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An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial
IMPORTANCE: Investing in health care staffs’ education can change the scope of action and improve care. The effectiveness of staff education remains inconclusive. OBJECTIVE: To examine whether an evidence-based educational intervention for nurses decreases the use of seclusion rooms in psychiatric h...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9428738/ https://www.ncbi.nlm.nih.gov/pubmed/36040740 http://dx.doi.org/10.1001/jamanetworkopen.2022.29076 |
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author | Välimäki, Maritta Lantta, Tella Anttila, Minna Vahlberg, Tero Normand, Sharon-Lise Yang, Min |
author_facet | Välimäki, Maritta Lantta, Tella Anttila, Minna Vahlberg, Tero Normand, Sharon-Lise Yang, Min |
author_sort | Välimäki, Maritta |
collection | PubMed |
description | IMPORTANCE: Investing in health care staffs’ education can change the scope of action and improve care. The effectiveness of staff education remains inconclusive. OBJECTIVE: To examine whether an evidence-based educational intervention for nurses decreases the use of seclusion rooms in psychiatric hospitals compared with usual practice. DESIGN, SETTING, AND PARTICIPANTS: In this pragmatic, 2-arm parallel, stratified cluster randomized clinical trial, 28 wards in 15 psychiatric hospitals in Finland were screened for eligibility and randomly allocated (1:1). Nurses joined on either intervention (n = 13) or usual practice (n = 15) wards. The intervention was performed from May 1, 2016, to October 31, 2017. The follow-up data for January 1 to December 31, 2017, were collected from hospital registers in 2018. Data analysis was performed October 27, 2021. INTERVENTIONS: Evidence-based education delivered during 18 months, including 8 months of active education, followed by a 10-month maintenance period. MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of patient seclusion (events per total number of patients). RESULTS: Of 28 psychiatric hospital wards screened (437 beds and 648 nurses), 27 wards completed the study. A total of 8349 patients were receiving care in the study wards, with 53% male patients and a mean (SD) age of 40.6 (5.7) years. The overall number of seclusions was 1209 (14.5%) in 2015 and 1349 (16.5%) in 2017. In the intervention group, the occurrence rate of seclusion at the ward level decreased by 5.3% from 629 seclusions among 4163 patients (15.1%) to 585 seclusions among 4089 patients (14.3%) compared with a 34.7% increase from 580 seclusions among 4186 patients (13.9%) to 764 seclusions among 4092 patients (18.7%) in the usual practice group. The adjusted rate ratio was 0.86 (95% CI, 0.40-1.82) in 2015 and 0.66 (95% CI, 0.31-1.41) in 2017 (P = .003). However, the number of forced injections increased in the intervention group from 317 events among 4163 patients (7.6%) in 2015 to 486 events among 4089 patients (11.9%) in 2017 compared with an increase in the usual practice group from 414 events among 4186 patients (9.9%) in 2015 to 481 events among 4092 patients (11.8%) in 2017. Seven adverse events were reported. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the educational intervention had a limited effect on the change of occurrence rate of patient seclusion, whereas the use of forced injections increased. More studies are needed to better understand the reasons for these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02724748 |
format | Online Article Text |
id | pubmed-9428738 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-94287382022-09-16 An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial Välimäki, Maritta Lantta, Tella Anttila, Minna Vahlberg, Tero Normand, Sharon-Lise Yang, Min JAMA Netw Open Original Investigation IMPORTANCE: Investing in health care staffs’ education can change the scope of action and improve care. The effectiveness of staff education remains inconclusive. OBJECTIVE: To examine whether an evidence-based educational intervention for nurses decreases the use of seclusion rooms in psychiatric hospitals compared with usual practice. DESIGN, SETTING, AND PARTICIPANTS: In this pragmatic, 2-arm parallel, stratified cluster randomized clinical trial, 28 wards in 15 psychiatric hospitals in Finland were screened for eligibility and randomly allocated (1:1). Nurses joined on either intervention (n = 13) or usual practice (n = 15) wards. The intervention was performed from May 1, 2016, to October 31, 2017. The follow-up data for January 1 to December 31, 2017, were collected from hospital registers in 2018. Data analysis was performed October 27, 2021. INTERVENTIONS: Evidence-based education delivered during 18 months, including 8 months of active education, followed by a 10-month maintenance period. MAIN OUTCOMES AND MEASURES: The primary outcome was the occurrence of patient seclusion (events per total number of patients). RESULTS: Of 28 psychiatric hospital wards screened (437 beds and 648 nurses), 27 wards completed the study. A total of 8349 patients were receiving care in the study wards, with 53% male patients and a mean (SD) age of 40.6 (5.7) years. The overall number of seclusions was 1209 (14.5%) in 2015 and 1349 (16.5%) in 2017. In the intervention group, the occurrence rate of seclusion at the ward level decreased by 5.3% from 629 seclusions among 4163 patients (15.1%) to 585 seclusions among 4089 patients (14.3%) compared with a 34.7% increase from 580 seclusions among 4186 patients (13.9%) to 764 seclusions among 4092 patients (18.7%) in the usual practice group. The adjusted rate ratio was 0.86 (95% CI, 0.40-1.82) in 2015 and 0.66 (95% CI, 0.31-1.41) in 2017 (P = .003). However, the number of forced injections increased in the intervention group from 317 events among 4163 patients (7.6%) in 2015 to 486 events among 4089 patients (11.9%) in 2017 compared with an increase in the usual practice group from 414 events among 4186 patients (9.9%) in 2015 to 481 events among 4092 patients (11.8%) in 2017. Seven adverse events were reported. CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the educational intervention had a limited effect on the change of occurrence rate of patient seclusion, whereas the use of forced injections increased. More studies are needed to better understand the reasons for these findings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02724748 American Medical Association 2022-08-30 /pmc/articles/PMC9428738/ /pubmed/36040740 http://dx.doi.org/10.1001/jamanetworkopen.2022.29076 Text en Copyright 2022 Välimäki M et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Välimäki, Maritta Lantta, Tella Anttila, Minna Vahlberg, Tero Normand, Sharon-Lise Yang, Min An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial |
title | An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial |
title_full | An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial |
title_fullStr | An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial |
title_full_unstemmed | An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial |
title_short | An Evidence-Based Educational Intervention for Reducing Coercive Measures in Psychiatric Hospitals: A Randomized Clinical Trial |
title_sort | evidence-based educational intervention for reducing coercive measures in psychiatric hospitals: a randomized clinical trial |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9428738/ https://www.ncbi.nlm.nih.gov/pubmed/36040740 http://dx.doi.org/10.1001/jamanetworkopen.2022.29076 |
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