title: Seclusion and the importance of contextual factors: An innovation project revisited.
abstract: Variation in seclusion rates between psychiatric facilities cannot be adequately explained by patient characteristics alone and there is a growing awareness of the influence of 'cultural' and staff factors on the use of seclusion. In this study, staff variables as well as seclusion parameters were investigated during the implementation of an innovation project, against the background of an institutional program to reduce the use of coercive measures. The results demonstrate the impact of confidence within the team, staffing level and communication with the patient on nurses' decisions on seclusion. The importance of the organizational context is further illustrated by the negative effects of organizational instability on nurses' attitudes and decision making with respect to seclusion, and on seclusion rates. A reduction in the use of seclusion was achieved after the implementation of the innovation project; however, during a period of organizational turmoil, the work engagement scores of staff decreased and the use of seclusion increased. The results of this study show the vulnerability of innovations within the continuously changing organizational context of mental health care.
authors.affiliation: Mental Health Institute Oost Brabant, Boekel, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands. Electronic address: cboumans@live.nl.
authors.forename: Christien E
authors.initials: CE
authors.lastname: Boumans
authors.affiliation: Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands; Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands; Pompe Institute for Forensic Psychiatry, Pro Persona, Nijmegen, The Netherlands.
authors.forename: Jos I M
authors.initials: JI
authors.lastname: Egger
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bouts
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands; Pro Persona Centre for Education and Science (ProCES), Wolfheze, The Netherlands.
authors.forename: Giel J M
authors.initials: GJ
authors.lastname: Hutschemaekers
mesh_terms: D001291:Attitude of Health Personnel; D003068:Coercion; D003657:Decision Making; D005260:Female; D006778:Hospitals, Psychiatric / Q000458:organization & administration*; D006801:Humans; D008297:Male; D009426:Netherlands; D009730:Nursing Assessment; D015279:Organizational Culture; D009936:Organizational Innovation; D010348:Patient Care Team; D010356:Patient Isolation; D011369:Professional-Patient Relations; D011795:Surveys and Questionnaires
keywords: Seclusion; attitudes; context; decision making; psychiatric hospital; work engagement