Decreasing the Use of Restraint and Seclusion Among Psychiatric Inpatients

Hellerstein, David J.; Staub, Amy Bennett; Lequesne, Elizabeth

doi:10.1097/01.pra.0000290669.10107.ba

Cited by 49 publications

(58 citation statements)

References 45 publications

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“…There was no significant change in one study (45), while another study showed an apparent increase (29). Three studies found reduced total 1 4 hours in restraints (24,28,35) while one found no significant change (36). The evidence was mixed for mean time in restraint.…”

Section: Restraintmentioning

confidence: 87%

“…All three studies reporting the number of patients restrained found no reductions (36,40,46). Restraint episodes, often averaged by month and/or patient, were the most common outcome measure and almost all the studies using it reported a reduction (30,32,37,40,43,44,48).…”

Section: Restraintmentioning

confidence: 99%

“…The training content tended to focus on aspects of crisis intervention or non-violent interventions as alternative to restraint, such as de-escalation techniques (26)(27)(28)(31)(32)(33)(34)(35)(36)(37)(38) or aspects of violence awareness or risk assessment (24,36,37,39). One study reported that requirements for staff training had been formalised but provided no details (20).…”

Section: Staff Trainingmentioning

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: Restraintmentioning

confidence: 87%

Section: Restraintmentioning

confidence: 99%

Section: Staff Trainingmentioning

confidence: 99%

Section: Review Proceduresmentioning

confidence: 99%

See 2 more Smart Citations

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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“…Ces derniers sont variés, on rapporte des échecs (Crenshaw et al, 1997). (Keski-Valkama et al, 2007) et des succès (Smith et al, 2005 ;Hellerstein et al, 2007). L'analyse des facteurs expliquant ces résultats incohérents occupe une place significative dans les articles cités ici.…”

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Les droits du patient : une menace pour les soignants ?

Keating

2010

smq

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Au cours des dernières années, les groupes de défense des droits des personnes atteintes de troubles mentaux ont obtenu des résultats importants dont l’adoption de politiques de réduction des mesures d’isolement et de contention. Ces politiques témoignent d’un consensus à l’effet que la coercition doit être utilisée uniquement en dernier recours et dans des circonstances exceptionnelles. L’attention grandissante sur les droits des personnes ayant un problème de santé mentale suscite des réactions qui sont très peu abordées dans la littérature. En effet, il n’est pas rare d’entendre les soignants se demander si les patients ne jouissent pas de plus de droits qu’eux-mêmes. Cet article examine cette interrogation de deux perspectives : d’une part, l’auteur tente de cerner ce qu’elle traduit de l’expérience des soignants, d’autre part il identifie les enjeux éthiques et juridiques des politiques des programmes de réduction des mesures d’isolement et de contention.

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