Effectiveness of CRSCE-Based De-escalation Training on Reducing Physical Restraint in Psychiatric Hospitals: A Cluster Randomized Controlled Trial

Ye, Junrong; Xia, Zhichun; Wang, Chen; Liao, Yixiang; Xu, Yan; Zhang, Yunlei; Lin, Yongcheng; Li, Sijue; Lin, Jen‐Der; Xiao, Aixiang

doi:10.3389/fpsyt.2021.576662

Cited by 8 publications

(9 citation statements)

References 44 publications

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“…In the updated search (2022), of 2695 hits from the updated search, 29 had theoretical components [ 213 – 241 ], including 4 reviews [ 217 , 218 , 221 , 233 ] and 14 non-maternity controlled studies with at least one measure of verbal or physical abuse [ 242 – 255 ] ( Fig 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Six of these were controlled studies, based in emergency/ITU/critical care[ 246 , 253 , 254 ] inpatient geriatric care [ 243 ]; a youth behavioural unit [ 247 ] and adult psychiatric care [ 255 ]. Three quantitative reviews were included [ 242 , 245 , 252 ] and their reference lists generated five of the included primary studies [ 244 , 248 – 251 ].…”

Section: Resultsmentioning

confidence: 99%

“…Three were reviews [ 242 , 245 , 252 ]. Most studies were set in psychiatric hospitals (n = 20) [ 176 , 177 , 181 – 183 , 185 – 189 , 198 , 200 – 202 , 206 , 217 , 243 , 244 , 247 , 255 ] or elderly care homes (n = 12) [ 174 , 191 – 193 , 195 , 196 , 199 , 203 – 205 , 207 , 209 ]. Other settings included acute and other hospitals (n = 4) [ 118 , 178 – 180 ], intensive care units (ICU) or emergency units (n = 11) [ 175 , 196 , 197 , 212 , 246 , 248 – 250 , 251 , 253 , 254 ], children’s care homes (n = 2) [ 184 , 190 ] and a residential camp (n = 1) [ 210 ].…”

Section: Maternity Studies (N = 58)mentioning

confidence: 99%

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Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care

Downe

Nowland

Clegg

et al. 2023

PLOS Glob Public Health

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Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for ‘othered’ groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against ‘othered’ groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Maternity Studies (N = 58)mentioning

confidence: 99%

See 1 more Smart Citation

Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care

Downe

Nowland

Clegg

et al. 2023

PLOS Glob Public Health

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“…The reduction in the incidence of coercive measures following the non-pharmacological management of aggression has been observed in several cluster randomized trials, but the comparison is limited due to the different methodology of presentation of results. Putkonen et al reported a reduction in the proportion of hospitalization days with the use of restraints in men with severe mental disorders and in forensic patients from 30 to 15% ( 28 ), Abderhalden et al reported a 27% reduction in the incidence of coercive measures following a short-term risk assessment using the Broset Violence Checklist ( 30 ), while Ye et al found a statistically significant decrease in the frequency and duration of PR after de-escalation training ( 35 ). The use of seclusion and restraints is not always associated with aggressive behavior.…”

Section: Discussionmentioning

confidence: 99%

“…The authors emphasized that there is still insufficient evidence to determine the effectiveness of de-escalation for managing aggressive behavior ( 33 ). A recent study published by Ye et al found a reduction in the frequency and duration of physical restraints after de-escalation training in wards at one large psychiatric hospital ( 35 ).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of De-Escalation in Reducing Aggression and Coercion in Acute Psychiatric Units. A Cluster Randomized Study

et al. 2022

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ObjectiveMost guidelines for the management of aggressive behavior in acute psychiatric patients describe the use of de-escalation as the first-choice method, but the evidence for its effectiveness is inconsistent. The aim of the study was to assess the effect of verbal and non-verbal de-escalation on the incidence and severity of aggression and the use of physical restraints in acute psychiatric wards.MethodsA multi-center cluster randomized study was conducted in the acute wards of all psychiatric hospitals in Slovenia. The research was carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. The intervention was implemented after the baseline period and included training in verbal and non-verbal de-escalation techniques for the staff teams on experimental wards.ResultsIn the baseline study period, there were no significant differences in the incidence of aggressive behavior and physical restraints between the experimental and control groups. The incidence rates of aggressive events, severe aggressive events, and physical restraints per 100 treatment days decreased significantly after the intervention. Compared to the control group, the incidence rate of aggressive events was 73% lower in the experimental group (IRR = 0.268, 95% CI [0.221; 0.342]), while the rate of severe events was 86% lower (IRR = 0.142, 95% CI [0.107; 0.189]). During the intervention period, the incidence rate of physical restraints due to aggression in the experimental group decreased to 30% of the rate in the control group (IRR = 0.304, 95% CI [0.238; 0.386]). No reduction in the incidence of restraint used for reasons unrelated to aggression was observed. After the intervention, a statistically significant decrease in the severity of aggressive incidents (p < 0.001) was observed, while the average duration of restraint episodes did not decrease.ConclusionDe-escalation training is effective in reducing the incidence and severity of aggression and the use of physical restraints in acute psychiatric units.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT05166278].

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Restrictive measure reduction in psychiatric wards: A snapshot of China's mental health law reform under the new era of disability rights convention

Chen,

Yao

2024

International Journal of Law and Psychiatry

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Effectiveness of CRSCE-Based De-escalation Training on Reducing Physical Restraint in Psychiatric Hospitals: A Cluster Randomized Controlled Trial

Cited by 8 publications

References 44 publications

Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care

Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care

Effectiveness of De-Escalation in Reducing Aggression and Coercion in Acute Psychiatric Units. A Cluster Randomized Study

Restrictive measure reduction in psychiatric wards: A snapshot of China's mental health law reform under the new era of disability rights convention

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