Effects of a Psychiatric Intensive Care Unit in an Acute Psychiatric Ward.
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The psychiatric acute departments are intensive units serving patients with a broad spectrum of psychiatric conditions. Patients with the most florid psychiatric symptoms are admitted to Psychiatric Intensive Care Units (PICUs). These units are supposed to provide the necessary diagnostic and acute therapeutic help, control inappropriate behaviours, and provide the services in an environment which assists the patients’ recovery and is acceptable to patients, health workers and the general society. PICUs are criticised for poor environments, high levels of coercion and lack of evidence base from controlled trials or post occupancy evaluations. Long term studies of the rate of seclusion indicate no decrease in spite of changing political attitudes and hospital environments. There is a need fo new methods to treat violent or threatening incidents in psychiatric wards. Norwegian PICUs use segregation nursing with the patients placed in separately locked areas with staff. This model may be an alternative to seclusion. Controlled trials regarding effects of principles and facilities for such treatment are lacking. The general aim of the present study was to investigate effects of facilities for segregation, and several assumed risk factors in a Norwegian PICU. The current thesis is based on data from 118 consecutively admitted patients to the PICU at St. Olavs University Hospital, Trondheim, Norway. The thesis has the following conclusions: Main conclusions 1: Interior and furnishing like an ordinary home in the PICU create an environment with comparable treatment outcomes to the traditional dismal interior and has positive effects on many patients’ well being. Patient selfrating were significantly in favour of the ordinary home interior compared to the traditional interior 2: The principles of patient segregation in PICUs have favourable effects on behaviours associated with and the actual numbers of violent and threatening incidents. The changes in assessments of behaviour measured by differences in BVC ratings from baseline (admittance) to day 3 were significantly in favour of segregating the patients in the PICU compared to not segregating the patients in the same area. There were significantly lower reported incidents of violent or threatening incidents when using the PICU as a segregation area compared to not using the PICU as a segregation area. 3: In PICUs substance use is associated with favourable outcomes compared to patients not using substances. There was a significant difference in the changes of GAF-S –symptom ratings from admittance (baseline) to day three between the patient groups with or without a substance use diagnosis. The largest increase was in the patient group with a substance use diagnosis indicating more reduction of symptoms. 4: Threatening and violent incidents are not common acute manifestations of recent substance use in PICU populations. There was no significant difference in the number of threatening or violent incidents between the patient groups with or without a substance use diagnosis. 5: Substance use predicts shorter length of inpatient stay in PICU populations. The mean length of stay in the PICU was significantly shorter in the patient group with a substance use diagnosis compared to the patient group without a substance use diagnosis. 6: In PICUs prediction of short-term aggressive and threatening incidents should be based on clinical global judgement, and instruments designed to predict short-term aggression in psychiatric inpatients. In the hierarchical multiple linear regression analysis the global clinical evaluation from the physician on duty, the nurse clinicians’ global evaluation of “intensity of testing out and pushing limits”, and the observer rated scale scoring behaviours predicting imminent violence in psychiatric inpatients (BVC), were the factors positively associated with short-term threatening and violent incidents. 7: The predictive properties for BVC in the PICU-setting are satisfactory for the first three days after a single rating at admittance. Additional conclusions: 1: Patients who have experienced segregation settings like seclusion have desires for alternative treatment conditions. These desires are to a large extent met by Norwegian PICUs. These PICUs are effective. 2: In the architecture and design of PICUs it is important to take into consideration the possibilities for segregation of patients.
Has partsVaaler, Arne E.; Morken, Gunnar; Linaker, Olav M.. Effects of different interior decorations in the seclusion area of a psychiatric acute ward. Nordic Journal of Psychiatry. (ISSN 0803-9488). 59(1): 19-24, 2005.
Vaaler, Arne E.; Morken, Gunnar; Fløvig, John Chr.; Iversen, Valentina C.; Linaker, Olav M.. Effects of a psychiatric intensive care unit in an acute psychiatric department. Nordic Journal of Psychiatry. (ISSN 0803-9488). 60(2): 144-149, 2006.