational problem.Conclusion: Present study highlights that the stressful life events have substantial relationship with the onset of acute and transient psychotic disorder.

Mental Health Nurses' Experiences of Caring for Suicidal Patients in Psychiatric Wards: An Emotional Endeavor

The purpose of the study is to investigate mental health nurses' experiences of recognizing and responding to suicidal behavior/self-harm and dealing with the emotional challenges in the care of potentially suicidal inpatients. Interview data of eight mental health nurses were analyzed by systematic text condensation. The participants reported alertness to patients' suicidal cues, relieving psychological pain and inspiring hope. Various emotions are evoked by suicidal behavior. Mental health nurses seem to regulate their emotions and emotional expressions, and balance involvement and distance to provide good care of patients and themselves. Mental health nurses have an important role and should receive sufficient formal support.

The Talk About the Psychiatric Patient

Essential to psychiatric nursing practice and care, verbal handovers and ward rounds are reporting systems for communication that shapes psychiatric staff's ability to recognize, understand, and construct patients, as well as patients’ ability to construct themselves. Given the centrality of such language in psychiatric practice, the aim of this study was to describe how psychiatric staff talk about patients in psychiatric wards, what their talk encompasses, and what consequences it might pose for patient care. Empirical data were collected from audio recordings of staff discussions of patients during nine verbal handovers and three ward rounds in six different general psychiatric wards in mid and southern Sweden. Findings showed that to describe patients’ mood, characteristics, and behavior, nurses used culturally common words and concepts related to three themes—good patients, bad patients, and to stay or be discharged—and six subthemes—looking well, looking poorly, desirable patients, undesirable patients, continuing work, and being discharged. However, since assessments of and decisions about patients’ conditions and care used everyday language and did not involve patients’ participation, opportunities for patients to participate in their own care were rare.