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Patient engagement and problematic behaviours in nurse-staffed residential rehabilitation units

  • Alan Meaden (a1), Martin Commander (a1), Colin Cowan (a2) and Tom Edwards (a3)
Abstract
Aims and method

To build on previous research findings by examining engagement and problematic behaviours of patients in 10 residential rehabilitation units. Two measures were completed on patients in community rehabilitation, longer-term complex care and high-dependency units (109 patients in total). Data were analysed and categorised into higher-engagement ratings across the domains of engagement and behaviour over the past 6 months and lifetime in terms of presence of the behaviour and likelihood of resulting harm.

Results

Data were available for 73% of patients. All aspects of engagement were consistently low for all units, with highest levels in community rehabilitation units. Levels of problematic behaviours were similar across all units. Socially inappropriate behaviours and failure to complete everyday activities were evident for over half of all patients and higher for lifetime prevalence. Verbal aggression was at significantly lower levels in community units. Lifetime behaviours likely to lead to harm were much more evident in high-dependency units.

Clinical implications

Despite some benefits of this type of care, patients continue to present challenges in engagement and problematic behaviours that require new approaches and a change in focus.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Declaration of interest

None.

Footnotes
References
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1 Meaden, A, Nithsdale, V, Rose, C, Smith, J, Jones, C. Engagement and other factors associated with outcome in assertive outreach. J Ment Health 2004; 13: 415–24.
2 Commander, M, Sashidharan, S, Rana, T, Ratnayake, T. North Birmingham assertive outreach evaluation: patient characteristics and clinical outcomes. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 988–93.
3 Holloway, F. The Forgotten Need for Rehabilitation in Contemporary Mental Health Services (Faculty Report FR/RS/04). Royal College of Psychiatrists' Faculty of Rehabilitation and Social Psychiatry, 2005 (http://www.rcpsych.ac.uk/pdf/FR_RS_04.pdf).
4 Wolfson, P, Holloway, F, Killaspy, H (eds) Enabling Recovery for People with Complex Mental Health Needs: A Template for Rehabilitation Services (Faculty Report FR/RS/1). Royal College of Psychiatrists' Faculty of Rehabilitation and Social Psychiatry, 2009 (http://www.rcpsych.ac.uk/pdf/fr_rs_1_forwebsite.pdf).
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12 Seikkula, J, Alakare, B, Aaltonen, J, Holma, J, Rasinkangas, A, Lehtinen, V. Open dialogue approach: treatment principles and preliminary results of a two-year follow-up on first episode schizophrenia. Ethical Hum Sci Serv 2003; 5: 163–82.
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BJPsych Bulletin
  • ISSN: 2053-4868
  • EISSN: 2053-4876
  • URL: /core/journals/bjpsych-bulletin
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Patient engagement and problematic behaviours in nurse-staffed residential rehabilitation units

  • Alan Meaden (a1), Martin Commander (a1), Colin Cowan (a2) and Tom Edwards (a3)
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