Reduction of Episodes of Seclusion and Restraint in a Psychiatric Emergency Service

D’Orio, Barbara; Purselle, David; Stevens, Debbie; Garlow, Steven J.

doi:10.1176/appi.ps.55.5.581

Cited by 57 publications

(48 citation statements)

References 6 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). However, the way in which policy changes translate into practice was not examined by these studies.…”

Section: Changes In State or Local Policymentioning

confidence: 99%

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%

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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“…Extensive efforts have been made in Europe and America over the past decade to assess rates of coercive measures systematically [1][2][3] and to reduce them [4]. D'Orio et al [5], for example, report a 39% reduction in coercion following introduction of a package which included enhanced access to expertise during emergency situations. Involvement in the use of these measures or witnessing their use can be highly distressing for both service users and staff [6][7][8] and few are likely to remain neutral about them.…”

Section: Introductionmentioning

confidence: 99%

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Whittington

Bowers²,

Nolan

et al. 2009

128

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: A cross-sectional design was adopted. The Attitudes to Containment Measures Questionnaire (ACMQ) was completed by 1,361 service users and 1,226 staff in acute care mental health services from three regions of England. This provided evaluation of eleven coercive measures (e.g. seclusion) on six dimensions of approval (e.g. indignity, safety) in a large national sample. Comparisons between groups were tested using independent samples t-tests, χ 2 or Spearman correlations. Permanent repository linkResults: Both service users and staff disapproved strongly of mechanical restraint and expressed a relative preference for compulsory intramuscular medication and seclusion. Male staff, older service users and staff who had been involved in implementing coercion expressed greater approval of coercive measures.Conclusion: Mechanical restraint remains highly objectionable to staff and service users in English mental health services despite its widespread acceptance elsewhere in the world.

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“…The use of counselling/de-escalation is reflective of the value placed on this method, which is regarded as a core skill of nursing staff in reducing the use of restrictive measures (D'Orio, Purselle, Stevens, & Garlow, 2004). The information on PRN use in the present study is important, given the lack of data in this area and questions regarding its efficacy in managing aggressive and disturbed behaviour (Delaney, 2006).…”

Section: Resultsmentioning

confidence: 98%

The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

Muir‐Cochrane

Oster

Gerace

2014

Archives of Psychiatric Nursing

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Reduction of Episodes of Seclusion and Restraint in a Psychiatric Emergency Service

Cited by 57 publications

References 6 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

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

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