Construct validity of the Mechanical Restraint – Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument.

Lea Deichmann Nielsen, Per Bech, Lise Hounsgaard, Frederik Gildberg

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: A new short-term risk assessment instrument, the Mechanical Restraint–Confounders, Risk, Alliance Score (MR–CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists’ etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient’s readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR–CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR–CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR–CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient’s readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR–CRAS among clinicians at closed forensic mental health inpatient units. MR–CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.

Original languageEnglish
JournalNordic Journal of Psychiatry
Volume73
Issue number6
Pages (from-to)331-339
ISSN0803-9488
DOIs
Publication statusPublished - 18. Aug 2019

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Mental Health
Nurses
Inpatients
Checklist
Psychometrics
Language
Delivery of Health Care

Keywords

  • Forensic psychiatry
  • forensic mental health
  • mechanical restraint
  • physical restraint
  • risk assessment

Cite this

@article{7f2efc2836a843c8a0cc97c28b25e666,
title = "Construct validity of the Mechanical Restraint – Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument.",
abstract = "Background: A new short-term risk assessment instrument, the Mechanical Restraint–Confounders, Risk, Alliance Score (MR–CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists’ etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient’s readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR–CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR–CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR–CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient’s readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR–CRAS among clinicians at closed forensic mental health inpatient units. MR–CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.",
keywords = "Forensic psychiatry, forensic mental health, mechanical restraint, physical restraint, risk assessment",
author = "Nielsen, {Lea Deichmann} and Per Bech and Lise Hounsgaard and Frederik Gildberg",
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Construct validity of the Mechanical Restraint – Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument. / Nielsen, Lea Deichmann; Bech, Per; Hounsgaard, Lise; Gildberg, Frederik.

In: Nordic Journal of Psychiatry, Vol. 73, No. 6, 18.08.2019, p. 331-339.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Construct validity of the Mechanical Restraint – Confounders, Risk, Alliance Score (MR-CRAS): a new risk assessment instrument.

AU - Nielsen, Lea Deichmann

AU - Bech, Per

AU - Hounsgaard, Lise

AU - Gildberg, Frederik

PY - 2019/8/18

Y1 - 2019/8/18

N2 - Background: A new short-term risk assessment instrument, the Mechanical Restraint–Confounders, Risk, Alliance Score (MR–CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists’ etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient’s readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR–CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR–CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR–CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient’s readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR–CRAS among clinicians at closed forensic mental health inpatient units. MR–CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.

AB - Background: A new short-term risk assessment instrument, the Mechanical Restraint–Confounders, Risk, Alliance Score (MR–CRAS) checklist, including three subscales with altogether 18 items, has been developed in close collaboration with forensic mental health nurses, psychiatrists’ etc., and shows evidence of being comprehensible, relevant, comprehensive and easy to use for assessing the patient’s readiness to be released from mechanical restraint. Aim: The aim of this study was to investigate whether the subscales: confounders, risk and parameters of alliance constituted separate subscales and needed further revisions. Materials and methods: MR–CRAS was field-study tested among nurses, nurse assistants and social and health care assistants in 13 Danish closed forensic mental health inpatient units, and a Mokken analysis of scalability and a Spearman correlation analysis were performed. Results: MR–CRAS was completed by clinicians in 143 episodes of mechanical restraint, representing 88 patients, with a mean duration of 63.25 hours. Most patients were younger men, diagnosed within the schizophrenia spectrum. One-third of the patients had repeated mechanical restraint episodes ranging between 2 and 8 episodes. MR–CRAS and especially the parameters of alliance were perceived as usable for assessment of the patient’s readiness to be released from mechanical restraint. The psychometric analyses showed that the three subscales were unidimensional. Conclusions: The study shows evidence of the construct validity of MR–CRAS among clinicians at closed forensic mental health inpatient units. MR–CRAS contributes with a common language and structured, systematic and transparent observations and assessments on an hour by hour basis during mechanical restraint.

KW - Forensic psychiatry

KW - forensic mental health

KW - mechanical restraint

KW - physical restraint

KW - risk assessment

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DO - 10.1080/08039488.2019.1634757

M3 - Journal article

VL - 73

SP - 331

EP - 339

JO - Nordic Journal of Psychiatry

JF - Nordic Journal of Psychiatry

SN - 0803-9488

IS - 6

ER -