Reducing use of seclusion on a male medium secure forensic ward.

The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients' feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice.Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration (outcome measure) and frequency (balancing measure) of the use of seclusion by 10% over 6 months. Following the analysis of our local data systems and feedback from both patients and staff, we identified the high levels of use of seclusion, and reluctance to terminate it. These included a lack of awareness of the effective and appropriate use of such a facility, a hesitancy to use de-escalation techniques and an over-reliance on multidisciplinary team and consultant decision making.We subsequently designed and implemented three tests of change which reviewed seclusion processes, enhanced de-escalation skills and improved decision making. Our tests of change were applied over a 6-month period. During this period, we surpassed our original target of a reduction of frequency and duration by 10% and achieved a 33% reduction overall. Patients reported feeling safer on the ward, and the team reported improvements in relationships with patients.Our project highlights the importance of relational security within the secure setting and provides a template for other wards wishing to reduce the frequency and duration of seclusions.

Power of saying 'I Don't Know': psychological safety and participatory strategies for healthcare leaders.

As healthcare systems grow increasingly complex and integrate with other services and sectors, creating complex patient pathways, this inevitably leads to additional layers within a system. Consequently, high-tier leaders become progressively detached from the inner workings of the systems in which they operate. Several barriers exist that may deter a leader from embracing uncertainty and acknowledging the limits of their expertise in these systems. These barriers range from personal insecurities about perception to organisational stigmas that compound these concerns through expectations of infallible leadership. In this article, I draw on my experience as an embedded researcher and someone who has taught leadership in healthcare settings to examine the importance of leadership vulnerability, considering not only for the leaders themselves but also for fostering a learning and innovative culture within the organisation. I focus on two fundamental tenets: psychological safety and participatory approaches to innovation. In addition, I offer practical considerations for embracing vulnerability and discuss the ensuing benefits. Given the rapidly evolving complexities in healthcare and paradigm-shifting innovations, such as the integration of digital solutions, this article serves as a call to action. It urges leaders to embrace uncertainty, encourage participation and venture into the unknown.

Bringing nature into CAMHS inpatient services: reflections for the implementation and integration of training into practice.

Poor mental health is a global concern and is exacerbated by recent challenges concerning COVID-19 and the climate emergency, with significant consequences to individuals and to society. Increasing evidence demonstrates that nature-based approaches (NBAs) have numerous benefits to mental health services and the people they support with mental health needs. Despite these benefits, understanding how to integrate these approaches into practice is challenging. In this paper, we report our findings from a recent qualitative study with staff from a CAMHS inpatient unit who had recently undergone NatureWell Facilitator training. This is a particular approach to working with people in nature developed by The Natural Academy. Participants identified the importance of implementation of discreet, novel NBAs, as well as integrating nature into current practice, the benefits when fostering psychologically safe and therapeutic relationships with staff, and the clinical and operational factors when carrying out NBAs in these settings.

Improving mealtimes for patients and staff within an eating disorder unit: the next chapter.

OBJECTIVES: Mealtimes are an integral part of treatment for patients in an eating disorder inpatient unit. However, they are often distressing and anxiety provoking for both patients and staff. A consequence of patients' distress is an increase in eating disorder behaviours specific to mealtimes. This is the second paper detailing a quality improvement project following on from an initial paper outlining the first test of change. The aim of this quality improvement project was to decrease the number of eating disorder behaviours at mealtimes in the dining room through the implementation of interventions identified through diagnostic work. METHODS/DESIGN: The Model for Improvement was used as the systematic approach for this project. Baseline assessment included observations in the dining room, gathering of qualitative feedback from staff and patients and the development of a form which identifies eating disorder behaviours completed by staff. Interventions in the form of three change ideas have so far been introduced including (1) a host role in the dining room, (2) a guide to the dining room for new staff along with competencies and (3) a dining goals group. The impact of the three interventions is assessed. RESULTS: The introduction of the interventions has overall reduced the average number of eating disorder behaviours per patient in the dining room by 33%. CONCLUSIONS: This paper reports the challenges and successes of continuing a QI project through the COVID-19 pandemic and the need for multiple tests of change to improve a complex problem. The results demonstrate a consistent reduction in eating disorder behaviours over a period of nearly 2 years.

Ethical considerations in quality improvement: key questions and a practical guide.

Quality improvement (QI) provides a rigorous and innovative approach to improving patient's lives in the healthcare system. Still, it can pose challenges in understanding what ethical considerations apply to some projects to minimise the possibility of patient harm or prevent other ethical wrongs and potential staff burden. While many commentaries discuss the extent to which QI ethics should match research ethics, there is minimal literature regarding what QI project teams should do when considering ethics at the planning stage. This paper provides a practical walkthrough of some of the ethical considerations across the breadth of QI projects, starting from some of the key questions when planning a QI project and a guide for the different ethical considerations that may apply.

Bioenergetic costs and state influence distance perception.

Bioenergetic resources and states have been found to influence visual perception, with greater expected energy expenditure being associated with perceptions of greater distances and steeper slopes. Here we tested whether resting metabolic rate (RMR), which can serve as a proxy for the bioenergetic costs of completing physical activity, is positively correlated with perceived distance. We also tested whether temporarily depleting bioenergetic resources through exercise would result in greater perceived distance. Eighty-two members of the public were recruited at a beach in Weston-super-Mare, UK. Half completed moderate exercise and half acted as controls. They then estimated distance to a set point. Results showed that RMR (computed using a recognized equation) was positively correlated with distance perception, meaning that participants requiring greater energy to traverse a set distance perceived the set point as farther away. In addition, those participants who had their bioenergetic resources temporarily depleted through exercise perceived the set distance as greater, compared to controls. There was no interaction effect between RMR and exercise. To our knowledge, these results are the first to show a relationship between metabolic rate and distance perception, and they contribute to the literature on embodied perception.

Making your skin crawl: The role of tactile sensitivity in disease avoidance.

Mounting evidence indicates that animals, including humans, have evolved a behavioral disease-avoidance system designed to facilitate the detection and avoidance of sources of pathogens, and that this system interacts with physiological defenses. The skin acts as an important anatomical barrier, yet little research has investigated the role of tactile sensitivity in disease avoidance. Increased tactile sensitivity in the presence of potential sources of pathogens may facilitate prophylactic behaviors such as self-grooming. Across multiple studies, we tested the hypothesis that the induction of disgust-the key emotion underlying disease avoidance-may lead to greater tactile sensitivity compared to control conditions. A nonsignificant trend was found in a pilot study, which was replicated (and found to be significant) in Studies 1 and 2. To our knowledge, these results are the first to demonstrate disgust-induced changes in tactile sensitivity, and they contribute to the growing literature on the integrated evolved defenses against infectious disease.

Is Obesity Stigma Based on Perceptions of Appearance or Character? Theory, Evidence, and Directions for Further Study.

Theoretical approaches to stigmatization have highlighted distinct psychological mechanisms underlying distinct instances of stigmatization. Some stigmas are based on inferences of substandard psychological character (e.g., individuals deemed untrustworthy), whereas others are based on perceptions of substandard physical appearance (e.g., individuals with physical deformities). These inferences and perceptions are associated with specific cognitive and motivational processes, which have implications for understanding specific instances of stigmatization. Recent theoretical approaches and empirical findings suggest that obesity stigma involves both inferences of substandard psychological character and perceptions of substandard physical appearance. We provide a review of the relevant evidence and discuss directions for future research.