Attitudes about Mechanical Restraint Use in Mental Health Hospitalization Services: A Spanish Survey.

The aim of this study was to analyze the attitudes of professionals in Mental Health Services throughout Spain who are directly or indirectly involved in the use of mechanical restraint and the barriers perceived to reduce its use. The study involved an online anonymous survey using Google Forms completed by Spanish mental health professionals working with service users; the survey assessed their involvement in and general attitudes and beliefs towards mechanical restraint. The survey was completed by 225 participants. Only 13.30% of the participants considered that mechanical restraint use was never necessary to guarantee the safety of users/staff in dangerous situations. Poor staff training (38.0%) and a lack of resources/staff (34.7%) were the most frequent barriers identified for the reduction of mechanical restraint. In the multivariate analysis, participation in learning programs to prevent the use of mechanical restraint was associated with lower acceptance of the use of mechanical restraint, but the result was barely significant (p = 0.050). A high percentage of mental health staff still consider mechanical restraint use necessary for safety reasons. According to the results, the participants perceived that more staff and resources and better training could reduce the use of mechanical restraint in Mental Health Hospitalization Services.

Factors associated with prolonged episodes of mechanical restraint in mental health hospitalization units in Andalusia.

WHAT IS KNOWN ON THE SUBJECT?: Risk factors associated with prolonged episodes of mechanical restraint and other coercive measures are understudied. There have been no studies of this phenomenon in the context of the Andalusian public health system. Knowledge about factors associated with prolonged episodes is essential to increase the understanding of this phenomenon and develop strategies to reduce its occurrence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at the level of the units could be necessary to prevent prolonged episodes of mechanical restraint. The results suggest the need for stricter control during the shifts on which restraint starts, especially in the first days after the patient's admission. Preventive risk assessment considering clinical and sociodemographic risk factors could help to reduce prolonged restraint. ABSTRACT: Introduction Factors associated with prolonged episodes of mechanical restraint and other coercive interventions are not clearly established and have been not studied in Andalusia (Spain). Aim To study factors associated with prolonged episodes of mechanical restraint. Method We analysed retrospectively episodes of mechanical restraint (N = 6267, prolonged episode >9.5 hours) in all public mental health hospitalization units (N = 20, 535 beds) that offer health coverage for the autonomous community of Andalusia. The data came from clinical records. A multivariable mixed logistic regression was used. Results In Andalusia, prolonged restraint is still frequent and varies depending on the unit. It is associated with less time since admission, male gender, diagnosis, reason for restraint and the shift on which it was initiated. Discussion The results provide evidence that prolonged episodes largely depend on the unit where they occur and that stricter control and regulation are necessary to prevent prolonged episodes. Implications for practice Interventions at the level of the unit are necessary. Stricter control in the shifts during which there is more risk of prolonged restraint may be necessary, especially in the first days following admission.

A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards.

WHAT IS KNOWN ON THE SUBJECT?: A relevant number of restraint prevention programmes have been developed internationally. In Spain, there is no harmonized policy to prevent the use of restraint. More studies are necessary to establish which programmes and components are necessary to prevent restraint. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention. There was no significant decreasing trend in the number of mechanical restraint episodes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context. All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. ABSTRACT: Introduction Mechanical restraint (MR) is used in many countries, including Spain, where non-harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (-1.79%, p < .001), but not in the number of restraint episodes (-0.45%; p = .149). Discussion The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice Interventions at a regional level aimed at preventing MR are feasible in the Spanish context.

Manejo del paciente pediátrico ante sospecha de infección por el nuevo coronavirus SARS-CoV-2 en atención primaria (COVID-19). AEPap-SEIP/AEP-SEPEAP / No disponible

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Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España / Social networks in the clinical practice evidence implementation strategy: experience from Hospital Regional Universitario de Málaga, Spain / Redes sociais na estratégia de implementação de evidências na prática clínica: experiência do Hospital Regional Universitario de Málaga, Espanha

Introducción. Twitter se ha convertido en el foro favorito para la comunicación de la atención médica, en cuanto permite a los usuarios publicar y compartir mensajes fácilmente a sus seguidores. En el Hospital Regional Universitario de Málaga (HRUM) se ha recurrido al uso de las redes sociales, particularmente Twitter, para facilitar la implementación y difusión de las recomendaciones de las Guías de Buenas Prácticas (GBP) de la Registered Nurses Association of Ontario (RNAO) en la práctica clínica. El objetivo del presente artículo es describir la estrategia y reflexionar acerca del rol de las redes sociales en las estrategias y los resultados de implantación de recomendaciones de GBP de la RNAO. Temas de reflexión. Siguiendo la metodología del modelo Best Practice Spotlight Organization (BPSO), se ha otorgado un papel protagonista a las enfermeras asistenciales de cada unidad a través de la formación, creación de equipos de implantación y difusión del programa. El uso de nuevos registros y, sobre todo, el uso de las redes sociales, ha obtenido unos resultados excelentes de adherencia de los profesionales al programa tanto a nivel cuantitativo como cualitativo. Conclusiones. El uso de las redes sociales como estrategia de difusión en la implantación de las recomendaciones de las GBP de la RNAO ha conseguido muy buena acogida por parte de los profesionales, pues muestra un alto nivel de participación, y es una herramienta útil como estrategia de difusión. Se necesita más tiempo para monitorizar el uso de las redes sociales y su posible impacto en la implantación de evidencias y la mejora de los resultados de salud de los pacientes y organizaciones de salud. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Introduction. Twitter has become the favored forum for communicating health care, since it allows users to publish and share messages with their followers. At Hospital Regional Universitario de Málaga (HRUM), they have used social networks, particularly Twitter, to facilitate implementing and broadcasting the recommendations from the Registered Nurses Association of Ontario's (RNAO) Best Practice Guideline (BPG) for clinical practice. The objective of this paper is to describe the strategy and reflect on the role of social networks on the strategies and results of implementing the RNAO's BPG recommendations. Topics of reflection. In accordance to the methodology of the Best Practice Spotlight Organization (BPSO) model, a leading role has been given to the nurses at each unit through training, creation of implementation teams and broadcasting the program. Using new records and, most of all, social networks, the strategy has obtained excellent results from professionals when it comes to adherence to the program, both quantitatively and qualitatively. Conclusions. The use of social networks as a broadcasting strategy in implementing the RNAO's BPG recommendations has been well received by professionals. The strategy shows high participation levels and is a useful tool as a broadcasting strategy. More time is needed to monitor social network use and its possible impact on generating evidence, as well as the improvement of healthcare organizations and patient's health results. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Introdução. O Twitter se tornou o fórum favorito para a comunicação no atendimento médico, pois permite que os usuários publiquem e compartilhem facilmente mensagens para seus seguidores. No Hospital Regional Universitário de Málaga (HRUM), foram utilizadas as redes sociais, particularmente o Twitter, para facilitar a implementação e disseminação das recomendações das Guias de Boas Práticas (GBP) da Registered Nurses Association of Ontario (RNAO) na prática clínica. O objetivo deste artigo é descrever a estratégia e refletir sobre o papel das redes sociais nas estratégias e nos resultados da implementação das recomendações do GBPs da RNAO. Tópicos de reflexão. Seguindo a metodología do modelo Best Practice Spotlight Organization, foi atribuído um papel essencial às enfermeiras de cada unidade por meio de treinamento, criação de equipes de implementação e divulgação do programa. O uso de novos registros e, sobretudo, o uso de redes sociais, obteve excelentes resultados de adesão dos profissionais ao programa, tanto quantitativa quanto qualitativamente. Conclusões. O uso das redes sociais como estratégia de disseminação na implementação das recomendações do GBPs da RNAO alcançou uma boa recepção pelos profissionais, pois mostra um alto nível de participação e é uma ferramenta útil como estratégia de disseminação. É necessário mais tempo para monitorar o uso das redes sociais e seu possível impacto na implementação de evidências e na melhoria dos resultados de saúde de pacientes e organizações de saúde. Cómo citar: Bujalance Hoyos J, Grinspun D, Pérez Jiménez MT, Viñas Vera C, Jiménez Fernández MS, García Sánchez JA. Las redes sociales en la estrategia de implementación de evidencias en la práctica clínica: experiencia del Hospital Regional Universitario de Málaga, España. MedUNAB. 2020;23(1):107-117. doi:10.29375/01237047.3571

Experience coercion, post-traumatic stress, and satisfaction with treatment associated with different coercive measures during psychiatric hospitalization.

Coercive measures are frequently used in psychiatric hospitalization. However, there are few studies that analyse perceived coercion, post-traumatic stress, and subjective satisfaction with the hospitalization treatment associated with different types of coercive measures. The sample consisted of 111 patients admitted to two psychiatric units and divided into three groups based on the measure applied: involuntary medication (N = 41), mechanical restraint (N = 32), and combined measures (mechanical restraint and involuntary medication; N = 38). The outcome variables were perceived coercion evaluated with the Coercion Experience Scale (CES), post-traumatic stress evaluated with the Davidson Trauma Scale (DTS), and satisfaction with the treatment evaluated with the Client's Assessment of Treatment (CAT). The results found higher levels of perceived coercion associated with the use of mechanical restraint (P = 0.002) and combined measures (P < 0.001) in comparison with involuntary medication. Additionally, in relation to post-traumatic stress, mechanical restraint (P = 0.013) and combined measures (P = 0.004) were more stressful compared to involuntary medication. Finally, the use of combined measures was associated with lower satisfaction with inpatient psychiatric treatment compared to the use of involuntary medication (P = 0.006). The following recommendation would be consistent with the results found: if a patient does not specify a preference for some type of measure, involuntary medication could be used and mechanical restraint avoided, especially when used in combination with involuntary medication.

Validation of a short version of the Coercion Experience Scale (CES-18): Psychometric characteristics in a Spanish sample.

The Coercion Experience Scale (CES) is a questionnaire that evaluates the subjective experience of coercion during psychiatric hospitalization. This study aimed to assess a short version of the Coercion Experience Scale (CES-18) in a Spanish Sample (N = 114). Two authors independently selected the items, choosing those that could also be applied to the experience of coercion after the use of forced medication. Reliability was estimated using internal consistency coefficients. Internal validity was assessed by means of a factorial analysis based on the method of extraction of main components and using orthogonal rotation VARIMAX. Convergent and discriminatory validity was evaluated by correlation between the total score of the CES-18 with the original CES and a Visual Analogue Scale, The Davidson Trauma Scale and the Client Assessment of Treatment Scale. The CES-18 showed adequate internal consistency (Cronbach α = 0.940). Factor analysis resulted in a two-factor solution (Coercion and Humiliation and Fear) explaining 64.2% of the total variance. The correlation between the original CES and CES-18 was adequate (r = 0.968). The scores suggested good divergent and convergent validity. The Spanish language CES-18 demonstrated adequate psychometric proprieties in order to assess perceived coercion during psychiatric hospitalization.