Purpose (1) This article is an update of the January 19, 2000, Volume 7, Number 2 article of the synthesis of research findings on the use of restraint and seclusion with patients in psychiatric and acute care settings. Conclusions (2) The little that is known about restraint/seclusion use with these populations is inconsistent. Attitudes and perceptions of patients, family, and staff differ. However, all patients had very negative feelings about both, whether they were restrained/secluded or observed by others who were not restrained. The reasons for restraint/seclusion use vary with no accurate use rate for either. What precipitates the use of restraint/seclusion also varies, but professionals claim they are necessary to prevent/treat violent or unruly behavior. Some believe seclusion/restraint is effective, but there is no empirical evidence to support this belief. Many less restrictive alternatives have been tested with varying outcomes. Several educational programs to help staff learn about different ways to handle violent/confused patients have been successful. Implications (3) Until more is known about restraint/seclusion use from prospective controlled research, the goal to use least restrictive methods must be pursued. More staff educational programs must be offered and the evaluation of alternatives to restraint/seclusion pursued. When seclusion/restraint is necessary, it should be used less arbitrarily, less frequently, and with less trauma. As the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Health Care Financing Administration (HCFA) have prescribed, “Seclusion and restraint must be a last resort, emergency response to a crisis situation that presents imminent risk of harm to the patient, staff, or others” (p. 25) [99A].

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Purpose (1) This article synthesizes research findings on the use of restraint and seclusion with patients in psychiatric and acute care settings. Conclusions (2) The little that is known about restraint/seclusion use with these populations is inconsistent. Attitudes and perceptions of patients, family, and staff differ. However, all patients had very negative feelings about both, whether they were restrained/secluded or observed by others who were not restrained. The reasons for restraint/seclusion use vary with no accurate use rate for either. What precipitates the use of restraint/seclusion also varies but professionals claim they are necessary to prevent/treat violent or unruly behavior. Some believe seclusion/restraint is effective but there is no empirical evidence to support this belief. Many less restrictive alternatives have been tested with varying outcomes. Several educational programs to help staff learn about different ways to handle violent/confused patients have been successful. Implications (3) Until more is known about restraint/seclusion use from prospective controlled research, the goal to use least restrictive methods must be pursued. More staff educational programs must be offered and the evaluation of alternatives to restraint/seclusion pursued. When seclusion/restraint is necessary it should be used less arbitrarily, less frequently, and with less trauma.

Because of the need for advanced practice nurses to perform more outcome measurement, a survey was conducted in the fall of 1997 to determine how master's level students learned the research process. Three hundred four surveys were mailed to schools with master's programs, and 222 were returned for a return rate of 73%. Sixty-six percent of the programs surveyed required a thesis and/or a research project. However, there was great variation in the research projects. A comprehensive examination was used to measure research ability by 36 programs (16%), either in conjunction with a thesis or research project or alone. One hundred forty-six programs (66%) offered only one option, be it a thesis, research project, comprehensive examination, or the many other alternative activities described by respondents. Seventy-six programs (34%) offered a variety of options from which students could select. The major differences between the thesis and the research project were related to three issues: a) the nature of the supervision; b) whether the activity was an individual or group project; and c) the amount of participation of the students. Because of the variability of expectations and the ways students are taught research, it was recommended nurse educators determine whether master's level nurse graduates were prepared to conduct outcome measurement and whether the means used to teach the research process were effective considering that endeavor.