Journal of Psychosocial Nursing and Mental Health Services
Vol. 48 No. 6 June 2010
Caring with Comfort Rooms: Reducing Seclusion and Restraint Use in Psychiatric Facilities
Kathleen S. Cummings, BSN, RN-BC; Sylvia A. Grandfield, RN-BC; and Craig M. Coldwell, MD, MPH
ABSTRACT
The reduction of seclusion and restraint is a national patient safety focus in psychiatric settings. Studies have demonstrated that multisensory or comfort rooms contribute to higher consumer satisfaction and lower rates of seclusion and restraint in general hospitals. As an alternative to the traditionally uncomfortable time-out room, a comfort room was constructed on an acute adult inpatient unit. This space was designed with comfortable furniture, soothing colors, soft lighting, quiet music, and other sensory aids to help reduce unsettled patients’ level of stress. The frequency and duration of seclusion and restraint use on the pilot unit was studied before and after implementation of the comfort room. The use of seclusion and restraint was also compared with a similar admission unit without a comfort room. Results supported the hypothesis that the presence of a comfort room significantly reduced seclusion and restraint, and that the use of the comfort room helped reduce patients’ stress.
AUTHORS
Ms. Cummings is Nurse Specialist, and Ms. Grandfield is Nursing Coordinator, New Hampshire Hospital, Concord, New Hampshire; and Dr. Coldwell is Associate Chief of Staff and Mental Health Service Line Manager, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Kathleen S. Cummings, BSN, RN-BC, Nurse Specialist, New Hampshire Hospital, 36 Clinton Street, Concord, NH 03301; e-mail: kcummings@dhhs.state.nh.us.
Submitted: May 15, 2009
Accepted: January 26, 2010
Posted: March 22, 2010
doi:10.3928/02793695-20100303-02
Delivering Difficult News: Views of Mental Health Staff in Inpatient Settings
Michelle Cleary, PhD, RN; Glenn E. Hunt, PhD; and Garry Walter, MD, PhD
ABSTRACT
In this study, we surveyed clinical staff to ascertain their views regarding the delivery of difficult news (DDN), such as the need for lifelong medication with possible side effects, in inpatient mental health settings. Nearly all staff agreed patients had a right to information about their diagnosis, two thirds thought the doctor was the best person to inform patients of their diagnosis, and approximately half believed full diagnosis and treatment disclosure may have negative consequences. Providing hope when delivering difficult news was endorsed by almost all staff, and most took special precautions (e.g., greater monitoring) after DDN. Two thirds had never received specific training for DDN, yet most considered themselves competent in DDN. In DDN, staff usually or always considered patients’ level of insight/awareness, likely distress, diagnosis, and whether they would understand the consequences of the diagnosis.
AUTHORS
Dr. Cleary is Associate Professor (Mental Health Nursing), School of Nursing and Midwifery, University of Western Sydney, Dr. Hunt is Senior Research Fellow, Discipline of Psychiatry, University of Sydney, and Sydney South West Area Mental Health Service, Concord Hospital, and Dr. Walter is Professor of Child and Adolescent Psychiatry, Discipline of Psychiatry, University of Sydney, and Child and Adolescent Mental Health Services, Northern Sydney Central Coast Health, Coral Tree Family Service, North Ryde, New South Wales, Australia.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Michelle Cleary, PhD, RN, Associate Professor (Mental Health Nursing), School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, New South Wales, 1797, Australia; e-mail: M.cleary@uws.edu.au.
Received: September 23, 2009
Accepted: February 16, 2010
Posted: May 21, 2010
doi:10.3928/02793695-20100504-02
Receiving Difficult News: Views of Patients in an Inpatient Setting
Michelle Cleary, PhD, RN; Glenn E. Hunt, PhD; Phil Escott, BA; and Garry Walter, MD, PhD
ABSTRACT
For this quantitative study, a cross-sectional design was used to assess patients’ ratings regarding receiving difficult news pertaining to their psychiatric illness, such as deleterious lifestyle consequences and lifelong medications. One hundred inpatients were interviewed and completed the survey. Nearly all agreed they had a legal or moral right to information about their diagnosis, and most agreed they should be told their diagnosis. The majority believed the doctor was the best person to tell them their diagnosis, and more than half indicated that not providing a diagnosis was more concerning than being told. Approximately two fifths of patients indicated they would prefer to hear difficult news in the presence of key family members or over several sessions, and more than three quarters thought providing hope, regardless of circumstances, was important. The highest response rates were for staff to provide accurate and reliable information, be honest and answer patients’ questions, and inform patients of their treatment options and side effects. These results indicate the importance of communicating accurate and timely information to patients in an empathic and understanding manner.
AUTHORS
Dr. Cleary is Associate Professor (Mental Health Nursing), School of Nursing and Midwifery, University of Western Sydney, Dr. Hunt is Senior Research Fellow, Discipline of Psychiatry, University of Sydney, and Sydney South West Area Mental Health Service, Concord Hospital, Mr. Escott is Consumer Consultant, Sydney South West Area Mental Health Service, Concord Hospital, and Dr. Walter is Professor of Child and Adolescent Psychiatry, Discipline of Psychiatry, University of Sydney, and Child and Adolescent Mental Health Services, Northern Sydney Central Coast Health, Coral Tree Family Service, North Ryde, New South Wales, Australia.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Michelle Cleary, PhD, RN, Associate Professor (Mental Health Nursing), School of Nursing and Midwifery, University of Western Sydney, Locked Bag 1797, Penrith South DC, New South Wales, 1797, Australia; e-mail: M.cleary@uws.edu.au.
Received: September 23, 2009
Accepted: February 16, 2010
Posted: May 21, 2010
doi:10.3928/02793695-20100504-01
