Skip to main content
SpringerLink
Log in

Differences in Seclusion Rates Between Admission Wards: Does Patient Compilation Explain?

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

Comparison of seclusion figures between wards in Dutch psychiatric hospitals showed substantial differences in number and duration of seclusions. In the opinion of nurses and ward managers, these differences may predominantly be explained by differences in patient characteristics, as these are expected to have a large impact on these seclusion rates. Nurses assume more admissions of severely ill patients are related to higher seclusion rates. In order to test this hypothesis, we investigated differences in patient and background characteristics of 718 secluded patients over 5,097 admissions on 29 different admission wards over seven Dutch psychiatric hospitals. We performed an extreme group analysis to explore the relationship between patient and ward characteristics and the wards’ number of seclusion hours per 1,000 admission hours. In a multivariate and a multilevel analysis, various characteristics turned out to be related to the number of seclusion hours per 1,000 admission hours as well as to the likelihood of a patient being secluded, confirming the nurses assumptions. The extreme group analysis showed that seclusion rates depended on both patient and ward characteristics. A multivariate and multilevel analyses revealed that differences in seclusion hours between wards could partially be explained by ward size next to patient characteristics. However, the largest deal of the difference between wards in seclusion rates could not be explained by characteristics measured in this study. We concluded ward policy and adequate staffing may, in particular on smaller wards, be key issues in reduction of seclusion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Janssen WA, van der Sande R, Noorthoorn EO, Nijman HLI, Bowers L, Mulder CL, Smit A, Widdershoven GAM, Steinert T: Methodological issues in monitoring the use of restrictive measures. International Journal of Law and Psychiatry 34:429–438, 2011

    Article  PubMed  CAS  Google Scholar 

  2. Steinert T, Lepping P: Legal provisions and practice in the management of violent patients. A case vignette study in 16 European countries. European Psychiatry 24:135–142, 2009

    Article  PubMed  Google Scholar 

  3. van de Werf B, Lantink P: De separeren in Europees perspectief Maandblad voor Geestelijke. Volksgezondheid 64:471–479, 2009

    Google Scholar 

  4. Lendemeijer B, Shortridge-Baggett L: The use of seclusion in psychiatry: A literature review. Scholarly Inquiry for Nursing Practice 11:299–315, 1997

    PubMed  CAS  Google Scholar 

  5. Sailas E, Fenton M: Seclusion and restraint for people with serious mental illnesses (Cochrane review) In: The Cochrane Library, issue 1. John Wiley & Sons, Chichester, 2002

  6. Kaltiala-Heino R, Tuohimaki C, Korkeila J, Lehtinen V: Reasons for using seclusion and restraint in psychiatric inpatient care. International Journal of Law and Psychiatry 26:139–149, 2003

    Article  PubMed  CAS  Google Scholar 

  7. Fisher WA: Restraint and seclusion: A review of the literature. American Journal of Psychiatry 151:1584–1591, 1994

    PubMed  CAS  Google Scholar 

  8. Hoekstra T, Lendemeijer HHGM, Jansen MGMJ: Seclusion: The inside story. Journal of Psychiatric and Mental Health Nursing 11:276–283, 2004

    Article  PubMed  CAS  Google Scholar 

  9. VanderNagel JEL, Tuts KP, Hoekstra T, Noorthoorn EO: Seclusion; the perspective of nurses. International Journal of Law and Psychiatry 32:408–412, 2009

    Article  PubMed  CAS  Google Scholar 

  10. Happell B, Koehn S: Impact of seclusion and the seclusion room: Exploring the perceptions of mental health nurses in Australia. Archives of Psychiatric Nursing 25:109–119, 2011

    Article  PubMed  Google Scholar 

  11. Meehan T, Bergen H, Fjeldsoe K: Staff and patients perceptions of seclusion: Has anything changed? Journal of Advanced Nursing 47:33–38, 2004

    Article  PubMed  Google Scholar 

  12. Keski-Valkama A, Sailas E, Eronen M, Koivisto AM, Lönnqvist J, Kaltiala-Heino R: Who are the restrained and secluded patients: A 15-year nationwide study. Social Psychiatry and Psychiatric Epidemiology 45:1087–1093, 2009

    Article  PubMed  Google Scholar 

  13. Veltkamp E, Nijman H, Stolker JJ Frigge K, Dries P, Bowers L: Patients’ preferences for seclusion or forced medication in acute psychiatric emergency in the Netherlands. Psychiatric Services 59:209–211, 2008

    Article  PubMed  Google Scholar 

  14. Bowers L, van der Werf B, Vokkolainen A, Muir-Cochrane E, Allan T, Alexander J: International variation in containment measures for disturbed psychiatric inpatients: A comparative questionnaire survey. International Journal of Nursing Studies 44:357–364, 2006

    Article  PubMed  Google Scholar 

  15. Steinert T, Schmid P: Effect of voluntariness of participation in treatment on short-term outcome of inpatients with schizophrenia. Psychiatric Services 55:786–791, 2004

    Article  PubMed  Google Scholar 

  16. Prinsen EJD, van Delden JJM: Can we justify eliminating coercive measures in psychiatry? Journal of Medical Ethics 35:69–73, 2009

    Article  PubMed  CAS  Google Scholar 

  17. Janssen WA, Noorthoorn EO, de Vries WJ, Hutschemeakers GJM, Widdershoven GAM, Lendemeijer HHGM: The use of seclusion in the Netherlands compared to countries in and outside Europe. International Journal Law and Psychiatry 31:463–470, 2008

    Article  Google Scholar 

  18. Janssen WA, Noorthoorn EO, de Vries WJ, Hutschemeakers GJM, Nijman HLI, Smit A, Mulder CL, Widdershoven GAM: Separaties in psychiatrische ziekenhuizen 2002–2008: Nederland international vergeleken. MGV 164:457–469, 2009

    Google Scholar 

  19. Steinert T, Lepping P, Bernhardsgrütter R, Conca A, Hatling T, Janssen W, Keski-Valkama A, Mayoral F, Whittington R: Incidence of seclusion and restraint in psychiatric hospitals: A literature review and survey of international trends. Social Psychiatry and Psychiatric Epidemiology 46:889–897, 2009

    Google Scholar 

  20. Legemaate J, Frederiks BJM, de Roode RP: Internationale ontwikkelingen. Rijswijk, Ministerie van Volksgezondheid, Welzijn en Sport, 2007

    Google Scholar 

  21. GGZ Nederland: De krachten gebundeld Ambities van de GGZ. Amersfoort, GGZ-Nederland, 2004

  22. GGZ Nederland: Argus: Uniforme registratie van vrijheidsbeperkende interventies in de Geestelijke Gezondheidszorg. Amersfoort/Den Haag, GGZ Nederland, Ministerie van VWS en Inspectie voor de Gezondheidszorg, 2010

    Google Scholar 

  23. Steinert T, Martin V, Baur M, Bohnet U, Goebel R, Hermelink G, Knopp M, Kronstorfer R, Kuster W, Martinez-Funk B, Roser M, Schwink A, Voigtländer W: Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics. Social Psychiatry and Psychiatric Epidemiology 42:140–145, 2006

    Article  PubMed  Google Scholar 

  24. Bowers L, van der Merwe M, Nijman H, Hamilton B, Noorthoorn E, Stewart D, Muir-Cochrane E: The practice of seclusion and time-out on English acute psychiatric wards the City-128 Study. Archives of Psychiatric Nursing 24:275–286, 2010

    Article  PubMed  Google Scholar 

  25. Hattie J, Timperly H: The power of feedback. Review of Educational Research 77:81–112, 2007

    Article  Google Scholar 

  26. Donat DC: Impact of a mandatory behavioral consultation on seclusion/restraint utilization in a psychiatric hospital. Journal of Behavioral Therapy Experimental Psychiatry 29:13–19, 1998

    Article  CAS  Google Scholar 

  27. Donat DC: An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital Psychiatric Services 54:1119–1123, 2003

    Article  PubMed  Google Scholar 

  28. Fisher WA: Elements of successful restraint and seclusion reduction programs and their application in a large, urban, state psychiatric hospital. Journal of Psychiatric Practice 9:7–15, 2003

    Article  PubMed  Google Scholar 

  29. Gaskin CJ, Elsom SJ, Happell B: Interventions for reducing the use of seclusion in psychiatric facilities; review of the literature. British Journal of Psychiatry 191:298–303, 2007

    Article  PubMed  Google Scholar 

  30. Huckshorn KA: Reducing seclusion restraint use in mental health settings: Core strategies for prevention. Journal of Psychosocial Nursing and Mental Health Services 42:22–32, 2004

    PubMed  Google Scholar 

  31. Way BB, Banks SM: Use of seclusion and restraint in public psychiatric hospitals: Patient characterics and facility effects. Hospital and Community Psychiatry 41:75–81, 1990

    PubMed  CAS  Google Scholar 

  32. Betemps EJ, Somoza E, Buncher CR: Hospital characteristics, diagnoses and staff reasons associated with use of seclusion and restraint. Hospital and Community Psychiatry 44:376–371, 1993

    Google Scholar 

  33. Demeestere M, Abraham I, Moens G: Incidenten en determinanten van dwangmaatregelen in de intramurale zorgverlening. Acta Hospitalla 95:39–53, 1995

    Google Scholar 

  34. Martin V, Kuster W, Baur M, Bohnet U, Hermelink G, Knopp M, Kronstorfer R, Martinez-Funk B, Roser M, Voigtländer W, Brandecker R, Steinert T: Die inzidenz von zwangsmassnahmen als qualitätsindikator in psychiatrischen kliniken: Probleme der datanerfassung und –verarbeitung und erste ergebniss. Psychiatrische Praxis 32:1–9, 2005

    Google Scholar 

  35. Bowers L, Douzenis A, Galeazzi GM, Forghieri M, Tsopelas C, Simpson A, Allen T: Disruptive and dangerous behaviour by patients on acute psychiatric wards in three European centres. Social Psychiatry and Psychiatric Epidemiology 40:822–828, 2005

    Article  PubMed  Google Scholar 

  36. Forquer SL, Earle KA, Way BB, Banks SM: Predictors of the use of restraint and seclusion in public psychiatric hospitals. Administration and Policy in Mental Health 23:527–532, 1996

    Article  Google Scholar 

  37. Kaltiala-Heino R, Korkeila J, Tuohimäki C, Tuori T, Lehtinen V: Coercion and restrictions in psychiatric inpatient treatment. European Psychiatry 15:213–219, 2000

    Article  PubMed  CAS  Google Scholar 

  38. Tunde-Ayinmode M, Little J: Use of seclusion in a psychiatric acute inpatient unit. Australasian Psychiatry 12:347–351, 2004

    PubMed  Google Scholar 

  39. Stolker JJ, Hugenholtz GWK, Heerdink ER, Nijman HLI, Leufkens HGM, Nolen WA: Seclusion and the use of antipsychotics in hospitalized psychiatric patients. Psychology, Crime and Law 11:489–495, 2005

    Article  Google Scholar 

  40. Bowers L, Alexander J, Simpson A, Ryan C, Carr-Walker P: Cultures of psychiatry and the professional socialization process: The case of containment methods for disturbed patients. Nurse Education Today 24:435–442, 2004

    Article  PubMed  Google Scholar 

  41. van Doeselaar M, Sleegers P, Hutschemaekers G: Professionals’ attitudes toward reducing restraint: The case of seclusion in the Netherlands. Psychiatry Quarterly 79:97–109, 2007

    Article  Google Scholar 

  42. Nijman HLI, Rector G: Crowding and aggression on inpatient psychiatric wards. Psychiatric Services 50:830–831, 1999

    PubMed  CAS  Google Scholar 

  43. Noorthoorn E, Janssen W, Hoogendoorn A, Bousardt A, Voskes Y, Smit A, Nijman H, Mulder N, Widdershoven G: Vier jaar Argus: Rapportage uitkomsten vrijheidsbeperkende interventies 2010 Warnsveld/Amersfoort GGNet/GGZ Nederland, 2011. www.veiligezorgiederszorg.nl/vier-jaar-argus.pdf

  44. Laundis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 33:159–174, 1977

    Article  Google Scholar 

  45. de Jong A, Giel R, Slooff CJ, Wiersma D: Relationship between symptomatology and social disability. Empirical evidence from a follow up study in schizophrenic patients. Social Psychiatry 21:200–205, 1986

    Article  Google Scholar 

  46. Preacher KJ, Rucker DD, MacCallum RC, Newcombe AA: Use of the extreme groups approach: A critical reexamination and new recommendations. Psychological Medicine 26:176–192, 2006

    Google Scholar 

  47. Cohen J: Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Hillsdale, Lawrence Erlbaum Associates, 1988.

    Google Scholar 

  48. Bowers L, Flood C: Nurse staffing, bed numbers and the cost of acute psychiatric inpatient care in England. Journal of Psychiatric and Mental Health Nursing 15:630–637, 2008

    Article  PubMed  CAS  Google Scholar 

  49. Husum TJ, Bjørngaard JH, Finset A, Torleif R: A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: Patient, staff and ward characteristics. BMC Health Services Research 10:89, 2010

    Article  PubMed  Google Scholar 

  50. Janssen WA, Hutschemaekers GHM, Lendemeijer HHGM: Dwang Cijfermatig in Beeld. In: Abma TA, Widdershoven GAM, Lendemeijer HHGM (Eds) Dwang en drang in de psychiatrie; kwaliteit van vrijheidsbeperkende interventies. Utrecht, Lemma, pp. 67–76, 2005

    Google Scholar 

  51. Stewart D, Van der Merwe M, Bowers L, Simpson A, Jones J: A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues in Mental Health Nursing 6:413–424, 2010

    Article  Google Scholar 

Download references

Conflict of interest

None for any author.

Author information

Authors and Affiliations

  1. Board Agency, GGNet Mental Healthcare, Box 2003, NL-7230 GC, Warnsveld, The Netherlands

    W. A. Janssen & E. O. Noorthoorn

  2. Altrecht, Division Aventurijn, Den Dolder, and Radboud University, Nijmegen, The Netherlands

    H. L. I. Nijman

  3. King’s College, Institute of Psychiatry, Health Service and Population Research, London, UK

    L. Bowers

  4. GGZ inGeest, Amsterdam, The Netherlands

    A. W. Hoogendoorn

  5. Pro Persona Mental Healthcare, Nijmegen, The Netherlands

    A. Smit

  6. VU University Medical Center, Amsterdam, The Netherlands

    G. A. M. Widdershoven

Authors
  1. W. A. Janssen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. O. Noorthoorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. L. I. Nijman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Bowers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. W. Hoogendoorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Smit
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. A. M. Widdershoven
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to W. A. Janssen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Janssen, W.A., Noorthoorn, E.O., Nijman, H.L.I. et al. Differences in Seclusion Rates Between Admission Wards: Does Patient Compilation Explain?. Psychiatr Q 84, 39–52 (2013). https://doi.org/10.1007/s11126-012-9225-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-012-9225-3

Keywords

Search

Navigation