Overcoming the Use of Mechanical Restraints in Psychiatry: A New Challenge in the Everyday Clinical Practice at the Time of COVID-19

Berardis, Domenico De; Ventriglio, Antonio; Fornaro, Michele; Vellante, Federica; Martinotti, Giovanni; Fraticelli, Silvia; Giannantonio, Massimo Di

doi:10.3390/jcm9113774

Cited by 6 publications

(5 citation statements)

References 43 publications

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“…Numerous studies have demonstrated the benefits of managing violent situations or agitated patients by means of verbal de-escalation techniques (Berring et al 2016;Cusack et al 2016;Fern andez-Costa et al 2020;Garriga et al 2016;Hallett & Dickens 2015, 2017Jury et al 2019;Kuivalainen et al 2017;Lavelle et al 2016;Mavandadi et al 2016;McKeown et al 2019;Price et al 2015Price et al , 2018Richmond et al 2012). In addition to the reduced intervention time, other authors have described the following benefits: (i) avoiding violence and preventing harm without having to resort to mechanical restraint or isolation (Fern andez-Costa et al 2020;Jury et al 2019), (ii) verbal de-escalation helps nurses develop better relationships with their patients (Garriga et al 2016), increasing self-esteem, and job satisfaction (Cowin et al 2004;De Berardis et al 2020;Price et al 2018), (iii) verbal de-escalation is less time-consuming than the process of mechanical restraint and involuntary medication (Richmond et al 2012).…”

Section: Introductionmentioning

confidence: 99%

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Relationship between nurses' use of verbal de‐escalation and mechanical restraint in acute inpatient mental health care: a retrospective study

Pérez‐Toribio

Poyato

Lluch‐Canut

et al. 2021

Int J Mental Health Nurs

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Although the use of verbal de-escalation in nursing has been shown to be an effective tool for controlling agitation and avoiding mechanical restraint, there is scarce evidence supporting the use of de-escalation by nurses and factors related to the patients who ultimately receive mechanical restraint. This retrospective study sought to examine the relationship between the use of verbal de-escalation by nurses and the clinical profile of patients who had received mechanical restraint at an acute mental health unit. This study analysed the records of patients who had received mechanical restraint between the years 2012 and 2019. A bivariate analysis was initially performed, followed by multiple logistic regression analysis. A total of 493 episodes of restraint were recorded. Of these, in almost 40% of cases, no prior use of verbal de-escalation was noted. The factors associated with the use of verbal de-escalation by nurses were patients with a history of restraint episodes and patients who previously had been administered medication. Furthermore, episodes of mechanical restraint that occurred later during the admission were also associated with the use of de-escalation. These findings confirm the relevance of early nurse interventions. Consequently, it is important to establish an adequate therapeutic relationship from

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Section: Introductionmentioning

confidence: 99%

“…2004; De Berardis et al . 2020; Price et al . 2018), (iii) verbal de‐escalation is less time‐consuming than the process of mechanical restraint and involuntary medication (Richmond et al .…”

Section: Introductionmentioning

confidence: 99%

Relationship between nurses' use of verbal de‐escalation and mechanical restraint in acute inpatient mental health care: a retrospective study

Pérez‐Toribio

Poyato

Lluch‐Canut

et al. 2021

Int J Mental Health Nurs

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“…Recently, de-escalation techniques to manage aggressive behaviors have been provided: always respect the personal space of the patient while maintaining a protected position with the possibility to escape, do not be provoking or offensive, create verbal contact and do not often make eye contact, be concise and communicate clearly, recognize patients' needs and feelings, pay attention to what the patient is saying without lying to them, agree or agree to disagree with the patient's thoughts and sensations, lay down the law and set clear and definite confines, propose sincerely the patient's choices and try to gain their trust, debrief the subject and the staff after the de-escalation [12]. Furthermore, in terms of diagnosis and severe psychopathological conditions, aggressive behaviors are often detectable and MR could be limited and prevented with the use of adequate pharmacological treatment, especially because the first three days are related to the highest prevalence rates of aggressive behaviors [45].…”

Section: Discussionmentioning

confidence: 99%

“…This traumatic event is a very rare phenomenon; however, permanent lesions (of the wrist, legs, nerves), respiratory distress, venous thromboembolism, deep vein thrombosis, especially if the MR is prolonged, could frequently occur. Furthermore, patients report decreased self-esteem and empowerment, strong feelings of humiliation, as well as loss of trust in healthcare personnel [11,12].…”

Section: Introductionmentioning

confidence: 99%

Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables

Aguglia,

Corsini,

Berardelli

et al. 2023

Medicina

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Background and Objectives: mechanical restraint (MR) is a controversial issue in emergency psychiatry and should be better studied to implement other alternative therapeutic interventions. The aim of this study was to estimate the prevalence of MR in an Italian psychiatric unit and identify the sociodemographic and clinical characteristics as well as the pharmacological pattern associated with MR. Materials and Methods: all subjects (N = 799) consecutively admitted to an Italian psychiatric inpatient unit were recruited. Several sociodemographic and clinical characteristics were recorded. Results: The prevalence of MR was 14.1%. Males, a younger age, and a single and migrant status were associated with the MR phenomenon. MR was more prevalent in patients affected by other diagnoses and comorbid illicit substance use, in patients with aggressive behaviors, and those that were involuntary admitted, leading significantly to hospitalization over 21 days. Furthermore, the patients that underwent MR were taking a lower number of psychiatric medications. Conclusions: Unfortunately, MR is still used in emergency psychiatry. Future research should focus on the dynamics of MR development in psychiatry, specifically considering ward- and staff-related factors that could help identify a more precise prevention and alternative intervention strategies.

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“…However, it is currently unknown whether R/S intervention use changed in other clinical settings, such as EDs, which saw dramatic changes in service provision during the pandemic [4,[10][11][12]. Similarly, existing research has focused solely on R/S use for patients with MH issues [33][34][35][36][37][38][39][40][41], despite the fact that SU-related concerns increased on par with MH-related concerns during the pandemic [19][20][21][22][23][24][25][26] and are a known risk factor for the use of R/S interventions [42,43].…”

Section: Current Studymentioning

confidence: 99%

The impact of the COVID-19 pandemic on the use of restraint and seclusion interventions in Ontario emergency departments: A population-based study

Weissflog,

Kim,

Rajack

et al. 2024

PLoS ONE

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While COVID-19 impacted all aspects of health care and patient treatment, particularly for patients with mental health/substance use (MH/SU) concerns, research has suggested a concerning increase in the use of restraint and seclusion (R/S) interventions, although results vary depending on facility type and patient population. Thus, the present study sought to explore COVID-related changes in the use of R/S interventions among patients presenting to Ontario emergency departments (EDs) with MH/SU complaints. To determine whether temporal and clinical factors were associated with changes in R/S use during COVID, binary logistic regression models were computed using data from the National Ambulatory Care Reporting System database. We then compared both prevalence rates and probability of an R/S event occurring during an ED visit in Ontario before and after the onset of COVID. The number of ED visits during which an R/S event occurred for patients presenting with MH/SU concerns increased by 9.5%, while their odds of an R/S event occurring during an ED visit increased by 23% in Ontario after COVID onset. Similarly, R/S event probability increased for patients presenting with MH/SU concerns after COVID onset (0.7% - 21.3% increase), particularly during the first wave, with the greatest increases observed for concerns associated with increased restraint risk pre-COVID. R/S intervention use increased substantially for patients presenting to Ontario EDs with MH/SU concerns during the first wave of COVID when the strain on healthcare system and uncertainty about the virus was arguably greatest. Patients with concerns already associated with increased R/S risk also showed the largest increases in R/S probability, suggesting increased behavioural issues during treatment among this population after COVID onset. These results have the potential to inform existing policies to mitigate risks associated with R/S intervention use during future public health emergencies and in general practice.

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Overcoming the Use of Mechanical Restraints in Psychiatry: A New Challenge in the Everyday Clinical Practice at the Time of COVID-19

Abstract: Restraining interventions, which comprise physical (PR) and mechanical restraint (MR), have a long history in mental health services [...]

Cited by 6 publications

References 43 publications

Relationship between nurses' use of verbal de‐escalation and mechanical restraint in acute inpatient mental health care: a retrospective study

Relationship between nurses' use of verbal de‐escalation and mechanical restraint in acute inpatient mental health care: a retrospective study

Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables

The impact of the COVID-19 pandemic on the use of restraint and seclusion interventions in Ontario emergency departments: A population-based study

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