Seclusion with or without restraint is a measure used to manage patients with challenging behaviours. Although controversial, the intervention remains poorly documented, especially in Canadian psychiatric hospitals. The purpose of this study is to assess the prevalence of the measure and identify any correlated demographic characteristics and psychiatric disorders. Episodes of seclusion with or without restraint were extracted from a computerized, hospital-based system introduced specifically to track such interventions. Of 2721 patients hospitalized during that time, 23.2% (n = 632) were secluded with or without restraint, and 17.5% (n = 476) were secluded with restraint. Younger age, schizophrenia or other psychosis, bipolar and personality disorder, and longer stay in hospital are predictors of an episode of seclusion with or without restraint. Younger age, bipolar and personality disorders and a longer stay in hospital are predictors of an episode of seclusion with restraint. For patients who spent longer in seclusion and under restraint, there is a positive association with longer stay in hospital. In this inpatient psychiatric facility, seclusion with or without restraint thus appears to be common. More research is warranted to better identify the principal factors associated with seclusion and restraint and help reduce resort to these measures.

This study explores and describes nursing interventions performed during episodes of seclusion with or without restraint in a psychiatric facility and examines the relationship between the interventions' local protocols and best-practice guidelines. Twenty-four nurses working in a psychiatric facility were interviewed about the nursing interventions they performed before, during, and after an episode of seclusion with or without using restraint. Analysis of the data reveals that the interventions meet quality standards. However, nursing practice would be further refined by conducting post-event reviews, especially by discussing how a client's aggressive behaviour is to be understood.

The purpose of this study is to describe the nursing practices recorded in reports of patient episodes of seclusion, with or without restraints, in a specialized psychiatric facility in Quebec. The reports for all adult patients secluded (n = 4863) in a psychiatric unit between April 1, 2007 and March 31, 2009, were examined. Descriptive analyses were performed. The main reasons for seclusion were agitation, disorganization, and aggressive behaviour. The alternative methods that were attempted included stimulus reduction, extra medication, and working with the patient to find a solution. Few families were notified about their relation's seclusion. More hours of seclusion were reported in the evening and at night. Our results are comparable to those obtained by other investigators. Some of the variables have not been the subject of much research: for example, health conditions during seclusion with or without restraint and partnerships with family members. Our findings also suggest that, in their analyses, studies should differentiate between cognitive-impairment and adult-psychiatry units as well as long-term seclusion and short-term seclusion. The information reported by the nurse makes no distinction between short-stay and long-stay adult psychiatric units. Only one psychiatric facility was investigated in this study, precluding generalization.

OBJECTIVES: To validate the economic advantages of Mirena, a new hormone releasing contraceptive system that can be inserted in the uterus for 5 years, compared to oral contraceptives (OC) in Canada. Mirena and OC offer equivalent contraceptive efficacy with a similar safety profile. METHODS: A cost‐minimization analysis with a third‐party payer perspective and a 5‐year horizon. Three major scenarios were analysed. In the first scenario, only the drug acquisition cost of both treatments was used. Mean cost of OC was calculated based on the amount reimbursed in the April 2000 list of the Régie de l'assurance‐maladie du Québec (RAMQ). In the second scenario, the pharmacy's dispensing fee (Quebec RAMQ fee) was added. In the third scenario, real‐life conditions of use of Mirena were applied, i.e. an expulsion rate of 6% and estimated continuation rate of 56% and 65% after 5 years. Sensitivity analysis was performed on OC cost using the lowest and highest costs from the RAMQ list. Discounting was performed at 0%, 3% and 5% over 65 time‐periods (13 cycles × 5 years) for OC. No discount rate was applied to Mirena since acquisition cost is paid once at treatment start. RESULTS: The mean cost of an OC is determined to be $11 per cycle, while drug acquisition cost of Mirena is $290. All scenarios favour Mirena. With a 5% discount rate, Mirena offered a mean saving of $346 over 5 years. When the pharmacist's dispensing fee was included Mirena offered a mean saving of $750. In real life conditions, with a 5% discount rate, the use of Mirena resulted in a mean saving of at least 30% (i.e., between $194 and $221). CONCLUSION: Mirena represents a less expensive alternative to long‐term contraception when compared to OC and this, in all proposed scenarios.