Restraint in paediatrics: A delicate balance

Preisz, Anne; Preisz, Paul

doi:10.1111/jpc.14607

Cited by 12 publications

(15 citation statements)

References 22 publications

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“…In our study, the nurses also faced ethical dilemmas, for example, the number of punctures required and sometimes, restraining the child against its will. Children in hospital are a vulnerable group and any restraining should be minimized by good planning and adjusted pain relief methods by the healthcare personnel with focus on the patients dignity and privacy [ 30 ]. This highlights the wide range of issues a paediatric nurse must cope with when executing blood sampling.…”

Section: Discussionmentioning

confidence: 99%

Nurses’ experiences of blood sample collection from children: a qualitative study from Swedish paediatric hospital care

et al. 2022

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Background Nurses play an active role in supporting the children with the blood sampling experience. Unfortunately, the blood sampling collection procedure is often affected by pre-analytical errors, leading to consequences such as delayed diagnosis as well as repeated sampling. Moreover, children state that needle procedures are the worst experience of their hospital stay. The nurses’ experiences of errors occurring during blood sample collection is unknown. Therefore, the aim of this study therefore was to describe paediatric nurses’ experiences of blood sampling collections from children. Method We used a qualitative study design with a (reflexive) thematic analysis (TA) method described by Braun and Clarke. Three focus group interviews were conducted, with 19 nurses collected by purposeful sampling from Sweden working at two different paediatric hospitals, focusing on their experiences of the blood sample collection procedure. Results From the three focus group interviews we analysed patterns and meanings of the following main theme Paediatric blood sampling is a challenge for the nurses and the four subthemes Nurses’ feelings of frustration with unsuccessful samplings, Nurses believe in team work, Venous blood sampling was experienced as the best option, and Nurses’ thoughts and needs regarding skills development in paediatric blood sampling. Conclusion The narrative results of this study illustrate that nurses working in paediatric hospital care face a big challenge in blood sampling collection from children. The nurses felt frustrated due to unsuccessful blood samplings and frequently could not understand why pre-analytical errors occurred. Nevertheless, they felt strengthened by colleagues in their team and shared feelings of responsibility to help each other with this complex procedure. The implications of this study are that paediatric hospital care needs to focus on improving guidelines for and increasing competence in blood sampling children and helping nurses to understand why samplings may be unsuccessful and how this can be avoided.

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Section: Discussionmentioning

confidence: 99%

Nurses’ experiences of blood sample collection from children: a qualitative study from Swedish paediatric hospital care

et al. 2022

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“…Early senior clinical review to determine whether ongoing physical restraint is required is essential. This is a challenging situation, where clinicians must weigh up the patient's rights, autonomy and dignity; whilst ensuring they are protected from harm 25,26 …”

Section: Discussionmentioning

confidence: 99%

“…This is a challenging situation, where clinicians must weigh up the patient's rights, autonomy and dignity; whilst ensuring they are protected from harm. 25,26 If ongoing restraint is required and the patient has been brought to the ED in handcuffs by police, these must be removed as an early priority and replaced with the least restrictive mode of control that is deemed safe. 25 Any young person who is restrained needs continuous monitoring and clear documentation of the rationale relating to the reasons for restraint.…”

Section: Discussionmentioning

confidence: 99%

Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder

Bourke

Say

Carison

et al. 2021

J Paediatrics Child Health

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Aim To characterise the key features and management of young people presenting to the emergency department (ED) with a mental health (MH) complaint and a known diagnosis of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD). Methods Retrospective review of all ED MH presentations in children aged 7–17 years, presenting over a 12‐month period from the 1st of January 2018 to the 31st of December 2018, to the Royal Children's Hospital in Melbourne, Australia. Univariate analyses were carried out to examine the relationship between an underlying diagnosis of ASD and/or ADHD and a number of key presentation variables. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated for ED management outcomes. Results There were 374 presentations in this cohort, representing 28% of the total MH presentations in 2018. The most common reason for presentation was acute severe behavioural disturbance. Young people with ASD and ADHD were at increased risk of having an acute crisis team response activated (ASD RR 2.3, CI 1.6–3.3, ADHD RR 2.2, CI 1.2–4.1). Compared to those without either diagnosis, young people with ASD were more likely to be physically restrained (RR 2.8, CI 1.7–4.6), managed in seclusion (RR 3.3, CI 1.7–6.4) and to receive medication to assist with behavioural de‐escalation (RR 2.8, CI 1.6–4.9). Conclusions Children with ASD and/or ADHD represent one‐quarter of all children presenting to the ED with MH complaints. They experience high rates of acute severe behavioural disturbance. Future research is needed to co‐design, implement and evaluate better approaches for their management.

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“…There is at the very least, a ‘delicate balance’ between restraint for the purposes of care, and causing preventable harm (Preisz & Preisz, 2019 ):1165. Previous research has explored strategies to reduce RP with adults in mental health (e.g.…”

Section: Introduction: Restrictive Practices In Children's Institutio...mentioning

confidence: 99%

Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study

et al. 2022

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Restrictive practices are often used harmfully with children in institutional settings. Interventions to reduce their use do not appear to have been mapped systematically. Using environmental scanning, we conducted a broad-scope mapping review of English language academic databases, websites and social media, using systematic methods. Included records (N = 121) were mostly from the United States and contained details of 82 different interventions. Children's participation was limited. Reporting quality was inconsistent, which undermined claims of effectiveness. Overall, despite a multitude of interventions, evidence is limited. Leaders should consider the evidence, including children's perspectives, before introducing poorly understood interventions into children's settings.

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Restraint in paediatrics: A delicate balance

Cited by 12 publications

References 22 publications

Nurses’ experiences of blood sample collection from children: a qualitative study from Swedish paediatric hospital care

Nurses’ experiences of blood sample collection from children: a qualitative study from Swedish paediatric hospital care

Emergency mental health presentations in children with autism spectrum disorder and attention deficit hyperactivity disorder

Mapping review of interventions to reduce the use of restrictive practices in children and young people's institutional settings: The CONTRAST study

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