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Nurse and patient factors: Predicting seclusion in adolescent psychiatric units
journal contribution
posted on 2021-01-04, 00:00 authored by Miriam K Yurtbasi, Glenn MelvinGlenn Melvin, Christine Pavlou, Michael GordonProblem
Seclusion is considered a necessity when alternatives have failed. There is a consensus that seclusion has no therapeutic benefit, which justifies efforts to reduce the practice. This study aimed to identify nurse and patient variables that are predictive of seclusion on a large adolescent inpatient unit.
Methods
Nested case controls were used to compare 72 afternoon shifts on which seclusion occurred to 216 afternoon shifts on which no seclusion occurred, between 2010 and 2013, at an Adolescent Psychiatric Inpatient Unit.
Findings
Increased seclusion was predicted by a lower nurse to patient ratio, more male nurses on shift, fewer female nurses on shift, the presence of agency/temporary nurses on shift, greater combined years of mental health experience, and lower total HoNOSCA behavior subscale score. Unique predictors that increased risk of seclusion included greater number of male nurses and the presence of agency/temporary nurses, while a greater number of female nurses decreased risk of seclusion.
Conclusions
Nurses play a unique role in seclusion outcomes that are separate to patient‐factors and act as both protective and risk factors for seclusion. Changes can be made to staffing to reduce seclusion and future research should investigate why these nurse‐factors contribute to seclusion.
Seclusion is considered a necessity when alternatives have failed. There is a consensus that seclusion has no therapeutic benefit, which justifies efforts to reduce the practice. This study aimed to identify nurse and patient variables that are predictive of seclusion on a large adolescent inpatient unit.
Methods
Nested case controls were used to compare 72 afternoon shifts on which seclusion occurred to 216 afternoon shifts on which no seclusion occurred, between 2010 and 2013, at an Adolescent Psychiatric Inpatient Unit.
Findings
Increased seclusion was predicted by a lower nurse to patient ratio, more male nurses on shift, fewer female nurses on shift, the presence of agency/temporary nurses on shift, greater combined years of mental health experience, and lower total HoNOSCA behavior subscale score. Unique predictors that increased risk of seclusion included greater number of male nurses and the presence of agency/temporary nurses, while a greater number of female nurses decreased risk of seclusion.
Conclusions
Nurses play a unique role in seclusion outcomes that are separate to patient‐factors and act as both protective and risk factors for seclusion. Changes can be made to staffing to reduce seclusion and future research should investigate why these nurse‐factors contribute to seclusion.
History
Journal
Journal of Child and Adolescent Psychiatric NursingVolume
Early ViewIssue
Online Version of Record before inclusion in an issuePublisher
Wiley-Blackwell PublishingLocation
Hoboken, N.J.Publisher DOI
ISSN
1073-6077eISSN
1744-6171Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2021, Wiley Periodicals LLCUsage metrics
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