Reducing Restraints: Alternatives to Restraints on an Inpatient Psychiatric Service?Utilizing Safe and Effective Methods to Evaluate and Treat the Violent Patient

Sullivan, Ann M.; Bezmen, Janet; Barron, Charles; Rivera, James J.; Curley-Casey, Linda; Marino, Dominic J.

doi:10.1007/s11089-005-5581-3

Cited by 72 publications

(89 citation statements)

References 8 publications

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“…For example, one study of a hospital in New York reported reductions in restraint/seclusion despite the 'one hour rule' (reassessment of a patients within one hour of initiating restraint or seclusion) and other regulations being in place for some time before a range of interventions were introduced (26). In another study, JCAHO standards were introduced in the middle of the study period, but did not appreciably contribute to the already reduced levels of restraint/seclusion episodes (27).…”

Section: Changes In State or Local Policymentioning

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%

“…Alternatively, reviews were patient specific and intended to reduce the chances of restraint or seclusion episodes occurring again for these individuals (26,32,33). In one case this review was conducted by the nurse during the seclusion or restraint episode and was accompanied by a later review of documentation (19).…”

Section: Review Proceduresmentioning

confidence: 99%

“…Significant reductions in seclusion were reported but not restraint. Two 1 2 successful interventions involved identifying personal stress triggers and methods of managing agitation or anger (26,34). Another study reported the use of nursing led anger management plans for the most high risk patients only (29).…”

Section: Crisis Managementmentioning

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: Changes In State or Local Policymentioning

confidence: 99%

Section: Staff Trainingmentioning

confidence: 99%

Section: Review Proceduresmentioning

confidence: 99%

Section: Crisis Managementmentioning

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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“…In clinical psychiatry, the balance between care, security, and abuse is challenging. Thus, there is an overall intention to limit the use of coercion to an absolute minimum, and there is national [1] as well as international [2][3][4] focus on how this can be achieved. Knowledge on factors influencing the use of coercion is mandatory to optimize the situation.…”

Section: Introductionmentioning

confidence: 99%

Use of mechanical and pharmacological restraint over an eight-year period and its relation to clinical factors

Reitan

Helvik

Iversen

2017

Nordic Journal of Psychiatry

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Background: Use of restraint and finding the balance between security and ethics is a continuous dilemma in clinical psychiatry. In daily clinic and in planning health-care service, knowledge on the characteristics of restraint situations is necessary to optimize its use and avoid abuse. Methods: We describe characteristics in the use of pharmacological and mechanical restraint in psychiatric acute wards in a hospital in Middle Norway over an eight-year period. Data on all cases of mechanical and pharmacological restraint from 2004 to 2011 were retrospectively collected from handwritten protocols. Complementary information on the patients was obtained from the hospital patient administrative system. Results: Restraint in acute wards was used on 13 persons per 100,000 inhabitants annually. The percentage of admitted patients exposed to restraint was 1.7%, with a mean of 4.5 cases per exposed patient. Frequency per 100 admitted patients varied from 3.7 (in 2007) to 10 (in 2009). The majority of restraint cases concerned male patients under 50 years and with substance-abuse, psychotic, or affective disorders. Significantly more coercive means were used during daytime compared to night and morning. There was a significant increase in pharmacological coercion during spring and mechanical coercion during summer. Conclusions: Restraint was used on 1.7% of admitted patients, representing 13 per 100,000 inhabitants per year. Use of restraint was higher during certain periods of the day and was associated with the patient's diagnosis, age, gender, and legal status of hospitalization. There was a marked variation over the years.

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Coercive Measures in the Management of Imminent Violence: Restraint, Seclusion and Enhanced Observation

Whittington

Baskind

Paterson

Violence in Mental Health Settings

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First paragraph: Even the most effective prediction techniques will not prevent all aggression in mental health care settings and when deescalation alone (see preceding chapter) is ineffective, staff will make the judgment to move toward more intrusive techniques, alongside continued deescalation, to coerce and ultimately control the patient. Such coercive and physical control is fraught with ethical, moral, and legal dilemmas and can be a potent cause of physical injury and psychological harm in both patients and staff. Once the decision to "up the stakes" has been taken, it is difficult to go back down the ladder of coercive interventions and there is a real risk that incompetent coercion can exacerbate the situation and be highly dangerous to the patient. In this chapter we will consider three things. Firstly, we will examine some of the difficult conceptual, ethical, and legal issues around the use of coercive measures in psychiatry. Secondly we will summarize some key, best practice, guidelines with regard to special observation, physical restraint, and seclusion with reference to the relevant sections of the UK National Institute for Clinical and Health Excellence (NICE) Clinical Practice Guidelines for the management of imminent violence. These guidelines are based on one of the most extensive and thorough appraisals of existing research on this issue. Thirdly, since this is a rapidly evolving area, we will examine recent research emerging in the past two to three years which was not included in the NICE review. Special attention will be paid in this section to two high priority questions: What is the service user perspective on the causes of conflict resulting in coercive measures and the actual experience of undergoing them? And, how can mental health services around the world act to reduce their reliance on seclusion and restraint and develop alternative, less coercive interventions

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Reducing Restraints: Alternatives to Restraints on an Inpatient Psychiatric Service?Utilizing Safe and Effective Methods to Evaluate and Treat the Violent Patient

Cited by 72 publications

References 8 publications

A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients

Use of mechanical and pharmacological restraint over an eight-year period and its relation to clinical factors

Coercive Measures in the Management of Imminent Violence: Restraint, Seclusion and Enhanced Observation

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