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- Eckerström, Joachim, 1982-, et al.
(author)
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Brief admission (BA) for patients with emotional instability and self-harm : nurses’ perspectives - person-centred care in clinical practice
- 2019
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In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 14:1
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Journal article (peer-reviewed)abstract
- Purpose: Emotional instability and self-harm pose major problems for society and health care. There are effective interventions in outpatient care, but when patients need inpatient care, nurses often struggle meeting their patient’s needs. Brief admission (BA) is a newly implemented crisis intervention and novel form of inpatient care. The aim of this study is to describe nurses’ experiences working with BA related to patients with emotional instability and self-harm.Methods: Eight nurses were interviewed according to a semi-structured interview guide. The data was analysed using qualitative content analysis.Results: Four main categories emerged regarding nurses’ experiences with BA: provides security and continuity, fosters caring relationships, shifts focus towards patient’s health and empowers the patient. The nurse’s role shifted from “handling problems” to establishing caring relationships with a focus on the person’s health and possibilities for recovering instead of psychiatric symptoms.Conclusions: Previous studies on patients’ perspective of BA describe positive experiences such as increased autonomy and participation in the healthcare process. This study supports those findings, albeit from the perspective of nurses. Our findings suggest that BA may reduce work-related stress experienced by nurses while caring for persons with emotional instability and self-harm. BA may also support nurses in their ability to provide more meaningful and constructive psychiatric inpatient care.
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| 2. |
- Helleman, Marjolein, et al.
(author)
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Individuals’ experiences with Brief Admission during the implementation of the Brief Admission Skåne RCT, a qualitative study
- 2018
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In: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 72:5, s. 380-386
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Journal article (peer-reviewed)abstract
- Background: Brief admission (BA) is an adjunctive treatment option for individuals with self-harming behavior, having traits of borderline personality disorder (BPD). It is offered alongside outpatient psychotherapy for the purpose of strengthening autonomy, self-reflection and self-care and to increase the likelihood of being able to stay in therapy by avoiding lengthy inpatient hospitalizations. Aims: To investigate participants’ experiences with BA during the pilot phase of the Brief Admission Skåne Randomized Controlled Trial (BASRCT), in order to detect possible strengths and limitations of the intervention and gain knowledge to facilitate implementation of BA at other treatment centers. Method: Eight participants randomized to BA were interviewed to obtain their experience of BA, or alternatively their reasons for choosing not to use BA. Thematic analysis was conducted upon their transcribed interviews. Results: Reported as most helpful by the participants was the structure/routines at the ward and the positive attitudes from the staff. However, some individuals reported problems with perceived negative attitudes from the staff administering BA and negative rumination about themselves. The reported reasons to request BA were: preventing urges to self-harm from escalating; ending isolation; preventing longer admissions and forced admission; feelings of emotional exhaustion, and the need for rest and support in re-creating a daily routine. Reasons for not requesting BA were fear of rejection, questioning the method; presumed room shortage; difficulties in deciding whether one’s problems are serious enough; experiencing the situation to be too clinically acute. Conclusion: The results from this study indicated the importance of repeated staff education on all aspects of BA when it is being newly implemented, as well as the importance of working with attitudes of staff delivering BA. These were the key ingredients in making BA implementation successful. Our findings may be of value to other treatment centers implementing BA for the first time. Trial registration: NCT02985047.
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| 3. |
- Liljedahl, Sophie, et al.
(author)
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A standardized crisis management model for self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder: The Brief Admission Skåne randomized controlled trial protocol (BASRCT) : Study Protocol
- 2017
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In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 17:220
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Journal article (peer-reviewed)abstract
- Background: Brief Admission is a crisis and risk management strategy in which self-harming and suicidal individuals with three or more diagnostic criteria of borderline personality disorder self-admit to hospital at times of increasing risk when other efforts to stay safe are failing. Standardized in the current randomized controlled trial, the intensity of Brief Admission Skåne is implemented in durations of three days, with a maximum frequency of three times a month. Brief Admission is integrated into existing treatment plans in advance of crises to prevent reliance on general psychiatric admissions for risk management, as these may be lengthy, unstructured, and of uncertain therapeutic value. Methods/design: The overall objective of the Brief Admission Skåne randomized controlled trial is to determine if Brief Admission can replace general psychiatric admission for self-harming and suicidal individuals with complex mental illness at times of escalating risk. Other objectives of the study are to evaluate whether Brief Admission increases daily functioning and enhances coping, reduces psychiatric symptoms including frequency and severity of self-harm and suicidal behaviours. A final objective is to determine if Brief Admission is an effective crisis management model for this population. Participants are randomized at an individual level to either Brief Admission Skåne plus Treatment as Usual or Treatment As Usual. Based on a priori power analyses, N = 124 participants will be recruited to the study. Data collection is in progress, and will continue until June 2018. All participant data are single-blinded and will be handled with intention-to-treat analysis.Discussion: Based on the combined clinical experience of our international research group, the Brief AdmissionSkåne randomized controlled trial upon which the current protocol is based represents th e first initiative tostandardize, implement and evaluate Brief Admission amongst self-harming and suicidal individuals, including thosewith borderline traits. Objectively measuring protocol fidelity and developing English-language Brief Admissionstudy protocols and training materials are implementation and dissemination targets developed in order tofacilitate adherent international export of Brief Admission Skåne.Trial registration: NCT02985047. Registered November 25, 2016. Retrospectively registered.
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| 6. |
- Lindkvist, Rose-Marie, et al.
(author)
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Predictable, collaborative and safe: Healthcare provider experiences of introducing brief admissions by self-referral for self-harming and suicidal persons with a history of extensive psychiatric inpatient care
- 2019
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In: Issues in Mental Health Nursing. - : Informa UK Limited. - 1096-4673 .- 0161-2840. ; 40:7, s. 548-556
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Journal article (peer-reviewed)abstract
- People with severe self-harming behavior and histories of lengthy psychiatric inpatient admissions can represent a challenge to care providers. This interview-based study illuminates healthcare provider experiences (n = 12) of Brief Admission (BA) among self-harming individuals, with >180 days of psychiatric admission the previous year. Qualitative content analysis revealed that providers experienced benefits of increased predictability, and a shift from trigger and conflict to collaboration with individuals admitted to BA. Staff participants expressed an increased sense of safety and a strengthened link between inpatient and outpatient caregiving. Results indicated that BA is a promising intervention for self-harming individuals with extensive psychiatric histories.
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| 7. |
- Westling, Sofie, et al.
(author)
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Effect of Brief Admission to Hospital by Self-referral for Individuals Who Self-harm and Are at Risk of Suicide. A Randomized Clinical Trial
- 2019
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In: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 2:6, s. 1-14
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Journal article (peer-reviewed)abstract
- Importance To our knowledge, there is no consensus regarding when individuals who repeatedly self-harm and are at risk of suicide should be hospitalized. To evaluate a new alternative, we examined the effects of brief admission (BA) to hospital by self-referral.Objectives To determine the effects of BA on inpatient service use and on secondary outcomes of daily life functioning, nonsuicidal self-injuries, and attempted suicide among individuals who self-harm and are at risk of suicide.Design, Setting, and ParticipantsThe single-masked Brief Admission Skåne Randomized Clinical Trial was conducted from September 2015 to June 2018 at 4 psychiatric health care facilities in southern Sweden. Data were collected 6 months retrospectively at baseline and at 6-month and 12-month follow-ups. Participants were randomized to either BA and treatment as usual (BA group) or treatment as usual (control group). The sample was a referral population, with the most important inclusion criteria being current episodes of self-harm and/or recurrent suicidality, at least 3 diagnostic criteria for borderline personality disorder, and hospitalization in the last 6 months.Interventions Self-referred BA was offered for 12 months, with standard limits for duration and frequency, after the negotiation of a contract outlining the intervention.Main Outcomes and Measures Prespecified main outcome measures were days admitted to the hospital, including voluntary admission, BA, and compulsory admission.ResultsThe 125 participants had a mean (SD) age of 32.0 (9.4) years, 106 (84.8%) were women, and 63 were randomized to the BA group and 62 to the control group. No significant advantage was observed in the number of days in the hospital for the BA group compared with the control group. Within-group analyses demonstrated significant decreases in both groups regarding days admitted to the hospital (BA group: χ2 = 22.71; P < .001; control group: χ2 = 23.01; P < .001) and visits to the emergency department (BA group: χ2 = 13.95; P < .001; control group: χ2 = 21.61; P < .001), but only the BA group showed a reduction in days with compulsory admission (χ2 = 7.67; P = .02) and nonsuicidal self-injuries (χ2 = 6.13; P = .047). The BA group showed significantly greater improvements in the mobility domain of daily life functioning (z = −2.39; P = .02) and significant within-group improvements in 3 other domains (cognition: F = 9.02; P < .001; domestic responsibilities: F = 3.23; P = .049; and participation: F = 3.79; P = .03).Conclusions and Relevance Brief admission appears no more efficacious in reducing use of inpatient services than usual care for individuals who self-harm and are at risk of suicide. Future studies should explore other possible beneficial effects.
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