The demography of nurses and patients on acute psychiatric wards in England

St Bartholomew School of Nursing and Midwifery, City University, London, UK.
Journal of Clinical Nursing (Impact Factor: 1.26). 04/2009; 18(6):884-92. DOI: 10.1111/j.1365-2702.2008.02362.x
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To describe the ethnic and demographic composition of staff and patients on acute psychiatric wards in England.
A significant proportion of the UK population (7.6%) belong to an ethnic minority and there are concerns that ethnic minority patients are not well served by psychiatry, in particular that they are subject to excessive force and coercion.
Survey of a random sample of psychiatric wards in three regions.
A survey was conducted of staff (n = 1536) and patients (n = 11,128) on 136 acute admission psychiatric wards.
Ethnic minority patients were more likely to be admitted with a diagnosis of schizophrenia, younger, more likely to be admitted for a risk of harm to others and more likely to be legally detained. The association between ethnic minority status and detention remains, even when risk, age, gender and diagnosis are taken into account. Ethnic minority patients come from areas of greater social deprivation and fragmentation. Ethnic concordance between staff and patients varies, but the greatest difference is found in London where the proportion of minority staff is greater than the proportion of minority patients.
There continues to be evidence that ethnic minority patients are subject to an excessive amount of legal coercion in English mental health services. However, the proportion of staff belonging to an ethnic minority is greater than the proportion of patients.
Solutions to the problem of excessive use of legal coercion with ethnic minority patients need to be found. Changes of recruitment strategies are required if concordance is to be achieved.

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Available from: Len Bowers, Oct 10, 2015
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    • "A further 407 selected patients refused to participate, with the most frequent concern being the confidentiality of information in the case notes. Demographic characteristics had a good match to a previously collect sample of over 11,000 admissions to acute psychiatric wards in England (Bowers et al. 2008b): proportion male, this sample 53% vs. reference sample 49%; proportion white British 68% vs. 73%; although this sample was older, proportion 35 years and under 37% vs. 55%. The proportion of the sample detained under the mental health act on admission was 40%, as compared to 47% across all psychiatric services reported by a recent census (Care Quality Commission 2010). "
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    ABSTRACT: The use of seclusion is unpalatable to nurses and frequently unpleasant for patients. Time out is rated by nurses and patients as more acceptable. Several countries have initiated exercises to reduce the use of seclusion, but England has not. In this study, data were collected on the sequence of conflict (aggression, rule breaking, absconding etc.) and containment (coerced medication, restraint, special observation etc., including time out and seclusion) for the first 2 weeks of 522 acute admissions on 84 wards in 31 English hospitals between June 2009 and March 2010. Data were analysed to describe what preceded and followed time out and seclusion episodes in a nursing shift. Seclusion was used with 7·5% of patients, and time out with 15·5%. Both containment methods were used with similar patients in similar circumstances, and both brought disturbed behaviour to a close in half of the cases. Some seclusion appeared to follow less serious disturbed behaviour. There was an important variation in rates of seclusion between hospitals. Seclusion and time out had equally good outcomes in the management of physical violence to others. There is good evidence that seclusion rates can be reduced safely, and time out can sometimes be used as a substitute. A national registration and reporting system should be introduced in England, and serious efforts made to reduce seclusion use in hospitals where rates are high.
    Journal of Advanced Nursing 07/2011; 68(4):826-35. DOI:10.1111/j.1365-2648.2011.05784.x · 1.74 Impact Factor
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    • "Some elements of the data do support its representativeness. For example, the demographic data on staff and patients matches very closely that in the larger City- 128 dataset (Bowers et al., 2008c), and the rate of daytime door locking is slightly higher (up from 30% in 2005 during the original study to 42% in 2008 during this survey), commensurate with known trends. "
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    ABSTRACT: Accessible summary• Locking of psychiatric wards doors is more frequent, but the impact is unknown.• Staff patients and visitors returned a questionnaire about the issue.• Patients did not like the door being locked as much as staff, and being on a locked ward was associated with greater rejection of the practice.• Staff working on locked wards were more positive about it than those who did not.AbstractLocking the door of adult acute psychiatric wards has become increasingly common in the UK. There has been little investigation of its efficacy or acceptability in comparison to other containment methods. We surveyed the beliefs and attitudes of patients, staff and visitors to the practice of door locking in acute psychiatry. Wards that previously participated in a previous study were contacted and sent a questionnaire. A total of 1227 responses were obtained, with the highest number coming from staff, and the smallest from visitors. Analysis identified five factors (adverse effects, staff benefits, patient safety benefits, patient comforts and cold milieu). Patients were more negative about door locking than the staff, and more likely to express such negative judgments if they were residing in a locked ward. For staff, being on a locked ward was associated with more positive judgments about the practice. There were significant age, gender and ethnicity effects for staff only. Each group saw the issue of locked doors from their own perspective. Patients registered more anger, irritation and depression as a consequence of locked doors than staff or visitors thought they experienced. These differences were accentuated by the actual experience of the ward being locked.
    Journal of Psychiatric and Mental Health Nursing 11/2010; 17(10):873 - 880. DOI:10.1111/j.1365-2850.2010.01614.x · 0.84 Impact Factor
    • "Coercion in acute psychiatric inpatients represents a crucial and challenging problem in clinical practice, underlying the dilemma of individual freedom versus the need of treatment (Isohanni et al., 1991), and has to date been broadly investigated (Steinert and Lepping, 2009). The frequency of compulsory admissions (CA) to psychiatric hospitals varies considerably between different countries and regions (Bowers et al., 2009; Preti et al., 2009a,b; Steinert et al., 2009; Keown et al., 2008; Kjellin et al., 2008; Mulder et al., 2008; Potkonjak and Karlovic, 2008; Priebe et al., 2008; Salize and Dressing, 2004; Salize et al., 2008). The respective national rates are influenced by ethical and medical issues, e.g. "
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    ABSTRACT: We explored socio-demographic and clinical variables associated with compulsory admissions (CA) compared with voluntary admissions in schizophrenia-spectrum patients; moreover, we investigated the ability of excitement, emotion perception, and lack of insight to predict CA. 119 consecutive schizophrenia-spectrum patients admitted to the Servizio Psichiatrico di Diagnosi e Cura (SPDC = PES = psychiatric emergency service) of the Department of Neuroscience and Mental Health-San Giovanni Battista Hospital of Turin in the period between December 2007 and December 2009 were enrolled in the study. A backward stepwise logistic regression was used to test factors contributing to CA. CA rate in our sample was 28.5%. Previous CAs, drop-out, severity of illness, positive symptoms, excitement, emotion perception, and insight were significantly different in CA patients compared to voluntary ones. After backward selection of variables, three variables predicted CA in our sample: excitement, impaired emotion perception and lesser insight. Finally, the effect of excitement on CA status seemed partially mediated by emotion perception, the prediction model accounting for 53.8% of the variance of CA status. Conversely, insight seemed not to be a mediator of excitement on CA. Understanding CA patterns in special populations represents a first step towards improving clinical decision-making and developing appropriate interventions and service-provision.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 10/2010; 35(1):137-45. DOI:10.1016/j.pnpbp.2010.10.005 · 3.69 Impact Factor
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