Least Restrictive Alternatives: Do They Really Work?

Richmond, Ira; Tmjillo, Denese; Schmelzer, Jim; Phillips, Sharon; Davis, D. K.

doi:10.1097/00001786-199610000-00010

Cited by 31 publications

(35 citation statements)

References 0 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: 91%

“…Craig et al (28) found a large reduction in restraint hours a year after implementing a package of restraint reduction measures, but hours of seclusion initially increased despite the explicit intention of preventing this from happening (there was a subsequent decline to much lower levels). A programme of least restrictive alternatives also reduced levels of restraint but time spent in seclusion increased (35). A study of restraint and seclusion over a seven year period showed no reduction in restraint after a programme implementation, but there was a statistically significant decline in seclusion (36).…”

Section: Substitutionmentioning

confidence: 98%

“…The time patients were secluded was reduced in eight studies, whether expressed as total hours (28,36) or averaged by patient and/or month (30,31,37,44,45). However, two studies found no significant change (25,47) and two indicated an increase (29,35) Combined restraint/seclusion Reductions were found for the number of patients restrained/secluded (26,49), duration of confinement (15-19, 21, 23, 41, 50), and episodes of confinement (19,23,26,27,38,50). Only one study reported no significant change in restraint/seclusion hours (47).…”

Section: Seclusionmentioning

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%

See 4 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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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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