{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:11:26Z","timestamp":1787019086737,"version":"build-2736575974"},"reference-count":21,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Am Psychiatr Nurses Assoc"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Actions of physical violence, harassment, or other threatening and intimidating behavior characterize workplace violence, often subsequently followed by seclusion to maintain safety in emergency department (ED) and psychiatric settings. Though there is no universally identified benchmark of acceptable rates of seclusion, April to September 2023 preintervention rate of seclusion hours on a psychiatric ED unit at a public state hospital in the southeast was 5.57\/1,000 patient care hours, exceeding current comparison data from Centers for Medicare and Medicaid Services (CMS) for calendar year 2022 with a state average, 0.26\/1,000 patient care hours and national average, 0.35\/1,000 patient care hours.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>This project aimed to reduce seclusion rates through the implementation of a violence risk identification and management protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Interventions included brief training and implementation of a violence risk protocol using the Violence Assessment Tool (VAT) and seclusion debriefing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Reports of workplace violence decreased by 25% in the psychiatric ED and 17% across the adult psychiatric inpatient units, and there was a cumulative decrease in Inpatient Psychiatric Facility Quality Reporting seclusion rates by 5% across the adult psychiatric inpatient units where the components of the VAT were communicated in report from the psychiatric ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Early identification of violence risk, patient-specific agitation factors, and de-escalation preferences in the ED setting may have the potential to improve safety through reduced seclusion and workplace violence events. Future research could study patient perspectives of the VAT as a patient-centered tool in de-escalation to reduce seclusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10783903251338043","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T05:05:43Z","timestamp":1748235943000},"page":"563-569","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Seclusion Rates and Workplace Violence on a Psychiatric Emergency Department Unit"],"prefix":"10.1177","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3923-4485","authenticated-orcid":false,"given":"Joshua D.","family":"Moran Jimenez","sequence":"first","affiliation":[{"name":"Joshua D. Moran Jimenez, DNP, PMHNP-BC, CPHQ, CPAHA, CARN, NE-BC, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7131-0975","authenticated-orcid":false,"given":"Christa","family":"Walden","sequence":"additional","affiliation":[{"name":"Christa Walden, BSN, RN, PMH-BC, Staff Leader and Shared Governance Chair, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8564-7816","authenticated-orcid":false,"given":"Alexa","family":"Carey","sequence":"additional","affiliation":[{"name":"Alexa Carey, BSN, RN, PMH-BC, Charge Nurse and Shared Governance Chair, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Miller","sequence":"additional","affiliation":[{"name":"Jennifer Miller, MSN, RN, PMH-BC, NPD-BC, Nursing Professional Development Specialist, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerry","family":"Keyes Young","sequence":"additional","affiliation":[{"name":"Kerry Keyes Young, DNP, CHSE, PMH-BC, Nursing Professional Development Specialist, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5288-7653","authenticated-orcid":false,"given":"Lynnette","family":"Morris","sequence":"additional","affiliation":[{"name":"Lynnette Morris, MSN, RN, PMH-BC, NE-BC, Nurse Manager, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3297-9602","authenticated-orcid":false,"given":"Tammy","family":"Erbaio","sequence":"additional","affiliation":[{"name":"Tammy Erbaio, BSN, RN, Mental Health Quality and Safety Manager, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"e_1_3_3_2_1","unstructured":"American Psychiatric Nurses Association (2022 March). Standards of practice: Seclusion and restraint. https:\/\/www.apna.org\/standards-of-practice-seclusion-and-restraint\/"},{"key":"e_1_3_3_3_1","doi-asserted-by":"crossref","unstructured":"Bowers L. James K. Quirk A. Simpson A. Sugar Stewart D. Hodsoll J. (2015). Reducing conflict and containment rates on acute psychiatric wards: The safewards cluster randomized controlled trial. International Journal of Nursing Studies 52(9) 1412\u20131422. https:\/\/doi.org\/10.1016\/j.ijnurstu.2015.05.001","DOI":"10.1016\/j.ijnurstu.2015.05.001"},{"key":"e_1_3_3_4_1","unstructured":"Centers for Medicare and Medicaid Services. (2020). State operations manual: Appendix A\u2014Survey protocol regulations and interpretive guidelines for hospitals. https:\/\/www.cms.gov\/Regulations-and-Guidance\/Guidance\/Manuals\/downloads\/som107ap_a_hospitals.pdf"},{"key":"e_1_3_3_5_1","doi-asserted-by":"crossref","unstructured":"Chapin J. Koller C. D. (2022). Are healthcare professionals optimistic about workplace violence?. The Online Journal of Issues in Nursing 27(3). https:\/\/www.doi.org\/10.3912\/OJIN.Vol27No03PPT41","DOI":"10.3912\/OJIN.Vol27No03PPT41"},{"key":"e_1_3_3_6_1","doi-asserted-by":"crossref","unstructured":"Chieze M. Hurst S. Kaiser S. Sentissi O. (2019). Effects of seclusion and restraint in adult psychiatry: A systematic review. Frontiers in Psychiatry 10 491. https:\/\/doi.org\/10.3389\/fpsyt.2019.00491","DOI":"10.3389\/fpsyt.2019.00491"},{"key":"e_1_3_3_7_1","doi-asserted-by":"crossref","unstructured":"Du M. Wang X. Yin S. Shu W. Hao R. Zhao S. Rao H. Yeung W. L. Jayaram M. B. Xia J. (2017). De-escalation techniques for psychosis-induced aggression or agitation. The Cochrane Database of Systematic Reviews 4(4) CD009922. https:\/\/doi.org\/10.1002\/14651858.CD009922.pub2","DOI":"10.1002\/14651858.CD009922.pub2"},{"key":"e_1_3_3_8_1","doi-asserted-by":"crossref","unstructured":"Fletcher J. Spittal M. Brophy L. Tibble H. Kinner S. Elsom S. Hamilton B. (2017). Outcomes of the Victorian safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement. International Journal of Mental Health Nursing 26(5) 461\u2013471. https:\/\/doi.org\/10.1111\/inm.12380","DOI":"10.1111\/inm.12380"},{"key":"e_1_3_3_9_1","doi-asserted-by":"crossref","unstructured":"Gaynes B. N. Brown C. L. Lux L. J. Brownley K. A. Van Dorn R. A. Edlund M. J. Coker-Schwimmer E. Weber R. P. Sheitman B. Zarzar T. Viswanathan M. Lohr K. N. (2017). Preventing and de-escalating aggressive behavior among adult psychiatric patients: A systematic review of the evidence. Psychiatric Services 68(8) 819\u2013831. https:\/\/doi.org\/10.1176\/appi.ps.201600314","DOI":"10.1176\/appi.ps.201600314"},{"key":"e_1_3_3_10_1","doi-asserted-by":"crossref","unstructured":"Hawsawi T. Power T. Zugai J. Jackson D. (2020). Nurses\u2019 and consumers\u2019 shared experiences of seclusion and restraint: A qualitative literature review. International Journal of Mental Health Nursing 29(5) 831\u2013845. https:\/\/doi.org\/10.1111\/inm.12716","DOI":"10.1111\/inm.12716"},{"key":"e_1_3_3_11_1","volume-title":"Six core strategies\u00a9: Preventing violence, conflict and the use of seclusion and restraint in inpatient behavioral health settings. An evidence-based practice curriculum training","author":"Huckshorn K. A.","year":"2024","unstructured":"Huckshorn K. A., LeBel J. (Eds.) (2024). Six core strategies\u00a9: Preventing violence, conflict and the use of seclusion and restraint in inpatient behavioral health settings. An evidence-based practice curriculum training. Originally developed with the National Association of State Mental Health Program Directors (2002\u20132009). All rights apply to use of these author edited and copywritten materials."},{"key":"e_1_3_3_12_1","unstructured":"Medicare. (n.d.). Hospital compare: Psychiatric unit services. https:\/\/www.medicare.gov\/care-compare\/"},{"key":"e_1_3_3_13_1","unstructured":"Occupational Safety and Health Administration. (n.d). Workplace violence. https:\/\/www.osha.gov\/workplace-violence"},{"key":"e_1_3_3_14_1","unstructured":"Public Services Health and Safety Association (PSHSA). (2017). EMS violence assessment tool. https:\/\/workplace-violence.ca\/wp-content\/uploads\/2021\/04\/VPRASCEN0417-EMS-Violence-Assessment-Tool-V1.3-2021.04.27.docx"},{"key":"e_1_3_3_15_1","doi-asserted-by":"crossref","unstructured":"Putkonen A. Kuivalainen S. Louheranta O. Repo-Tiihonen E. Ryyn\u00e4nen O. P. Kautiainen H. Tiihonen J. (2013). Cluster-randomized controlled trial of reducing seclusion and restraint in secured care of men with schizophrenia. Psychiatric Services 64(9) 850\u2013855. https:\/\/doi.org\/10.1176\/appi.ps.201200393","DOI":"10.1176\/appi.ps.201200393"},{"issue":"4","key":"e_1_3_3_16_1","first-page":"465","article-title":"Restraint and seclusion in psychiatric treatment settings: Regulation, case law, and risk management","volume":"39","author":"Recupero P. R.","year":"2011","unstructured":"Recupero P. R., Price M., Garvey K. A., Daly B., Xavier S. L. (2011). Restraint and seclusion in psychiatric treatment settings: Regulation, case law, and risk management. The Journal of the American Academy of Psychiatry and the Law, 39(4), 465\u2013476.","journal-title":"The Journal of the American Academy of Psychiatry and the Law"},{"key":"e_1_3_3_17_1","doi-asserted-by":"crossref","unstructured":"Sacks M. H. Walton M. F. (2014). Seclusion and restraint as measures of the quality of hospital care: Any exceptions?. Psychiatric Services 65(11) 1373\u20131375. https:\/\/doi.org\/10.1176\/appi.ps.201300577","DOI":"10.1176\/appi.ps.201300577"},{"key":"e_1_3_3_18_1","doi-asserted-by":"crossref","unstructured":"Staggs V. S. (2020). Variability in psychiatric facility seclusion and restraint rates as reported on hospital compare site. Psychiatric Services 71(9) 893\u2013898. https:\/\/doi.org\/10.1176\/appi.ps.202000011","DOI":"10.1176\/appi.ps.202000011"},{"key":"e_1_3_3_19_1","doi-asserted-by":"crossref","unstructured":"Svensson J. (2022). Patient safety strategies in psychiatry and how they construct the notion of preventable harm: A scoping review. Journal of Patient Safety 18(3) 245\u2013252. https:\/\/doi.org\/10.1097\/PTS.0000000000000885","DOI":"10.1097\/PTS.0000000000000885"},{"key":"e_1_3_3_20_1","unstructured":"The Joint Commission. (2020). Physical hold versus restraint or seclusion: What is the difference between seclusion\/restraint and physical holding of children\/youth? https:\/\/www.jointcommission.org\/standards\/standard-faqs\/behavioral-health\/care-treatment-and-services-cts\/000002269\/#:~:text=Seclusion%20%2D%20Involuntary%20confinement%20of%20an is%20physically%20prevented%20from%20leaving."},{"key":"e_1_3_3_21_1","doi-asserted-by":"crossref","unstructured":"Vandamme A. Wullschleger A. Garbe A. Cole C. Heinz A. Bermpohl F Mielau J. Mahler L. Montag C. (2021). The role of implicit and explicit staff attitudes in the use of coercive measures in psychiatry. Frontiers in Psychiatry 12 699446. https:\/\/doi.org\/10.3389\/fpsyt.2021.699446","DOI":"10.3389\/fpsyt.2021.699446"},{"key":"e_1_3_3_22_1","doi-asserted-by":"crossref","unstructured":"Wieman D. A. Camacho-Gonsalves T. Huckshorn K. A. Leff S. (2014). Multisite study of an evidence-based practice to reduce seclusion and restraint in psychiatric inpatient facilities. Psychiatric Services 65(3) 345\u2013351. https:\/\/doi.org\/10.1176\/appi.ps.201300210","DOI":"10.1176\/appi.ps.201300210"}],"container-title":["Journal of the American Psychiatric Nurses Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10783903251338043","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10783903251338043","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10783903251338043","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T19:44:44Z","timestamp":1777491884000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10783903251338043"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,26]]},"references-count":21,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1177\/10783903251338043"],"URL":"https:\/\/doi.org\/10.1177\/10783903251338043","relation":{},"ISSN":["1078-3903","1532-5725"],"issn-type":[{"value":"1078-3903","type":"print"},{"value":"1532-5725","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,26]]}}}