The ‘S&amp;R Challenge’: Reducing the Use of Seclusion and Restraint in a State Psychiatric Hospital

Belanger, Suzanne

doi:10.1111/j.1945-1474.2001.tb00319.x

Cited by 8 publications

(5 citation statements)

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“…Moreover, out of the three types of debriefing, immediate staff debriefing remains unclear on who should conduct the process. A few studies have proposed that a senior clinical staff who was not involved in the seclusion or restraint event should facilitate immediate staff debriefing (Lewis et al, 2009;Maguire et al, 2012;SAMHSA, 2006c;Sutton et al, 2014), while some have suggested a clinical supervisor or manager (Belanger, 2001;Huckshorn, 2008). However, without a clearly identified debriefing facilitator, immediate staff debriefing could be rushed and unsupportive, or it might not even occur at all because no one is accountable for it.…”

Section: Discussionmentioning

confidence: 99%

Immediate Staff Debriefing Following Seclusion or Restraint Use in Inpatient Mental Health Settings: A Scoping Review

2018

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The aim of this scoping review is to synthesize the academic and gray literature on the use of immediate staff debriefing following seclusion or restraint events in inpatient mental health settings. Multiple electronic databases were searched to identify literature on the topic of immediate staff debriefing. The analysis identified several core components of immediate staff debriefing: terminology, type, critical reflection, iterative process, training, documentation, and monitoring. While these components were regarded as vital to the implementation of debriefing, they remain inconsistently described in the literature. Immediate staff debriefing is an important intervention not only to prevent future episodes of seclusion and restraint use, but as a forum for staff to support each other emotionally and psychologically after a potentially distressing event. The core components identified in this review should be incorporated into the organization's policies, practice guidelines, and training modules to ensure consistent conceptualization and implementation of the debriefing process.

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Section: Discussionmentioning

confidence: 99%

Immediate Staff Debriefing Following Seclusion or Restraint Use in Inpatient Mental Health Settings: A Scoping Review

2018

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“…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%

“…This has been a feature of US regulatory agency policy over the last decade which now explicitly defines restraint and seclusion as emergency measures and that alternative interventions should be tried first. Two studies of single psychiatric hospitals found that new Health Care Financing Administration (HFCA) rules requiring hospitals to assess patients within one hour of initiation of restraint did appear to reduce restraint and seclusion (19,20). Similarly, were not regulated sufficiently.…”

Section: Changes In State or Local Policymentioning

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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“…In the UK, there has been a considerable investment in the training of mental health nurses and their unqualified assistants in de-escalation and manual restraint, although the efficacy of that training is uncertain (Bowers et al 2005c). In the US there has been a greater emphasis on reducing the use of seclusion and mechanical restraint (Belanger 2001). …”

Section: Introductionmentioning

confidence: 99%

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

Bowers

Allan

Simpson

et al. 2009

Issues in Mental Health Nursing

130

152

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This is the accepted version of the paper.This version of the publication may differ from the final published version. to ascertain those factors most strongly associated with verbal aggression, aggression towards objects and physical aggression against others. High levels of aggression were associated with a high proportion of patients formally detained under mental health legislation, high patient turnover, alcohol use by patients, ward doors being locked, and higher staffing numbers (especially qualified nurses). The findings suggest that the imposition of restrictions on patients exacerbates the problem of violence, and that alcohol management strategies may be a productive intervention. Permanent repository linkInsufficient evidence is available to draw conclusions about the nature of the link between staffing numbers and violence.3

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The ‘S&R Challenge’: Reducing the Use of Seclusion and Restraint in a State Psychiatric Hospital

Cited by 8 publications

References 1 publication

Immediate Staff Debriefing Following Seclusion or Restraint Use in Inpatient Mental Health Settings: A Scoping Review

Immediate Staff Debriefing Following Seclusion or Restraint Use in Inpatient Mental Health Settings: A Scoping Review

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

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

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