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Sensory assessment and therapy to help reduce seclusion use with service users needing psychiatric intensive care

Published online by Cambridge University Press:  10 March 2010

Stuart J Lee ,
Allison Cox ,
Fiona Whitecross ,
Pamela Williams  and
Yitzchak Hollander
Stuart J Lee
Affiliation:
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychiatry and Psychology, Melbourne, Australia
Allison Cox*
Affiliation:
Department of Psychiatry, The Alfred, Melbourne, Australia Occupational Therapy Department, The Alfred, Melbourne, Australia
Fiona Whitecross
Affiliation:
Department of Psychiatry, The Alfred, Melbourne, Australia
Pamela Williams
Affiliation:
Monash Alfred Psychiatry Research Centre, The Alfred and Monash University, School of Psychiatry and Psychology, Melbourne, Australia
Yitzchak Hollander
Affiliation:
Department of Psychiatry, The Alfred, Melbourne, Australia
*
Correspondence to: Allison Cox, The Alfred Hospital, Commercial Rd, Melbourne 3004, Australia. Tel: +61 3 9076 3526; Fax: +61 3 9076 2920; E-mail: [email protected]
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Abstract

Background: In acute psychiatry, seclusion has traditionally been used to manage people at risk of harming themselves or others. However, being secluded can be traumatising and cause harm to service users and staff. In North America, sensory modulation strategies and a focus on early identification of aggression warning signs and tailored responses have significantly improved care and reduced seclusion use.

Methods: A six-month pilot of the use of sensory modulation strategies and a brief sensory and risk assessment tool (Safety Tool) was implemented on a 30-bed acute psychiatric unit. Indicators of the impact on seclusion use were audited from service users’ files with feedback collected from clinical staff.

Results: Safety Tools for 43 psychiatric intensive care service users were audited. They required significantly longer hospitalisation (mean=39.4 days) than was the average for the unit (mean=19.0 days). Whereas 65% had been previously secluded, only 26% were secluded after completing a Safety Tool. Most staff had completed or read a Safety Tool with 76% saying it should become part of standard care.

Conclusion: Findings support the significant role that sensory assessment and engagement can play in improving service user care in acute psychiatry.

Keywords

Acute psychiatryseclusion reductionsensory assessmentservice user engagement
Type
Original Article
Information
Journal of Psychiatric Intensive Care , Volume 6 , Issue 2 , December 2010 , pp. 83 - 90
Copyright
Copyright © NAPICU 2010

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References

Baillon, S., Van Diepen, E. and Prettyman, R. (2002) Multi-sensory therapy in psychiatric care. Advances in Psychiatric Treatment. 8: 444–450.CrossRefGoogle Scholar
Bebbington, P., Brugha, T., Hill, T., Marsden, L. and Window, S. (1999) Validation of the Health of the Nation Outcome Scales. British Journal of Psychiatry. 174: 389–394.CrossRefGoogle ScholarPubMed
Busch, A.B. and Shore, M.F. (2000) Seclusion and restraint: A review of recent literature. Harvard Review of Psychiatry. 8: 261–270.CrossRefGoogle ScholarPubMed
Champagne, T. and Stromberg, N. (2004) Sensory approaches in inpatient psychiatric settings: Innovative alternatives to seclusion and restraint. Journal of Psychosocial Nursing & Mental Health Services. 42: 34–44.CrossRefGoogle ScholarPubMed
Colaizzi, J. (2005) Seclusion and restraint: A historical perspective. Journal of Psychosocial Nursing & Mental Health Services. 43: 31–37.Google Scholar
D'Orio, B.M., Purselle, D., Stevens, D. and Garlow, S.J. (2004) Reduction of episodes of seclusion and restraint in a psychiatric emergency service. Psychiatric Services. 55: 581–583.Google Scholar
Department of Human Services Mental Health Branch Victoria (2004) Chief Psychiatrist's Annual Report. Melbourne: Department of Human Services. http://www.health.vic.gov.au/chiefpsychiatrist/anrep.htmGoogle Scholar
Duxbury, J. (2002) An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: A pluralistic design. Journal of Psychiatric and Mental Health Nursing. 9: 325–337.Google Scholar
Frueh, B.C., Knapp, R.G., Cusack, K.J., Grubaugh, A.L., Sauvageot, J.A., Cousins, V.C., Yim, E., Robins, C.S., Monnier, J. and Hiers, T.G. (2005) Patients' reports of traumatic or harmful experiences within the psychiatric setting. Psychiatric Services. 56: 1123–1133.CrossRefGoogle ScholarPubMed
Hancock, C.K., Buster, P., Oliver, M., Fox, S.W., Morrison, E. and Burger, S.L. (2001) Restraint reduction in acute care: An interdisciplinary approach. Journal of Nursing Administration. 31: 74–77.CrossRefGoogle ScholarPubMed
Huckshorn, K.A. (2004) Seclusion and restraint: Where have we been? Where are we now? Where are we going? Journal of Psychosocial Nursing & Mental Health Services. 42: 6–7.Google Scholar
Jonikas, J.A., Cook, J.A., Rosen, C., Laris, A. and Kim, J.-B. (2004) Brief reports: A program to reduce use of physical restraint in psychiatric inpatient facilities. Psychiatric Services. 55: 818–820.CrossRefGoogle Scholar
LeBel, J., Stromberg, N., Duckworth, K., Kerzner, J., Goldstein, R., Weeks, M., Harper, G., LaFlair, L. and Sudders, M. (2004) Child and adolescent inpatient restraint reduction: A state initiative to promote strength-based care. Journal of the American Academy of Child & Adolescent Psychiatry. 43: 37–45.CrossRefGoogle ScholarPubMed
Lendemeijer, B. and Shortridge-Baggett, L. (1997) The use of seclusion in psychiatry: A literature review. Scholarly Inquiry for Nursing Practice. 11: 299–315.Google Scholar
Meehan, T., Bergen, H. and Fjeldsoe, K. (2004) Staff and patient perceptions of seclusion: Has anything changed? Journal of Advanced Nursing. 47: 33–38.CrossRefGoogle ScholarPubMed
Ryan, R. & Happell, B. (2009) Learning from experience: Using action research to discover consumer needs in post-seclusion debriefing. International Journal of Mental Health Nursing. 18: 100–107.CrossRefGoogle ScholarPubMed
Sailas, E. and Wahlbeck, K. (2005) Restraint and seclusion in psychiatric inpatient wards. Current Opinion in Psychiatry. 18: 555–559.Google Scholar
Sullivan, A.M., Bezmen, J., Barron, C.T., Rivera, J., Curley-Casey, L. and Marino, D. (2005) Reducing restraints: Alternatives to restraints on an inpatient psychiatric service: Utilizing safe and effective methods to evaluate and treat the violent patient. Psychiatric Quarterly. 76: 51–65.Google Scholar
Whitecross, F. (2006) Psychiatric Intensive Care: Developing an evidenced based, least restrictive model of inpatient care. Victorian Travelling Fellowship: Fellow Project Report. http://www.health.vic.gov.au/__data/assets/pdf_file/0018/306441/f_whitecross_final_report.pdfGoogle Scholar