People hospitalised on acute psychiatric wards report mixed feelings of safety and vulnerability

Author accepted manuscript (Post Print) made available in accordance with publisher copyright policy.Commentary on: Stenhouse RC. ‘Safe enough in here?’: patients’ expectations and experiences of feeling safe in an acute psychiatric inpatient ward. J Clin Nurs 2013;22:3109–18. Implications for practice and research - Patients expect to be cared for and kept safe by nurses. They feel physically safer when male nurses are present and feel vulnerable among fellow patients. - Nurses need to be sensitive to the experience of hospitalisation and need to provide physical and emotional safety for all inpatients through close engagement with them. - Further research is needed to explore the factors that promote feelings of being safe and recovery in acute inpatient units

The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

© . This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/There are significant issues associated with the use of restrictive measures, such as seclusion and restraint, in child and adolescent mental health care. Greater understanding of how restrictive measures are used is important for informing strategies to reduce their use. In this brief report we present a 12-month audit (1/1/2010-31/12/2011) of the use of restrictive measures (seclusion, physical restraint) in one child and adolescent acute inpatient mental health unit in Australia. The study highlights the need for continued efforts to reduce the use of restrictive measures in child and adolescent mental health services

Hold my hand and walk with me: Empathy on the mental health inpatient unit

Published version reproduced here with permission from publisher

Multidisciplinary health professionals' assessments of risk: how are tools used to reach consensus about risk assessment and management?

Author accepted manuscript (Post-Print) made available in accordance with publisher copyright policy.Risk assessment and management are among the most important and complex tasks health professionals undertake in their practice to prevent harm to patients and ensure safe and effective treatment. The aim of this study was to examine how multidisciplinary team members use tools to assess and manage risk, through examination of how tools are used to gather, record and “score” risk information; and how this process impacts on the formulation of risk assessment and management plans, interaction with patients, and consensus with colleagues regarding patient care. Fourteen professionals completed an assessment for a hypothetical client using a risk assessment and management tool, and then discussed their assessment in semi-structured interviews. Professionals were in moderate agreement in their assessments of the client on the tool, and highlighted the complexity of their decision making. Clinical management decisions, such as the amelioration of particular risks, followed assessment of the patient in a consistent way. The tool was an important way to for clinicians to communicate their judgments to others and set plans to direct patient care. Implications for the use of clinical decision making tools and instruments in mental health care, and the need for a focus on multidisciplinary decision making, are highlighted

Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia

Author version made available in accordance with publisher copyright

An exploration of absconding behaviours from culturally and linguistically diverse psychiatric hospital patients in Australia

“This is an Accepted Manuscript of an article published by Taylor & Francis in [International Journal of Culture and Mental Health] on [19 Nov 2010], available online: http://www.tandfonline.com/10.1080/17542863.2010.488324.”United Kingdo

Restraint use in acute and extended mental health services for older persons

Author version made available in accordance with publisher copyright policy.Restraint of older persons in inpatient and residential care is used to control aggression, and prevent falls and other adverse outcomes. Initiatives to reduce these practices are being implemented worldwide. However, there has been little examination of restraint practice in psychiatric services for older persons. This paper reports a retrospective comparative analysis of restraint use in three acute and two extended care psychiatric inpatient wards in Australia. The analysis involved examination of restraint incidents and comparison of restrained and non-restrained patients. There was significant variation in restraint use between wards. On one acute ward, 12.74% of patients were restrained, although restraint use declined during the data collection period. Patients with dementia were restrained at higher rates than patients with other diagnoses, and restrained patients stayed in hospital for a longer duration. Restraint occurred early in admission, and few differences emerged between those restrained once or multiple times. Mechanical restraint was more prevalent than physical restraint, with restraint predominantly used to manage aggression and falls. Findings provide new data on restraint in older persons' psychiatric services. Greater conceptual understandings of behaviours associated with dementia and the unique needs of patients with these disorders may assist in reducing restraint use in these settings

Empathic processes during nurse–consumer conflict situations in psychiatric inpatient units: A qualitative study

© 2016 The Authors. International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Australian College of Mental Health Nurses Inc. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Empathy is a central component of nurse–consumer relationships. In the present study, we investigated how empathy is developed and maintained when there is conflict between nurses and consumers, and the ways in which empathy can be used to achieve positive outcomes. Through semistructured interviews, mental health nurses (n = 13) and consumers in recovery (n = 7) reflected on a specific conflict situation where they had experienced empathy, as well as how empathy contributed more generally to working with nurses/consumers. Thematic analysis was used to analyse the data, utilizing a framework that conceptualizes empathy experiences as involving antecedents, processes, and outcomes. The central theme identified was ‘my role as a nurse – the role of my nurse’. Within this theme, nurses focussed on how their role in managing risk and safety determined empathy experienced towards consumers; consumers saw the importance of nurse empathy both in conflict situations and for their general hospitalization experience. Empathy involved nurses trying to understand the consumer's perspective and feeling for the consumer, and was perceived by consumers to involve nurses ‘being there’. Empathic relationships built on trust and rapport could withstand a conflict situation, with empathy a core component in consumer satisfaction regarding conflict resolution and care. Empathy allows the maintenance of therapeutic relationships during conflict, and influences the satisfaction of nurses and consumers, even in problematic situations. Nurse education and mentoring should focus on nurse self-reflection and building empathy skills in managing conflict

The use of restraint in four general hospital emergency departments in Australia

Author version made available in accordance with publisher copyright policy.Objective: The purpose of this study was to investigate restraint use in Australian emergency departments (EDs). Method: A retrospective audit of restraint incidents in four EDs (from 1 January 2010 to 31 December 2011). Results: The restraint rate was 0.04% of total ED presentations. Males and females were involved in similar numbers of incidents. Over 90% of restrained patients had a mental illness diagnosis and were compulsorily hospitalised. Mechanical restraint with the use of soft shackles was the main method used. Restraint was enacted to prevent harm to self and/or others. Median incident duration was 2 hours 5 minutes. Conclusions: In order to better integrate the needs of mental health clients, consideration is needed as to what improvements to procedures and the ED environment can be made. EDs should particularly focus on reducing restraint duration and the use of hard shackles