Clinical and demographic characteristics of secluded and mechanically restrained mentally ill patients: a retrospective study

Abstract

BackgroundRestraint or seclusion measures in acute psychiatric care are used as a last resort when all other methods for removal of physical threat have failed. The purpose of this study is to find a correlation between coercive measures, demographic characteristics within this patient group, and factors associated with shortened periods of restriction.MethodsThis is a one-year retrospective study conducted in a male acute closed ward of a psychiatric hospital in Israel. The data from January 1, 2014 to December 31, 2014 were retrieved from the records of patients who underwent restraint and/or seclusion interventions during this period. The analyzed data included age, psychiatric diagnosis, marital status, education, race, ethnicity, length of hospital stay, legal status during admission, type of coercive measure (mechanical restraint, seclusion), number and duration of coercive episodes, reasons for coercion, time of event, number of previous hospitalizations, aggression in past and present treatment, and treatment during events.ResultsDuring this time period, there were 563 admissions in the study ward. Over this period, 176 subjects (31.3%) underwent 488 restraints and/or seclusions. 98% were aggressive in the past. (Although some results reached statistical significance, we prefer to emphasize here only the most important results, while the others will be presented in the text.) Patients with personality disorders were physically limited for the longest time, while schizophrenia patients were restricted for the shortest time compared with other diagnoses (p = 0.007). A negative correlation was found between the length of coercion and the number of academic female nurses on duty (p = 0.005), as well as the administration of sedative medications during the restricting procedure.ConclusionsWe believe that the presence of registered, academic female nurses on duty and medication administration during coercive measures can reduce the length of restriction.

Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review

“…These results are consistent with the recent literature that reports associations between schizophrenic or organic mental disorders and risk of use of seclusion (81) and coercive measures generally (8, 22, 82). Martin et al and Miodownik et al found an augmented risk of seclusion and restraint for patients with schizophrenic disorders (83, 84), and Beghi et al an increase of restraint for the same diagnoses (27). These associations have implications in clinical practice: psychotic disorders are known to often be chronic and associated with recurrent decompensation.…”

Commentary: seclusion and mechanical restraint of psychiatric patients in Israel - an update

“…They have to deal with life threating situations, conflicting ethical values, changing governmental policies, poor physical conditions of the work place and pressure from the public. In our opinion, one of the main findings of Miodownik et al [12], which is relevant even in light of the changes that occurred since then, is the negative correlation between the length of the use of coercive measures and the presence on the wards of academic nurses (which usually means registered nurses with a baccalaureate degree). Education and training helps staff understand that physical restraint and seclusion should be used only to protect patients and others and not as therapeutic measures by themselves or as punishment.…”

Influence of nursing staff characteristics on seclusion in acute mental health care—A prospective two-year follow-up study

“…The probability of seclusion seems higher in male patients, those of younger age and admitted involuntarily (Beghi, Peroni, Gabola, Rossetti, & Cornaggia, 2013;Bullock, McKenna, Kelly, Furness, & Tacey, 2014;Cullen et al, 2018;Dumais, Larue, Drapeau, Menard, & Giguere Allard, 2011;Flammer, Steinert, Eisele, Bergk, & Uhlmann, 2013;Georgieva, Vesselinov, & Mulder, 2012;Happell & Koehn, 2010;Lay, Nordt, & Rossler, 2011;Miodownik et al, 2019;Thomsen et al, 2017).…”

“…Nurses seem to influence the decision to seclude patients (Laiho et al, 2013). Studies on demographic characteristics of nurses, such as gender and age, or professional characteristics, such as education and work experience, show inconclusive results (Bowers et al, 2010;De Benedictis et al, 2011;de Cangas, 1993;Doedens et al, 2017;Janssen, Noorthoorn, Linge, & Lendemeijer, 2007;Miodownik et al, 2019;Vollema, Hollants, Severs, & Hondius, 2012).…”