This study aims to explore and understand factors influencing the decisions of mental health professionals releasing service users from seclusion.Seclusion should only be used as a last resort and for the minimum possible duration. Current evidence outlines which service users are more likely to be secluded, why and what influences professionals' decision to seclude. Little is known about factors professionals consider when releasing service users.A qualitative study was undertaken to explore factors which influence decision-making of mental health professionals when terminating episodes of seclusion.Semi-structured face-to-face interviews with 21 professionals were undertaken between May 2017-January 2018. Framework analysis was used to systematically manage, analyse, and identify themes, while maintaining links to primary data and providing a transparent audit trail.Six themes were identified where professionals looked for service users to demonstrate cooperation and compliance before they would be released. Decisions were subjective, being influenced by the experience and composition of the review team, the availability of resources plus the emotional tone and physical environment of the ward. Release could be delayed by policy and protocol.Professionals should have greater awareness of factors that hinder or facilitate decisions to release service from seclusion and an understanding of how service user views and involves in decisions regarding seclusion should be explored.Senior staff should be available to facilitate release at the earliest opportunity. Staff should ensure that policy and procedures do not prolong the time service users remain secluded.目的: 本研究旨在于探讨并理解影响心理健康专业人员决定让服务用户脱离隔离状态的因素。 背景: 隔离仅应作为最后的手段,并且尽可能在最短的时间内使用。现有迹象大致显现了哪些服务用户更可能被隔离,为什么隔离以及影响专业人员决定隔离的因素。专业人士在释放服务用户时很少考虑影响因素。 设计: 本项定性研究探讨响心理健康专业人员终止隔离决策的因素。 方法: 2017年5月至2018年1月,对21名专业人士进行了半结构式面对面访谈。框架分析方法用于系统管理、分析和确定主题,同时保持与原始数据的联系并进行透明的审计追踪。 结果: 确定了6大主题,专业人士希望服务用户在得到释放之前进行配合并且服从指挥。决策具有主观性,受审查小组的经验和构成、资源的可用性、情绪基调以及病房的物理环境的影响。释放时间可能会因为政策和医疗方案而延迟。 结论: 专业人士应提高对将服务用户从隔离状态中释放出来的决策起到阻碍或推动作用因素的认识,并了解如何探讨服务用户看待和参与有关隔离的决策。 影响: 应安排高级工作人员尽早获释。工作人员应确保政策和程序不会延长服务使用者的隔离时间。.
Abstract Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision‐making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety . In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection . Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence‐based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion.
Concerns have been raised about the sexual safety of people in mental health inpatient settings and it has been identified that the reporting of sexual safety incidents is inconsistent across healthcare services. This article describes the strategy developed by Humber Teaching NHS Foundation Trust (HTFT) to improve sexual safety for people using mental health services and comply with recommendations from the Care Quality Commission.The strategy was informed by a literature review and several reports into sexual safety. The literature review found that staff are often unsure how to identify and categorise sexual safety incidents, while debriefing and support for those who experience such incidents are often lacking. In addition, not all healthcare services have policies and protocols in place to guide staff who experience sexual safety incidents. Based on the findings of the literature review, along with recommendations from various organisations, HTFT developed a strategy to ensure the delivery of safe and accountable care. This strategy included: a review of trust policies and procedures; staff and service user focus groups; and the development of a staff education programme. The aim is to disseminate this learning across other inpatient services in the trust.
Background Involving carers is a key priority in mental health services. Carers report the sharing of service users’ safety information by mental health nurses is problematic and seldom takes place. Aims The impact of an intervention on consensus between nurses and carers on perceptions of risk was investigated. Methods Carer–nurse risk consensus scores were measured pre- and post-introduction of a structured dialogue (paired t-test/ANOVA). Carer experience with involvement was surveyed pre-test ( n = 60) and compared with the post-test intervention group ( n = 32) (chi-square tests of linear-by-linear association). Results Consensus and perceptions regarding type and severity of risk did not change significantly for carers or nurses after engaging in a structured dialogue. Statistically significant differences were found with carers reporting higher levels of satisfaction with services in four out of six areas surveyed. Conclusions Findings provide support for increasing carer contribution to discussions regarding risk. Further work to embed carer involvement in clinical practice is warranted.
This article describes a service evaluation of the introduction of a successful local initiative aimed at assisting the development and retention of a group of newly qualified mental health nurses in adult inpatient teams at Humber Teaching NHS Foundation Trust. The project offered extra support to complement the trust's preceptorship programme. The nurses reported the group to be beneficial and identified peer support as important in the transition to becoming a staff nurse.
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