An Analysis of Successful Efforts to Reduce the Use of Seclusion and Restraint at a Public Psychiatric Hospital

Donat, Dennis C.

doi:10.1176/appi.ps.54.8.1119

Cited by 113 publications

(101 citation statements)

References 15 publications

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“…When these and other interventions introduced at the hospital were examined together statistically, the revised case review procedure was the only significant predictor of reduced restraint/seclusion (18). The procedures lowered the threshold for review to include lower risk patients and ensured that reviews and modifications to treatment occurred more quickly.…”

Section: Multi-faceted Interventionsmentioning

confidence: 99%

“…In one, a decrease in hospital beds over a decade was accompanied by an increase in staff numbers (30). Two studies from the same state psychiatric hospital found statistically significant correlations between higher staffpatient ratios and lower use of seclusion and restraint (15,18). One study reported the introduction of a staff roster system to enable nurses to work with a variety of patients in order to reduce burnout associated with continuous work with acutely unwell patients (31).…”

Section: Staffingmentioning

confidence: 99%

“…This included structural reviews of restraint and seclusion and progress with the intervention programme through regular team meetings (35,37), or senior staff reviewing and monitoring the frequency of restraint and seclusion cases (15,18,36,38).…”

Section: Review Proceduresmentioning

confidence: 99%

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A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

Stewart

Merwe

Bowers

et al. 2010

Issues in Mental Health Nursing

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link ObjectiveThis review examines nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients. MethodElectronic searches were conducted to locate post-1960 empirical studies of restraint and seclusion reduction in English. A total of 36 studies were identified, mostly from the USA. Analysis was conducted using a structured data extraction tool. ResultsThe majority of studies reported reduced levels or mechanical restraint and/or seclusion, but the standard of evidence was poor. There were no randomised trials.Most were retrospective studies of official records before and after the intervention was introduced, with varying follow-up periods. The interventions were diverse, but tended to include one or more of the following: new restraint and/or seclusion policies, staffing changes, staff training, review procedures and crisis management initiatives. The research was unable to address which of these elements was most effective. There was also evidence that some improved outcomes were achieved by substituting restraint or seclusion for each other or for alternatives forms of containment (medication in particular). Nurses' attitudes, skills and approach to patient care were absent from the literature. Conclusions 3Interventions probably can reduce the use of restraint and seclusion, but better designed research is required to demonstrate their effectiveness conclusively. More attention should also be paid to understanding how interventions work, particularly from the perspective of nursing staff. This is essential to the successful implementation of restraint and seclusion interventions across different psychiatric settings and treatment populations.4

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Section: Multi-faceted Interventionsmentioning

confidence: 99%

Section: Staffingmentioning

confidence: 99%

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A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

Stewart

Merwe

Bowers

et al. 2010

Issues in Mental Health Nursing

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“…Staffing levels are a long standing and an important concern in some forensic psychiatric hospitals (Arboleda-Fl orez 2006; Livingston 2006;Way et al 1990). Increasing staff-to-patient ratios, and investing in staff education on alternative behavioural management techniques, decreased violent incidents, and SR use; attention to staff-to-patient ratio may help some forensic regimes reduce their SR incidence (Donat 2003;Donovan et al 2003;Morrison et al 2002). Like clinicians have a parens patriae duty towards their patients and clients, so do organisations towards their staff members.…”

Section: Ecological Factorsmentioning

confidence: 99%

Coercion in Forensic Healthcare: A North American Perspective

Brink

Goossens

2016

The Use of Coercive Measures in Forensic Psychiatric Care

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The debate concerning non-consensual, or coerced, forensic mental healthcare continues to engage clinicians, scholars, lawyers, decision makers, bio-ethicists, and the judiciary across Canada and the United States. This chapter reviews and discusses the theoretical, clinical, legal, and ethical aspects of seclusion and restraint practices in forensic psychiatric hospital settings and reports the results from empirical studies. The chapter also discusses the provisions for involuntary treatment in mental health legislation, specialty courts, and compulsory community based treatment and supervision models.

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“…Administrative and staffing changes, specifically increases in the ratio of staff to service users, have also been shown to reduce the use of seclusion and restraint. Donat [106][107][108] found that changes at these levels reduced use by up to 75%.…”

Section: Coercion In Services and Treatmentmentioning

confidence: 99%

Directions for Future Patient-Centered and Comparative Effectiveness Research for People With Serious Mental Illness

Green¹,

Estroff²,

Yarborough³

et al. 2014

Schizophrenia Bulletin

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An Analysis of Successful Efforts to Reduce the Use of Seclusion and Restraint at a Public Psychiatric Hospital

Abstract: The results of this analysis underscore the importance of clinical and administrative priorities in efforts to reduce the use of seclusion and restraint in public psychiatric hospitals.

Cited by 113 publications

References 15 publications

A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

Coercion in Forensic Healthcare: A North American Perspective

Directions for Future Patient-Centered and Comparative Effectiveness Research for People With Serious Mental Illness

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