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| |  ECNP: Nurse-Supervised Seclusion Reduces Violence in Psychiatric Acute Ward By Paula Moyer PRAGUE, CZECH REPUBLIC -- October 15, 2003 -- The use of seclusion areas with closed doors can reduce the frequency of violence and threats of violence in a psychiatric acute ward, according to a study of more than 100 patients. "A critical component of effective seclusion is the continuous presence of a nurse," said Arne E. Vaaler, MD, head psychiatrist, department of neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. "With that element in place, seclusion in a closed-door ward helps lower the external stimuli and reduces the tendency to violence more quickly than if such patients are in an open-door ward." Dr. Vaaler presented the findings of an observational study here September 24th at the 16th Congress of the European College of Neuropsychopharmacology. Seclusion traditionally has functioned as a management technique in psychiatric hospitals, Dr. Vaaler said, by containing behaviourally disturbed patients. If it helps decrease such patients' sensory and emotional input, it may also benefit them as a treatment technique, he added, but that seclusion's potential as treatment depends on the way it is administered. He and his colleagues developed their study to analyse the effects of two different levels of seclusion on symptoms, behaviours, and treatment in psychiatric acute patients who were admitted to a seclusion area. They compared the impact of a seclusion ward with permanently closed doors to seclusion in the same ward with the doors either removed or left permanently open. Among the approximately 600 patients admitted to the hospital in a 12-month period, Dr. Vaaler and his colleagues consecutively evaluated all patients for inclusion in the study. In the two different study periods within this time, 118 patients eligible for seclusion were enrolled in the study, with 56 in the closed-door group and 62 in the open-door group. There were no significant differences in group characteristics at admittance, or in the total number of therapeutic and control steps taken or diagnoses. The investigators used three instruments to evaluate patients: the Positive and Negative Syndrome Score (PANSS), the Split-Global Assessment of Functioning (S-GAF), and the Brøset Violence Checklist (BVC). Patients received evaluations by these instruments at admittance, on Day 3, and at discharge from the seclusion area. The investigative team recorded violent or threatening incidents using the Staff Observation Aggression Scale-Revised (SOAS-R). The staff coded therapeutic and control steps daily on a 23-item checklist. The investigators documented five threatening or violent incidents in the closed-door period and 32 in the open-door period (P<0.001). The reduction from baseline in BVC-scores measuring imminent, threatening violence was significantly different between groups, with a greater reduction in the closed-door group (P=0.02). Dr. Vaaler stressed that seclusion as practiced in this facility differs from the stereotype of "the patient alone in a padded cell." Nurses are continuously present with secluded patients, a factor that reduces patient anxiety, he said.
[Study title: Effects Of Secluded Areas In A Psychiatric Acute Ward. Abstract P.6.027]
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