Impact of the physical environment of psychiatric wards on the use of seclusion
The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce....
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| Veröffentlicht in: | British journal of psychiatry 2013-02, Vol.202 (2), p.142-149 |
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| container_title | British journal of psychiatry |
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| creator | van der Schaaf, P. S. Dusseldorp, E. Keuning, F. M. Janssen, W. A. Noorthoorn, E. O. |
| description | The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce.
To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care.
Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses were used to explore the relationship with seclusion. Admission was the first level in the analyses and ward was the second level.
Overall, 14 design features had a significant effect on the risk of being secluded during admission. The 'presence of an outdoor space', 'special safety measures' and a large 'number of patients in the building' increased the risk of being secluded. Design features such as more 'total private space per patient', a higher 'level of comfort' and greater 'visibility on the ward', decreased the risk of being secluded.
A number of design features had an effect on the use of seclusion and restraint. The study highlighted the need for a greater focus on the impact of the physical environment on patients, as, along with other interventions, this can reduce the need for seclusion and restraint. |
| doi_str_mv | 10.1192/bjp.bp.112.118422 |
| format | Article |
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To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care.
Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses were used to explore the relationship with seclusion. Admission was the first level in the analyses and ward was the second level.
Overall, 14 design features had a significant effect on the risk of being secluded during admission. The 'presence of an outdoor space', 'special safety measures' and a large 'number of patients in the building' increased the risk of being secluded. Design features such as more 'total private space per patient', a higher 'level of comfort' and greater 'visibility on the ward', decreased the risk of being secluded.
A number of design features had an effect on the use of seclusion and restraint. The study highlighted the need for a greater focus on the impact of the physical environment on patients, as, along with other interventions, this can reduce the need for seclusion and restraint.</description><identifier>ISSN: 0007-1250</identifier><identifier>EISSN: 1472-1465</identifier><identifier>DOI: 10.1192/bjp.bp.112.118422</identifier><identifier>PMID: 23307922</identifier><identifier>CODEN: BJPYAJ</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Admissions ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aggression - psychology ; Architecture ; Built environment ; Child ; Coercion ; Data collection ; Environment ; Female ; Forensic Psychiatry ; Forensic science ; Health Facility Environment - standards ; Health Facility Environment - statistics & numerical data ; Hospitals, Psychiatric ; Humans ; Male ; Mental Disorders - psychology ; Mental Disorders - therapy ; Mental health ; Mental health services ; Middle Aged ; Multicenter studies ; Multilevel Analysis ; Netherlands ; Nursing Stations ; Patient admissions ; Patient Isolation - utilization ; Patient Safety ; Patients ; Patients' Rooms - standards ; Principal Component Analysis ; Principal components analysis ; Privacy - psychology ; Psychiatric hospitals ; Psychiatric units ; Psychiatry ; Restraint, Physical - utilization ; Restraints ; Risk ; Safety measures ; Secluded ; Seclusion ; Social isolation ; Violence ; Visibility ; Young Adult</subject><ispartof>British journal of psychiatry, 2013-02, Vol.202 (2), p.142-149</ispartof><rights>Copyright © Royal College of Psychiatrists, 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c515t-76575e394c2b86d4e0b3a0926f12b416cd650a388d7a500cdc4774123113d6523</citedby><cites>FETCH-LOGICAL-c515t-76575e394c2b86d4e0b3a0926f12b416cd650a388d7a500cdc4774123113d6523</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S0007125000273480/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>164,314,776,780,12825,27321,27901,27902,30976,30977,33751,55603</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23307922$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van der Schaaf, P. S.</creatorcontrib><creatorcontrib>Dusseldorp, E.</creatorcontrib><creatorcontrib>Keuning, F. M.</creatorcontrib><creatorcontrib>Janssen, W. A.</creatorcontrib><creatorcontrib>Noorthoorn, E. O.</creatorcontrib><title>Impact of the physical environment of psychiatric wards on the use of seclusion</title><title>British journal of psychiatry</title><addtitle>Br J Psychiatry</addtitle><description>The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce.
To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care.
Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses were used to explore the relationship with seclusion. Admission was the first level in the analyses and ward was the second level.
Overall, 14 design features had a significant effect on the risk of being secluded during admission. The 'presence of an outdoor space', 'special safety measures' and a large 'number of patients in the building' increased the risk of being secluded. Design features such as more 'total private space per patient', a higher 'level of comfort' and greater 'visibility on the ward', decreased the risk of being secluded.
A number of design features had an effect on the use of seclusion and restraint. The study highlighted the need for a greater focus on the impact of the physical environment on patients, as, along with other interventions, this can reduce the need for seclusion and restraint.</description><subject>Admissions</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aggression - psychology</subject><subject>Architecture</subject><subject>Built environment</subject><subject>Child</subject><subject>Coercion</subject><subject>Data collection</subject><subject>Environment</subject><subject>Female</subject><subject>Forensic Psychiatry</subject><subject>Forensic science</subject><subject>Health Facility Environment - standards</subject><subject>Health Facility Environment - statistics & numerical data</subject><subject>Hospitals, Psychiatric</subject><subject>Humans</subject><subject>Male</subject><subject>Mental Disorders - psychology</subject><subject>Mental Disorders - therapy</subject><subject>Mental health</subject><subject>Mental health services</subject><subject>Middle Aged</subject><subject>Multicenter studies</subject><subject>Multilevel Analysis</subject><subject>Netherlands</subject><subject>Nursing Stations</subject><subject>Patient admissions</subject><subject>Patient Isolation - utilization</subject><subject>Patient Safety</subject><subject>Patients</subject><subject>Patients' Rooms - standards</subject><subject>Principal Component Analysis</subject><subject>Principal components analysis</subject><subject>Privacy - psychology</subject><subject>Psychiatric hospitals</subject><subject>Psychiatric units</subject><subject>Psychiatry</subject><subject>Restraint, Physical - utilization</subject><subject>Restraints</subject><subject>Risk</subject><subject>Safety measures</subject><subject>Secluded</subject><subject>Seclusion</subject><subject>Social isolation</subject><subject>Violence</subject><subject>Visibility</subject><subject>Young Adult</subject><issn>0007-1250</issn><issn>1472-1465</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>BHHNA</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNkUtLAzEUhYMotlZ_gBsZcONmanLzmllK8VEodKPrkMlk7JR5mcwo_femDxUEwUXIvZzvnktyELokeEpICrfZuptmXaghnIQBHKExYRJiwgQ_RmOMsYwJcDxCZ96vQ0sZyFM0AkqxTAHGaDmvO236qC2ifmWjbrXxpdFVZJv30rVNbZud1vmNWZW6d6WJPrTLfdQ2u4HB263urakGX7bNOTopdOXtxeGeoJeH--fZU7xYPs5nd4vYcML7WAouuaUpM5AlImcWZ1TjFERBIGNEmFxwrGmS5FJzjE1umJSMACWEBgnoBN3sfTvXvg3W96ouvbFVpRvbDl4RymRCEi7_gUL4uoSnggX0-he6bgfXhIeosJoLSNJUBorsKeNa750tVOfKWruNIlhtg1EhGJV1oQa1DybMXB2ch6y2-ffEVxIBoAdTXWeuzF_tz-6_bT8BBMeYYQ</recordid><startdate>201302</startdate><enddate>201302</enddate><creator>van der Schaaf, P. 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S.</au><au>Dusseldorp, E.</au><au>Keuning, F. M.</au><au>Janssen, W. A.</au><au>Noorthoorn, E. O.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of the physical environment of psychiatric wards on the use of seclusion</atitle><jtitle>British journal of psychiatry</jtitle><addtitle>Br J Psychiatry</addtitle><date>2013-02</date><risdate>2013</risdate><volume>202</volume><issue>2</issue><spage>142</spage><epage>149</epage><pages>142-149</pages><issn>0007-1250</issn><eissn>1472-1465</eissn><coden>BJPYAJ</coden><abstract>The physical environment is presumed to have an effect on aggression and also on the use of seclusion on psychiatric wards. Multicentre studies that include a broad variety of design features found on psychiatric wards and that control for patient, staff and general ward characteristics are scarce.
To explore the effect of design features on the risk of being secluded, the number of seclusion incidents and the time in seclusion, for patients admitted to locked wards for intensive psychiatric care.
Data on the building quality and safety of psychiatric as well as forensic wards (n = 199) were combined with data on the frequency and type of coercive measures per admission (n = 23 868 admissions of n = 14 834 patients) on these wards, over a 12-month period. We used non-linear principal components analysis (CATPCA) to reduce the observed design features into a smaller number of uncorrelated principal components. Two-level multilevel (logistic) regression analyses were used to explore the relationship with seclusion. Admission was the first level in the analyses and ward was the second level.
Overall, 14 design features had a significant effect on the risk of being secluded during admission. The 'presence of an outdoor space', 'special safety measures' and a large 'number of patients in the building' increased the risk of being secluded. Design features such as more 'total private space per patient', a higher 'level of comfort' and greater 'visibility on the ward', decreased the risk of being secluded.
A number of design features had an effect on the use of seclusion and restraint. The study highlighted the need for a greater focus on the impact of the physical environment on patients, as, along with other interventions, this can reduce the need for seclusion and restraint.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>23307922</pmid><doi>10.1192/bjp.bp.112.118422</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of psychiatry, 2013-02, Vol.202 (2), p.142-149 |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection; Sociological Abstracts; Cambridge University Press Journals Complete |
| subjects | Admissions Adolescent Adult Aged Aged, 80 and over Aggression - psychology Architecture Built environment Child Coercion Data collection Environment Female Forensic Psychiatry Forensic science Health Facility Environment - standards Health Facility Environment - statistics & numerical data Hospitals, Psychiatric Humans Male Mental Disorders - psychology Mental Disorders - therapy Mental health Mental health services Middle Aged Multicenter studies Multilevel Analysis Netherlands Nursing Stations Patient admissions Patient Isolation - utilization Patient Safety Patients Patients' Rooms - standards Principal Component Analysis Principal components analysis Privacy - psychology Psychiatric hospitals Psychiatric units Psychiatry Restraint, Physical - utilization Restraints Risk Safety measures Secluded Seclusion Social isolation Violence Visibility Young Adult |
| title | Impact of the physical environment of psychiatric wards on the use of seclusion |
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