Convergence and divergence: An analysis of mechanical restraints.

BACKGROUND: Psychiatric nurses are regularly confronted with the uses and effects of control interventions such as mechanical restraints. Although there are evident tensions in the literature regarding the use of mechanical restraints, very little research has focused on the lived and embodied experience of their use, whether from the patient's perspective or the perspective of nursing staff responsible for their application. RESEARCH AIMS: (1) to gain access to the bodily phenomenon of being placed in mechanical restraints; (2) to give voice to the intimate experiential understanding of this experience; and (3) through phenomenological interpretation, to understand the subjective processes and meaning-making of this experience. RESEARCH DESIGN: For this research, we adopted a distinctly ethics-oriented application of the methodology known as interpretative phenomenological analysis, that is, the interpretive dimension of the research focused on ethical practice in mental healthcare - one that is informed by experiential accounts of the lived body. PARTICIPANTS AND RESEARCH CONTEXT: A total of 40 in-depth semi-structured, nondirected interviews with both nurses (n = 21) and patients (n = 19) we conducted to meet the aims of this article. Participants were recruited from an inpatient psychiatric unit of a Canadian general hospital. ETHICAL CONSIDERATIONS: The research received research ethics board clearance from both the hospital where the study took place and the University of Ottawa. FINDINGS: The comparative analysis is presented under the following headings: (1) context of care, (2) meaning of quality of care, (3) emotional reactions and nurse-patient relationship, (4) meeting the needs and (5) need for alternatives. DISCUSSION/CONCLUSIONS: The research findings are discussed in light of current literature and implications for practice.

Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons.

In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants' experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.

Medicaid Reimbursement for the Female Condom.

OBJECTIVES: To examine state-level female condom use through Medicaid from 2004 to 2014, because in 2010, the Patient Protection and Affordable Care Act (ACA) allowed for expanded Medicaid coverage in many states, extending requirements for contraceptive care to more of the poorest women in the United States and to most women with private insurance. METHODS: We collected data via brief survey of Medicaid offices in all 50 states between March 2015 and March 2016. RESULTS: The number of states providing Medicaid reimbursement for the female condom increased 33% (from 25 to 36) since 2007. Twenty-nine states provided data showing low numbers of claims for female condoms but high rates of reimbursement. CONCLUSIONS: This period of heightened access demands that the public health community seize the moment to increase awareness about and promote the female condom among health care professionals and consumers. The pending repeal of the ACA may thwart important gains in access; policies promoting women's reproductive health must be implemented immediately.

Improving access to acute mental health services in a general hospital.

BACKGROUND: There is a paucity of service research on the effectiveness of short-term mental health clinics. AIMS: To outline the development of the Urgent Consultation Clinic (UCC), an inter-professional, short-term, mental health program in a general hospital, and to evaluate the effectiveness of the UCC from a quality improvement perspective. METHOD: Participants (n = 143) completed a battery of validated measures assessing psychological and physical symptoms, quality of life, life satisfaction, and satisfaction with services at three time-points. Inter-professional team members rated participants' overall functioning and severity of mental health problems at intake and termination. RESULTS: The median time from referral to initial UCC visit was 12 days. A significant decline in the severity of mental health symptoms was observed, with 87% of participants reporting clinically elevated symptoms at intake compared to 71% at termination. Significant improvements were observed in life satisfaction, overall functioning, and mental quality of life. Sixty-nine percent of participants rated the quality of services as good or excellent. CONCLUSIONS: The UCC model of care contributed to improved access to psychiatric evaluation and short-term treatment. This inter-professional model could be applied to other health care settings to meet the needs of patients requiring acute psychiatric services.

Interventions to improve emergency department use for mental health reasons: protocol for a mixed-methods systematic review.

BACKGROUND: Healthcare resources are limited and unnecessary, and inappropriate emergency department use is now a highly visible healthcare priority. Individuals visiting the emergency department for mental health-related reasons are often amongst the most frequent presenters. In response, researchers and clinicians have created interventions to streamline emergency department use and several primary studies describe the effects of these interventions. Yet, no consensus exists on the optimal approach, and information on the quality of development, effectiveness, acceptability, and economic considerations is hard to find. The purpose of this study is to systematically review interventions designed to improve appropriate use of the emergency department for mental health reasons. METHOD: A mixed-method systematic review using Joanna Briggs Methodology. Search combining electronic databases (EMBASE, MEDLINE, PsycINFO, CINAHL, HealthSTAR, PROQUEST, Cumulative Index to Nursing and Allied Health) and secondary searches (grey literature and hand search with consultation). Two independent reviewers will screen titles and abstracts using predetermined eligibility criteria and a third reviewer will resolve conflicts. Full texts will also be screened by two independent reviews and conflicts resolved in a consensus meeting with a third reviewer. A pilot-tested data extraction form will be used to retrieve data relevant to the study objectives. We will assess the quality and of all included studies. Data describing interventions will be summarized using logic models and reported narratively. Quality of development will be assessed using the Oxford Implementation Index. For data on intervention effectiveness, we will assess statistical heterogeneity and conduct a meta-analysis using a random effects method, if appropriate. For interventions that cannot be pooled, we will report outcomes narratively and descriptively. Qualitative data on acceptability will be synthesized using meta-aggregation and an economic evaluation of interventions will be done. The reporting of this protocol follows the PRISMA-P statement. DISCUSSION: Using a combined systematic review methodology and integrated knowledge translation plan, the project will provide decision makers with concrete evidence to support the implementation and evaluation of interventions to improve emergency department use for mental health reasons. These interventions reflect widespread priorities in the area of mental health care. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018087430.