Assessing behavioral coping preferences of psychiatric inpatients: a pilot study

Recently there has been increased concern about excessive restraint and seclusion on inpatient psychiatric units and the resulting injuries and deaths. Individual crisis management strategies may be one way to reduce restraint and seclusion, which may include active engagement of inpatients in behavioral coping plans.

We developed a 5-question Coping Agreement Questionnaire (CAQ) asking inpatients for their preferences on how to prevent loss of control if they become agitated. Nurses completed the CAQ with each patient to find alternatives to restraint and seclusion. A total of 264 admissions were reviewed, with the following diagnoses: mood disorders (n = 111 [42%]), schizophrenia or other psychotic disorders (n = 69 [26%]), or substance use disorders (n = 58 [22%]). One hundred thirty-seven patients (52%) were male.

Many CAQ answers differed by diagnosis, sex, age, and ethnicity. For example, when asked how staff could help if they were about to lose control, all groups rated "talk with me" highly, although substance abusers preferred to "sit by self in room." Adolescent patients were more often upset by not having visitors, whereas elderly patients reported being upset by having visitors. Overall, white patients gave more answers to CAQ questions than did black or Hispanic patients.

The findings have implications for practice on 3 levels. First, overall implications for the milieu were suggested by patients' preferences. Second, responses that differed by group suggested that optimal case management strategies may vary according to population characteristics. Third, patients may be engaged on the basis of individual preferences as active partners in managing their behavior during inpatient hospitalization.