Systematic review of therapeutic leave in inpatient mental health services

AimTo identify, critically evaluate, and synthesise the empirical evidence about therapeutic leave from mental health inpatient settings.Background“Leave” occurs when a mental health inpatient exits the hospital ward with the appropriate authorisation alone, or accompanied by staff, family, or friends. Limited research has previously addressed therapeutic as opposed to unauthorised leave, and the evidence-base has not been systematically evaluated.DesignSystematic review methodology following relevant Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidance.Data SourcesMultiple electronic databases (CINAHL; Criminal Justice database; PsycARTICLES; Scopus; OpenGrey; Cochrane; GoogleScholar) for papers published from January 1967 to July 2017.Review MethodsInformation was extracted under the following headings: study, purpose/aims, sample, country, setting, design and data collection method(s), data collection instrument, and results. Papers were assessed, as per the hierarchy of scientific evidence, and where there was sufficient data, we calculated a range of standardised rates of leave incidence.ResultsStandardised leave rates in forensic settings reflect security level. There was little meaningful information on which to base calculation of rates for civil settings. The strongest evidence supports leave used for supervised discharge; other forms of leave lack an evidence base and decisions appear to be made on the basis of heuristic rules and unsupported assumptions. Clinical decision making about therapeutic leave cannot claim to be evidence-based.ConclusionResearch is urgently needed to provide information about how leave is managed, the best ways to support leave, and what happens on leave

Therapeutic leave from secure mental health inpatient services::a review

I am delighted to have been invited to contribute a paper to this liber amicorum for Prof. dr. Frans Koenraadt in honour of his lifetime’s contribution to clinical and theoretical advances in forensic psychology, law, mental health, and education. I first had the pleasure of meeting Frans in Toronto when both he, I, and Lydia Dalhuisen, Frans’ then PhD student, were all presenting work on firesetters and firesetting. Our mutual interest led to further contact and an invitation was extended to me to join the examination panel for Dr Dalhuisen’s PhD thesis defence in Utrecht, a fascinating experience for me since it is not our tradition in the UK to conduct such a public defence. Since then, I have read with great interest and admiration the outputs of the PhD. It was my impression that Prof. Koenraadt provided a highly constructive and flexible educational experience which allowed the PhD room to breathe and grow. My acquaintance with Frans has been short, but I can say with sincerity that his natural curiosity, intellectual openness, and willingness to share his vast accumulated knowledge should serve as a model for us all. In this spirit of sharing, my colleague, EmilyMay Barlow, and I have chosen to address an issue which we feel passionate about. It is also an issue that lies firmly in those intersections between law, criminality, psychology, risk, and clinical practice in which Prof. Koenraadt excels. That issue is the use of therapeutic leave by patients in secure, forensic mental health care

Three issues for mental health nurse educators preparing new preregistration programmes

Universities across the UK must develop and have in place new preregistration programmes by 2020. Unlike in the rest of the world, where initial nurse preparation is generic, preregistration education in the UK allows students to specialize in one of four specific fields of practice - adult, mental health, child or learning disability. To the relief of many , the new standards confirmed the continued survival of the specialist fields at undergraduate level. Educators across the UK now have an opportunity to fully review existing provision and address areas of significance. This paper explores three such issues. These are: •How best to respond to adverse life experiences or trauma.•The ethical tension which we believe is inherent in the use of coercive practice.•The potential to make a difference to the appalling mortality statistics which indicate that people with long standing mental health problems die much younger than their contemporaries In each case we make tentative suggestions for how they might be approached

Effectiveness and experiences of mental health nurses in cases of medical emergency and severe physiological deterioration

BackgroundFrom a baseline of near zero, there has in recent years been a growing number of empirical studies related to mental health nurses’ delivery of healthcare for severely physically deteriorating patients or in medical emergency situations. To date, this evidence-base has not been systematically identified, appraised, and integrated.ObjectivesTo systematically identify, appraise and synthesise the available empirical evidence about mental health nurses, medical emergencies, and the severely physiologically deteriorating patient.DesignA systematic review in accordance with relevant points of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesMultiple electronic databases (CINAHL; PubMed; MedLine; Scopus, ProQuest Dissertations and Theses) were searched using comprehensive terms.Review methodsInclusion criteria: English language papers describing empirical studies (any design) about i) the effectiveness of interventions to improve any outcome related to mental health nurses' delivery of emergency medical care or care for the severely deteriorating patient; or ii) mental health nurses’ emergency medical care-related knowledge, skills, experience, attitudes, or training needs. Further information was sought from study authors. Included studies were independently assessed for quality. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative synthesis of study findings was conducted.ResultsA total of 22 studies, all but one published since 2011, met inclusion criteria. Ten were intervention studies and twelve were cross-sectional observational or qualitative studies. Intervention studies were all of weak quality overall and utilised pre- post designs mostly with limited post intervention follow-up time. Observational and qualitative studies were generally of good quality but only parts of the evidence from these studies were relevant to emergency physical care since most focused on mental health nurses and their routine physical healthcare practice.ConclusionsThere are currently no validated instruments to investigate mental health nurses’ emergency medical care-related attitudes. More rigorous controlled trials of interventions are needed to better establish an evidence-base for educational interventions to improve this groups’ emergency care-related practice

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries