Variations in Seclusion and Restraint Practices by Hospital Location

Carpenter, Mary D.; Hannon, Virginia R.; McCleery, Gerald; Wanderling, Joseph

doi:10.1176/ps.39.4.418

Cited by 26 publications

(31 citation statements)

References 5 publications

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“…Different national legislation and practices in use of coercive measures during treatment are challenges in comparative studies [13,28,42]. Coercive measures during hospitalization in this study are defined as seclusion, restraint and involuntary medication.…”

Section: Methodsmentioning

confidence: 99%

“…Physical characteristics of ward, size of ward, double or single rooms, crowding and patient turnover [12,13,18,21,24-26]. …”

Section: Introductionmentioning

confidence: 99%

“…Staff/patient ratio, age and sex of staff, experience of staff, proportion of unqualified staff, level of qualifications, de-escalation training, staff turnover, attitudes of staff and administrators [12,13,16,27-39]. …”

Section: Introductionmentioning

confidence: 99%

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A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

Husum

Bjørngaard

Finset

et al. 2010

BMC Health Serv Res

141

127

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BackgroundPrevious research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards.MethodsMultilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization.ResultsThe total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint.ConclusionsThe substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.

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Section: Methodsmentioning

confidence: 99%

“…Physical characteristics of ward, size of ward, double or single rooms, crowding and patient turnover [12,13,18,21,24-26]. …”

Section: Introductionmentioning

confidence: 99%

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A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

Husum

Bjørngaard

Finset

et al. 2010

BMC Health Serv Res

141

127

View full text Add to dashboard Cite

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“…1990). A frequent consequence of threats of, or acts of violence, is the use of coercion (seclusion/restraint) by hospital staff (Soloff & Turner 1981, Thompson 1986, Carpenter et al . 1988).…”

Section: Introductionmentioning

confidence: 99%

Violence and aggression: a literature review

Woods¹,

Ashley²

2007

Psychiatric Ment Health Nurs

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This paper reports the results of a literature review that was undertaken to provide background for a small pilot study that introduced violence measurement instruments that was to assist the development of nursing practice on an acute psychiatric unit. Multiple databases were searched, focusing on publications since 1994: CINAHL, Ovid Healthstar, Ovid MEDLINE (R), EMBASE, and PsycINFO. The search used the following four groups of key word alternatives (used in truncated form to allow for ending permutations) in combination with each other: violence, aggression, dangerous; prediction, assessment, factor, risk, issue, cause, reason; mental, psychiatric; inpatient, short-term, acute, admission. Searching was supplemented with footnote chasing of those papers retrieved and existing resources of the first author. Consequently, the synthesis of the results discussed cannot be considered a systematic review of the literature and is a reflection of some of the key issues found in the literature.

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“…They are therefore at times unprepared for the personal and professional consequences of these acts, such as staff members being less willing to work with potentially aggressive patients and unprepared to handle serious, albeit rare, events when they do occur. Moreover, lack of preparation and fear of harm is likely to increase the probability that staff members resort to the use of coercion, seclusion, and inappropriate pharmacological sedation and polypharmacy-options that in turn result in greater risk of adverse effects for patients (Thompson, 1986;Carpenter et al, 1988).…”

mentioning

confidence: 99%

Violent Behavior in Acute Psychiatric Inpatient Facilities

Biancosino¹,

Delmonte²,

Grassi³

et al. 2009

Journal of Nervous &Amp; Mental Disease

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Violence committed by acute psychiatric inpatients represents an important and challenging problem in clinical practice. Sociodemographic, clinical, and treatment information were collected for 1324 patients (677 men and 647 women) admitted to Italian public and private acute psychiatric inpatient facilities during an index period in 2004, and the sample divided into 3 groups: nonhostile patients (no episodes of violent behavior during hospitalization), hostile patients (verbal aggression or violent acts against objects), and violent patients (authors of physical assault). Ten percent (N = 129) of patients showed hostile behavior during hospitalization and 3% (N = 37) physically assaulted other patients or staff members. Variables associated with violent behavior were: male gender, <24 years of age, unmarried status, receiving a disability pension, having a secondary school degree, compulsory admission, hostile attitude at admission, and a diagnosis of schizophrenia, bipolar disorder, personality disorder, mental retardation, organic brain disorder or substance/alcohol abuse. Violent behavior during hospitalization was a predictive factor for higher Brief Psychiatric Rating Scale scores and for lower Personal and Social Performance scale scores at discharge. Despite the low percentage of violent and hostile behavior observed in Italian acute inpatient units, this study shed light on a need for the careful assessment of clinical and treatment variables, and greater effort aimed at improving specific prevention and treatment programs of violent behavior.

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Variations in Seclusion and Restraint Practices by Hospital Location

Cited by 26 publications

References 5 publications

A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

Violence and aggression: a literature review

Violent Behavior in Acute Psychiatric Inpatient Facilities

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