Transcript Los hospitales de Caritas

How do you address trauma in a
busy hospital setting?
Mental Health Nursing &
Acute Inpatient Mental Health Services.
Luke Molloy (University of Tasmania)
Paul Beckett (St Vincent’s Hospital)
Acute Inpatient Mental Health
Services

Hospital based care.

Hospitals provide inpatient care for consumers
experiencing acute symptoms of mental illness.

Biomedical model.

The reorientation of hospital services towards
supporting personal recovery as well as promoting
clinical recovery remains a significant challenge.
Trauma and inpatient mental health
nursing
 Compelling evidence base for inpatient mental health
nurses to become trauma informed
 90% of people seeking treatment for serious and enduring
personality disorders, substance abuse, and mental illnesses
were exposed to significant emotional, physical, and or
sexual abuse in childhood.
 To better meet the needs of persons accessing these
services, trauma-informed care has therefore
emerged as a key paradigm.
Trauma and Acute Inpatient Mental
Health Services

Re-traumatisation of consumers within a mental health
inpatient setting.




Many studies report consumers feel unsafe in psychiatric
inpatient units
Literature highlights the prevalence of aggressive behaviour
in acute mental health inpatient facilities
Research raises concerns about sexual safety in mental
health units
Those with a previous history of trauma reported feeling
increasingly unsafe, fearful, helpless, and distressed
Trauma and Acute Inpatient Mental
Health Services
 Systemic abuse refers to abuse perpetrated either
purposefully or unknowingly by staff through system
practices, policies, and protocols (Department of Health, 2000).
 Consumers who felt they had no control concerning decisions
around their care report high rates of frightening
experiences.
 Coercive practices, such as being forced to take medication
on threat of seclusion or other negative outcomes were
identified.
Trauma and Acute Inpatient Mental
Health Services

Hodas (2006) stated that trauma-informed services
are those that are cognisant that their services can
re-traumatise consumers who have significant
trauma histories through the indiscriminate
application of coercive practices.
 These services commit themselves to “do no
harm” (Fallot & Harris, 2009, p.2).
Caritas Ward, St Vincent’s Hospital


27 bed acute admission ward
High incidence of co-morbidity
 Drugs and alcohol
 Homelessness
 Frequent contact with police & criminal justice system


High demand & high occupancy
Average length of stay < 14days
Admission




Most admissions to ward via ED
Police involvement common
Drug and alcohol intoxication often complicating factor
IV sedation, mechanical and physical restraint used to
manage aggressive and disturbed behaviour
Mental Health Nurses
 Nursing team responsible for the day-to-day management of
patient care and ward safety.

Experience of nursing staff in acute setting is often reported as negative –
emotional fatigue can lead to avoidant or overly controlling responses to
consumers

Negative Interpretation of consumer behaviours - perceived as challenging
or uncooperative; deliberately bad.

Anxiety related to consumer aggression

Medical Model dominant treatment approach
Practice Improvement Strategies
 Seclusion reduction project 2008 –
 During 3 year period reduced seclusion by 80%
 Trained in de-escalation & physical restraint
 Seclusion and restraint as last resort
 Reduce reliance on security staff
 Pharmacology research and training
 Lower doses of medication used for sedation
 Reduce incidence of over-sedation
Practice Improvement Strategies
 Strengths-based Practice
 Integration of strengths philosophy and principles
 Challenging attitudes and language of deficit focus
 Encouraging compassion and collaboration
 Sexual Safety training and practice development
 Improved staff awareness through training
 Policy and procedure development
 Segregated, female-only bedroom areas
Practice Improvement Strategies
 Therapeutic art and group activities
 Allied health staff provide a range of group activities
 Focus on interpersonal relationships & relaxation
 Opportunities to participate in ward improvement
Trauma Aware
 Staff training to raise awareness of trauma and
reframing of ‘symptoms’
 Acknowledgement of the high incidence of trauma in consumers
admitted to the ward - survey indicated over 75%
 Physical restraint avoided as much as possible – > sexual trauma
 Minimise participation of male staff in restraint of female patients,
particularly when there is a known history of sexual assault
 Reduce the duration of seclusion episodes
 Post-incident debrief with consumers and opportunity to discuss
safety planning
Conclusions
 It is possible to incorporate trauma-informed care in
inpatient settings, but….
 Whole of service model
 Needs to be incorporated into an holistic approach
 Improved clinical pathways for people who are
intoxicated – reduce demand on inpatient beds
 Staff need to be trained
 Peer support workers part of the clinical team
 Clinical supervision and support for staff