Mental health nursing practice in acute psychiatric close-observation areas.

School of Nursing, Family and Community Health, University of Western Sydney, Parramatta Campus, Penrith DC, New South Wales 1797, Australia.
International journal of mental health nursing (Impact Factor: 1.29). 07/2004; 13(2):89-99. DOI: 10.1111/j.1440-0979.2004.00324.x
Source: PubMed

ABSTRACT The provision of evidence-based therapeutic nursing care in close-observation units or psychiatric intensive care units, has been identified as a problem internationally. These areas of nursing practice have been the subject of considerable discussion particularly in relation to the management of aggression, violence, involuntary treatment, and seclusion. This study used a participatory action research framework to identify qualitative and quantitative measures of activity in the area. Quantitative data collected included rates of critical incidents, the use of prn medication, and the use of seclusion. These data were used as base-line data and were predicted as a measure of change. Qualitative data, collected by interview and focus groups, were used to reveal the experience of patients, relatives, and nurses in a close-observation area. Analysis of this data revealed three main themes: design and environment, lack of activity and structured time, and nursing care. The importance of this study is in demonstrating the multiple problems that exist in the provision of care in close-observation areas and the corresponding need for fundamental changes.

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    ABSTRACT: ACCESSIBLE SUMMARY: • An extensive review of empirical literature (n = 39) on patient and staff perceptions of seclusion in psychiatric inpatient settings was undertaken. • Patients perceived seclusion negatively while staff perceived it to be therapeutic and vital for the running of inpatient units. • Better communication, more contact with patients and staff engaging with patients before during and after a seclusion episode were suggestions for improvements to care processes. ABSTRACT: This review explores patient and staff perceptions and improvement suggestions regarding seclusion in psychiatric inpatient settings. After an extensive literature search, 39 empirical papers were included in the review. According to the literature, patients perceived seclusion to be a distinct negative incident. Staff thought seclusion had a therapeutic effect and believed that units could not operate effectively without seclusion, but regretted that the situation was not resolved differently. Staff and patients had suggestions to improve the seclusion experience. Common themes in relation to the implications for practice are the need for better communication and more contact between patients and staff before, during and after the seclusion event.
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Jun 5, 2014