Inhaltsvalidierung des Fragebogens «The Management of Aggression in People with Dementia Attitude Questionnaire German Version» (MAPDAQ-G) [Content validation of the questionnaire "German Version of the Management of Aggression in People with Dementia Attitude Questionnaire" (G-V-MAPDAQ)]

Background: Dementia is one of the most common diseases of aging and leads to an increased need for care. Caregivers' attitudes about aggression can influence their interaction with people with dementia. To examine this further, “The Management of Aggression in People with Dementia Attitude Questionnaire” (MAPDAQ) was developed for use in nursing homes in the United Kingdom. In Switzerland, the MAPDAQ has been translated into a German Version (MAPDAQ-G), but not yet tested for its validity and reliability. Aim: Therefore the present study examined the content and face validity, comprehensibility and interpretability of MAPDAQ-G in a Swiss context. Methods: The review was based on expert surveys and interviews with caregivers in nursing homes and psychiatric hospitals. Results: According to experts, the optimised MAPDAQ-G is comprehensive (88 %) and shows good content validity (I-CVI = 0,6 – 0,1; S-CVI-Ave = 0,88). 15 items have been adapted and further validated by 16 nurses. Finally, apart from two items, the MAPDAQ-G is understood by nurses and can be interpreted consistently. Conclusions: A questionnaire of this sort allows nurses to reflect in practice upon their own attitude with regard to the management of aggression in people with dementia and to influence the quality of care. The MAPDAQ-G should be statistically tested for validity and reliability using a larger sample

A hermeneutic phenomenological exploration of 'last resort' in the use of restraint.

Restraining patients is a practice that dates back at least three centuries. In recent years, there has been a mandate and advocacy in various countries for organizations to shift towards the minimization of restraint, whereby its use is only as a 'last resort'. There is growing evidence internationally indicating the negative impact of the use of restraint. However, to date there is no research specifically focusing on trying to understand the concept of 'last resort'. Further insights to explore this concept among mental health nurses are therefore warranted. The empirical research comprised a hermeneutic phenomenological study. By recruiting and interviewing thirteen mental health nurses from across Canada who had experiences of restraint use, the research aimed to generate a deeper understanding of the meanings and lived experiences of the concept of 'last resort'. Data were collected through fifteen in-depth interviews. Data analysis was undertaken through a hermeneutic phenomenological framework based on van Manen's approach and Heideggerian philosophy. Five Heideggerian concepts were used to illuminate 'last resort' in restraint use by mental health nurses - temporality, inauthenticity, thrownness, leaping in and leaping ahead, and mood (fear). Key findings highlight the influence of nurses' past experiences, how nursing staff adopt a collective (rather than individual) approach, and the dependency on knowledge and skills of others in using restraint as a 'last resort'. Overall, the lived experience of 'last resort' is comprised of many elements. This study provides insights and an initial understanding, which is hoped to advance the field of restraint minimization. [Abstract copyright: © 2020 Australian College of Mental Health Nurses Inc.

An evaluation of the implementation of the 'Restraint Reduction Network (RRN) Training Standards’ in mental health and learning disability settings

Training is an integral part of programmes aimed at reducing restrictive practices. Evidence suggests, however, that there is too much emphasis on reactive techniques and technical competence rather than preventative approaches, as well as too much inconsistency regarding quality of training and quality assurance across healthcare settings. The Restraint Reduction Network (RRN) Training Standards were launched in England, UK, to encourage a positive change in practice and provide a framework on which training can become more standardised across health and social care services. Since April 2020, it has been a statutory requirement that organisations delivering training on restrictive practices including restraint must be certified. This timely research study examines views and experiences regarding the processes involved in the implementation of the Standards to learn and share good practice and identify ways to improve practice, with the view to inform future iterations of the Standards, as well as the potential transferability/application to other areas of practice or countries

mHealth based interventions for the assessment and treatment of psychotic disorders: a systematic review

The relative burden of mental health disorders is increasing globally, in terms of prevalence and disability. There is limited data available to guide treatment choices for clinicians in low resourced settings, with mHealth technologies being a potentially beneficial avenue to bridging the large mental health treatment gap globally. The aim of the review was to search the literature systematically for studies of mHealth interventions for psychosis globally, and to examine whether mHealth for psychosis has been investigated. A systematic literature search was completed in Embase, Medline, PsychINFO and Evidence Based Medicine Reviews databases from inception to May 2016. Only studies with a randomised controlled trial design that investigated an mHealth intervention for psychosis were included. A total of 5690 records were identified with 7 studies meeting the inclusion criteria. The majority of included studies, were conducted across Europe and the United Sates with one being conducted in China. The 7 included studies examined different parameters, such as Experiential Sampling Methodology (ESM), medication adherence, cognitive impairment, social functioning and suicidal ideation in veterans with schizophrenia. Considering the increasing access to mobile devices globally, mHealth may potentially increase access to appropriate mental health care. The results of this review show promise in bridging the global mental health treatment gap, by enabling individuals to receive treatment via their mobile phones, particularly for those individuals who live in remote or rural areas, areas of high deprivation and for those from low resourced settings

Healthcare staff's experiences of using manual physical restraint: A meta‐synthesis review

Manual restraint is a hands‐on type of physical restraint used to prevent harm to service users and staff, and to administer necessary treatments. This article reports on a review and meta‐synthesis of the qualitative literature on healthcare staff's experiences of using manual restraint. Three electronic databases (CINAHL Complete, MEDLINE, and PsycINFO) were systematically searched, and 19 studies were included. Thematic synthesis was used to synthesize the findings. The Critical Appraisal Skills Programme (CASP) checklist was used to appraise study quality. The synthesis generated one overarching interpretive theme, “unpleasant but necessary,” and five subthemes: “maintaining safety triumphs all,” “emotional distress,” “significance of coping,” “feeling conflicted,” and “depletion.” Seven studies indicated that, from staff perspectives, manual restraint was not always used as a last resort. Healthcare staff experience manual restraint as a psychologically and physically unpleasant practice, yet paradoxically deem its use to be sometimes necessary to keep themselves and service users safe from harm. The findings indicate a need for healthcare staff support, post‐restraint debriefing meetings with service users, and the implementation of manual restraint minimization programs in healthcare settings

Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF)

Background Physical restraint is a coercive intervention used to prevent individuals from harming themselves or others. However, serious adverse effects have been reported. Minimising the use of restraint requires a multimodal approach to target both organisational and individual factors. The ‘Six Core Strategies’ developed in America, underpinned by prevention and trauma informed principles, is one such approach. Objective An adapted version of the Six Core Strategies was developed and its impact upon physical restraint usage in mental health Trusts in the United Kingdom evaluated. This became known as ‘REsTRAIN YOURSELF. The hypothesis was that restraint would be reduced by 40% on the implementation wards over a six-month period. Design A non-randomised controlled trial design was employed. Setting Fourteen, adult, mental health wards from seven mental health hospitals in the North West of England took part in the study. Two acute care wards were targeted from all eligible acute wards within each site in negotiation with each Trust. The intervention wards (total n = 144 beds, mean = 20.1 beds per ward) and control wards (total n = 147 beds, mean = 21.0 beds per ward) were primarily mixed gender but included single sex wards also (2 female-only and 1 male-only in each group). All wards offered pharmacological and psychosocial interventions over short admission durations (circa 15 days) for patients with a mixture of enduring mental health problems. Method As part of a pre and post-test method, physical restraint figures were collected using prospective, routine hospital records before and 6 months after the intervention. Restraint rates on seven wards receiving the REsTRAIN YOURSELF intervention were compared with those on seven control wards over three study phases (baseline, implementation and adoption). Results In total, 1680 restraint incidents were logged over the study period. The restraint rate was significantly lower on the intervention wards in the adoption phase (6.62 events/1000 bed-days, 95% CI 5.53-7.72) compared to the baseline phase (9.38, 95% CI 8.19-10.55). Across all implementation wards there was an average reduction of restraint by 22%, with some wards showing a reduction of 60% and others less so (8%). The association between ward type and study phase was statistically significant. Conclusion In conclusion, it is possible that reductions in the use of physical restraint are achievable using a model such as the Six Core Strategies. This approach can be adapted for global settings and changes can be sustained over time with continued support

Beyond intimate partner relationships: utilising domestic homicide reviews to prevent adult family domestic homicide

Increasing evidence documents domestic violence and abuse (DVA) and domestic homicide of adults killed by a relative in non-intimate partner relationships. Most literature focuses on intimate partner violence and homicide, yet non-intimate partner homicides form a substantial but neglected minority of domestic homicides. This article addresses this gap by presenting an analysis from 66 domestic homicide reviews (DHRs) in England and Wales where the victim and perpetrator were related, such as parent and adult child. Intimate partner homicides are excluded. These 66 DHRs were a sub-sample drawn from a larger study examining 317 DHRs in England and Wales.The article contributes towards greater understanding of the prevalence, context and characteristics of adult family homicide (AFH). Analysis revealed five interlinked precursors to AFH: mental health and substance/alcohol misuse, criminal history, childhood trauma, economic factors and care dynamics. Findings indicate that, given their contact with both victims and perpetrators, criminal justice agencies, adult social care and health agencies, particularly mental health services, are ideally placed to identify important risk and contextual factors. Understanding of DVA needs to extend to include adult family violence. Risk assessments need to be cognisant of the complex dynamics of AFH and must consider social-structural and relational-contextual factors.<br />Key messages<br /><ol><li>Understanding of domestic violence and abuse needs to include adult family violence.</li><br /><li>Risks and dynamics of adult family homicide are complex and must consider social-structural and relational-contextual factors.</li><br /><li>Criminal justice agencies, social care, substance misuse and mental health services provide opportunities for prevention

Taser use on individuals experiencing mental distress: an integrative literature review

Introduction Conducted electrical weapons, or ‘Tasers’, are currently used by over 15,000 law enforcement and military agencies worldwide. There are concerns regarding the effectiveness, potential for harm, and overuse with people experiencing mental distress. Aim To explore the literature about police use of Tasers with people experiencing mental distress. Method An integrative review was undertaken and qualitative and quantitative analytical approaches were used. Results Thirty‐one studies were included. Of all recorded usage, overall prevalence of Taser use on people experiencing mental distress was 28%. This population may require a greater number of shocks to subdue them than other people. Discussion There are substantial gaps in the research literature particularly with respect to the decision‐making processes involved in deploying Tasers on this population and the physical and psychological consequences of Taser use in this context. Implications for practice Police use of Tasers in mental health crises is relatively common, and occurs in a variety of environments including mental health settings. Mental health professionals need to work with police towards greater understanding of the needs of people with mental illness, and to promote the use of non‐coercive interventions in mental health crisis events

Multinational Experiences in Reducing and Preventing the Use of Restraint and Seclusion

Restraint and seclusion (R/S) have been used in many countries and across service sectors for centuries. With the recent and increasing recognition of the harm associated with these procedures, efforts have been made to reduce and prevent R/S. Following a scathing media exposé in 1998 and congressional scrutiny, the United States began a national effort to reduce and prevent R/S use. With federal impetus and funding, an evidence-based practice, the Six Core Strategies1 to Prevent Conflict, Violence and the Use of Seclusion and Restraint, was developed. This model was widely and successfully implemented in a number of U.S. states and is being adopted by other countries, including Finland, Australia, and the United Kingdom. Recently, the first cluster randomized controlled study of the Six Core Strategies in Finland provided the first evidence-based data of the safety and effectiveness of a coercion prevention methodology. Preliminary findings of some of the international efforts are discussed. Reduction in R/S use and other positive outcomes are also reported

Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study

Restrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad-scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings