Identification of the specific nursing area & generation of related research questions   Systematic literature search   Evaluation and integration of the evidence

Identification of the specific nursing area & generation of related research questions   Systematic literature search   Evaluation and integration of the evidence 150 150 Affordable Capstone Projects Written from Scratch

TYPE OF ASSESSMENT: SUMMATIVE

 

Summative assignment: An integrated literature review in a selected, field-specific area of nursing or nursing practice which should include, identification of that area, why it was selected and considered to be a problem area, and generation of related research question(s). Thereafter, a systematic outline of the literature search process should be provided. Following this, there should be an evaluation of the evidence i.e. a diverse range of research studies (quantitative, qualitative and mixed-method) with a succinct systematic outline of their respective methods (study design/approach, sampling method, data collection method(s) and key findings. Studies should be cited, strictly following the systematic stages of the research process in doing so and critically appraised in respect of their respective methodological strengths and shortcomings with corroborative references here. The reviewed evidence should then be collated and unified in the form of matrices using a provided template and included as an Appendix. Thereafter, observed consistencies, commonalities and/or inconsistencies, contradictory differences within and between the findings of the reviewed evidence used should be identified and brief explanations for these should be provided. The clinical implications of the reviewed findings should be considered in the field-specific area of nursing/healthcare practice selected. Continued gaps in clinical and research knowledge should be identified and linked to suggested, specific directions for future clinical development/innovation and research in the topic area identified (4,000 words).

Assessment criteria

 

  • Title Sheet for Assignment:

The student should use the header front sheet provided which should include: the module code, the student’s number and word count.

 

  • Title:The title for the integrative review must identify a clear nursing and field-specific area which is considered to be problematical.

 

  • 0 Introduction & Background:In this section, the student must clearly identify the field-specific area of nursing or nursing practice and offer some evidenced-based justifications as to why it was selected and why it might be considered a clinical problem? Research question(s) should be generated related to the area identified that requires further investigation. The student should then offer a proposed structural outline for the entire contents of the integrative review to be covered (phrased in future tense), (Recommend approximately 550 words).
  • 0 Search Strategy Process: In this section, the student should state which search database(s) they used (don’t use too many) and briefly provide justifications why they choose them? The student must then identify search terms (be highly specific here) that he/she used and indicate how they combined them together? The student should summarise their search inclusion/exclusion criteria, for example the search years covered or search time parameter and whether the student chose only studies conducted in the U.K. or used International studies. The student should then summarise the types of studies found I.E. quantitative and/or qualitative studies and what these focused on in relation to their field-specific topic area? In short, this section should show the student’s understanding of their strategy for searching and the sort of results they found. The use of a search inclusion/exclusion criteria table is not recommended for this section of the integrative review (Recommend approximately 350 words).

 

  • 0 Evaluation & Integration of the Evidence:The students must firstly outline each of the relevant studies yielded by the search and selected for the integrative review in tabular form within the text (8-10 studies). The student must then compile sub-headings which are informed by grouping studies with similar areas of investigatory focus or those with similar findings and those with contradictory findings. Thereafter, each selected study (quantitative and qualitative) should have their methods systematically outlined and critically evaluated in the text following the systematic stages of the research process in the process: Firstly, the investigation must be referenced and then the type of study design/approach identified and what the study investigated/explored? Secondly, the type of sampling method used, the study population recruited for the study (n-?) and the primary related socio-demographic characteristics of the study population outlined. Thirdly, the data collection method(s) should be identified and briefly what it/they individually sought to investigate or measure? Fourthly, the key study findings should be succinctly outlined. Fifthly, the respective methodological strengths and limitations identified and brief explanations as to why these were strengths or shortcomings? One of the methodological strengths or limitations of each study considered must be corroborated with a research reference where possible. Correct use of research terminology/language should be demonstrated in this section, as in all others. Finally, the studies selected and included in the review must be summarised in matrices (using a provided template) and included as an Appendix. (Recommend approximately 2,500 words).

 

  • 0 Commentary Key Findings of the Studies Reviewed:In this section, the student must carefully examine the key findings of each of the studies and comment on consistencies or inconsistencies and differences within and between studies selected for the integrative review. In essence, students must observe whether there are commonalities, consistent or contrasting findings within and between the results of the various reviewed studies and offer explanations for these. In this section students are advised to group studies with similar and dissimilar or contradictory findings under sub-headings. Sub-headings will be informed by the findings of grouped studies. The student must also briefly consider the nursing and multi-professional, clinical implications of the reviewed findings in relation to the field-specific, nursing area considered. (Recommend approximately 350 words).

 

  • 0 Conclusion & Research Recommendations: In this section, the student must also offer a succinct synthesis of the contents covered in the integrative review. Thereafter, the student having considered the findings collectively in the integrative review must identify continued gaps in clinical and research knowledge linking these to suggested directions for future investigation and clinical practice in the area. (Recommend approximately 250 words).
  • Academic presentation: The title and all numbered sub-headings should be in Ariel bold, font-size 12. The text should be in Ariel, font-size 12 with 1.5 spacing between text and double-spacing between paragraphs. The recommended number of paragraphs per page is 3-4 only. Margins of text should be justified throughout. Page numbers must be located central-footer. In Section 3.0 of the assignment cited studies must be cited in past tense. All tables and Appendices must be titled and numbered appropriately. Research language must be used appropriately throughout. There should be no syntax, grammatical, typographical and punctuation errors. The assignment must be structured according to the systematic stages of an integrative review (Refer overleaf).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stages of an Integrative Review

Identification of the specific nursing area & generation of related research questions

 

Systematic literature search

 

Evaluation and integration of the evidence

Dr.

  1. Price, S. Ramkissoon,
  2. Bodley, Dr. H. Sehmi

 

                                                                                                                                Collation & commentary on the key findings across reviewed studies

 

 

 

Conclusion & research recommendations based upon the overview

Elaboration of the Assignment Sections

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Title: The title for the integrative review must clearly identify a nursing and field-specific area which is considered to be problematical. It is recommended that the field-specific area of nursing practice selected for the integrative review be problematical, controversial or where inconsistencies of practice are evident:

 

‘An Integrative Review of the Evidence Examining the Relationship between Nurses’ Handwashing Practices and Infection in Hospitalised Acute Care Settings within the UK’

 

‘An International Integrative Review of the Evidence Examining Reasons

for Nurses Drug Errors’

 

‘An Integrative Review on the Use of Seclusion in Acute Mental Health and Forensic Settings within the UK’

 

  • Introduction & Background:Clear identification of the field-specific area

of nursing practice and evidenced-based justifications as to why it was selected and why it might be considered a clinical problem? e.g. the use of seclusion in mental health settings. This is a highly controversial practice, why? Consider what problems are associated with the use of this practice for both nurses and patients? Evidence by a number of investigators including Bowman et al., (2010); Sharp & Mellick (2012); Kaposky (2014) have all shown that the practice of seclusion in acute mental health and forensic settings is alarmingly high varying from between 70%-80% and is often used as a mode of punishment, especially when patients are aggressive toward staff and to each other. Elsewhere, the findings of Kumar et al., (2016) have revealed that patients have sustained both minor and serious injuries arising because of seclusion. These ranged from minor bruising of the arms and legs, fractures of the ulnar and tibia, and even death due to cardiac arrest. Moreover, in a UK study by Merril et al., (2016) showed that there were inconsistencies in nursing protocols for the practice of seclusion used across many different NHS trusts in the UK. More alarmingly, Sailas & Wahlbeck (2008) have observed an ethnic bias for whom seclusion is used. They found that in a population of 30% Caucasian and 50% of Black gentlemen and women within 4 Northern NHS Trusts that there was a differential rate of seclusion of 20% use for the former and 50% for the latter. Elsewhere, the consequences of seclusion have been documented by Salman & Denney (2017) who point out the heavy financial costs incurred with its use by NHS Trusts arising through patient litigation, staff injury claims and staff sickness. This unfortunate state of affairs coincides with high staff turnover rates, poor retention, austerity and budget-cuts for Mental Health Services within the NHS.

 

The aforementioned findings warrant a closer analytical inspection of further evidence in this area if nursing practice is to become more consistent with the safety of mental health patients and nursing staff alike being paramount.  Research questions to that end might include the following areas for further investigation: what are the short and long-term psychological effects of seclusion for patients and mental health nursing staff? Is the practice of seclusion in mental health and forensic settings ethical? Are there moral objections to this procedure amongst this vulnerable group? Why are clinical protocols/procedural guidelines on the use of seclusion inconsistent across many NHS Trusts in the UK?

 

The proposed structural outline for this integrative review will firstly offer a systematic outline of the search strategy process. Thereafter, the studies selected for the review will be identified in tabular form and justifications provided for their selection. Following this, each individual study will have its methods outlined following the systematic stages of the research process. The key findings of the investigation will then be summarised. Thereafter, the respective methodological limitations will be critically appraised with brief explanations offered, as to why these were shortcomings and referenced accordingly. The studies collectively selected and included in the review will then be summarised and unified in matrices and included as an Appendix. Next, the key findings of the selected studies will be assessed for consistencies and/or inconsistencies with explanations offered for both. The nursing and multi-professional, clinical implications of the reviewed findings will also be considered. Finally, the conclusion will offer a synthesis of the contents covered in the integrative review. Thereafter, continued gaps in clinical and research knowledge will be discussed. These in turn will be linked to suggested directions for future research in the area selected. (Recommend approximately 550 words).

 

  • Search Strategy Process: The search databases used to guide the search

were, CINAHL, Cochrane and PsycInfo. CINAHL was chosen since it was the largest nursing search database, Cochrane yielded relevant systematic reviews and meta-analysis. PsychInfo was used since the topic related to the mental health field. The search terms used in combination to guide the search focused on how the field-specific topic was defined in the literature and the clinical setting(s) in which it occurred. Therefore, the search terms included, ‘patient seclusion and/or patient isolation and/or confinement’; ‘mental health and/or psychiatric and/or forensic’. The search inclusion/exclusion criteria as part of the search refinement specified a time parameter which ranged 2008-2017 to elicit contemporary evidence in the area. Alternatively, the justification for reverting back to evidence in the early part of the millennium was prompted by the need to obtain an evolving perspective on how the reasons for and practice of seclusion has remained static or changed over the course decade. Furthermore, the search inclusion focused only on studies conducted in the UK because of DoH initiatives and clinical protocols exclusive to that country. Alternatively, the search included international studies because of the dearth of research in the UK and the fact that this field-specific topic has global ramifications,  whilst operating under E.U. and International Human Rights Laws. The main types of studies found were quantitative and qualitative ones. The former mainly focused on the types, prevalence and incidence of seclusion used in mental health settings. The latter focused on staff and patient experiences of the procedure. Alternatively, the main types of studies found were quantitative, with little or no qualitative ones. The quantitative studies mainly focused on the types, prevalence and incidence of seclusion used in mental health settings. The corresponding dearth of qualitative studies in this field-specific topic may indicate a gap in research knowledge exploring staff and patient experiences of the procedure. (Recommend approximately 350 words).

 

  • Evaluation & Integration of the Evidence: The total number of studies

included in this integrative review amounted to 10 studies of which 8 were quantitative and 2 qualitative. For an overview of the studies reviewed and their area of investigation (Refer Table 1 overleaf).

 

 

Table 1. Studies Selected for Integrative Review

Investigator(s) Study Design/Approach Study Aim/Purpose
Stavock et al., (2008) RCT Examined Ethnic differences in the purpose and timing of seclusion between an experimental group of Afro-Caribbean and control group of Caucasian participants.
Bowman et al., (2015) RCT Investigated differences in use of seclusion between 15 experimental forensic units and 15 acute wards.
Kumar et al., (2016) RCT Analysed differences between an experimental group with major injuries and a controlled group with minor injuries arising because of seclusion in 4 mental health forensic units.
Howard et al. (2009) Systematic review Examined and analysed the evidence across 15 RCT’s investigating the short-term psychological impact of seclusion upon psychiatric nurses and the consistency of the combined findings.
Tassel et al. (2014) Systematic review Investigated and analysed the evidence across 28 RCT’s examining the differential impact of reported sickness rates between psychiatric nurses practising seclusion in acute care settings with those in forensic settings and the consistency of collective findings.
Sadoski (2013) Meta-analysis Analysed 35 experimental studies investigating the consistency of their collective findings examining differences in the reporting of seclusion by an experimental group of psychiatric nurses with a controlled group of patient reports of the same.
Sailas & Wahlbeck (2008) Correlational study Investigated the relationship between ethnic origin and use of seclusion in 4 NHS Trusts in the North of England.
Merrick, Salus & Crease (2008) Correlational study Examined the association between age, gender and ethnicity with incidence of seclusion.
Silverman, Mann & Calvert (2015) Ethnographic study Explored the cultural perceptions of Caucasian and Black Caribbean Nurses of seclusion of patients in Forensic Mental Health Units.
Marshall-Lucette, Kinsey & Rakassoon (2017) Phenomenological study Explored the perceptions and lived experiences of registered mental health nurses practice of seclusion and its reporting for aggressive patients in 3 NHS Trusts.

 

Students must then formulate sub-headings in this section which are informed by grouping studies with similar areas of investigatory focus or whose findings are either consistent or, those studies whose results are contradictory or dissimilar e.g.

3.1 Ethnocultural Perceptions of the Purpose & Practice of Seclusion (Stavock et al., (2008); Sailas & Wahlbeck (2008); Merrick, Salus & Crease (2008); Silverman, Mann & Calvert (2015).

3.2 Psycho-Physiological Impact of Seclusion (Howard et al. (2009); Tassel et al. (2014); Kumar et al., (2016).

3.3 The Practice & Reporting of Seclusion (Sadoski (2013); Bowman et al., (2015); Marshall-Lucette, Kinsey & Rakassoon (2017)  

 

Students must now cite each of the studies (using past tense) contained within sub-headings and table above. They must do so in depth following the systematic stages of the research process in their presentation. An exemplar of the citation of one of the quantitative studies in the table (pg. 9) is as follows:  Bowman et al., (2015) conducted an RCT (type of study approach) which investigated differences in use of seclusion (topic being investigated) between 15 experimental forensic mental health units and 15 control acute wards in 4 NHS Trusts in the South of England. A non-probability method of purposive sampling (sampling method) was used which comprised (n-30) (sample number) psychiatric wards or which 15 were acute mental health and 15 forensic secure units. The acute wards contained 5 registered nurses and 4 HCA’s, whilst the forensic units contained 10 registered nurses and 6 HCA’s with the same shift patters of working including 8-hour day, long-day of 12 hours and 12-hour night shift (socio-demographic characteristics of the study population). Two methods of data collection were used the first of which consisted of intermittent observation (method of data collection) of the practice of seclusion for patients (brief overview of what the method of data collection explored) and the Use of Seclusion Scale (method of data collection) developed by (Korsey et al. 2009) which measured the type and frequency of seclusion (brief overview of what the method of data collection explored). The key findings revealed highly significant differences (p<0.001) in the use of seclusion on forensic secure units compared to acute wards. Moreover, there were 30% more patent injuries associated with seclusion in the former areas, compared with 10% injuries in the latter areas (key findings outlined). The primary methodological strength was associated with the use of an RCT experimental design which according to NICE comprised the strongest piece of scientific evidence able to permeate clinical practice. Two methodological limitations were evident with the first being associated with the use of a non-probability method of purposive sampling, which because of its non-random nature may have led to selection bias thereby, limiting the generalisability of the study findings. The second limitation was the use of the questionnaire which yielded superficial data on the reasons why seclusion was used for patients in both areas (methodological shortcomings outlined and reasons for why identified). Indeed, Burns & Grove, (2013) similarly argue that questionnaires do not yield in-depth rich data (research reference corroborating one of the methodological shortcomings).

 

An exemplar of the citation of one of the qualitative studies in the table (pg. 9) is as follows: Marshall-Lucette, Kinsey & Rakassoon (2017) conducted a hermeneutical, phenomenological study (type of study approach) which explored the perceptions and lived experiences of registered mental health nurses practice of seclusion for aggressive patients in 3 NHS Trusts (topic being explored). A non-probability method of convenience sampling (sampling method) comprised (n-17) (sample number) mental health nurses which ranged 5-10 years’ professional experience of different ethnic groups including Caucasian, Eastern-European nurses, Afro-Caribbean and Black-African and (socio-demographic characteristics of the study population). The method of data collection consisted of semi-structured, tape-recorded interviews (method of data collection) which explored qualified psychiatric nurses’ perceptions of the nursing practice of seclusion in their individual NHS Trusts (brief overview of what the method of data collection explored). The key findings of the study generated two emergent themes namely, ‘the dilemma of seclusion’ and ‘approval and disapproval of seclusion’ (identification of emergent themes). These revealed that registered nurses had mixed feelings about the practice of seclusion varying from acceptance to rejection for different professional, religious and cultural reasons (key findings outlined). The methodological strength of this study was its use of semi-structured individualised interviews which yielded richness and depth of data in contrast to quantitative measures. The methodological limitations of this study were the fact that it used a non-probability method of convenience sampling which because of its non-random nature can lead to potential selection bias (methodological strengths and shortcomings outlined and reasons for why identified). This is corroborated by Polit & Hungler (2009) who argue similarly that this form of sampling is one the weakest and one which is least likely to be representative of the wider population (research reference supporting one of the methodological shortcomings).

An exemplar of the citation of one of the systematic reviews in the table (pg. 9) is as follows: Tassel et al., (2014) conducted a systematic review which analysed data from 28 RCT’s (nos & types of studies reviewed) to assess the consistency of the evidence on the differential impact of reported sickness rates between psychiatric nurses practising seclusion in acute care settings with those in forensic settings (area being reviewed across these RCT’s). The review included a composite sample of (n-140) (composite sample numbers across the studies reviewed) registered mental health nurses of which 50 were working in 15 acute mental health wards and 90 nurses in 17 forensic units from NHS Trusts in England (key socio-demographic characteristics of all the samples across the different studies). The main data collection methods included Staff Sickness Questionnaire (Kongsberg, 2013), Use of Seclusion Scale (Korsey et al. 2009), Staff-Patient Incident Forms, Occupational Health Questionnaire (NHS, England, 2000) and anthropometric measures including, BP, temperature readings and eye tests (main data collection methods used across the studies reviewed). The key findings of this systematic review showed highly significant differences (p<0.0001) in the sickness rates between forensic (CI, 0.53 – 0.01) and acute wards (CI, 0.04 – 0.58). However, the injury rate sustained by nurses in acute (20%) and forensic wards (26%) was only just significant (p<0.05) (key findings of systematic review). The primary methodological strength of systematic reviews where RCT’s are unified and analysed are that they constitute the strongest and purest form of scientific evidence which underpins and influences clinical practice. Conversely, a potential methodological shortcoming was the fact that the data underwent secondary analysis, leaving the possibility that reinterpretation may have misrepresented the findings (methodological limitation and reason for why identified). Evans (2003) supports this when he argues that independent and secondary research reviews may use different analytical methods yielding differential interpretations of the original results in systematic reviews (research reference supporting one of the methodological shortcomings). At the end of this section, the student must indicate that the studies selected for the review have been collectively unified and summarised in matrices included as an Appendix (Refer Appendix 1). Studies in this Appendix must be systematically grouped according to design/approach from earliest-latest dates conducted. Recommend 2 studies per page using provided template (pg. 16 & 18). (Recommend approximately 2,500 words).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPENDIX 1

 

 

 

 

Unified Collective Summary of Studies on Use of Seclusion in Acute Wards and Forensic Mental Health Units

 

 

 

 

 

 

 

 

Investigators Study design/approach & purpose Sampling method, (n-) & socio-demographic details Method(s) of data collection Key findings
Stavock et al., (2008) RCT (experimental group 60) and (control group 55) to investigate Ethnic differences in the purpose and timing of seclusion.

 

 

Simple random sampling method (n-115), 60 Afro-Caribbean and 55 Caucasian registered mental health nurses working in 3 Acute and 2 Forensic Units in two NHS Trusts. Professional experience ranged between 2-20 years with 75 males & 35 females. Three methods of data collection comprised incident forms, nursing notes and structured observation. No significant differences (ns) were found in the purpose of seclusion (staff/patient safety concerns and de-escalation of aggressive/violent behaviour) between both groups, but there were significant similarities (p<0.01). Significant differences found between Acute & Forensic settings in timing of seclusion (p<0.02) with former 15-30 mins and latter 1-2 hours.
Bowman et al.,  (2008) RCT (experimental group 15, control group 15) to determine differences between Acute Wards and Forensic Units in the use of seclusion.

 

Non-probability, purposive sampling method (n-30), 15 Acute wards and 15 Forensic Units in Three NHS Trusts. Acute wards contained 5 registered RMS, & 4 HCAs. Forensic Units contained 10 registered RMS & 6 HCAs. Same shift patters of 8 hours day duty, 12 hours long-day, 12 hours night shift. Two methods of data collection comprised Seclusion Scale (Korsey et al., (2009) and structured intermittent observation. Highly significant differences (p<0.001) between use of seclusion between Acute wards (containment of aggression/violence and staff-patient safety) and Forensic Units (time-out & confinement, and negative reinforcement for challenging behaviour). Use of seclusion in the former 30%, whilst 60% in the latter. 10% associated patient injuries in Acute wards and 30% patient injuries in Forensic Units.    

 

 

Investigators Study design/approach & purpose Sampling method, (n-) & socio-demographic details Method(s) of data collection Key findings
Tassel et al., (2014) Systematic review which comprised 28 RCT’s to assess the consistency of evidence on differential impact of reported sickness rates between registered mental health nurses in Acute Care Wards and Forensic Units. Randomised methods of sampling (n-140) of registered mental health nurses of which 50 were working in 15 Acute Care Wards and 90 in 17 Forensic Units in NHS Trusts. Methods of data collection comprised Staff Sickness Questionnaire (Kongsberg, 2013); Use of Seclusion Scale (Kongsberg, 2013); Staff-Patient Incident Forms; Occupational Health Questionnaire (NHS, England, 2000) and Anthropometric measures: BP, temperature readings, eye tests. Highly significant differences in sickness rates (p<0.0001) between Forensic Units (CI, 0.53 – 0.01) and Acute Care Wards (CI, 0.04 – 0.58). Moderate significant difference (p<0.05) between staff-patient injury rates sustained in Acute wards (20%) and Forensic Units (26%).   

 

 

 

 

 

 

 

 

 

 

 

 

Investigators Study design/approach & purpose Sampling method, (n-) & socio-demographic details Method(s) of data collection Key findings
Silverman, Mann & Calvert, (2015) Ethnographic approach which explored the cultural perceptions of seclusion of patients in Forensic Units.  

 

Non-probability method of purposive sampling (n-23), 12 Caucasian & 11 Black-Caribbean registered mental health nurses working in 2 Forensic Units in two NHS Trusts. Professional experience ranged between 4-15 years with 15 males & 9 females. Two methods of data collection comprised focus-group interviews and nursing notes. Three emergent themes, ‘Seclusion: fair/unfair’; ‘seclusion safe/unsafe’ and ‘seclusion protection vs punishment’. Caucasian nurses generally perceived the procedure as appropriate in maintaining patients’ containment and safety when aggressive. Whilst Black-Caribbean nurses felt it was unsafe for both patients and staff alike, and was often used punitively. 
Marshall-Luctte, Kinsey & Rakassoon,  (2017) Hermeneutical, phenomenological approach exploring the perceptions & lived-experiences of registered mental health nurses of the practice of seclusion for aggressive patients in three NHS Trusts.

 

Non-probability, method of convenience (n-17), in 3 Forensic Units in three NHS Trusts. Mental health nurses ranged from 5-10 years of professional experience, and comprised Caucasian, Eastern-European, Afro-Caribbean and Black-African ethnicity. The method of data collection comprised semi-structured, tape-recorded interviews. Two emergent themes, ‘The dilemma of seclusion & ‘approval and disapproval of seclusion’. Mental health nurses displayed mixed feelings about the practice of seclusion varying from acceptance to its rejection for different professional, religious and cultural reasons. 

 

 

  • Commentary Key Findings of the Studies Reviewed:Collective consideration

of the studies revealed that similarities of the findings across studies were far outweighed by differences between them. Indeed, for some studies there were even contradictory findings therein. For example, in the Stavock et al. investigation there were similarities in the purpose of seclusion, but differences in its duration between acute and forensic areas. Differences were also evidenced in the comparison of the studies by Silverman, Mann & Calvert and Marshall-Lucette, Kinsey & Rakassoon, which both revealed ethnic differences between registered mental health nurses in their perceptions of and the reasons for the practice of the same procedure. Other differences between Acute and Forensic Units were the time duration of seclusion, use of seclusion, staff sickness rates and staff-patient injury rates which were found respectively in the investigations by Stavock et al., Bowman et al. and Tassel et al. An explanation for the similarity of the finding for the purpose of seclusion may have arisen because of similar clinical protocols across Trusts for the procedure. Conversely, differences in the duration, ethnic perceptions of the reasons for and use of seclusion, sickness and staff-patient injury rates in the findings across studies might be explained by differential staffing levels, attitudes and types of patients between Acute & Forensic Units, along with contrasting stress levels and cultural differences. The multi-professional clinical implications of these collective findings have relevance for Nurse Managers & HR departments in the recruitment and retention of different ethnic groups of nurses reflecting patient diversity, occupational health departments in supporting nursing staff, nurse educationalists in equipping staff to manage aggressive incidents and health counsellors to assist in the aftermath (Recommend approximately 350 words). 

 

5.0 Conclusion & Research/Clinical Recommendations: This integrative review has selected 10 research investigations (8 quantitative & 2 qualitative) in the area of the use of seclusion in acute mental Health and forensic Settings within the UK. These studies were selected from an in-depth search and analytical scrutiny of the relevant literature in the area. The findings of these studies collectively considered revealed just one mere similarity in the purpose of seclusion between both acute and forensic mental health settings. By contrast there was a plenitude of differences in the findings across studies in respect of time duration of seclusion, use of seclusion, staff sickness rates and staff-patient injuries. Explanations for this trend were offered accordingly and their multi-professional clinical implications considered. Gaps in clinical knowledge included patient groups & relatives being involved in developing clinical protocols for seclusion. In summary, there appeared to be a predominance of quantitative studies (8) in the area in contrast to quantitative ones (2) which constitute a gap in research knowledge. Suggested directions to redress this would include the need for more qualitative studies in the area to be conducted including, Grounded theory studies to generate a developmental base upon which quantitative studies could build, hermeneutical, phenomenological studies to further explore the perceptions and lived-experiences of patients who have been the recipients of seclusion and ethnographic studies exploring cultural perceptions of nurses, and patients and their partners/family of the procedure and the reasons for its initiation. (Recommend approximately 250 words). 

 

 

  • What will be counted as part of the Word Limit: The word count is defined as any words included in the text of the assignment (counted electronically by your word processing programme). All main and sub-headings within the text, all cited references within the text, any footnotes related to the text.

 

  • What will not be counted as part of the Word Limit: The title page, the contents pages, reference and bibliography list, the Appendices.

 


 

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