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1.
BMC Health Serv Res ; 22(1): 941, 2022 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-35869551

RESUMO

BACKGROUND: Psychiatric wards treating involuntarily admitted patients are traditionally locked to prevent absconding. However, on the basis of observational evidence, the necessity for locked units in psychiatric hospitals has increasingly been questioned. Updated Mental Health Laws in several Federal States of Germany legitimate involuntary commitment without generally locked doors. METHODS: We examined the effects of an open-door policy in a quasi-experimental, prospective design. For the first time, at each of two locations, two identical wards serving as control and intervention could be compared. After a baseline period of three months, one ward at each location started the 12 month intervention period with the implementation of an open-door policy, while the respective control ward, as before, used open doors only facultatively. Primary outcomes were average opening times of the four wards between 8 a.m. and 8 p.m., and the number of involuntary treatment days with the doors open. Secondary outcomes were adverse events including aggressive incidents, absconding, suicide attempts and coercive measures. RESULTS: Overall, door-opening times increased significantly at both sites´ intervention wards. The number of adverse events did not increase during intervention period. Frequencies of coercive measures decreased in Friedrichshafen and remained unchanged in Tuebingen. In case of the intervention ward in Friedrichshafen, doors were open in up to 91% of all involuntary treatment days, whereas in the control ward, this was only the case in 67% of all involuntary treatment days (p < .001). In case of the intervention ward in Tuebingen, 45% of involuntary treatment days had open doors, compared to 30% in the control ward (p < .001). CONCLUSIONS: It is possible to manage psychiatric wards with open doors without taking inappropriate risks. The extent to which open-door policies are achievable is be dependent on staffing and patient characteristics. Further research is necessary to explore the role of staff attitudes. TRIAL REGISTRATION: Our trial "Open Doors by Fair Means" is retrospectively registered with DRKS ( DRKS00015154 ) on Sept. 10th 2018 and displayed on the public web site. It is searchable via its meta-registry ( http://apps.who.int/trialsearch/ ).


Assuntos
Transtornos Mentais , Unidade Hospitalar de Psiquiatria , Coerção , Hospitais Psiquiátricos , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Políticas
2.
Psychiatr Pol ; 56(1): 115-122, 2022 Feb 27.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-35569152

RESUMO

The novel coronavirus disease (COVID-19) epidemic - in addition to its many widely described negative consequences - has created achallenge for the mental health care system in every country, including Poland to safely manage psychiatric disorders in addition to preventing and treating COVID-19. In Poland, online mental health services are provided for the outpatients. Still there are patients with severe psychiatric disorders who have suspected or confirmed COVID-19 and need to be treated in a psychiatric hospital. The Department of Child and Adolescent Psychiatry of the Medical University of Warsaw was appointed by local authorities to hospitalize childrenwith mental disorders and with confirmed or suspected COVID-19. This created an urgent need to adapt our department for treating COVID-19 infected patients. As far as we know no guidelines for psychiatric hospitals management during the COVID-19 pandemic are available in English. In this manuscript, we present our guidelines regarding safe management of patients with suspected or confirmed COVID-19 in the Department of Child and Adolescent Psychiatry of the Medical University of Warsaw.


Assuntos
COVID-19 , Transtornos Mentais , Adolescente , COVID-19/terapia , Criança , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Pandemias/prevenção & controle , Unidade Hospitalar de Psiquiatria , SARS-CoV-2
3.
PLoS One ; 17(5): e0269044, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35617261

RESUMO

It has been reported that the COVID-19 pandemic has predisposed adolescents to risky behaviors such as substance use and subsequent substance use disorder (SUD). However, it is unknown how the pandemic has changed the prevalence of SUD among adolescents in Uganda. We aimed to determine the prevalence of SUD and associated factors among adolescents in southwestern Uganda. Retrospectively, psychiatry ward records from November 2018 to July 2021 were collected from the largest tertiary hospital in southwestern Uganda. A total of 441 adolescent records were included in the analysis, with a mean age was 17±1.88 years, and the majority were males (50.34%). The overall prevalence of SUD was 7.26% (5.90% and 9.80% before and during the pandemic). Despite a little rise in SUD (3.9% increment) during the COVID-19 pandemic, there was no statistical difference compared to before the pandemic. The likelihood of being diagnosed with SUD was more among older adolescents at any period. In addition, having a diagnosis of bipolar mood disorder reduced the likelihood of SUD during the pandemic. This study indicated no statistical change in the diagnosis of SUD among adolescents before and during the COVID-19 pandemic. As older-male adolescents (17 to 19 years) were at higher risk of SUD, there is a need for early intervention for this group.


Assuntos
COVID-19 , Transtornos Relacionados ao Uso de Substâncias , Adolescente , COVID-19/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pandemias , Unidade Hospitalar de Psiquiatria , Sistema de Registros , Estudos Retrospectivos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Uganda/epidemiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-35627570

RESUMO

The need to better monitor coercion practices in psychiatric hospitals has been recognised. We aim to describe how physical restraint events occur in psychiatric hospitals and identify factors associated with physical-restraint use. A cohort register study was used. We analyzed physical restraint documents among 14 wards in two psychiatric hospitals in Hong Kong (1 July and 31 December 2018). In total, 1798 incidents occurred (the rate of physical restraint event 0.43). Typically, physically restrained patients were in early middle-age, of both genders, diagnosed with schizophrenia-spectrum and other psychotic disorders, and admitted voluntarily. Alternate methods for physical restraint were reported, such as an explanation of the situation to the patients, time-out or sedation. A longer period of being physically restrained was associated with being male, aged ≥40 years, having involuntary status, and neurodevelopmental-disorder diagnosis. Our findings support a call for greater action to promote the best practices in managing patient aggression and decreasing the use of physical restraint in psychiatric wards. The reasons for the use of physical restraint, especially for those patients who are admitted to a psychiatric hospital on a voluntary basis and are diagnosed with neurodevelopmental disorders, needs to be better understood and analysed.


Assuntos
Hospitais Psiquiátricos , Restrição Física , Coerção , Feminino , Hong Kong/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Unidade Hospitalar de Psiquiatria , Restrição Física/psicologia
6.
Eur. j. psychiatry ; 36(2): 137-139, apr.-june 2022.
Artigo em Inglês | IBECS | ID: ibc-203062

RESUMO

Noncompliance is a worldwide problem in medical care, leading to prolonged recovery times and rehospitalizations. Especially in the field of psychiatry, consistent therapy compliance is crucial. Hence the Munich Integrated Care program for patients suffering from psychiatric disorders aims at improving patients’ compliance. To bring to light participants' personal experiences with the program, we conducted group interviews that we evaluated using qualitative methods. We shed light on what aspects make a psychiatric health care program so valuable in the eyes of its participants that it can develop its effect as a relapse-preventive agent. We found that in this program, patients experienced safety, stability, support, hope, motivation and understanding.


Assuntos
Humanos , Ciências da Saúde , Serviço Social em Psiquiatria/métodos , Unidade Hospitalar de Psiquiatria
7.
Australas Psychiatry ; 30(3): 386-390, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35320036

RESUMO

OBJECTIVE: Trauma-informed care and physical (including sexual and reproductive) health screening is standard in Western Australian mental health settings. We sought to determine the rates of reported sexual trauma and domestic violence (DV), the rates of sexual and reproductive health screening, and associations between sexual trauma and reproductive health screening in a sample of women of child-bearing age (WOCBA), that is, 18-49 years, admitted to an inpatient psychiatric unit (IPU). METHODS: A retrospective study on 12 months of admissions to an outer metropolitan IPU (2017-2018), using descriptive analysis. RESULTS: Review of 160 admissions demonstrated high rates of reported sexual trauma (49.4%) and DV (38.8%). Rates of screening for pregnancy (56.9%) and sexually-transmitted infection risk (18.8%) were low. 5 out of 25 (20.0%) patients prescribed a mood stabiliser had documented discussions regarding reproductive risks of their medication. An overall lack of effect (p > .6) was found between sexual trauma history and reproductive health screening. CONCLUSIONS: WOCBA admitted to an IPU are vulnerable to having experienced sexual trauma and DV, with low rates of documented reproductive health screening despite existing clinical guidelines.


Assuntos
Pacientes Internados , Saúde Reprodutiva , Adulto , Austrália , Feminino , Humanos , Serviços de Saúde Mental , Pessoa de Meia-Idade , Gravidez , Unidade Hospitalar de Psiquiatria , Estudos Retrospectivos , Comportamento Sexual
8.
BMJ Open ; 12(2): e058501, 2022 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-35173011

RESUMO

INTRODUCTION: The reduction of coercion in psychiatry is a high priority for both the WHO and many member countries. Open-door policy (ODP) is a service model for psychiatric ward treatment that prioritises collaborative and motivational measures to better achieve acute psychiatric safety - and treatment objectives. Keeping the ward main door open is one such measure. Evidence on the impact of ODP on coercion and violent events is mixed, and only one randomised controlled trial (RCT) has previously compared ODP to standard practice. The main objectives of the Lovisenberg Open Acute Door Study (LOADS) are to implement and evaluate a Nordic version of ODP for acute psychiatric inpatient services. The evaluation is designed as a pragmatic RCT with treatment-as-usual (TAU) control followed by a 4-year observational period. METHODS AND ANALYSIS: In this 12-month pragmatic randomised trial, all patients referred to acute ward care will be randomly allocated to either TAU or ODP wards. The primary outcome is the proportion of patient stays with one or more coercive measures. Secondary outcomes include adverse events involving patients and/or staff, substance use and users' experiences of the treatment environment and of coercion. The main hypothesis is that ODP services will not be inferior to state-of-the art psychiatric treatment. ODP and TAU wards are determined via ward-level randomisation. Following conclusion of the RCT, a longitudinal observational phase begins designed to monitor any long-term effects of ODP. ETHICS AND DISSEMINATION: The trial has been approved by the Regional Committees for Medical and Health Research Ethics (REC) in Norway (REC South East #29238), who granted LOADS exemption from consent requirements for all eligible, admitted patients. Data are considered highly sensitive but can be made available on request. Results will be published in peer-reviewed journals and presented at scientific conferences and meetings. TRIAL REGISTRATION NUMBER: ISRCTN16876467. PROTOCOL VERSION: 1.4, 21 December 2021.


Assuntos
Coerção , Pacientes Internados , Hospitalização , Humanos , Pacientes Internados/psicologia , Políticas , Ensaios Clínicos Pragmáticos como Assunto , Unidade Hospitalar de Psiquiatria , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
Int J Ment Health Nurs ; 31(3): 611-624, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35128772

RESUMO

The ward climate or atmosphere refers to its material, emotional and social conditions. A good ward climate in psychiatric settings can influence the mood, behaviour and self-concept of patients and staff members and improve patient outcomes. Many studies have examined the relationship between ward climate and aggression, but only a few have investigated the effect of a ward's environment, rules and activities. This multicentric observational study aimed to assess the relationship between the rules/activities and the climate of four acute psychiatric units of Northern Italy. The Essen Climate Evaluation Scheme (EssenCES) questionnaire, which was administered to patients and staff, was used to evaluate the different dimensions of ward atmosphere. There was a good response rate (79%) in patients and staff members who completed the questionnaire (114 patients and 109 staff). Safety perception appeared to be quite different in patients and staff. The patients who were authorized to have more visiting hours and more time to use their mobile phone had higher scores on Experienced Safety subscale. A negative correlation between the Therapeutic Hold and Experienced Safety subscales was found in the staff members, and this was due to their negative perception. The ward climate seemed to be affected by the unit's rules, especially with respect to visits and the smartphones use. Nurses need to be aware of the importance of ward climate and how their own perception may differ from and that of patients: this gap could lead to decisions detached from the patients' needs.


Assuntos
Transtornos Mentais , Unidade Hospitalar de Psiquiatria , Agressão , Atitude do Pessoal de Saúde , Humanos , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Inquéritos e Questionários
10.
Adm Policy Ment Health ; 49(4): 587-595, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35171375

RESUMO

Forensic High and Intensive Care (FHIC) has recently been developed as a new care model in Dutch forensic psychiatry. FHIC aims to provide contact-based care. To support Dutch forensic care institutions in the implementation of the model, a model fidelity scale was developed called the FHIC monitor. The aim of this study was to assess the inter-rater reliability, content validity, and construct validity of the FHIC monitor. A multi-methods design was used, combining qualitative and quantitative research. To collect data, audits and focus group meetings were organized to score care at individual wards with the monitor and get feedback from auditors and audit receiving teams about the quality of the monitor. In total, fifteen forensic mental healthcare institutions participated. The instrument showed acceptable inter-rater reliability and content validity, and a significant difference between expected high and low scoring institutions, supporting construct validity. The instrument can be used as a valid instrument to measure the level of implementation of the FHIC model on forensic psychiatric wards in the Netherlands.


Assuntos
Psiquiatria Legal , Unidade Hospitalar de Psiquiatria , Cuidados Críticos , Humanos , Países Baixos , Psicometria , Reprodutibilidade dos Testes
11.
Artigo em Inglês | MEDLINE | ID: mdl-35206203

RESUMO

AIM: To create and analyze an instrument to assess the possible agitation triggers of hospitalized psychiatric patients. BACKGROUND: No tools exist for identifying according to a professional's experience. METHODS: Descriptive and cross-sectional study. The questionnaire of possible triggers of agitation behaviors of patients hospitalized in psychiatric wards according to professional experience (TAPE) was designed and analyzed. RESULTS: The questionnaire was provided to 156 mental health workers (76.9% women, average work experience: 10.15 ± 8 years, 46.8% were nurses specialized in mental health, and 21.2% psychiatrists). A good internal consistency was obtained, with a Cronbach α value of 0.791 in the initial test, and 0.892 in the retest. The factorial analysis found four factors: factor 1 "personnel", factor 2 "routines", factor 3 "norms-infrastructure", and factor 4 "clinic". Factor 1 obtained the highest value, with a mean of 4.16 ± 0.63, highlighting the item "lack of specialized personnel" (mean 4.38 ± 0.81). The specialized professionals provided higher scores to the items from the factors associated with the training of the personnel and routines (p = 0.017; p = 0.042). CONCLUSIONS: The TAPE questionnaire is useful for identifying the possible triggers that could lead to situations of agitation of hospitalized patients.


Assuntos
Serviços de Saúde Mental , Unidade Hospitalar de Psiquiatria , Estudos Transversais , Feminino , Hospitalização , Humanos , Masculino , Inquéritos e Questionários
12.
J Korean Med Sci ; 37(4): e28, 2022 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-35075827

RESUMO

BACKGROUND: A rapid decline in immunity and low neutralizing activity against the delta variant in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinees has been observed. This study describes an outbreak of coronavirus disease 2019 (COVID-19) breakthrough infections caused by the SARS-CoV-2 delta variant in a psychiatric closed ward. METHODS: Data from epidemic intelligence service officers were utilized to obtain information regarding demographic, vaccination history, and clinical data along with SARS-CoV-2 PCR test results for a COVID-19 outbreak that occurred in a closed psychiatric ward. RESULTS: Among the 164 residents, 144 (87.8%) received two doses of vaccines and 137 (95.1%) of them received ChAdOx1 nCoV-19 vaccine. The mean interval between the second vaccination and COVID-19 diagnosis was 132.77 ± 40.68 days. At the time of detection of the index case, SARS-CoV-2 had spread throughout the ward, infecting 162 of 164 residents. The case-fatality ratio was lower than that in the previously reported outbreak before the vaccination (1.2%, 2/162 vs. 6.9%, P = 0.030). Prolonged hospitalization occurred in 17 patients (11.1%) and was less prevalent in the vaccinated group than in the unvaccinated group (8.5% vs. 25.0%, P = 0.040). CONCLUSION: The findings of this study highlight that while vaccination can reduce mortality and the duration of hospitalization, it is not sufficient to prevent an outbreak of the SARS-CoV-2 delta variant in the present psychiatric hospital setting.


Assuntos
COVID-19/epidemiologia , COVID-19/mortalidade , Surtos de Doenças/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , SARS-CoV-2/imunologia , Teste para COVID-19 , Vacinas contra COVID-19 , Pessoal de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Vacinação/estatística & dados numéricos
15.
Int J Ment Health Nurs ; 31(1): 189-198, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34723444

RESUMO

The role of nurses and nursing in CAP inpatient care is unclear, and nurses are at risk of moral distress due to having to deal with complex demands while lacking organizational support. This study aimed to describe nurses' and assistant nurses' experiences working in child and adolescent psychiatric inpatient care. Eight nurses and seven assistant nurses working in a child and adolescent ward in Sweden participated in the study. Data were collected in 2019 using semi-structured qualitative interviews and subject to qualitative content analysis. Results describe nurses' and assistant nurses' experiences of child and adolescent psychiatric inpatient care in one theme, Constrained nursing, and four categories: Striving to be there for children and parents; Finding a way to manage work; Depending on others; Lacking nursing leadership. Findings suggest that good, person-centred and recovery-oriented nursing practice can exist in CAP inpatient care but remain unrecognized and lacking support due to unclear roles and responsibilities and lack of nursing leadership. This study is reported in accordance with the COREQ guidelines.


Assuntos
Enfermeiras e Enfermeiros , Enfermagem Psiquiátrica , Adolescente , Criança , Família , Hospitalização , Humanos , Liderança , Unidade Hospitalar de Psiquiatria , Pesquisa Qualitativa
16.
Lancet Psychiatry ; 9(1): 35-45, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34822758

RESUMO

BACKGROUND: A childhood cancer diagnosis and treatment-induced somatic late effects can affect the long-term mental health of survivors. We aimed to explore whether childhood cancer survivors are at higher risk of psychiatric disorders later in life than their siblings and the general population. METHODS: In this register-based cohort study (part of the Socioeconomic Consequences in Adult Life after Childhood Cancer [SALiCCS] research programme), we included 5-year survivors of childhood cancer diagnosed before 20 years of age between Jan 1, 1974 and Dec 31, 2011, in Denmark, Finland, and Sweden. In Denmark and Sweden, 94·7% of individuals were born in a Nordic country (ie, Denmark, Finland, Iceland, Norway, or Sweden); similar information was not available in Finland. Data on ethnicity were not collected. Survivors were compared with their siblings and randomly selected individuals from the general population who were matched to the survivors by year of birth, sex, and geographical region. We followed up our study population from 5 years after the childhood cancer diagnosis or corresponding calendar date for matched individuals (the index date) until Aug 11, 2017, and assessed information on hospital contacts for any and specific psychiatric disorders. For siblings, the index date was defined as 5 years from the date on which they were of the same age as their sibling survivor when diagnosed with cancer. FINDINGS: The study population included 18 621 childhood cancer survivors (9934 [53·3%] males and 8687 [46·7%] females), 24 775 siblings (12 594 [50·8%] males and 12 181 [49·2%] females), and 88 630 matched individuals (47 300 [53·4%] males and 41 330 [46·6%] females). The cumulative incidence proportion of having had a psychiatric hospital contact by 30 years of age between Jan 1, 1979, and Aug 11, 2017, was 15·9% (95% CI 15·3-16·5) for childhood cancer survivors, 14·0% (13·5-14·5) for siblings, and 12·7% (12·4-12·9) for matched individuals. Despite a small absolute difference, survivors were at higher relative risk of any psychiatric hospital contact than their siblings (1·39, 1·31-1·48) and matched individuals (hazard ratio 1·34, 95% CI 1·28-1·39). The higher risk persisted at the age of 50 years. Survivors had a higher burden of recurrent psychiatric hospital contacts and had more hospital contacts for different psychiatric disorders than their siblings and the matched individuals. INTERPRETATION: Childhood cancer survivors are at higher long-term risk of psychiatric disorders than their siblings and matched individuals from the general population. To improve mental health and the overall quality of life after childhood cancer, survivorship care should include a focus on early signs of mental health problems, especially among high-risk groups of survivors. FUNDING: NordForsk, Aarhus University, Swedish Childhood Cancer Foundation, Danish Health Foundation, and Swiss National Science Foundation.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Finlândia/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Irmãos , Suécia/epidemiologia , Adulto Jovem
17.
Nurs Ethics ; 29(1): 171-180, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34486442

RESUMO

BACKGROUND: Nurses working within acute psychiatric settings often face multifaceted moral dilemmas and incompatible demands. METHODS: Qualitative individual and focus group interviews were conducted. ETHICAL CONSIDERATIONS: Approval was received from the Norwegian Social Science Data Services. Ethical Research Guidelines were followed. PARTICIPANTS AND RESEARCH CONTEXT: Thirty nurses working within acute psychiatric wards in two mental health hospitals. RESULTS: Various coping strategies were used: mentally sorting through their ethical dilemmas or bringing them to the leadership, not 'bringing problems home' after work or loyally doing as told and trying to make oneself immune. Colleagues and work climate were important for choice of coping strategies. DISCUSSION: Nurses' coping strategies may influence both their clinical practice and their private life. Not facing their moral distress seemed to come at a high price. CONCLUSIONS: It seems essential for nurses working in acute psychiatric settings to come to terms with distressing events and identify and address the moral issues they face. As moral distress to a great extent is an organisational problem experienced at a personal level, it is important that a work climate is developed that is open for ethical discussions and nourishes adaptive coping strategies and moral resilience.


Assuntos
Adaptação Psicológica , Unidade Hospitalar de Psiquiatria , Humanos , Princípios Morais , Noruega , Pesquisa Qualitativa , Estresse Psicológico , Inquéritos e Questionários
18.
Int J Ment Health Nurs ; 31(1): 199-221, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34773348

RESUMO

Safewards is an internationally adopted framework that provides interventions to reduce conflict and containment in healthcare settings. This systematic review evaluated the effect of Safewards on conflict and containment events in inpatient units and the perceptions of staff and consumers. Quantitative, qualitative, and mixed-methods studies were considered for inclusion. Following the Joanna Briggs Institute methodology, two reviewers independently screened, appraised, and extracted data. Qualitative data were synthesized using inductive-thematic analysis. Quantitative and qualitative data were integrated with a convergent-segregated approach and presented in tabular and narrative format. A search of 13 databases and grey literature yielded 14 studies of variable methodological quality. Four studies reported reduced rates of conflict and one study reported reductions that were not statistically significant. Six studies reported reductions in rates of containment, three studies found no statistical significance and one study reported statistically significant reductions at follow-up. Staff and consumers in four studies reported an improved experience of safety. Three themes were developed as follows: (i) therapeutic hold, cohesion, support and the environment, (ii) conflict, containment and the experience of safety, and (iii) the complexities of adapting and embedding change. This review found most staff and consumers reported Safewards improved therapeutic relationships, cohesion, and ward atmosphere. Staff and consumers reported improved ward atmosphere, leading to consumer-centred, recovery-oriented care. Safewards improved the experience of safety from the perspective of staff and consumers when combined with ongoing training, leadership and time for consolidation. While results are promising they should be used cautiously until more robust evidence is established.


Assuntos
Pacientes Internados , Unidade Hospitalar de Psiquiatria , Atenção à Saúde , Humanos , Estudos Longitudinais
19.
J Clin Psychopharmacol ; 42(1): 37-42, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34928559

RESUMO

PURPOSE: Little is known about the impact of different psychotropic drugs on acute readmission risk, when used concomitantly in a real-life setting. We aimed to investigate the association between acute readmission risk and use of antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines in patients with schizophrenia. METHODS: A cohort study included all patients diagnosed with schizophrenia admitted to a psychiatric acute unit at Haukeland University Hospital in Bergen, Norway, during a 10-year period (N = 663). Patients were followed from discharge until first readmission or censoring. Cox multiple regression analyses were conducted using antipsychotic drugs, antidepressants, mood stabilizers, and benzodiazepines as time-dependent variables, and periods of use and nonuse were compared within individual patients. Adjustments were made for sex, age at index admission, and excessive use of alcohol and illicit substances. RESULTS: A total of 410 patients (61.8%) were readmitted during follow-up, and the mean and median times in days to readmission were 709 and 575, respectively. Compared with nonuse, the use of antipsychotic drugs was associated with reduced risk of readmission (adjusted hazards ratio, 0.20; P < 0.01; confidence interval, 0.16-0.24), and the use of benzodiazepines was associated with increased risk of readmission (adjusted hazards ratio, 1.51; P < 0.01; confidence interval, 1.13-2.02). However, no relation to readmission risk was found for the use of antidepressants and mood stabilizers. CONCLUSIONS: We found that use of benzodiazepines and antipsychotic drugs are inversely associated with acute readmission risk in schizophrenia.


Assuntos
Antipsicóticos/uso terapêutico , Benzodiazepinas/uso terapêutico , Readmissão do Paciente/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Antimaníacos/uso terapêutico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Unidade Hospitalar de Psiquiatria , Risco , Adulto Jovem
20.
J Psychiatr Ment Health Nurs ; 29(3): 493-503, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34897910

RESUMO

WHAT IS KNOWN ON THE SUBJECT?: Frontline forensic mental health staff often face challenges when providing recovery-orientated care, as they must balance between caring for the forensic psychiatric patient and at the same time ensuring safety and security for all other patients and staff at the ward. Research shows that balancing between care and custody in everyday clinical practice is possible, but more practical nursing studies showing ways of balancing power relations are needed to guide clinical practice. Online video games are increasingly recognized as promising new tools to promote social relations, establish competencies and re-articulate power relations in therapeutic environments. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper provides insights into how using online video gaming interventions may influence the establishment of social power relations of staff and forensic psychiatric patients. It adds to existing research by providing a conceptual way to study and understand how mental health nurses may balance between care and custody, delivering care to accommodate patients' needs without compromising safety and security at the ward. This study answers a call in current research by providing qualified knowledge regarding the use of online video gaming to build and sustain therapeutic relations in mental health care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our paper suggests that balancing between care and custody is possible by using online video gaming interventions in forensic psychiatry. It moreover provides practice-close knowledge that may inspire and guide clinical mental health nurses to further develop online video gaming interventions in mental health care for the benefit of their patients. ABSTRACT: Introduction In recovery-oriented care, forensic psychiatric nurses must engage in care relationships with forensic psychiatric patients (FPs) whilst focussing on ward security. Online video games (OVGs) may provide a platform for negotiating power and social relations. Studies showing how OVG interventions may influence power balances in forensic psychiatric care are needed to guide clinical practice. Aim Our aim was to study how power relations were articulated between FPs and staff in an OVG intervention in a Danish forensic psychiatric ward. Method Data consist of three months of observational data and interviews with three staff members and six patients. We used sociologist Pierre Bourdieu's framework of field, power and capital to analyze data. Results The OVG intervention consisted of two power fields, "in-game" and "over-game." In-game concerned the practice of gaming. Over-game described the organization of the gaming intervention. Specific logics, skills and symbolic capitals drove power in each field. Discussion Power in-game was open to FPs and staff, leading to symmetric power relations. Power over-game was open to staff only, resulting in asymmetrical power relations. Implications for practice Online video game interventions may facilitate power balancing in forensic psychiatry. These insights may guide the development of new OVG interventions for patients and nurses in mental health care.


Assuntos
Enfermagem Psiquiátrica , Jogos de Vídeo , Psiquiatria Legal , Humanos , Unidade Hospitalar de Psiquiatria , Enfermagem Psiquiátrica/métodos , Pesquisa Qualitativa
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