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Brief Reports   |    
Association of Empathy of Nursing Staff With Reduction of Seclusion and Restraint in Psychiatric Inpatient Care
Chin-Po Paul Yang, M.D., Ph.D.; William A. Hargreaves, Ph.D.; Alan Bostrom, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200531
View Author and Article Information

Dr. Yang and Dr. Hargreaves are with the Department of Psychiatry and Dr. Bostrom is with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Send correspondence to Dr. Hargreaves (e-mail: billharg@comcast.net).

Copyright © 2014 by the American Psychiatric Association


Objective  Disruptive behavior leading to seclusion or restraint increases with patients in a high-acuity stage of mental illness who have histories of aggressive behavior. The study examined whether greater nursing staff empathy skills and motivation reduced use of seclusion and restraint and whether empathy training can further this effect.

Methods  In 1,098 nursing shifts in 2 six-month periods one year apart, hierarchical analyses examined the effects of nursing shift and patient characteristics, the effect for each shift of nurses' skill and motivation to use empathy, and whether empathy training reduced use of seclusion and restraint.

Results  With controls for shift, patient, and other staffing variables, analyses showed that the presence of more nursing staff with above-average empathy ratings was strongly associated with reduced use of seclusion and restraint but empathy training showed no further benefit.

Conclusions  Recruiting and retaining empathic nursing staff may be the best way to reduce the use of seclusion and restraint.

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Anchor for Jump
Table 1Predictors of seclusion or restraint during 1,098 work shifts in a psychiatric inpatient unit before and after nurses received empathy training
Table Footer Note

a Controlled for shift effects

Table Footer Note

b Controlled for shift and patient effects



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